When Canadians over 50 show up for a medical appointment, they usually have a number of concerns on their mind – which may leave no time to explore the topic of immunizations. Yet vaccines can play a crucial role in preventing adverse health outcomes for this demographic, and Dr. Iris Gorfinkel, a family physician with 25 years in practice, considers them “low-hanging fruit” for enhancing healthy aging.
“Patients over 50 are typically dealing with multiple health issues. They have so much to discuss that vaccines don’t usually make the list,” she says. “But as we get older, our aging immune system is less robust and less able to fight off infections.”
Due to this age-related decrease in the immune response – which is called immunosenescence – vaccinations for older adults are critical for safeguarding their health and well-being. It is as important for adults to ensure that their vaccinations are up to date as it is for children, believes Dr. Gorfinkel. “As we age, with every passing decade, the likelihood of having adverse outcomes from contracting the flu, pneumonia or shingles increases.”
Shingles, for example, which typically manifests in a distinctive rash that stays for about two to five weeks, has especially debilitating outcomes for the adults who develop post-herpetic neuralgia, says Dr. Gorfinkel. “The burning pain of post-herpetic neuralgia can persist long after the rash has disappeared.”
In shingles, the chickenpox virus – varicella zoster – reactivates after lying dormant in nerve structures near the spine in people who had the chickenpox. Once the virus reactivates, it can cause damaged nerves, which may send a constant abnormal signal of deep burning pain, according to Dr. Gorfinkel. This pain can be life-altering and difficult to treat.
Typically, the older the patient, the worse the pain – 50 per cent of individuals older than 60 develop pain, which is preventable through vaccination. Dr. Gorfinkel stresses that the risk of shingles should not be underestimated, especially for older Canadians, those with impaired immune systems and those with chronic medical conditions like cancer, diabetes or COPD.
In Canada, there are two vaccines available: the older Zostavax, introduced by Merck in 2008, and Shingrix, a new vaccine by GSK in early 2018. Compared to a placebo, Zostavax gave a 51 per cent reduction in shingles in people over the age of 60, and a 39 per cent reduction in post-herpetic neuralgia across the board.
Medical literature places Shingrix’s efficacy at 97 per cent in individuals 50 to 70 years of age and 91 per cent in those over 70 (compared to a placebo). For Dr. Gorfinkel, this percentage is a “game-changer in the world of vaccines.
“This vaccine has a major impact on how we manage shingles in patients over the age of 50,” she says. “It takes what is now a common disease and turns it into a rare event.” She adds that Shingrix should be considered for patients with immunosuppression.
Dr. Gorfinkel, who also works for PrimeHealth Clinical Research, is currently involved in a clinical trial for determining the duration of protection provided by Shingrix.
She says the shingles vaccine should be high on the list of immunizations provided to Canada’s older adults, along with pneumonia vaccinations, the annual flu shot, measles, mumps, rubella and tetanus vaccinations.
“There is a lot to cover with your physician, so it is important to make a special appointment just to discuss vaccinations,” suggests Dr. Gorfinkel. “It’s also helpful to bring along any previous immunization documents to ensure your doctor knows what you’ve already been given.”
This content produced by Randall Anthony Communications. The Globe’s editorial department was not involved in its creation.