Influenza Vaccination in Older Adults: Recent Innovations and Practical Applications
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Influenza can lead to serious illness, particularly for older adults. In addition to short-term morbidity and mortality during the acute infection, recovery can be prolonged and often incomplete. This may lead to persistent declines in health and function, including catastrophic disability, which has dramatic implications for the well-being and support needs of older adults and their caregivers. All of this means that prevention of infection and effective treatment when illness has occurred are of paramount importance. In this narrative review, we discuss the effectiveness of influenza vaccines for the prevention of influenza illness and serious outcomes in older adults. We review evidence of vaccine effectiveness for older adults in comparison with younger age groups, and also highlight the importance of frailty as a determinant of vaccine effectiveness. We then turn our attention to the question of why older and frailer individuals have poorer vaccine responses, and consider changes in immune function and inflammatory responses. This sets the stage for a discussion of newer influenza vaccine products that have been developed with the aim of enhancing vaccine effectiveness in older adults. We review the available evidence on vaccine efficacy, effectiveness and cost benefits, consider the potential place of these innovations in clinical geriatric practice, and discuss international advisory committee recommendations on influenza vaccination in older adults. Finally, we highlight the importance of influenza prevention to support healthy aging, along with the need to improve vaccine coverage rates using available vaccine products, and to spur development of better influenza vaccines for older adults in the near future.
Compliance with Ethical Standards
Conflict of interest
Melissa K. Andrew reports grant funding from GlaxoSmithKline (GSK), Pfizer, Sanofi, Canadian Institute of Health Research (CIHR), Public Health Agency of Canada (PHAC), and the Canadian Frailty Network; no personal financial conflicts of interest. Susan K. Bowles reports grant funding from the Dalhousie Pharmacy Endowment Fund; no financial conflicts of interest. Graham Pawelec reports no financial conflicts of interest. Laura Haynes reports grant funding from the National Institutes of Health (NIH; AG021600); no financial conflicts of interest. George A. Kuchel reports grant funding from the NIH (AG048023, AG021600, AI124297, AG052608, GM124922, AG056925), Patient-Centered Outcomes Research Institute (PCORI) and Novartis; no personal financial conflicts of interest. He is also supported by the Travelers Chair in Geriatrics and Gerontology. Shelly A. McNeil reports grants and payments from the GSK group of companies, Pfizer, Merck, Novartis, Sanofi, PHAC and CIHR. Janet E. McElhaney reports payments to her institution from GSK, Sanofi, and Pfizer, and is supported by the Health Sciences North Volunteer Association Research Chair in Healthy Aging.
None of the authors received any funding or payment for the preparation of this review.
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