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How to assess whether elderly people with chronic diseases should receive the Covid-19 vaccine

Recently, many readers have asked me if I should immunize older relatives who suffer from these diseases. This is a matter for medical experts, and I have sought the opinions of some experts. All strongly recommend that anyone in doubt contact their doctor and discuss their respective medical conditions.

Q: My 80-year-old mother has chronic lymphocytic leukemia. For weeks, her oncologist would not say “yes” or “no” to the vaccine. After a lot of pressure, he finally replied: “This will not work for you. Your immune system is too weak to produce antibodies.” She asked if she could still take the vaccine, just in case it could provide a little protection. , He told her that he had finished discussing with her.

First, some basic knowledge. Overall, the elderly have responded very well to the two Covid-1

9 vaccines specifically authorized by the Food and Drug Administration. In large clinical trials sponsored by pharmaceutical manufacturers Pfizer and Moderna, these vaccines provided effective protection against major diseases, with efficacy ranging from 87% to 94% for the elderly.

However, people 65 years and older receiving cancer treatment were not included in these studies. As a result, it is not clear what level of protection they might receive.

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Dr. Tobias Hohl, Director of Infectious Disease Services at Memorial Sloan Kettering Cancer Center in New York City, suggested that three factors should influence patients’ decisions: vaccines are safe and effective, and what is my risk of serious illness from Covid-19? Regarding the risk, he pointed out that the elderly are the most likely to be severely ill and die from Covid, accounting for about 80% of deaths so far, which is a compelling reason for vaccination.

Regarding safety, there is currently no evidence that cancer patients are more likely to suffer side effects from Pfizer-BioNTech and Moderna vaccines than others. Dr. Armin Shahrokni, a geriatrician and oncologist at Sloan Kettering Memorial Hospital, said, generally, “We believe these vaccines are safe for (cancer) patients, including elderly patients.

This exception applies to everyone, not just cancer patients: people who are allergic to the components of the Covid-19 vaccine or experience severe allergic reactions after the initial injection should not use the Covid-19 vaccine.

For patients whose immune system is suppressed by potential cancer or treatment, the efficacy should be considered. It is worth noting that patients with blood and lymph node cancers and patients receiving chemotherapy or radiation therapy may be slow to respond to the vaccine.

Even in this case, “we have every reason to believe that if their immune system is fully functional, they will have a certain degree of response to the vaccine,” which may be beneficial, said Dr. William Dale, Chair of Supportive Treatment. Director of the Center for Medicine and Cancer Aging Research in the City of Hope, a comprehensive cancer center in Los Angeles County.

In some cases, consider balancing the timing of cancer treatment and immunization. Hohl, who remembers Sloan Kettering, said that for patients with serious diseases that need to be treated as soon as possible, we should not postpone (cancer) treatment because we want to preserve immune function and vaccinate.

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Dr. Catherine Liu, professor of vaccines and infectious diseases at the Fred Hutchinson Cancer Research Center in Seattle, said one approach might be to try to schedule the Covid vaccine between possible cycles of chemotherapy.

In the new guidelines released late last week, the National Comprehensive Cancer Network, composed of cancer centers, urged that patients receiving active treatment be vaccinated as soon as possible. The team recommends a notable exception: patients who have received stem cell transplants or bone marrow transplants should wait at least three months before they can get the vaccine.

Dr. William Cance, chief medical and scientific officer of the American Cancer Society, said his organization “strongly supports the vaccination of cancer patients and cancer survivors, especially the elderly.” Considering the shortage of vaccines, he also recommended signing a contract with Covid-19 Of cancer patients, if their oncologists think they are good candidates, they should receive antibody therapy as soon as possible. These infusion therapies from Eli Lilly and Co. and Regeneron Pharmaceuticals rely on synthetic immune cells to help fight infections.

Q: Should my 97-year-old mother be vaccinated against Covid in a nursing home with dementia?

The federal government and all 50 states recommend the Covid vaccine to long-term care residents, most of whom suffer from Alzheimer’s disease or other types of cognitive impairment. This is to stop the wave of Covid-related diseases and deaths, which have swept nursing homes and assisted living facilities, and accounted for 37% of all Covid deaths as of mid-January.

The Alzheimer’s Association also strongly encourages immunization against Covid-19,” said Beth Kallmyer, Vice President of Care and Support, whether it is for people in long-term care (people with dementia) or people in the community.

Private practitioners express concern about when they and their patients will receive the Covid-19 vaccine

“The question I want to ask is,’Can my loved one live long enough to see the benefits of vaccination?'” said Dr. Joshua Uy, medical director of the Philadelphia Nursing Home and University Geriatrics Research Director. Perelman School of Medicine, Pennsylvania.

Uy suggested that potential benefits include not getting sick or dying from Covid-19, visiting family or friends, interacting with other residents, and participating in activities. (Due to partial benefits, these benefits may start to occur within a few weeks after residents in the facility are fully immunized. “I recommend this vaccine for 97-year-old people with severe dementia,” Uy said.

Dr. Michael Rafii, associate professor of clinical neurology at the Keck School of Medicine at the University of Southern California, said minimizing pain is a key factor. He said: “Even if a person has advanced dementia, you want to do anything that can reduce the risk of the disease. This vaccine can provide protection to individuals from suffering from severe Covey’s disease.”

Rafi said: “My advice is, no matter what state of dementia, everyone should be vaccinated.” He pointed out that this includes hospice care for patients with dementia.

If possible, relatives should rest assured, because people wearing masks and holding needles may cause anxiety for people with dementia. Rafi said: “Let the vaccinated people explain who they are, what they are doing and why they are wearing masks in clear and simple language.”

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Question: I am 80 years old and suffer from type 2 diabetes and autoimmune diseases. Should I get the vaccine?

There are two parts to this question. The first is related to “comorbidities”-suffering from multiple diseases. Should elderly people with comorbidities get the Covid vaccine?

Absolutely, because they have a higher risk of serious illness from Covid, said infectious disease expert Dr. Abinash Virk, co-chair of Mayo Clinic’s Covid-19 vaccine promotion.

She said: “Pfizer and Modena’s research specifically targeted older people with comorbidities. They showed that the vaccine response was similar to that of younger people.”

The second part is related to autoimmune diseases such as lupus or rheumatoid arthritis, which also puts people at a higher risk. The concern here is that vaccines may trigger an inflammatory response, thereby exacerbating these diseases.

Philippa Marrack, director of the Department of Immunology and Genomic Medicine at the National Jewish Health Council in Denver, said that there are no scientific and rigorous data on the response of patients with autoimmune diseases to Pfizer and Moderna vaccines.

So far, the cause of concern has not surfaced. Malak said: “Now more than 100,000 people have received these vaccines, including some vaccines that may have autoimmune diseases, and there are no systematic reports of problems.” She suggested that if patients have autoimmune diseases Really worried, they should discuss with their doctors to postpone immunization until other Covid vaccines with different formulations are available.

Last week, the National Multiple Sclerosis Association recommended that most patients with multiple sclerosis (another serious autoimmune disease) should use Pfizer or Moderna Covid vaccine.

It said in a statement: “The vaccine is unlikely to trigger MS recurrence or aggravate your chronic MS symptoms. The risk of getting COVID-19 is far greater than any risk of MS recurrence from the vaccine.”

KHN (Kaiser Health News) is a non-profit news service covering health issues. It is an independent editing program of KFF (Kaiser Family Foundation) and has nothing to do with Kaiser Permanente.

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