Pneumococcal Vaccination in Older Adults
Pneumococcal infection including meningitis, pneumonia, and bacteremia is a common cause of morbidity and mortality among older adults especially those with particular conditions such as asplenia and immunocompromising. It is believed that approximately one million people contract the pneumococcal disease each year. It is important to note that pneumococcal is both treatable and preventable (Cadlwell, 2019). The disease remains the most serious acute illness with which medical practitioners need to deal with as it attacks the feeble and old – persons who are unable to endure the sudden onset of the condition (Musher, File, & Bond, 2017). While pneumococcal immunization is a routine part of infant vaccination and childhood vaccinations schedule throughout the world. With the prevalence of pneumococcal among older adults, vaccination also become popular among adults. The prevalence of contracting the pneumococcal disease increases with age. Specifically, older adults between 65 years and above are at a higher risk of being infected (Musher, File, & Bond, 2017). Therefore, healthcare professionals including nurses have a primary duty to encourage and educate the older adults on the importance of vaccination.
Types of Pneumococcal Vaccinations available of Older Adults
There are two types of pneumococcal vaccines available for clinical use: pneumococcal conjugate vaccine and pneumococcal polysaccharide vaccine. Each type of vaccination contains pneumococcal polysaccharide antigens that commonly cause invasive illness. Pneumococcal polysaccharide vaccine (PPSV) comprises partially purified pneumococcal capsular polysaccharides. Pnu-Immune (PPSV23) is the widely used formulation as it contains 23 pneumococcal polysaccharides (Musher, File, & Bond, 2017). These serotypes were known to causes 85 to 90 percent of pneumococcal conditions. On the other hand, the pneumococcal conjugate vaccine is composed of capsular polysaccharides conjugated to a protein.
As the CDC recommendations, all adults aged 65 and above who do not have a cerebrospinal fluid leak, immunocompromising condition, or cochlear implant and would want to get PPSV23, one dose of should be administered. For an adult aged 65 and above who do not have a cerebrospinal fluid leak, immunocompromising condition, or cochlear implant and would want to get PCV13 and PPSV23 they should not be administered on the same day. Rather, 1 dose of PCV13 should be given and 1 dose of PPSV23 a year later.
Importance of Vaccination
Streptococcus pneumoniae is cited as the bacterial cause of pneumonia across the globe. Other signs of pneumococcal infections include bacteremia, meningitis, and otitis media. These infections lead to substantial morbidity and mortality. Fundamentally, vaccination of older adults with PPSV23 protects approximately 50 to 85 percent of the healthy adults against the invasive pneumococcal illness. Additionally, the use of 7- valent pneumococcal conjugate vaccine (PCV7) has led to a 90 percent reduction in PCV7 serotype illness among older adults (Musher, File, & Bond, 2017). Despite the effectiveness of these vaccines, immunization among older adults is still low.
Pneumococcal vaccinations help in reducing morbidity and mortality associated with pneumonia. Additionally, the vaccination helps to lighten the burden that is linked with pneumococcal disease. For instance, vaccination of older adults against pneumococcal disease boosts their productivity and income. Additionally, the value of the caretakers’ productive time is significantly saved as they are released from the supervision of adults who healthier because of pneumococcal vaccination. Vaccination against pneumococcal promotes risk reduction gain such that it helps to reduce uncertainties as well as contaminant anxiety which would impose costs on risk-averse individuals (Buynder & Booy, 2018). Another benefit that comes with pneumococcal vaccination is that it leads to a voluntary contribution to the community and family. Healthier adults can spend time with their children and grandchildren while investing in education. Additionally, healthier older adults can make a valuable contribution to their communities by participating in different activities.
Who should be immunized?
According to the CDC, older adults aged 65 and above should have both PCV13 and PPSV23 vaccines. However, the CDC also recommends that adults between the ages of 19 to 64 years who at a higher risk due to certain conditions or have a history of smoking should be vaccinated against pneumococcal (Musher, File, & Bond, 2017). An older adult who needs to be vaccinated includes those with asthma, heart failure, kidney disease, and HIV/AIDS should get PCV13 or/and PPSV23.
Barriers that Affect Vaccination among the Older Adults
The lack of vaccination among older adults in the population is multifactorial. The barriers are patient-related include lack of awareness, a belief that vaccine is unnecessary, skepticism about their safety and effectiveness, and fear of adverse effects. Individuals in this population may also fear that the vaccination will not be covered by insurance both Medicare and private insurance making them dig dipper into their pockets (Cadlwell, 2019). The identified barriers are caused by a lack of sufficient education. Therefore, patient outreach is important in increasing the number of adults obtaining pneumococcal vaccinations.
Practice –related barriers include inadequate public knowledge regarding immunizations, gaps in recommendations and screening, inaccurate vaccine information, and high cost of restocking vaccines. Besides, the increasing access for an older adult can be challenging since patient immunization records can be hard to access (Cadlwell, 2019). In most cases, providers spend more time treating chronic issues, reducing the time used in discussing preventing measures such as vaccinations. Identifying these barriers is critical in reducing the low immunization rates among older adults.
In summary, vaccination is the first step in promoting the wellbeing of older adults. Although pneumococcal is preventable, it is saddening to see that the number of people being infected with the disease is increasing. Older adults aged 65 and above are encouraged to obtain PCV13 or/and PPSV23 vaccines. Obtain the vaccines does not only benefit one individual but the whole community. The barriers that prevent these individuals should be eliminated by educating the population on the valuable benefits of vaccinations as well as the risk of not getting one.
References
Buynder, P., & Booy, R. (2018). Pneumococcal vaccination in older persons: where are we today? Pneumonia (Nathan), 10(1).
Cadlwell, T. (2019, November 25). Pneumococcal vaccine in older Adults: A primary care approach to increasing uptake. Retrieved from https://www.clinicaladvisor.com/home/topics/vaccine-information-center/pneumococcal-vaccine-in-older-adults-a-primary-care-approach-to-increasing-uptake/
Musher, D., File, T., & Bond, S. (2017, November 27). Pneumococcal vaccination in adults. Retrieved from https://www.uptodate.com/contents/pneumococcal-vaccination-in-adults#H2778511355