Public Health Impact of Adult Vaccine-Preventable Diseases on Performance, Disability, Mortality and Healthcare Costs in Europe

Abstract

Prevention and control of vaccine-preventable diseases (VPDs) in the elderly are becoming an important issue due to population ageing. VPDs affecting older people comprise the “cursed triad” of influenza (flu), pneumococcal pneumonia, and herpes zoster. The flu vaccine is the most widely used vaccine in Europe, and most countries have programmes to protect older individuals against flu. Interestingly, influenza is the only case where a specific Council Recommendation for the vaccination of older age groups exists at EU level and with a specific target for coverage (75% vaccine coverage rate, VCR). Unfortunately, accurate figures about the true magnitude of flu infection rates are lacking, although influenza is estimated to affect 5–15% of the population, corresponding to 35–110 million (average 70 million) persons, with around 94,000 excess deaths directly or indirectly attributable to influenza and 50,000 excess hospitalisations. Pneumococcal disease is also one of the main public health threats in the elderly, accounting for the majority of community-acquired pneumonia (CAP) cases in Europe, whose incidence rate is estimated to range from 1.07 to 1.2 per 1000 person-years. Finally, herpes zoster, whose annual HZ incidence is around 7 to 8/1000 person-years over 50 years of age, increasing to 10/1000 person-years after 80 years of age, may cause post-herpetic neuralgia in up to 20% of those affected, being an important cause of hospitalisation. Thus, the burden of VPDs among the elderly is high in Europe and urges for more aggressive vaccination policies at regional and country level.