ReviewThe public health value of vaccination for seniors in Europe
Introduction
Longer life expectancies and decreasing fertility rates mean that the proportion of older people in the populations of Organisation for Economic Co-operation and Development (OECD) countries is continually increasing [1]. Although populations are ageing in most countries worldwide, the speed is particularly fast in the European Union. In this region, the proportion of the population aged ≥80 years has increased from 1.5% in 1960 to almost 5% in 2010, and it is estimated that it will rise to 11% by 2050 [1]. The pressure that this growing population of seniors will put on long-term care systems will depend on their health status. Since the proportion of the economically active population that contributes financially to society is expected to fall, the financing of social protection systems, including healthcare will become challenging. In 2012 there were 4.2 working-age people (15–64 years) for every person aged ≥65 years in the OECD countries. Over the next 40 years it is estimated that this ratio will halve to an average of 2.1.
Vaccination is a critical component of infectious diseases preventive strategies for individuals of all ages. In children the burden of infectious diseases is high because they are exposed to a biological environment that is completely new for them. In the absence of vaccination, this natural exposure to infectious agents is the only way to prime the immune system. In contrast, the high burden of infectious diseases in elderly, usually defined as those aged ≥65 years, results from the age-related decline of the immune system, leaving them more vulnerable to infectious diseases. Vaccination at this age aims mainly to boost specific immunity that has been acquired in the past either through vaccination (e.g. tetanus or diphtheria) or natural exposure (e.g. influenza or varicella zoster virus). Vaccination is not only an essential tool in the control of infectious diseases and their costs, it is also pivotal component of a healthy ageing strategy that will contribute to the reduction of the increasing burden of ageing on healthcare systems and the society.
Vaccine-preventable diseases in seniors (i.e., people ≥ 65 years) in Europe represent a substantial burden despite the availability of vaccines. In Europe, vaccination programs for seniors are heterogeneous and vaccination coverage rates remain insufficient although there are convincing evidence-based medical and economic rationales. In this paper we present the burden of vaccine-preventable diseases in seniors in Europe and summarize the potential public health benefits of vaccination strategies for these subjects. Emphasis is given to the three vaccine-preventable diseases with the highest burden in elderly (i.e., influenza, pneumococcal diseases, herpes zoster) and then diphtheria, tetanus and pertussis have been discussed.
Section snippets
Burden of vaccine-preventable diseases in seniors in Europe
Although effective vaccines are available for vaccine-preventable diseases like influenza, pneumococcal diseases and herpes zoster, millions of European citizens develop these diseases every year, with the greatest burden of disease occurring in those ≥65 years [2]. Influenza and pneumonia are the leading cause of infectious morbidity and mortality in elderly [3], [4].
Medical rationale for vaccinating seniors in Europe
The impact of infectious diseases for people ≥65 years old is far greater than that for younger adults because of higher morbidity and mortality caused by infection, due to functional, demographic, and immunologic changes. Ageing is associated with immunosenescence, a decline in immune function and host defense capacity [31]. When this is combined with environmental factors and age-related anatomic and physiologic changes, which can result in reduced functional reserves, this can lead to an
Economic rationale for vaccinating seniors in Europe
The prevention of diseases in adults and elderly by vaccines results in savings in hospitalization costs and medical expenditure each year in Europe. For example, results from a model study suggest that achieving 100% influenza vaccine uptake for all risk groups in the European Union (EU-25) would prevent an estimated 7.2 million influenza cases, 2 million physician visits, 796,743 hospital admissions and 68,537 influenza-related deaths [53]. In addition, a study that used the UK as an example,
Vaccine recommendations and vaccination coverage rates in seniors in Europe: a need insufficiently taken in charge
In Europe in 2016, 18 countries had national or regional recommendations for pneumococcal vaccination and 8 had recommendations for herpes zoster vaccination in seniors despite the availability of strong evidence for the public health and medical benefits (Table 2) [59], [60], [61]. It has been estimated that among the 180 million Europeans targeted by influenza vaccination recommendations, only about 80 million, i.e. 44% are vaccinated [62]. In the 2011–2012 season, only the Netherlands;
Discussion and conclusions
This paper highlights the important burden of vaccine-preventable diseases in people ≥65 years old in Europe. Seniors have a real high risk associated with some infectious diseases, such as influenza, pneumococcal diseases, herpes zoster, diphtheria and tetanus. Seniors have also a higher risk of severe complications, hospitalization, loss of autonomy and death due to these infectious diseases. This increased risk for the disease and complications is associated with important healthcare costs,
Acknowledgement
The authors would like to thank Margaret Haugh (MediCom Consult, Villeurbanne, France) for editorial assistance funded by Sanofi Pasteur MSD.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors, with the exception of funding for editorial assistance.
Conflicts of interest
Isabelle Bertrand, Marie-Cécile Levant and Benoit Soubeyrand are employed by Sanofi Pasteur MSD, a company that commercializes vaccines in Europe. The other authors declare no potential conflicts of interest.
References (64)
- et al.
Ageing and infection
Lancet Infect Dis
(2002) - et al.
Vaccinations for the older adult
Clin Geriatr Med
(2016) The lifetime occurrence of Herpes zoster and prevalence of post-herpetic neuralgia: a retrospective survey in an elderly population
Eur J Pain
(1999)- et al.
A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction
Mayo Clin Proc
(2007) Management of herpes zoster and postherpetic neuralgia
J Am Acad Dermatol
(2007)- et al.
Sources of pertussis infection in young infants: a review of key evidence informing targeting of the cocoon strategy
Vaccine
(2013) - et al.
Pneumococcal polysaccharide vaccine effectiveness: study quality must not be ignored
Lancet Infect Dis
(2008) - et al.
The role of vaccination in successful independent ageing
Eur Geriatr Med.
(2016) - et al.
Influenza and pneumococcal vaccination and risk of stroke or transient ischaemic attack-matched case control study
Vaccine
(2014) - et al.
Establishing the health and economic impact of influenza vaccination within the European Union 25 countries
Vaccine
(2006)
Economic evaluation of strategies for the control and management of influenza in Europe
Vaccine
Mortality associated with influenza and respiratory syncytial virus in the United States
JAMA
Vaccines against influenza WHO position paper – November 2012
Wkly Epidemiol Rec
Estimates of deaths associated with seasonal influenza – United States, 1976–2007
MMWR Morb Mortal Wkly Rep
Clinical and economic burden of community-acquired pneumonia among adults in Europe
Thorax
The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis
Influenza Other Respir Viruses
Herpes zoster and postherpetic neuralgia: a review of the effects of vaccination
Aging Clin Exp Res
Similar herpes zoster incidence across Europe: results from a systematic literature review
BMC Infect Dis
Postherpetic neuralgia
J R Coll Gen Pract.
Postherpetic neuralgia: epidemiology, pathophysiology and management
Expert Rev Neurother
Varicella-zoster vaccine for the prevention of herpes zoster
N Engl J Med
Options for treating postherpetic neuralgia in the medically complicated patient
Ther Clin Risk Manage
Post-herpetic neuralgia in older adults: evidence-based approaches to clinical management
Drugs Aging
Herpes zoster ophthalmicus
Curr Treat Options Neurol
Tracking pertussis and evaluating control measures through enhanced pertussis surveillance, emerging infections program, United States
Emerg Infect Dis
Cited by (26)
Archetype analysis of older adult immunization decision-making and implementation in 34 countries
2020, VaccineCitation Excerpt :It will be essential that countries utilize several strategies to ensure that their older populations age in a healthy manner, including adult immunization [13,14]. As they have for children, vaccines have the potential to significantly reduce burden of disease and disability, dependence, healthcare costs, and more in older populations [15–20]. Given the imminence of a growing, worldwide adult population, anticipation of increased health costs has spurred multiple global, regional and national calls for action for policymakers and practitioners to prioritize adult immunization programs and improve uptake [19,21–27].
Vaccines in people at risk
2020, FMC Formacion Medica Continuada en Atencion Primaria