Should patients who have heart disease take vaccinations for flu, pneumonia, and shingles?
Annual vaccinations for influenza virus are recommended for many groups of people. I strongly suggest that all people over the age of 65, people who have any chronic condition that would make an illness such as influenza more dangerous, those who are essential to the operation of their business, and all health care professionals be vaccinated. If you have a chronic lung, kidney, blood, immunity or cardiac condition, the misery of the flu will be worse than if you are healthy. For anyone that has actually had influenza, the idea of having it again is not pleasant. Influenza is not the same as a cold. Each year, many thousands of people die of influenza. Unfortunately, we don’t yet have a vaccination for the common cold, or the 24 or 48-hour gastrointestinal virus, but they are not often seen as causes of death.
A pneumonia vaccination fortunately is needed less often than an influenza vaccination. The shot lasts from 8 to 12 years in most cases. If you are over age 65, Medicare mandates a pneumonia vaccine for everyone. If you have a chronic lung, kidney, blood, immunity or cardiac condition, good sense mandates that you be protected from pneumonia. If you have ever had pneumonia before, have had a problem with alcohol or drugs this vaccination is advised. Pneumonia can be a devastating disease even for the healthy. One of my family members got it at age 28, when healthy. Although diagnosed immediately the initial fever was accompanied by delirium. Fortunately the fever responded quickly to antibiotics, and the patient improved. It took 3 weeks for her to regain the ability to walk up a flight of stairs without stopping due to shortness of breath. Yet another 2 months were needed until she felt as healthy as before she had pneumonia. Before antibiotics were discovered, most people with pneumonia died.
The shingles (Herpes zoster) vaccine is new. The current recommendation is to give it to everyone over the age of 60, as well as to those at highest risk. Shingles is a disease that is brought about by the virus that causes chickenpox. This virus stays in your body for many years, but if your immune system drops its guard for whatever reason (cancer, chemotherapy, AIDS, heart attack, etc.) the virus causes painful rash and blisters (the fluid in the blisters actually contains the virus and can be contagious to others who have not had chickenpox or the vaccination before such as babies). Fortunately this virus is not usually deadly, but the rash can be disfiguring, and if you get shingles near your eye or ear it can lead to loss of vision or hearing. A vaccination was licensed in 2006 because it was able to prevent shingles in about half the people who took it over age 60. (For information on this vaccine check http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-shingles.pdf). As this vaccine currently is only 50% effective, and prevents a disease that does not usually cause long-term effects, I currently do not recommend it unless there is an overriding concern about the patient’s immunity (patients being considered for organ transplantation, chemotherapy or radiation), and only after a discussion with all of the patient’s health care practitioners. The vaccine is said to be more effective in preventing the longer-term painful consequences of shingles than it is in protecting outbreaks. With this vaccine, we do not know the duration of its protection, and we do not know if this vaccine is as protective in minority patients as it appears to be in whites. These studies have not yet been performed.
Larry Weinrauch is a cardiologist in Watertown, Massachusetts and is affiliated with Mount Auburn Hospital. He wrote for HealthCentral as a health professional for Heart Health, High Blood Pressure, and High Cholesterol.