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How older adults with chronic diseases can decide whether to receive the Covid-19 vaccine

Recently, a number of readers have asked me if older relatives with these conditions should be immunized. This is a matter for medical experts and I have asked for advice from several. Everyone urges people with questions to contact their doctors and discuss their individual medical circumstances.

Q: My 80-year-old mother has chronic lymphocytic leukemia. For weeks, her oncologist did not tell her “yes” or “no” to the vaccine. After much pressure, he finally replied, “It won’t work for you, your immune system is too compromised to produce antibodies. She asked if she could get the vaccine anyway, just in case she could offer some protection, and he told her he was done discussing it with her.

First, some basics. The elderly generally responded extremely well to the two Covid-1

9 vaccines, which received special approval from the Food and Drug Administration. In large clinical trials sponsored by drug manufacturers Pfizer and Moderna, vaccines have achieved significant protection against significant diseases, with efficacy for adults ranging from 87% to 94%.

But people aged 65 and over undergoing cancer treatment were not included in these studies. As a result, it is not known what degree of protection they could receive.

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Dr. Tobias Hall, head of the Infectious Diseases Department at the Memorial Sloan Kettering Cancer Center in New York, suggested that three factors should influence patients’ decisions: Are vaccines safe, effective, and my risk? to get seriously ill with Covid-19? As for the risk, he noted that the elderly are the people who most often get sick and die from Covid, which represents about 80% of deaths to date – a compelling argument for vaccination.

In terms of safety, there is currently no evidence that cancer patients are more likely to experience side effects from Pfizer-BioNTech and Moderna than other people. In general, “we are confident that these vaccines are safe for cancer patients,” including elderly patients, said Dr. Armin Shahrockney, a geriatrician and oncologist at Memorial Sloan Catering.

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

Efficacy is a consideration for patients whose underlying cancer or treatment suppresses their immune system. In particular, patients with cancer of the blood and lymph nodes may receive a dull response to vaccines, along with patients undergoing chemotherapy or radiation therapy.

Even so, “we have every reason to believe that if their immune system works at all, they will respond to the vaccine to some degree,” and that is likely to be helpful, said Dr. William Dale, chairman of nursing medicine. and director of the Center for Cancer Aging Research in the City of Hope, a comprehensive oncology center in Los Angeles County.

Balancing the timing of cancer treatment and immunization may be a consideration in some cases. For those with a serious illness who “need treatment as soon as possible, we should not delay treatment (cancer) because we want to maintain immune function and vaccinate them” against Covid, said Hall of Memorial Sloan Kettering.

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One approach might try to determine the timing of Covid vaccination “between cycles of chemotherapy, if possible,” said Dr. Catherine Liu, a professor in the Department of Vaccines and Infectious Diseases at the Fred Hutchinson Cancer Research Center in Seattle. .

In a new guideline published late last week, the National Comprehensive Cancer Network, an alliance of cancer centers, urges that patients undergoing active treatment be prioritized as soon as possible. Notable exception: Patients who have received a stem cell transplant or a bone marrow transplant must wait at least three months before receiving vaccines, the group recommends.

The chief medical and scientific director of the American Cancer Society, Dr. William Rann, said his organization “strongly supports the vaccination of cancer patients and cancer survivors, especially the elderly.” Given the shortage of vaccines, he also recommends that cancer patients who contract with 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 infections.

Question: Should my 97-year-old mother in a nursing home with dementia even take the Covid vaccine?

The federal government and all 50 states recommend Covid vaccines for residents of long-term care, most of whom have Alzheimer’s disease or other types of cognitive impairment. It is an attempt to stem the tide of Covid-related illnesses and deaths that have plagued nursing homes and assisted living facilities – 37% of all deaths in Covid by mid-January.

The Alzheimer’s Association also strongly promotes immunization against Covid-19, “both for people (with dementia) living in long-term care and for people living in the community,” said Beth Kalmayer, vice president of care and support.

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“What I think he’s trying to ask is, ‘Will my loved one live long enough to see the benefits of vaccination?’ Said Dr. Joshua Wei, medical director at a nursing home in Philadelphia and director of geriatric scholarships at Perelman Medical School in Pennsylvania.

Potential benefits include not getting sick or dying from Covid-19, visits from family or friends, engaging with other residents, and participating in activities suggested by Uy. (This is a partial list.) Because these benefits can begin to accumulate a few weeks after a person is fully immunized in a facility, “I would recommend the vaccine to a 97-year-old with significant dementia,” Wu said.

Minimizing suffering is a key consideration, said Dr. Michael Rafi, an associate professor of clinical neurology at Keck Medical School at the University of Southern California. “Even if a person has end-stage dementia, you want to do everything you can to reduce the risk of suffering. And this vaccine provides people with good protection against suffering from severe Covid,” he said.

“My advice is for everyone to get vaccinated, no matter what stage of dementia they are in,” Rafi said. This includes patients with dementia at the end of their lives in hospice care, he noted.

If possible, a loved one should be on hand for reassurance, as when approached by someone wearing a mask and wearing a needle, it can cause anxiety in patients with dementia. “Have the person administering the vaccine explain who they are, what they do and why they wear a mask in clear, simple language,” Rafia suggested.

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Question: I am 80 and have type 2 diabetes and autoimmune disease. Should I get the vaccine?

This question has two parts. The first is related to “concomitant diseases” – there is more than one medical condition. Should elderly people with comorbidities receive Covid vaccines?

Absolutely because they are at higher risk of getting seriously ill with Covid, said Dr. Abinash Virk, an infectious disease specialist and co-chair of the distribution of the Covid-19 vaccine at the Mayo Clinic.

“Studies by Pfizer and Moderna specifically look at people who are older and have co-morbidities, and show that the reaction to the vaccine is similar to (that of) people who are younger,” she said.

The second part is related to autoimmune diseases such as lupus or rheumatoid arthritis, which also put people at higher risk. The concern here is that the vaccine may cause inflammatory reactions that may worsen these conditions.

Filipa Marak, chair of the Department of Immunology and Genomic Medicine at Denver National Jewish Health, said there was no scientifically accurate data on how patients with autoimmune diseases responded to the Pfizer and Moderna vaccines.

So far, the reasons for concern have not surfaced. “More than 100,000 people have received these vaccines now, including some who may have had an autoimmune disease, and there has been no systematic reporting of problems,” Marak said. If patients with autoimmune disorders are really worried, they should talk to their doctors about delaying immunization until other Covid vaccines with different formulations become available, she suggested.

Last week, the National Multiple Sclerosis Society recommended that most patients with multiple sclerosis – another serious autoimmune condition – receive the Pfizer or Moderna Covid vaccines.

“Vaccines are unlikely to cause recurrence of MS or worsen your chronic symptoms of MS. The risk of getting COVID-19 far outweighs the risk of recurrence of MS from the vaccine,” the statement said.

KHN (Kaiser Health News) is a non-profit news service covering health issues. This is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.

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