Routine immunizations (measles/mumps/rubella, polio, tetanus toxoid, varicella, if appropriate) should be updated prior to travel. One dose of 23-valent pneumococ-cal vaccine and annual influenza immunization are recommended for healthy adults 65 years and older, and for high-risk individuals below age 65.
Age alone is not a contraindication to any vaccine, although seroconversion rates may decrease with age. For the healthy older traveler, general recommendations for both routine and travel vaccines apply. Hepatitis A seropositivity rates are higher in older travelers who have lived in or traveled extensively to endemic areas, or have a prior history of jaundice; serologic hepatitis A antibody screening prior to immunization in these individuals may be cost-effective (Castelli et al., 1996; Schwartz and Raveh, 1998).
Live vaccines (oral typhoid, oral polio, varicella, yellow fever) should not be given routinely to immunocom-promised travelers. Elderly travelers are at higher risk of adverse events related to yellow fever vaccine (Martin et al., 1999). Immunologically impaired individuals, including those on hemodialysis, require a higher vaccine dose for hepatitis B (usually double, but consult the manufacturer's recommendations).
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