Q. My elderly parents live in a cold place. Which vaccine is ideal for them?

Answered by
Dr. S D Sinha
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jan 08, 2021

Hello doctor,

My elderly parents are over 75 but are fairly healthy except for mild hypertension. They live in a cold place. Their doctor plans to give them a pneumococcal vaccine (e.g., Pneumovax) next week, followed by an influenza vaccine the next month. Would it not be better if they get influenza first and then pneumococcal the next month instead? Since flu season is around the corner and they are elderly? What would you suggest?

Is it fine to take the MMR vaccine as an adult more than twice in a lifetime? Is it dangerous to receive it more than twice (if someone forgot when they received it and do not have their records with them)? Would getting it to preclude one from receiving a potential Coronavirus vaccine for COVID-19. Later this year, assuming it will be available?



Welcome to icliniq.com.

Firstly, it is important to get the influenza vaccine every year and not a pneumococcal vaccine. Pneumococcal vaccine has two-shot S- PCV13 and PPSV23 for different pneumococcal bacterial strains to be taken at different time points. PCV13 vaccine should be taken earlier than PPSV23. The latter is recommended if the parent >65 years of age.

So the answer to your first query is that the pneumococcal vaccine is recommended to be taken later than the influenza vaccine. However, one variety of pneumococcal vaccine (PCV13) could be taken simultaneously with the flu vaccine. The other pneumococcal variety could be taken later.

As mentioned above, the sequencing of vaccination is recommended by guidelines, but it is up to your clinician's discretion to decide the sequence.

Your query is regarding the MMR vaccine. If you have proof of taking the MMR vaccine earlier, you may not need it again. It is also unlikely to be a contraindication for potential COVID-19 vaccine whenever it is available. However, as per recent reports, the MMR vaccine could protect from the worst complications of COVID-19 as it provides a non-specific immunity against severe infections. Hence, unless you have an allergy against the MMR vaccine, there is no harm retaking it. But it is not mandatory if you have proof of taking it already.

Thank you doctor,

So can my parents received the pneumococcal vaccine (first shot) and the influenza vaccine on the same day? Since both are inactivated viruses. Or is this too much vaccine for older adults?



Welcome back to icliniq.com.

As mentioned earlier, simultaneous influenza and one variety of pneumococcal vaccine can be taken. This has also been the CDC (Centers for Disease Control and Prevention) guidance. However, the treating physician's discretion and decision are the utmost in these circumstances as he/she is seeing, examining, and managing the patient there locally.

Thank you doctor,

Is MMR considered a safe vaccine? Have you seen any significant reactions to this vaccine among your patients? Is it possible to reactivate shingles? Is it safe to take the flu vaccine if it was taken 35 days ago?



Welcome back to icliniq.com.

MMR vaccine is approved by FDA and recommended by CDC. That usually does not happen if it were considered unsafe. However, there are precautions to the vaccine including moderate or severe acute illness with or without fever, recent (within 11 months) receipt of antibody-containing blood product, history of reduction of blood platelet count (thrombocytopenia or thrombocytopenic purpura), tuberculin skin testing for tuberculosis, history of seizures (epilepsy /fits), anaphylactic or allergic reactions.

Concomitant flu vaccine and MMR vaccine is not contraindicated. Reactivation of shingles is unlikely unless concomitant immunocompromised states such as HIV, renal failure, immunity-related diseases, and immune-suppressing medicines are given alongside.

Thank you doctor,

I received a PPD test about four months ago for employee health. Is this a contraindication to receive MMR?



Welcome back to icliniq.com.

Four months is a long duration, unlikely to affect the MMR effects. However, it is left to the clinical discretion of the treating physician who see you.

Hi doctor,

Thank you for your kind help.



Welcome back to icliniq.com.

You are welcome. Keep in touch for further doubts.

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