On behalf of the Advisory Committee on Immunization Practices (ACIP), Neil Murthy, MD, MPH, from the US Centers for Disease Control and Prevention in Atlanta, and colleagues break down the Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2024.

The authors note that changes to the 2024 adult immunization schedule include new COVID-19 vaccine recommendations, including that all adults should receive at least one dose of the updated vaccine. Respiratory syncytial virus vaccination is a new addition to the adult immunization schedule, with routine use of Abrysvo (Pfizer) recommended during pregnancy (at 32 to 36 weeks of gestation); for older adults (aged 60 years and older), shared clinical decision-making is recommended for vaccination with either Abrysvo (Pfizer) or Arexvy (GlaxoSmithKline).

“The CDC’s Advisory Committee on Immunization Practices’ Recommended Adult Immunization Schedule, United States, 2024 confirms ACIP’s competence in preparing current, evidence-based vaccination recommendations,” Scott C. Ratzan, MD, from City University of New York’s Graduate School of Public Health and Health Policy in New York City, and colleagues write in an accompanying editorial. “However, it also demonstrates that CDC has not moved sufficiently beyond merely providing information to clinicians and the public to persuasive communication.”

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Amanda B. Payne, PhD, from the CDC in Atlanta, and colleagues estimated the incremental benefit of receipt of a bivalent mRNA COVID-19 vaccine after receipt of an original monovalent COVID-19 vaccine. Two retrospective cohort studies were conducted among Medicare fee-for-service enrollees during Sept. 4, 2022, to March 4, 2023, to estimate the vaccine effectiveness (VE) of a bivalent mRNA COVID-19 dose for preventing thromboembolic events versus original monovalent COVID-19 doses only.

The researchers found that the effectiveness of a bivalent mRNA COVID-19 vaccine dose versus the original vaccine alone against COVID-19-related thromboembolic events was 47 and 51% among Medicare enrollees aged 65 years and older and among adults aged 18 years and older with end stage renal disease receiving dialysis, respectively. Among Medicare beneficiaries who were immunocompromised, VE was similar: 46 and 45 percent among adults aged 65 years and older and those aged 18 years and older with end-stage renal disease, respectively.

“To prevent COVID-19-related complications, including thromboembolic events, adults should stay up to date with recommended COVID-19 vaccination,” the authors write.

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Debbie Lin Teodorescu, MD, from the Cedars-Sinai Medical Center in Los Angeles, and colleagues prospectively collected data from 10 patients in a POTS clinic between July 2021 and June 2022 reporting new or exacerbated POTS symptoms after COVID-19 vaccination. Heart rate variability (HRV) and skin sympathetic nerve activity (SKNA) were compared between the patients and 24 healthy controls.

Conditions that could increase the risk for POTS were seen in all patients, including previous COVID-19 infection, hypermobile Ehlers-Danlos syndrome, mast cell activation syndrome, and autoimmune, cardiac, neurological or gastrointestinal conditions. The researchers found that compared with controls, a lower ambulatory root mean square of successive differences was seen in HRV for patients (46.19 ± 24 versus 72.49 ± 40.8 ms). Reduced mean amplitude was seen in SKNA for patients versus controls (0.97 ± 0.052 versus 1.2 ± 0.31 µV); burst amplitude was also reduced (1.67 ± 0.16 versus 4.3 ± 4.3 µV). All patients reported improvement with the usual POTS care after 417.2 ± 131.4 days of follow-up; relapses of POTS symptoms were reported in two with COVID-19 reinfection and one with small fiber neuropathy.

“These findings suggest it may be helpful to keep an eye on patients with underlying health issues after COVID-19 vaccination to monitor for postvaccine POTS,” coauthor Peng-Sheng Chen, M.D., also from the Cedars Sinai Medical Center, said in a statement.

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Increasing COVID-19, influenza and respiratory syncytial virus vaccination rates in older adults is going to require a village to battle vaccine reluctance in the form of misinformation, hesitancy and fatigue, according to senior living experts.

The Centers for Disease Control and Prevention recently released two reports on vaccination coverage and treatment for respiratory viruses. The agency found that vaccine fatigue, inaccurate health information and vaccine hesitancy contributed to lower vaccination rates in older adults. 

A significant challenge is that many people now tend to equate COVID-19 with catching a cold, Argentum Vice President of Government Relations Paul Williams told McKnight’s Senior Living. 

“We need to continue to emphasize how serious these respiratory viruses can be for our residents, who tend to have multiple comorbidities and chronic conditions, putting them at greater risk for serious complications, and even death,” Williams said. “At this point, so many people have made up their minds on vaccination, and trying to get folks to reconsider is an uphill task.”

Many people are “done with COVID” and any discussion of vaccines, he added.

“Vaccine fatigue is real, even though it remains a threat to the older adults we serve,” Williams said.

Raising vaccination rates

According to the CDC, uptake of the updated COVID-19 vaccine is approximately 37% in adults aged 75 or more years, compared with the national average of 19% among all adults. The statistics aren’t much better for the flu and RSV vaccines — only 34% of adults aged 65 or more years had received the flu vaccine as of Oct. 28 and only 17% of adults aged 60 or more years reported receiving an RSV vaccine as of Dec. 23.

Nursing homes have national reporting requirements for resident and staff member vaccination rates, making statistics more readily available than in assisted living, which does not have such requirements. And not all states are mandating or tracking vaccination in senior living community staff members for COVID, RSV or flu.

Williams said that Argentum is hearing that communities with strong leadership often have higher vaccination rates, and that staff members who trust and respect community leaders are more receptive to calls for vaccination and the importance of helping to protect residents and colleagues in the community.

“Communities that involve trusted nurses and clinicians to educate residents and answer questions on the risk and benefits of vaccines have higher rates,” he added. “The use of toolkits and talking points have proven to be helpful but the main barrier to increasing compliance remains ‘vaccine fatigue.’”

Challenges of vaccine reluctance

The challenge in battling vaccine reluctance is not unique to senior living or nursing home providers; it is systemic among the US population at large, according to the American Health Care Association / National Center for Assisted Living.

“As a country, we face significant challenges with vaccine reluctance that require a collective endeavor by public health officials, other healthcare providers and the public,” an AHCA/NCAL spokeswoman told McKnight’s Senior Living. “Assisted living providers remain persistent in talking to family members and residents about their vaccine concerns and appreciate the partnerships of the larger healthcare system to help reinforce the importance of the vaccines.”

Last week, US Department of Health and Human Services Secretary Xavier Becerra met virtually with representatives from LeadingAge and AHCA/NCAL to express concerns about low vaccination rates among residents of nursing homes, which are supported by federal dollars through the Medicare and Medicaid programs. LeadingAge said in a statement after that meeting that it had urged HHS to help ease logistical issues that have slowed vaccination rates and to encourage hospitals to offer vaccines on discharge. 

David Gifford, MD, MPH, chief medical officer of AHCA/NCAL, writing in a column in McKnight’s Senior Living sister publication McKnight’s Long-Term Care News last week, discussed the need for the nation to collectively combat vaccine reluctance. He opined that strides in the right direction since the pandemic have been taken with vaccines, especially in the long-term care industry, but much collective work remains to be done by the healthcare profession to combat widespread hesitancy.

Vaccine fatigue and hesitancy, Gifford said, are “rampant,’ but especially so when it comes to COVID-19 and RSV vaccines. And although vaccine uptake in skilled nursing facilities is higher than in the general community (a number easier to know for nursing homes due to federal reporting requirements), he called for a doubling down on efforts to increase those numbers.

Gifford called for the ready availability of vaccines for residents through on-site vaccine clinics, provider reimbursements and consistent public health messaging. He said many new admissions arrive at an assisted living community or nursing home without being offered or having received the vaccine during visits with physicians in other healthcare settings.

AHCA/NCAL created a #GetVaccinated website last year with resources for providers to secure and administer vaccines on site, as well as resources to help encourage residents and staff members to receive vaccines.

• In discussions, lead off by talking about the more popular flu vaccine.
• Be consistent in your messaging about the safety and effectiveness of both vaccines.
• Address people’s vaccine-specific beliefs, such as the limits of protection from prior COVID infections. 

The research, which included a July survey of more than 2,000 adults, including 659 of whom were aged 50 or more years, 71% of the older adults said it was “very likely” or “somewhat likely” that they would get the flu vaccine, and 64% said it was very or somewhat likely that they would get the updated COVID vaccine. Forty-nine and 50% of the older adults, respectively said they thought that the flu and COVID vaccines were “very effective,” and 65% and 51%, respectively, thought that they were “very safe.”

The survey results also reveal the most common reasons that some respondents said they are hesitant about vaccination, which can help you with your talking points.

Among those 50 and older who said they were “not very likely” to get the flu vaccine, the top three reasons were that they would prefer to get natural immunity from becoming ill (35%), that they don’t trust the government agencies that promote vaccination (33%) and that they feel as if people are expected to get too many vaccines in general (31%).

Among those 50 and older who said they were “not very likely” to get the COVID vaccine, the top three reasons were that they want to see more research done on the vaccine (62%), that they are worried about the vaccine’s safety (59%) and that they don’t trust the government agencies that promote vaccination (55%).

(You can read about the other concerns of respondents, including those aged 18 to 64, here.)

Other recent research also provides motivation for staying current with vaccines:

• For instance, an analysis of more than 10 million cases of COVID-19 in adults between May 2020 and February 2022, published in December in the Journal of the Royal Society of Medicine, found that among adults aged more than 50, the case fatality risk was 10 times higher in the unvaccinated compared with those who had been vaccinated within six months before testing positive for COVID-19.
• Research published in December in Lancet Infectious Diseases indicates that people hospitalized with seasonal flu also can end up with “long flu,” long-term, negative health effects, especially involving their lungs and airways.

See the Centers for Disease Control and Prevention’s website for more information and resources about COVID and flu vaccination for long-term care residents or workers — long-term care workers have relatively low vaccination rates compared with other healthcare personnel.

Lois A. Bowers is the editor of McKnight’s Senior Living. Read her other columns here.

Millions of adults in the United States are not taking their medications as prescribed because of the costs, according to a new report from the Centers for Disease Control and Prevention.

Most adults aged 18 to 64 took at least one prescription medication in 2021, noted a recent CNN report. But more than 8% of them — about 9.2 million people — said that they tried to save money by skipping doses, taking less than prescribed or delaying a prescription fill, according to the CDC data.

Although average drug costs did not increase in 2021, the number of prescriptions did, and that increased spending, CNN reported.

Many adults aged more than 65 years who have chronic conditions, however, may be taking too many medications and could benefit from a medication review with their primary care physician. Patients also may assume that their health providers check for drug interactions or assess whether a medication no longer is needed, even if that is not actually happening, according to a recent report from WebMD.

If given the option, up to 80% of older adults aged 50 to 80 would be open to stopping one or more of their prescribed medications, according to a 2023 poll by researchers at the University of Michigan. 

» Older Americans have access to more vaccines than ever, but increasing numbers cause concern for some individuals

From pneumonia and shingles to COVID boosters to the new respiratory syncytial virus vaccines and a broader range of flu shots for seniors, older Americans are facing an ever-growing array of vaccines to be mindful about every autumn, as one USA Today article posits.

And although most older adults understand and agree with the importance of prevention, the sheer numbers of shots are giving some of them pause.  “They are tired of getting shots, and their hesitation often comes from confusion about what they need and when,” one expert told the national newspaper. “Educating them about their risks and administering several shots at the same time can help,” she said.

“We have the opportunity as we never have before to prevent much more disease,” said an infectious disease specialist at Vanderbilt University School of Medicine.

“We’re going to help ensure American families have reliable access to medicines they need,” Biden stated, according to a published transcript of his remarks.

“Before the pandemic, supply chains weren’t something most Americans thought about or talked about. But today, after years of delay in parts and products, everyone knows why supply chains are so important,” the president said. 

The COVID-19 pandemic and its various iterations have brought supply challenges to the forefront for senior living community and nursing home operators. Provider advocates recently appealed to the White House to prioritize long-term care facilities for COVID vaccines, the access and availability of which, industry representatives said, has been inconsistent.

In Monday’s remarks, the president noted the difficulty of getting enough of some types of vaccines, due to lack of US manufacturing.

“You had to get it overseas. Well, that supply chain is going to start here in America,” he said.

Biden’s remarks came during the launch of a new Council on Supply Chain Resilience. The body, to be co-chaired by the national security adviser and national economic adviser, will include the secretaries and administrators of multiple agencies, the attorney general and other senior officials.

“I’m charging this group to ensure that our supply chains remain secure, diversified, resilient, and do all — and into the future,” Biden said. “I’ve also directed my cabinet to create an early warning system that uses data to spot … supply chains risks to our economic security, our national security, our energy security and our climate security.”

Jennifer S. Hanberg, MD, from Brigham and Women’s Hospital in Boston, and colleagues conducted an emulated target trial using observational data to compare receiving versus not receiving a fourth mRNA vaccine dose among patients with systemic autoimmune rheumatic diseases who were prescribed DMARDs. Data were included for 4,305 patients: 3,126 received a fourth dose, and 1,179 did not. After emulation of the time-sequential once-per-week trials and overlap propensity score weighting, both groups included 2,563 adults.

Of the 2,563 participants, 54.3% had rheumatoid arthritis; the most frequent treatments used were conventional synthetic DMARDs and biological DMARDs (58.1 and 39.3%, respectively). The researchers found that the risk for SARS-CoV-2 was lower among patients receiving versus not receiving a fourth vaccine dose (hazard ratio [HR], 0.59). The risk for admission to hospital or death within –3 to +14 days of SARS-CoV-2 infection was also lower with receipt of a fourth vaccine dose (HR, 0.35).

“Patients with systemic autoimmune rheumatic diseases should be encouraged to receive at least four doses of mRNA vaccines,” the authors write.

Several authors disclosed ties to the biopharmaceutical industry.

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