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This is how older adults with chronic diseases can assess whether to get vaccinated

2021-01-27T17:16:37.254Z


Should older adults with chronic diseases get vaccinated against covid-19? Here's the advice from the experts.


When and where to get the covid-19 vaccine 4:05

(KHN) -

As public demand for limited supplies of covid-19 vaccines grows, questions remain about the suitability of vaccines for older adults with various diseases.

Among them are cancer patients receiving active treatment, patients with dementia near the end of their lives, and people with autoimmune diseases.

Recently, several readers have asked me if older relatives with these conditions should get vaccinated.

This is a matter for medical experts and I sought the advice of several.

They all strongly suggested that people with questions contact their doctors and discuss their individual medical circumstances.

Expert advice can be helpful as states are beginning to offer vaccines to adults 65, 70 or 75 years old, including those with serious underlying medical conditions.

Twenty-eight states are doing it, according to the latest poll from The New York Times.

How do you know if the vaccine you are going to receive is reliable?

1:37

Question: My 80-year-old mother has chronic lymphocytic leukemia.

For weeks, her oncologist didn't tell her "yes" or "no" about the vaccine.

After a lot of pressure, he finally replied, "It won't work for you, your immune system is too compromised to produce antibodies."

She asked him if she could take the vaccine anyway, just in case it might offer some protection, and he told her that he was done discussing it with her.

First, some basics.

Older adults, in general, responded very well to the two covid-19 vaccines that have received special clearance from the Food and Drug Administration (FDA).

In large clinical trials sponsored by drug makers Pfizer and Moderna, the vaccines achieved substantial protection against major diseases, with efficacy for older adults ranging from 87% to 94%.

But people 65 years of age and older undergoing cancer treatment were not included in these studies.

As a result, it is not known what degree of protection they might get.

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Dr. Tobias Hohl, chief of the Infectious Diseases Service at Memorial Sloan Kettering Cancer Center in New York City, suggested that three factors should influence patient decisions: Are vaccines safe, will they be effective, and what is my risk of being seriously ill from covid-19?

Regarding risk, he noted that older adults are the people most likely to become seriously ill and die from COVID-19, accounting for about 80% of deaths to date, a compelling argument for vaccination.

Regarding safety, there is no evidence at this time that cancer patients are more likely to experience side effects from the Pfizer-BioNTech and Moderna vaccines than other people.

Overall, "we're confident these vaccines are safe for [cancer] patients," including older patients, said Dr. Armin Shahrokni, a geriatrician and oncologist at Memorial Sloan Kettering.

The exception, which applies to everyone, not just cancer patients: people who are allergic to components of the COVID-19 vaccine or who experience severe allergic reactions after receiving a first dose should not receive the vaccines against coronavirus.

Efficacy is a consideration for patients whose underlying cancer or treatment suppresses their immune systems.

In particular, patients with blood and lymph node cancers may experience an attenuated response to vaccines, along with patients undergoing chemotherapy or radiation therapy.

Even in this case, "we have every reason to believe that if their immune systems are working, they will respond to the vaccine to some degree," and that is probably beneficial, said Dr. William Dale, president of Medical Care and director of the Center. Cancer Aging Research Center at City of Hope, a comprehensive cancer center in Los Angeles County.

In some cases, a balance between timing of cancer treatment and vaccination may be considered.

For those with serious illnesses who "need therapy as quickly as possible, we shouldn't delay [cancer] treatment because we want to preserve immune function and vaccinate them" against COVID, said Dr. Hohl of Memorial Sloan Kettering.

One approach might be to try to schedule the covid vaccination "between cycles of chemotherapy, if possible," said Dr. Catherine Liu, a professor in the Division of Vaccines and Infectious Diseases at the Fred Hutchinson Cancer Research Center in Seattle.

In new guidelines released late last week, the National Comprehensive Cancer Network, an alliance of cancer centers, urged that patients undergoing active treatment be prioritized for vaccines as soon as possible.

One notable exception: Patients who have received stem cell transplants or bone marrow transplants must wait at least three months before receiving vaccines, the group recommended.

American Cancer Society chief medical and scientific officer Dr. William Cance said his organization is "strongly in favor of vaccinating cancer patients and survivors, particularly older adults."

Given the vaccine shortage, it also recommended that cancer patients who contract COVID-19 receive antibody therapies as soon as possible, if their oncologists believe they are good candidates.

These infusion therapies, from Eli Lilly and Co and Regeneron Pharmaceuticals, rely on synthetic immune cells to help fight infection.

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2:59

Question: Should my 97-year-old mother, who lives in a nursing home with dementia, get the Covid-19 vaccine?

The U.S. government and all 50 states recommend COVID-19 vaccines for residents of long-term care facilities, most of whom have Alzheimer's disease or other types of cognitive impairment.

This is an effort to stem the tide of COVID-related illness and death, which has swept through nursing homes and assisted living facilities - 37% of all COVID deaths as of mid-January.

The Alzheimer's Association also highly recommends immunization against COVID-19, "both for people [with dementia] living in long-term care settings and for those living in the community," said Beth Kallmyer, Vice President of Care and Support. .

"What I think about this question is 'Will my loved one live long enough to see the benefits of getting vaccinated?'" Said Dr. Joshua Uy, medical director of a Philadelphia nursing home and director of Geriatric Fellowships at the Perelman School of the University of Pennsylvania.

Potential benefits include not getting sick or dying from COVID-19, receiving visits from family or friends, socializing with other residents and participating in activities, Uy suggested.

(This is a partial list).

Because these benefits begin a few weeks after a facility's residents are fully immunized, "I would recommend the vaccine for a 97-year-old person with significant dementia," Uy said.

Minimizing suffering is a key consideration, said Dr. Michael Rafii, associate professor of clinical neurology at the Keck School of Medicine, University of Southern California.

Even if a person has end-stage dementia, they should do everything they can to reduce their risk of developing it.

And this vaccine gives people great protection against severe covid disease, "he said.

"My advice is that everyone should get vaccinated, regardless of what stage of dementia they are in," Rafii said.

That includes end-of-life dementia patients in palliative care, he noted.

If possible, a loved one should be nearby to reassure them, as someone wearing a mask and needle approaching them can cause anxiety in dementia patients.

"Have the people administering the vaccine explain who they are, what they are doing and why they are wearing a mask in clear and simple language," Rafii suggested.

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Question: I am 80 years old and I have type 2 diabetes and an autoimmune disease.

Should I get the vaccine?

There are two parts to this question.

The first has to do with comorbidities - having more than one medical condition.

Should older adults with comorbidities receive the covid-19 vaccine?

Absolutely, because they are at higher risk of getting seriously ill from covid, said Dr. Abinash Virk, Infectious Diseases Specialist and Co-Chair of the Mayo Clinic Covid-19 Vaccine Launch.

"The Pfizer and Moderna studies looked specifically at older people and people with comorbidities, and showed that the response to the vaccine was similar to that of younger people," he noted.

The second part has to do with autoimmune diseases like lupus or rheumatoid arthritis, which also put people at higher risk.

The concern here is that a vaccine could trigger inflammatory responses that could exacerbate these conditions.

Philippa Marrack, chair of the Department of Immunology and Genomic Medicine at National Jewish Health in Denver, said there is no scientifically rigorous data on how patients with autoimmune diseases respond to the Pfizer and Moderna vaccines.

So far, no cause for concern has emerged.

"More than 100,000 people have received these vaccines now, including some who probably had autoimmune diseases, and there have been no systematic reports of problems," Marrack said.

If patients with autoimmune disorders are really concerned, they should talk to their doctors about delaying immunization until other covid vaccines with different formulations are available, he suggested.

Last week, the National Multiple Sclerosis (MS) Society recommended that most patients with multiple sclerosis, another serious autoimmune condition, receive the Pfizer or Moderna vaccines against covid-19.

“Vaccines are not likely to cause a relapse of MS or worsen chronic MS symptoms.

The risk of contracting COVID-19 far outweighs any risk of having a relapse of MS from the vaccine, "he said in a statement.

- KHN (Kaiser Health News) is a non-profit news service that covers health topics.

It is an editorially independent program of KFF (Kaiser Family Foundation) that is not affiliated with Kaiser Permanente.

Coronavirus Vaccine

Source: cnnespanol

All news articles on 2021-01-27

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