Older adults with chronic diseases can assess whether to receive the Kovid-19 vaccine

Recently, many readers have asked me whether older relatives with these conditions should be vaccinated. This is a matter for medical experts, and I have consulted many. Everyone strongly suggested that people with questions contact their doctors and discuss their personal medical conditions.

Question: My 80-year-old mother has chronic lymphocytic leukemia. For weeks, her oncologist would not tell her about the “yes” or “no” vaccine. After much pressure, he finally responded: “It won’t work for you, your immune system is too compromised to make antibodies.” She asked if she could take the vaccine anyway, just in case it could provide some protection, and she told him that it was discussed with her.

First, some basics. Older adults in general responded very well to two Kovid-19 vaccines, which have received special authorization from the Food and Drug Administration. In large clinical trials sponsored by drug manufacturers Pfizer and Moderna, vaccines achieved adequate protection against critical illness, with efficacy for adults ranging from 87% to 94%.

But people treated for cancer aged 65 and older were not included in these studies. As a result, it is not known to what degree of protection they can achieve.

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The head of the infectious diseases service at Memorial Sloan Catering Cancer Center in New York City, Drs. Tobias Hohl suggested that three factors should influence patients’ decisions: Are vaccines safe, will they be effective, and what is my risk of becoming seriously ill from Kovid-19? Regarding the risk, he mentioned that older adult people are the most ill and become seriously ill with Kovid, accounting for about 80% of deaths – a compelling rationale for vaccination.

Regarding safety, there is no evidence at this time that cancer patients experience the side effects of Pfizer-BioNotech and Modern Vaccines compared to others. In general, “we are convinced that these vaccines are safe for (cancer) patients,” including older patients, Drs. Armin Shahrokani, a Memorial Sloan Catering Geriatrician and Oncologist.

The exception, which applies to all, not only cancer patients: Those who are allergic to the Kovid-19 vaccine components or who experience severe allergies after the first shot are not administered Kovid-19 vaccines. needed.

Efficacy is a consideration for patients whose underlying cancer or treatment suppresses their immune system. In particular, patients with blood and lymph node cancer may experience a rash response to vaccines, with patients undergoing chemotherapy or radiation therapy.

In this case also, “We have every reason to believe that if their immune system is functioning at all, they will respond to the vaccine to some extent,” and it is likely to be beneficial, Drs. William Dale, chair of supportive care medicine and director for the Cancer Aging Research Center in the City of Hope, a comprehensive cancer center in Los Angeles County.

Balancing cancer treatment and vaccination times may be a consideration in some cases. According to the Hohl of Memorial Sloan Kettering against Kovid, for people with critical illness who “need medical attention as soon as possible, we should not delay (cancer) treatment because we preserve immune function and they Want to vaccinate “.

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Professor of Vaccine and Infectious Diseases Division at Fred Hutchinson Cancer Research Center in Seattle, Dr. Katherine Liu said, if possible, an approach to Kovid vaccination could be tried between cycles of chemotherapy.

In the new guidelines published last weekend, the National Comprehensive Cancer Network, a coalition of cancer centers, urged that patients undergoing active treatment be given priority for vaccines as soon as possible. One notable exception: patients who have received either a stem cell transplant or a bone marrow transplant should wait at least three months before getting vaccinated, the group recommended.

The Chief Medical and Scientific Officer of the American Cancer Society, Drs. William Kance said his organization “favors vaccination of cancer patients and cancer survivors, particularly older adults.” Given the vaccine deficiency, he also recommended that cancer patients who contract Kovid-19 get antibody therapy as soon as possible if their oncologists believe they are good candidates. These infusion treatments from Eli Lilly and Company and Regeron Pharmaceuticals rely on synthetic immune cells to help fight infection.

Question: Should my 97-year-old mother go to a nursing home with dementia, even get a Kovid vaccine?

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

The Alzheimer’s Association also strongly encourages vaccination against Kovid-19, “for people in long-term care (with dementia) and people living in the community,” said Beth Culmeier, vice president of care and support.

Private practice doctors express concern when he and his patient receive the Kovid-19 vaccine

“I think it’s trying to ask the question ‘Will my dear person live long enough to see the benefits of vaccination?” “Said Dr. Joshua Uy, Medical Director at Philadelphia Nursing Home, and is the Director of Geriatric Fellowship at the University. Perelman School of Medicine, Pennsylvania.

Potential benefits do not include getting sick or dying from Kovid-19, visiting family or friends, connecting with other residents and participating in activities, Uy suggested. (This is a partial list.) Because these facilities may begin weeks after residents have been fully vaccinated, “I would recommend getting 97-year-old children vaccinated for significant dementia,” Uy said .

The Associate Professor of Clinical Neurology at the University of Southern California’s KK School of Medicine, Drs. Michael Rafi said that reducing the victim is an important consideration. “Even if a person has end-stage dementia, you can do anything to reduce the risk of grief. And this vaccine provides individuals with a good deal of protection from suffering from severe neoplasm, ” They said.

“My advice is that everyone should be vaccinated, regardless of any stage of dementia,” Rafi said. Dementia patients are involved in dementia at the end of their lives, he said.

If possible, hand over hand to reassure a loved one as contact with a masked person and carrying a needle can cause anxiety in dementia patients. “Do vaccinators explain to the person who they are, what they are doing and why they are wearing masks in clear, simple language,” Rafi suggested.

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

There are two parts to this question. The first has to do with “Combidities” – more than one medical condition. Should older adults with comorbidities get Kovid vaccines?

Exactly, because they are at greater risk of becoming seriously ill than Kovid, Drs. Avinash Virk, an infectious disease specialist and co-chairman of the Kovid-19 vaccine rollout of the Mayo Clinic.

“Pfizer and Modern’s study specifically looked at people who were older and had comorbidities, and showed that the response to the vaccine was similar to that of younger people.”

The second part deals with autoimmune diseases such as lupus or rheumatoid arthritis, which also puts people at high risk. The concern here is that a vaccine may trigger inflammatory reactions that may exacerbate these conditions.

Philip Marac, chair of the Department of Immunology and Genomic Medicine at the National Jewish Health in Denver, said there are no scientifically rigorous data on what the Pfizer and Moderna vaccine responds to in patients with autoimmune conditions.

So far, the reasons for concern have not surfaced. “Over 100,000 people have now received these vaccines, some of which probably had autoimmune disease, and there has been no systematic reporting of problems,” Marac said. If patients with autoimmune disorders are really concerned, they should talk with their physicians about delaying vaccination until other Kovid vaccines with different formulas become available, he suggested.

Last week, the National Multiple Sclerosis Society recommended that most patients with multiple sclerosis – a more severe autoimmune condition – get vaccinated by Pfizer or Modern Kovid.

“The vaccine is unlikely to trigger the MS relay or worsen your chronic MS symptoms. There is no risk of COVID-19 protecting against MS,” said a statement.

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


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