Pneumonia, flu and shingles all affect seniors disproportionately to the rest of the population. These vaccine-preventable diseases account for more than 50,000 deaths annually in the U.S., according to the Alliance for Aging Research in its newly released "The Silver Book." It attributes the cost of treating infectious diseases in seniors to 15 percent of all health care expense.
The aging process makes people more vulnerable to disease, and they may also have a chronic disease, such as asthma or heart disease, which lowers immunity. As a general guideline, the Virginia Department of Health recommends annual flu shots for everyone over the age of six months, but it reserves routine administration of the one-time zoster (shingles) vaccine for those 60 and older, and the pneumococcal (pneumonia) shot for those 65 and older. For Medicare recipients, both the flu and pneumonia shots are free under the Part B medical benefit.
In Virginia, more than 60 percent of seniors routinely receive preventive vaccines for flu and pneumonia, according to Dr. Laurie Forlano, Virginia's deputy state epidemiologist. This compares to a 22.6 percent rate for shingles coverage reported in 2012. "That's not unusual to see lower rates for a newer vaccine," she said; the vaccine was approved in 2006, and the Health Department started recommending it in 2008. "It's a generational issue," said Dr. Nzinga Teule-Hekima, director of the Peninsula Health District, as those who've had the varicella vaccine, which became standard for children in the 1990s, won't get chicken pox so won't be subject to the reactivated virus.
Currently, the Centers for Disease Control maintains that one in three people over 60 will experience shingles, a painful rash caused by the same virus that causes chickenpox, and those who live to 85 have a one in two chance of a shingles outbreak. In all, there are about 1 million cases annually. Its severity varies, but in more than 10 percent it can cause residual pain (PHN, postherpetic neuralgia) for months and even years after the rash has disappeared. It can also affect the eyes and cause loss of vision. Three percent affected require hospitalization.
"Shingles is a common illness. It can be prevented by getting the vaccine," Forlano said.
The CDC's Advisory Committee on Immunization Practices (ACIP) recommends the vaccine on several grounds: the high incidence of shingles; its painfulness that affects quality of life; its frequent complications; and difficulty in treating it effectively. The vaccine cuts incidence by more than half and reduces pain in all cases.
The vaccine, while recommended, is "rather expensive," according to Lisa Walker, a counselor at Bay Aging. She urges that everyone check with their individual insurance plan as she found a range from $45 to $95 in co-pay charges for Merck's ZOSTAVAX vaccine that costs about $170 a dose. For Medicare participants, those 65 and older, the cost can also vary. For people with Medicare Part D, there's a co-pay, but others may be subject to the full cost, Walker said.
Localized zoster, or shingles, is less contagious than chicken pox, and is spread only after the rash appears and until the lesions crust.
There are multiple other vaccines that can protect older adults, including Hepatitis B, meningococcal, and TdaP, for those in particular situations, said Teule-Hekima.
Salasky can be reached by phone at 757-247-4784.Copyright © 2015, The Baltimore Sun