Vaccination Risks for Elderly with Chronic Conditions: Key Considerations

Issues with administering the AstraZeneca vaccine to the elderly?

Hello, doctor.
We have two elderly individuals who are expected to receive vaccinations soon.
I would like to ask: 1.
Does having certain chronic diseases increase the risk associated with vaccination? Are they suitable candidates for vaccination? 2.
If they are suitable for vaccination, is it recommended (or necessary) to stop their long-term medications before and after the vaccination? If stopping medications is advised, for how long should they be discontinued?
Here is the information for both individuals:
1.
An 81-year-old male with the following conditions: I10 essential (primary) hypertension, I209 angina pectoris, E782 mixed hyperlipidemia, D1803 intra-abdominal vascular tumor, K739 chronic hepatitis, H35059 unspecified retinal neovascularization, and various ophthalmologic and gastrointestinal ulcer issues.
His medications include AB31596100 clopidogrel enteric-coated tablets 100 mg, AC46729100 "Seda" eplerenone tablets 0.25 mg, BC23374100 metoprolol enteric-coated tablets 160 mg, BC25350100 lisinopril enteric-coated tablets 2 mg, and BC225931G0 amlodipine soft capsules 5 mg.
Note: One of the medications, clopidogrel, has indications for thrombus prevention and side effects including low platelet and white blood cell counts.
I am concerned if this may have any impact.
2.
A 73-year-old female with a long-term history of E1165 type 2 diabetes mellitus, accompanied by hyperglycemia, E780 pure hypercholesterolemia, J441 chronic obstructive pulmonary disease with (acute) exacerbation, I119 hypertensive heart disease, without heart failure, and E782 mixed hyperlipidemia.
She has previously experienced R002 palpitations, R42 dizziness and vertigo, R079 chest pain, and R0600 dyspnea.
Her medications include AA42704100 amlodipine 5 mg (Norvasc), AC470861G0 metformin 500 mg, AC363491G0 glipizide 500 mg, and BC25350100 lisinopril enteric-coated tablets 2 mg.

Lulu, 40~49 year old female. Ask Date: 2021/06/18

Dr. Wu Xueming reply Cardiology

These chronic medications do not need to be discontinued due to vaccination.

Reply Date: 2021/06/18

More Info

When considering vaccination for elderly individuals with chronic conditions, there are several important factors to take into account. Vaccination is a critical public health measure, especially for older adults who are at higher risk for severe illness from infectious diseases. Here, I will address the concerns regarding vaccination risks for the two elderly individuals you mentioned, as well as general considerations for those with chronic health issues.

1. Chronic Conditions and Vaccination Risks
Chronic conditions such as hypertension, heart disease, diabetes, and liver disease can complicate the vaccination process, but they do not necessarily preclude individuals from receiving vaccines. In fact, many health authorities recommend that individuals with chronic conditions get vaccinated, as they are often at a higher risk for complications from vaccine-preventable diseases.

For the 81-year-old male with multiple chronic conditions, including hypertension, heart disease, and chronic hepatitis, it is generally safe for him to receive vaccines, including the COVID-19 vaccine and others recommended for older adults. The presence of conditions like low platelet counts or leukopenia (as noted with the medication he is taking) should be discussed with his healthcare provider, but these factors do not automatically disqualify him from vaccination. The benefits of vaccination in preventing severe disease often outweigh the risks.

For the 73-year-old female with diabetes, chronic obstructive pulmonary disease (COPD), and hypertension, vaccination is also advisable. Chronic diseases can impair the immune response, making vaccination even more crucial to protect against infections.

2. Medication Management Around Vaccination
Regarding the management of long-term medications around the time of vaccination, it is generally not necessary to stop medications unless specifically advised by a healthcare provider. In fact, stopping medications could lead to destabilization of the underlying chronic conditions, which could pose a greater risk than the vaccine itself.

However, some immunosuppressive medications may require special consideration. For example, if either individual is taking medications that significantly suppress the immune system, such as corticosteroids or certain biologics, it may be advisable to consult with their healthcare provider about the timing of the vaccine. In most cases, routine medications for chronic conditions like hypertension, diabetes, and heart disease do not need to be paused before or after vaccination.

Conclusion
In summary, both elderly individuals you mentioned are likely suitable candidates for vaccination despite their chronic conditions. Vaccination can significantly reduce the risk of severe illness from infectious diseases, which is particularly important for older adults. It is essential to have a thorough discussion with their healthcare providers to address any specific concerns related to their health status and medications.
Additionally, maintaining regular communication with healthcare providers about any changes in health status or medication side effects is crucial for ensuring safe and effective vaccination. Overall, the benefits of vaccination in protecting against serious illness far outweigh the potential risks, especially for those with chronic health conditions.

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