Chidiac, Christian

Grubeck-Loebenstein, Beatrix

Johnson, Robert

Lambert, Paul

Maggi, Stefania

Michel, Jean-Pierre

Moulias, Robert

Nicholson, Karl

Werner, Hans

RERO DOC Digital Library

Aging Clin Exp Res, Vol. 21, No. 3 254Key words: Healthy aging, public health, vaccine.Correspondence: Jean-Pierre Michel, MD, Department of Rehabilitation and Geriatrics, Geneva Medical School and University Hospitals,Chemin Pont Bochet, 3 Thonex-Geneve, CH 1226, Switzerland.E-mail: Jean-Pierre.Michel@hcuge.chReceived March 9, 2009; accepted in revised form April 26, 2009.Coalition of advocates to vaccinate of WesternEuropean citizens aged 60 years and olderAging Clinical and Experimental ResearchJean-Pierre Michel1, Christian Chidiac2, Beatrix Grubeck-Loebenstein3, Robert W. Johnson4,Paul Henri Lambert5, Stefania Maggi6, Robert Moulias7, Karl Nicholson8 and Hans Werner91Department of Rehabilitation and Geriatrics, Geneva Medical School and University Hospitals,Thonex-Geneve, Switzerland, 2Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse,Inserm U851, Lyon, France, 3Institute for Biomedical Aging Research, Innsbruck, Austria, 4Bristol RoyalInfirmary and University of Bristol, Bristol, United Kingdom, 5CMU, Centre of Vaccinology, Geneva,Switzerland, 6CNR, Center on Aging, Padova, Italy, 7Service de Médecine Interne, Hôpital Charles-Foix,Ivry-sur-Seine, France, 8University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester,United Kingdom, 9Ev. Krankenhaus Elisabethenstift, Darmstadt, GermanyABSTRACT. The high burden of infectious diseases inadults aged 60 years and older is disproportionate, con-sidering that many of these diseases are vaccine-pre-ventable. Based on careful analysis of the reasons for vac-cination barriers/failures in the European population,the two European geriatric and gerontological societies(the European Union Geriatric Medicine Society [EUGMS]and the International Association of Gerontology and Geri-atrics – European Region [IAGG-ER]) propose careful adap-tation of current vaccine guidelines to promote preventiveaspects, concerning both life threatening-diseases (in-fluenza, pneumococcal pneumonia and tetanus/diphtheria)and diseases which adversely impact patients’ quality oflife (pertussis and herpes zoster). This consensus statementis designed to support official recommendations and im-prove the willingness to vaccinate the most rapidly grow-ing segment of the population. The following guidelinesare based on the importance of the sustainability of vac-cine programs from midlife till extreme old age:- Promote healthy aging by optimizing health deter-minants of daily functions, active participation insociety and individual quality of life;- Provide useful information to contribute toward har-monizing vaccine strategies at European level;- Support the public health, social and economic valuesof vaccination.Both healthcare professionals and consumers associa-tions have a critical role to play in the implementationof such consensus clinical guidelines.(Aging Clin Exp Res 2009; 21: 254-257)©2009, Editrice KurtisThe European geriatric and gerontological societies [Eu-ropean Union Geriatric Medicine Society (EUGMS)and International Association of Gerontology andGeriatrics – European Region (IAGG-ER)], concernedwith the public health burden of vaccine-preventable dis-eases, convened a Working Group of experts, chaired bythe academic director of the EUGMS (JPM) for the pur-pose of advocating higher immunization rates amongEuropean citizens aged 60 years and older.The main purposes of the Joint Working Group were:1) to conduct an inventory of the current practical guide-lines for universally recommended vaccines in adults in Eu-ropean countries, and to compare guidelines with thoseof the USA; 2) to propose an adaptation of current vac-cine guidelines designed to support official recommen-dations; 3) to stress the importance of sustaining a life-course vaccine program from childhood to adulthooduntil extreme old age; 4) to support the public health, so-cial and economic value of vaccines to prevent infec-tious diseases in the whole population; and 5) to en-hance the willingness to vaccinate and the public accep-tance of vaccination.The group was composed of geriatricians designated bythe two societies (EUGMS: SM and JPM and IAGG-ER:RM and HW) and experts in immunology and vaccines (B-GL and PHL), pneumococcal vaccine (CC) and influenzavaccine (KN) and public health (Theri Kilpi), who allworked on a voluntary basis.Each of the working member was in charge of a spe-cific topic (formulating the bibliography, reporting ateach of the three meetings, and participating in the writ-J-P. Michel, C. Chidiac, B. Grubeck-Loebenstein et al.ing of the paper related to their main expertise). The aca-demic director of the EUGMS assured the coordination ofthe various chapters and wrote the first draft. All groupmembers participated in its improvement and agreedwith the content of the final version. The draft state-ment was then submitted to the executive boards of thetwo societies.Vaccines should be part of a healthy aging strategy, con-sidering that currently the period from retirement age(from 55 to 65 years in most Western European countries)to death is generally two to three decades. Several clinicalconsiderations must be included in it (Table 1):- Vaccinations: After a complete vaccine history as-sessment at 60 years of age, recommended vaccinesinclude TdaP, influenza, pneumococcal and herpeszoster. The association of influenza and pneumococ-cal vaccines has potential preventive effects (1).Choice of TdaP, a tetanus toxoid, reduced diphtheriatoxoid and acellular pertussis vaccine follows the rec-ommendation of the US Advisory Committee on Im-munization Practices (ACIP) (2). Moreover, this com-bined vaccine reduces the reservoir of pertussis inthe population at large, decreases exposure of personsat increased risk of complicated infections (e.g., in-fants) and also reduces the cost and disruption ofpertussis in health care facilities and other institu-tional settings (2). These different and/or sequentialvaccine shots more often cause local and transitory re-actions than systemic ones.255 Aging Clin Exp Res, Vol. 21, No. 3Vaccine program Recommended vaccines Clinical considerationsStarting at 60 years Tetanus-Diphtheria-Pertussis (TdaP) Assess vaccine status(but possibly earlier) - If no evidence of any previous vaccination, start a new completevaccination series.- If last booster ≥10 years before, give a booster doseTrivalent Influenza Vaccine (TIV) Adapted to annual strainPneumococcal (PV23) Assess vaccine status: if vaccine administered ≥5 years before, give 1 doseHerpes Zoster Assess vaccine status:If no evidence of any previous vaccination, give 1 doseRevaccinations Influenza (TIV) Every YEARPneumococcal (PV23) Every FIVE YEARSTetanus-Diphtheria-Pertussis (TdaP) Every TEN YEARSHerpes Zoster Not yet determinedSpecial indications1. New injury event Tetanus-Toxoid (TT) or - If no evidence of any previous vaccination, start a new completeTetanus-Diphtheria toxoids (Td) vaccination series.or TdaP - If last booster ≥10 years before, give a new booster dose2. Repeated hospital Pneumococcal Ask vaccine history: if vaccine administered ≥5 years, provide a boosteradmissions3. Nursing home Tetanus-Diphtheria-Pertussis (TdaP) If no evidence of any previous vaccination, start a new completeadmissions vaccination series.- If last booster ≥10 years before, give a new booster doseInfluenza (TIV) No upper age limit;Herd immunity is important for both residents of nursing home andhealthcare professionalsPneumococcal If already vaccinated, a booster is recommended if initial vaccinationwas ≥5 yearsHerpes Zoster If not already administered, give 1 dose. If already vaccinated, needfor revaccination is not yet knownContra-indications and precautions for every vaccine: Refer to official vaccine recommendations.http://www.ecdc.eu.inthttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5510a1.htmhttp://www.clinicalanswers.nhs.uk/index.cfm?question=643All the above-mentioned vaccines can be administered in the event of: Mild to moderate local reactions after a previous vaccination, mild acute illness, cur-rent antimicrobial therapy, persons receiving anticoagulant therapy, recent exposure to an infectious disease and stable neurological disorder.Administration: Maintain recommended vaccine storage temperature, and sterile injection technique, as well as injection route and site (e.g., persons onanticoagulant therapy can receive subcutaneous instead of intramuscular injections).A patient vaccination card is strongly recommended.Table 1 - Proposed vaccine guidelines for adults aged 60 years and older in Western Europe.©isrtEdit200E ONSONAPER- Revaccinations: an annual influenza vaccination is need-ed, as each year’s vaccine is adapted to new seasonalstrains. Repeated annual influenza immunizations broad-en antigenic protection, if the new strains are closely re-lated (3). Pneumococcal vaccine is recommended every5 years and TdaP every 10 years. Further studies areneeded to determine the duration of the protective effectof a single herpes zoster vaccination and to establishwhether a booster for it is required. Regular booster vac-cinations throughout life are important to maintain theability to respond to recall antigens with aging.Other special indications for vaccinations should beconsidered:- In case of trauma or a new medical event, a booster (ora complete vaccination) of tetanus toxoid or TdaP maybe provided if the previous tetanus vaccination wasgiven over 10 years previously.- In case of repeated hospitalizations, pneumococcal vac-cine should be considered, if the last immunization dat-ed back 5 years.- At the time of admission to residential care (approxi-mately 85 years in most Western European countries),a new clinical assessment of vaccine history is recom-mended, to ascertain if any vaccine updates are needed.This assessment needs to consider TdaP, influenza,pneumococcal and herpes zoster vaccines.Willingness to vaccinate and public acceptance ofvaccinationThese vaccine guidelines for citizens aged 60 years andolder, proposed by the two European geriatric and geron-tological societies, would be justified if there is evidencesuch programs are cost-effective and safe.Despite existing controversies concerning: a) estimat-ed influenza-related mortality; b) the effectiveness of in-fluenza vaccine in older adults; c) possible selection bias-es in cohort studies (4, 5); and d) the need for country-spe-cific assessment (6). Most recent analysis studies of in-fluenza vaccine show a high-impact, cost-effective servicefor persons aged over 50 years, and even over 70 years(7-11). Already in the mid-1990s, a cost-effectiveness anal-ysis of pneumococcal vaccination for prevention of in-vasive pneumococcal disease in populations aged over 65years in 10 Western European countries justified wider useof the vaccine (12). Most cost-effectiveness analyses ofpertussis vaccination in Europe were performed in Ger-many and based on a Markov model; the results weremore sensitive in favoring routine vaccination of adultsaged 20 to 64 with TdaP, if the incidence of pertussis inthis age group was greater than 120 per 100,000 pop-ulation (13, 14).More research is needed on the cost-effectiveness of allthese vaccines in adults aged 60 years and older. Com-munity and patient values for preventing herpes zoster andpost-herpetic neuralgia are currently under investigationto determine the quality-adjusted life-years saved (15-17). Improving vaccine uptake in this population re-quires addressing numerous barriers to adult immunization,which involve both consumers’ beliefs and healthcareprofessionals’ practices (18, 19).Consensus statementThe EUGMS and IAGG-ER have formed a Joint Work-ing Group to complement existing information, proposevaccine guidelines, and develop a consensus statementthat advocates immunization in adults aged 60 yearsand older. This consensus statement:- Demonstrates the need to strengthen and harmonizevaccine strategies at the European level;- Recognises the importance of sustaining a life-coursevaccine program;- Promotes healthy aging by increasing vaccine coverageto limit the burden of vaccine-preventable infectiousdiseases;- Supports the public health, social and economic value ofvaccination, and even- Improves willingness to vaccinate the most rapidly grow-ing segment of the general population.Healthcare professionals have a critical role to play inthe implementation of such consensus vaccine guide-lines. Communication and awareness of vaccine-pre-ventable diseases, such as an efficient reminder, recall andinformation system as well as improved access to vaccines,constitute the main pillars for success in establishing a vac-cine program for European citizens aged 60 years andolder.ACKNOWLEDGEMENTEuropean Union Geriatric Medicine Society (EUGMS), repre-senting 32 national geriatric societies of European countries.International Association of Geriatrics and Gerontology – Eu-ropean Region (IAGG-ER), representing national societies from 43 Eu-ropean countries.The authors would like to thank Jean-Pierre Baeyens (B), PeterCrome (UK), Luc Hessel (F), Yves Megard (F) and Eva Topinkova (Cz)for their valuable comments on this paper.Advocacy for vaccination in the elderlyAging Clin Exp Res, Vol. 21, No. 3 256REFERENCES1. Christenson B, Hedlund J, Lundbergh P, Ortqvist A. Additive pre-ventive effect of influenza and pneumococcal vaccines in elderlypersons. Eur Respir J 2004; 23: 363-8.2. Kretsinger K, Broder KR, Cortese MM et al. Preventing tetanus,diphtheria, and pertussis among adults: use of tetanus toxoid, re-duced diphtheria toxoid and acellular pertussis vaccine recom-mendations of the Advisory Committee on Immunization Practices(ACIP) and recommendation of ACIP, supported by theHealthcare Infection Control Practices Advisory Committee(HICPAC), for use of TdaP among health-care personnel. MMWRRecomm Rep 2006; 55: 1-37.3. Smith NM, Bresee JS, Shay DK, Uyeki TM, Cox NJ, Strikas RA.Prevention and Control of Influenza: recommendations of theAdvisory Committee on Immunization Practices (ACIP). MMWRRecomm Rep 2006; 55: 1-42.J-P. Michel, C. Chidiac, B. Grubeck-Loebenstein et al.4. Simonsen L, Reichert TA, Viboud C, Blackwelder WC, Taylor RJ,Miller MA. Impact of influenza vaccination on seasonal mortality inthe US elderly population. Arch Intern Med 2005; 165: 265-72.5. Simonsen L, Taylor RJ, Viboud C, Miller MA, Jackson LA.Mortality benefits of influenza vaccination in elderly people: an on-going controversy. Lancet Infect Dis 2007; 7: 658-66.6. Nicholson KG. Socioeconomics of influenza and influenza vac-cination in Europe. Pharmacoeconomics 1996; 9 (Suppl 3):75-8.7. Patel MS, Davis MM. Could a federal program to promote in-fluenza vaccination among elders be cost-effective? Prev Med2006; 42: 240-6.8. Nichol KL, Nordin J, Mullooly J. Influence of clinical outcome andoutcome period definitions on estimates of absolute clinical andeconomic benefits of influenza vaccination in community dwellingelderly persons. Vaccine 2006; 24: 1562-8.9. Maciosek MV, Solberg LI, Coffield AB, Edwards NM, GoodmanMJ. Influenza vaccination health impact and cost effectivenessamong adults aged 50 to 64 and 65 and older. Am J Prev Med2006; 31: 72-9.10. Turner DA, Wailoo AJ, Cooper NJ, Sutton AJ, Abrams KR,Nicholson KG. The cost-effectiveness of influenza vaccination ofhealthy adults 50-64 years of age. Vaccine 2006; 24: 1035-43.11. Prosser LA, O'Brien MA, Molinari NA et al. Non-traditional set-tings for influenza vaccination of adults: costs and cost effective-ness. Pharmacoeconomics 2008; 26: 163-78.12. Evers SM, Ament AJ, Colombo GL, et al. Cost-effectiveness ofpneumococcal vaccination for prevention of invasive pneumo-coccal disease in the elderly: an update for 10 Western Europeancountries. Eur J Clin Microbiol Infect Dis 2007; 26: 531-40.13. Lee GM, Murphy TV, Lett S et al. Cost effectiveness of pertussisvaccination in adults. Am J Prev Med 2007; 32: 186-93.14. Lee GM, Riffelmann M, Wirsing von Konig CH. Cost-effectivenessof adult pertussis vaccination in Germany. Vaccine 2008; 26:3673-9.15. Brisson M, Pellissier JM, Levin MJ. Cost-effectiveness of herpeszoster vaccine: flawed assumptions regarding efficacy againstpostherpetic neuralgia. Clin Infect Dis 2007; 45: 1527-9.16. Rothberg MB, Virapongse A, Smith KJ. Cost-effectiveness of avaccine to prevent herpes zoster and postherpetic neuralgia in old-er adults. Clin Infect Dis 2007; 44: 1280-8.17. Lieu TA, Ortega-Sanchez I, Ray GT et al. Community and patientvalues for preventing herpes zoster. Pharmacoeconomics 2008;26: 235-49.18. Johnson DR, Nichol KL, Lipczynski K. Barriers to adult immu-nization. Am J Med 2008; 121: S28-35.19. Kotchen TA. Why the slow diffusion of treatment guidelines intoclinical practice? Arch Intern Med 2007; 167: 2394-5.257 Aging Clin Exp Res, Vol. 21, No. 3

Coalition of advocates to vaccinate of Western European citizens aged 60 years and older

http://doc.rero.ch/record/318953/files/40520_2013_Article_BF03324911.pdf

Coalition of advocates to vaccinate of Western European citizens aged 60 years and older

Abstract

Similar works

Full text

Available Versions

RERO DOC Digital Library