A large portion of our older adult patients remain unimmunised or inadequately immunised against tetanus. The US is unique in that clinical tetanus occurs mostly in persons aged over 60 years. Worldwide, it is a disease of neonates. Both pneumococcal diseases and influenza cause markedly greater morbidity and mortality among elderly people compared with younger people. The prevalence of these chronic diseases can be decreased by immunising susceptible persons against the relevant infections. Hepatitis B is also a worldwide problem, causing a large number of acute infections and costly sequelae, 95% of which is preventable by hepatitis B vaccine. Rabies is a very lethal disease preventable by use of rabies vaccine. The decreased function of the aging immune system results in far fewer older persons developing antibodies following immunisation than their younger counterparts.
