Update on Vaccination Guidelines for Older Adults
Update on Vaccination Guidelines for Older Adults
Hepatitis A and B vaccines are routinely recommend in all children, but there is no age-specific recommendation in adults. Risk factors, including comorbidities such as liver failure, renal failure, and diabetes mellitus; international travel; and high-risk populations such as men who have sex with men and intravenous drug users, drive vaccine indication.
Diabetes mellitus, renal failure, and liver failure are increasingly prevalent in an aging population, and individuals with these conditions have a greater risk of acquiring hepatitis infection or having a more-fulminant course. Because adults with diabetes mellitus younger than 60 have twice the risk of acquiring hepatitis B virus (HBV) as those without diabetes mellitus, the ACIP recommends that they be vaccinated. The evidence is not as strong for adults aged 60 and older, and the decision can be individualized. Individuals with chronic renal insufficiency should be vaccinated for HBV, ideally before the initiation of dialysis. Chronic liver disease is an indication for vaccination against HBV and HAV.
Older adults are increasingly undertaking international travel for work and pleasure. Hepatitis A and B remain highly prevalent throughout much of the world. The risk of acquiring hepatitis A from international travel to endemic countries is significant. Vaccination with two doses of inactivated HAV provides essentially 100% immunogenicity. Older adults tend to have the same rate of response to HAV, although with lower antibody titers. The rate of natural infection with hepatitis A in individuals aged 60 and older is nearly 60%, so it is cost effective to screen for preexisting HAV immunity before vaccinating. Hepatitis B infection is also associated with travel and would warrant vaccination, with prevaccine screening based on risk factors independent of age. Primary care providers would be responsible for these vaccinations in travelers, whereas recommendations for destination-specific vaccinations can be sought at a travel clinic.
Hepatitis A and B
Hepatitis A and B vaccines are routinely recommend in all children, but there is no age-specific recommendation in adults. Risk factors, including comorbidities such as liver failure, renal failure, and diabetes mellitus; international travel; and high-risk populations such as men who have sex with men and intravenous drug users, drive vaccine indication.
Diabetes mellitus, renal failure, and liver failure are increasingly prevalent in an aging population, and individuals with these conditions have a greater risk of acquiring hepatitis infection or having a more-fulminant course. Because adults with diabetes mellitus younger than 60 have twice the risk of acquiring hepatitis B virus (HBV) as those without diabetes mellitus, the ACIP recommends that they be vaccinated. The evidence is not as strong for adults aged 60 and older, and the decision can be individualized. Individuals with chronic renal insufficiency should be vaccinated for HBV, ideally before the initiation of dialysis. Chronic liver disease is an indication for vaccination against HBV and HAV.
Older adults are increasingly undertaking international travel for work and pleasure. Hepatitis A and B remain highly prevalent throughout much of the world. The risk of acquiring hepatitis A from international travel to endemic countries is significant. Vaccination with two doses of inactivated HAV provides essentially 100% immunogenicity. Older adults tend to have the same rate of response to HAV, although with lower antibody titers. The rate of natural infection with hepatitis A in individuals aged 60 and older is nearly 60%, so it is cost effective to screen for preexisting HAV immunity before vaccinating. Hepatitis B infection is also associated with travel and would warrant vaccination, with prevaccine screening based on risk factors independent of age. Primary care providers would be responsible for these vaccinations in travelers, whereas recommendations for destination-specific vaccinations can be sought at a travel clinic.
