Vaccines for older adults – State of Art review – BMJ 2021 Feb 22

Vaccines protecting against these diseases have long been available, however, efficacy and persistence of immunity are suboptimal, especially in people of 70 and older. This can be improved, as was demonstrated by the efficacy (~90%) of the recombinant zoster vaccine (RZV). Improved influenza and pneumococcal vaccines are needed, 

 

The proportion of the global population aged 65 and older is rapidly increasing. Infections in this age group, most recently with SARS-CoV-2, cause substantial morbidity and mortality.

Major improvements have been made in vaccines for older people, either through the addition of novel adjuvants—as in the new recombinant zoster vaccine and an adjuvanted influenza vaccine—or by increasing antigen concentration, as in influenza vaccines.

This review is about improvements in immunization for the three most important vaccine preventable diseases of ageing.

  • The recombinant zoster vaccine has an efficacy of 90% that is minimally affected by the age of the person being vaccinated and persists for more than four years. Increasing antigen dose or inclusion of adjuvant has improved the immunogenicity of influenza vaccines in older adults, although the relative effectiveness of the enhanced influenza vaccines and the durability of the immune response are the focus of ongoing clinical trials.
  • Conjugate and polysaccharide pneumococcal vaccines have similar efficacy against invasive pneumococcal disease and pneumococcal pneumonia caused by vaccine serotypes in older adults. Their relative value varies by setting, depending on the prevalence of vaccine serotypes, largely related to conjugate vaccine coverage in children. Improved efficacy will increase public confidence and uptake of these vaccines.
  • Efficacy of seasonal influenza vaccine in people aged 65 and older is low.
  • Co-administration of these vaccines is feasible and important for maximal uptake in older people.
  • Development of new vaccine platforms has accelerated following the arrival of SARS-CoV-2, and will likely result in new vaccines against other pathogens in the future.
bmj.n188.full

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