Vaccines in older age: moving from current practice to optimal coverage—a multidisciplinary consensus conference

Abstract

Vaccines are a key strategy to promote healthy aging, but vaccine coverage remains below target levels in at-risk adults and older individuals. We present here the results of a multidisciplinary consensus conference convened to perform a multidimensional assessment of vaccination in geriatric medicine, with a view to developing a well-defined strategy for the promotion of vaccines in older people. We discuss recommended vaccines in older individuals, and describe the wide regional heterogeneity between regions in the Italian context. The main obstacles to implementation of vaccines in practice are reviewed, as well as potential strategies to remove these barriers. Finally, the importance of including vaccines and vaccination in undergraduate and postgraduate medical education is underlined. The information summarized in this document is expected to help develop educational and promotional initiatives to achieve greater uptake of vaccines among older individuals, as a key means to promote healthy aging.

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References

  1. 1.

    Machado A, Kislaya I, Larrauri A et al (2019) Impact of national influenza vaccination strategy in severe influenza outcomes among the high-risk Portuguese population. BMC Public Health 19:1690

    Article  Google Scholar 

  2. 2.

    Bonten MJ, Huijts SM, Bolkenbaas M et al (2015) Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med 372:1114–1125

    CAS  Article  Google Scholar 

  3. 3.

    Jackson LA, Gurtman A, Rice K et al (2013) Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine in adults 70 years of age and older previously vaccinated with 23-valent pneumococcal polysaccharide vaccine. Vaccine 31:3585–3593

    CAS  Article  Google Scholar 

  4. 4.

    Jackson LA, Gurtman A, van Cleeff M et al (2013) Influence of initial vaccination with 13-valent pneumococcal conjugate vaccine or 23-valent pneumococcal polysaccharide vaccine on anti-pneumococcal responses following subsequent pneumococcal vaccination in adults 50 years and older. Vaccine 31:3594–3602

    CAS  Article  Google Scholar 

  5. 5.

    Jackson LA, Gurtman A, van Cleeff M et al (2013) Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine compared to a 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naive adults. Vaccine 31:3577–3584

    CAS  Article  Google Scholar 

  6. 6.

    Miernyk KM, Butler JC, Bulkow LR et al (2009) Immunogenicity and reactogenicity of pneumococcal polysaccharide and conjugate vaccines in alaska native adults 55–70 years of age. Clin Infect Dis 49:241–248

    CAS  Article  Google Scholar 

  7. 7.

    Freedman M, Kroger A, Hunter P et al (2020) Advisory Committee on Immunization P: recommended adult immunization schedule, United States, 2020. Ann Intern Med 172:337–347

    Article  Google Scholar 

  8. 8.

    Matanock A, Lee G, Gierke R et al (2019) Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥ 65 years: updated recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep 68:1069–1075

    CAS  Article  Google Scholar 

  9. 9.

    Cunningham AL, Lal H, Kovac M et al (2016) Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. N Engl J Med 375:1019–1032

    CAS  Article  Google Scholar 

  10. 10.

    Lal H, Cunningham AL, Godeaux O et al (2015) Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med 372:2087–2096

    Article  Google Scholar 

  11. 11.

    Amirthalingam G, Andrews N, Keel P et al (2018) Evaluation of the effect of the herpes zoster vaccination programme 3 years after its introduction in England: a population-based study. Lancet Public Health 3:e82–e90

    Article  Google Scholar 

  12. 12.

    Italian government: Piano Nazionale Prevenzione Vaccinale (PNPV) 2017–2019.

  13. 13.

    Doherty TM, Connolly MP, Del Giudice G et al (2018) Vaccination programs for older adults in an era of demographic change. Eur Geriatr Med 9:289–300

    Article  Google Scholar 

  14. 14.

    Doherty TM, Del Giudice G, Maggi S (2019) Adult vaccination as part of a healthy lifestyle: moving from medical intervention to health promotion. Ann Med 51:128–140

    Article  Google Scholar 

  15. 15.

    Influenza. https://www.salute.gov.it/portale/influenza/homeInfluenza.jsp [Access date: 24 February 2020]

  16. 16.

    Giuffrida S (2019) Calabria: a successful experience implementing herpes zoster vaccination strategies. Aging Clin Exp Res 31:421–423

    Article  Google Scholar 

  17. 17.

    Maggi S, Michel JP (2019) When an “active call” can be a “wake-up call”. Aging Clin Exp Res 31:299–300

    Article  Google Scholar 

  18. 18.

    Sheikh S, Biundo E, Courcier S et al (2018) A report on the status of vaccination in Europe. Vaccine 36:4979–4992

    Article  Google Scholar 

  19. 19.

    Science Advice for Policy by European Academies (SAPEA): Transforming the future of ageing. Berlin. https://doi.org/10.26356/ageing Available at: https://sciencesnaturelles.ch/service/publications/115500-transforming-the-future-of-ageing [Access date: 24 February 2020]. 2019

  20. 20.

    Alici DE, Sayiner A, Unal S (2017) Barriers to adult immunization and solutions: personalized approaches. Hum Vaccin Immunother 13:213–215

    Article  Google Scholar 

  21. 21.

    Michel JP, Chidiac C, Grubeck-Loebenstein B et al (2009) Advocating vaccination of adults aged 60 years and older in Western Europe: statement by the joint vaccine working group of the European union geriatric medicine society and the international association of gerontology and geriatrics-European region. Rejuvenation Res 12:127–135

    Article  Google Scholar 

  22. 22.

    Ecarnot F, Pedone C, Cesari M et al (2020) Knowledge about vaccines and vaccination in older people: results of a national survey by the Italian society for gerontology & geriatrics. Vaccine 38:1535–1540

    Article  Google Scholar 

  23. 23.

    Ecarnot F, Crepaldi G, Juvin P et al (2019) Pharmacy-based interventions to increase vaccine uptake: report of a multidisciplinary stakeholders meeting. BMC Public Health 19:1698

    Article  Google Scholar 

  24. 24.

    Boey L, Bral C, Roelants M et al (2018) Attitudes, believes, determinants and organisational barriers behind the low seasonal influenza vaccination uptake in healthcare workers––a cross-sectional survey. Vaccine 36:3351–3358

    Article  Google Scholar 

  25. 25.

    Sundaram N, Duckett K, Yung CF et al (2018) "I wouldn't really believe statistics"––challenges with influenza vaccine acceptance among healthcare workers in Singapore. Vaccine 36:1996–2004

    Article  Google Scholar 

  26. 26.

    Wu S, Su J, Yang P et al (2017) Factors associated with the uptake of seasonal influenza vaccination in older and younger adults: a large, population-based survey in Beijing, China. BMJ Open 7:e017459

    Article  Google Scholar 

  27. 27.

    US Department of Health and Human Services: The National Vaccine Program Office. National Adult Immunization Plan 2015. Available at: https://www.hhs.gov/sites7default/files/nvpo/national-adult-immunization-plan/naip.pdf. 2015.

  28. 28.

    Kerneis S, Jacquet C, Bannay A et al (2017) Vaccine education of medical students: a nationwide cross-sectional survey. Am J Prev Med 53:e97–e104

    Article  Google Scholar 

  29. 29.

    Public Health England: Seasonal flu vaccine uptake in GP patients: monthly data, 2018 to 2019. Available at: https://www.gov.uk/government/statistics/seasonal-flu-vaccine-uptake-in-gp-patients-monthly-data-2018-to-2019 [Access date: 09 February 2020]. 2019.

  30. 30.

    Altay M, Ates I, Altay FA et al (2016) Does education effect the rates of prophylactic vaccination in elderly diabetics? Diabetes Res Clin Pract 120:117–123

    Article  Google Scholar 

  31. 31.

    Welte T, Torres A, Nathwani D (2012) Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax 67:71–79

    CAS  Article  Google Scholar 

  32. 32.

    Hope-Simpson RE (1975) Postherpetic neuralgia. J R Coll Gen Pract 25:571–575

    CAS  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Kawai K, Gebremeskel BG, Acosta CJ (2014) Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open 4:e004833

    Article  Google Scholar 

  34. 34.

    Kawakami K, Ohkusa Y, Kuroki R et al (2010) Effectiveness of pneumococcal polysaccharide vaccine against pneumonia and cost analysis for the elderly who receive seasonal influenza vaccine in Japan. Vaccine 28:7063–7069

    Article  Google Scholar 

  35. 35.

    Taylor J (2013) The new European society of cardiology core curriculum 2013. Eur Heart J 34:2331–2332

    Article  Google Scholar 

  36. 36.

    Van Epps P, Tumpey T, Pearce MB et al (2017) Preexisting immunity, not frailty phenotype, predicts influenza postvaccination titers among older veterans. Clin Vaccine Immunol 24:e00498–e516

    PubMed  PubMed Central  Google Scholar 

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Funding

This work, including travel and meeting expenses, was supported by an unrestricted grant from MSD Italia Srl. The sponsor had no role in selecting the participants, reviewing the literature, defining consensus statements, drafting or reviewing the paper, or in the decision to submit the manuscript. All views expressed are solely those of the authors.

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Correspondence to Fiona Ecarnot.

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Dr. Antonelli Incalzi reports personal fees from Angelini Pharma, MSD, Novartis, Lt3, Dynamicom, Ethos srl, Italia Longeva, outside the submitted work. Dr. Bonanni reports personal fees from GSK, MSD, Sanofi, Pfizer, Seqirus, outside the submitted work. Dr. Gabutti reports grants from Sanofi Pasteur MSD, Seqirus, Emergent BioSolutions, MSD Italy, Sanofi Pasteur Italy, Pfizer, GSK Biologicals SA, outside the submitted work. Dr. Maggi reports grants from Sanofi Pasteur, MSD, GSK, Pfizer, Takeda through institution as organizer of meetings/congresses and as principal investigator of epidemiological studies, for taking part to advisory boards and expert meeting, outside the submitted work. No other author has any conflict of interest to declare.

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Antonelli Incalzi, R., Bernabei, R., Bonanni, P. et al. Vaccines in older age: moving from current practice to optimal coverage—a multidisciplinary consensus conference. Aging Clin Exp Res (2020). https://doi.org/10.1007/s40520-020-01622-z

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Keywords

  • Vaccines
  • Consensus
  • Old age
  • Coverage