A large portion of our older adult patients remain unimmunised or inad
equately 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 infec
tions. 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 sys
tem results in far fewer older persons developing antibodies following
immunisation than their younger counterparts.