Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH Speaker: Dr. Rizah Mazzuin Razali, the head of Geriatric Unit and Internal Medicine Physician working in Kuala Lumpur Hospital, Ministry of Health Malaysia.

1. Vaccinating the
Elderly
Dr. Rizah Mazzuin Razali
Physician and Geriatrician
Head of Geriatric Unit
Kuala Lumpur Hospital

2. Disclaimers
•This slide was prepared for the Webinar Series
on COVID-19 session on 14th
of April, 2021, by
Dr. Rizah Mazzuin Razali, Consultant
Physician and Geriatrician at the Kuala Lumpur
Hospital, Malaysia.
•This is intended to share within healthcare
professionals, not for public.
•Kindly acknowledge “Clinical Updates in
COVID-19 http://www.nih.gov.my/covid-19”
should you plan to share the information
obtained from this slide with your colleagues.
Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research, NIH

3. Content/Outline
•Why vaccinate the elderly?
•Is it effective to vaccinate the elderly?
•Is it safe to vaccinate the elderly?
•Vaccinating the frail elderly
•Summary
•Conclusion

4. Why vaccinate the elderly?
Data tell us that older people are the most likely to be
severely ill and die from the virus
Severe illness means that a person with
COVID-19 may require:
• hospitalization
• intensive care or a
• ventilator to help them breathe
Centre for Disease Control
and Prevention, 2021

5. Why vaccinate the elderly?
Ioannidis J.P.A, Global perspective of COVID-19 epidemiology for a full-cycle pandemic.Eur J Clin Invest. 2020; 50: e13423

6. Why vaccinate the elderly?
H Brenner, Focusing COVID-19 vaccinations on elderly and high-risk people, The Lancet, Vol 2, Mar 01,2021
Reserving the limited vaccines to high-risk
people on a global scale and achieving timely
completion of vaccination campaigns in these
groups may prevent the vast majority of
COVID-19 deaths well before herd immunity
on the level of entire populations is achieved
In high-risk population; 95
people need to be vaccinated
to prevent one COVID-19
death.
In low-risk population; 13,000
people need to be vaccinated
to prevent one Covid-19 death.
(135 times higher)
Vaccination could save 217·9
thousand deaths, i.e. 99% in
the one third of the population
at high risk due to age or other
reasons.

7. Long-term care facilities are high-risk settings for severe outcomes
from outbreaks of Covid-19 owing to:
✔ advanced age
✔ chronic health conditions
✔ movement of health care personnel among facilities in a region
Why vaccinate the elderly?
D.C. Thompson, et al, "The Impact of COVID-19 Pandemic on Long-Term Care Facilities Worldwide: An Overview on International
Issues", BioMed Research International, vol. 2020, page,7, 2020

8. Medical conditions that can increase risk of severe
illness:
Why vaccinate the elderly?
D.C. Thompson, et al, "The Impact of COVID-19 Pandemic on Long-Term Care Facilities Worldwide: An Overview on International
Issues", BioMed Research International, vol. 2020, page,7, 2020

9. Is it effective to vaccinate
the elderly?
Affected 31,000 LTCF
in USA
More than 163,000
death (residents and
employees)

10. Is it effective to vaccinate
the elderly?

11. Centre for Disease Control and Prevention, CDC 2021
Is it effective to vaccinate
the elderly?

12. Is it effective to vaccinate the
elderly?
Age and Ageing 2021;50:279-283

13. Is it safe to vaccinate the elderly?
•Most trials show mild to moderate severity adverse
events are common and self-limiting but less
prevalent in older people. Serious adverse events
are very rare
•Phase II trials for many vaccines show good
antibody responses
•Unpublished Phase III analyses suggest high
efficacy
Age and Ageing 2021;50:279-283

14. Is it safe to vaccinate the elderly?
Centre for Disease Control and Prevention, CDC 2021

15. February 25, 2021

18. • This study estimates a high effectiveness of the BNT162b2 vaccine for preventing
symptomatic Covid-19 in a noncontrolled setting, similar to the vaccine efficacy
reported in the randomized trial across age group
• Effectiveness is high for the more serious outcomes: hospitalization, severe illness,
and death
• Estimated benefit increases in magnitude as time passes. These results strengthen
the expectation that newly approved vaccines can help to mitigate the profound
global effects of the Covid-19 pandemic.

19. Vaccinating the Frail Elderly
CLINICAL FRAILTY SCORE (CFS)
CFS 1-5 : iADL independent
CFS 6 : iADL dependent
CFS 7 : bADL dependent
CFS 8 :bADL dependent + could not
recover from minor illness
CFS 9 : Life expectancy < 6 months
(Rockwood & Theou, 2020)

20. Vaccinating the Frail Elderly
COMMUNICATION
BARRIER
• APHASIA
• COGNITIVE
IMPAIRMENT
ATYPICAL PRESENTATION:
• CHANGE IN BEHAVIOUR
• POOR ORAL INTAKE
MONITORING FOR 72 HOURS

21. Vaccinating the Frail Elderly

22. Vaccinating the Frail Elderly

23. Condition Home
(Family/carer to
register person)
Residential Care
(Responsible carer in
home to register
person)
Clinical Assessment
(performed by any clinician
reviewing patient at
hospital, outpatient or
homecare setting)
Fit to mild
frailty (Clinical
Frailty Score
1-5)
Vaccination is
encouraged
- Consent may be by
patient or carer
Vaccination is
encouraged
- Consent may be by
patient or carer
Pre-vaccination assessment
not required

24. Condition Home
(Family/carer to
register person)
Residential Care
(Responsible carer in
home to register
person)
Clinical Assessment
(performed by any clinician reviewing
patient at hospital, outpatient or
homecare setting)
Moderate
to severe
frailty
(Clinical
Frailty
Score 6-7)
Vaccination is
encouraged
- Consent may
be by patient
or carer
Vaccination is
encouraged
- Consent may be by
patient or carer.
- May involve care
home management
Patient must be stable in that there
are no on-going medical problems
such as acute or recurrent/persistent
infections or complications where
on-going deterioration is anticipated.

25. Condition Home
(Family/carer to
register person)
Residential Care
(Responsible carer in
home to register
person)
Clinical Assessment
(performed by any clinician reviewing
patient at hospital, outpatient or
homecare setting)
Very
severely
frail
(Clinical
Frailty
Score 8)
Vaccination
should still be
encouraged if
patient is not
actively dying
and there are
no acute
medical issues
Vaccination should still
be encouraged if patient
is not actively dying and
there are no acute
medical issues
Signs of active dying include declining
vital signs and clinical condition in the
face of medical complications which
are not reversible. (e.g. Sepsis not
responding to antibiotics or severe
AKI not for dialysis)

26. SUMMARY
•Older people who get Covid-19 infection are much more likely to get severe
illness due to multiple chronic medical illnesses
•The frail elderly with Covid-19 infection are most likely to die compared to
those who were not frail
•Residents of LTCFs are more likely to get and die from Covid-19 infection
•Covid-19 vaccines are safe for elderly. More data on efficacy is needed but
for now, benefits far outweighs risks
•Very severely frail elderly needs clinical assessment before vaccine is
administered

27. CONCLUSION
•Covid-19 vaccines are safe for elderly and therefore they
should be vaccinated
•Very severely frail elderly needs clinical assessment
before vaccine is administered

28. Email
dr.mazzuin@gmail.com