Abstract
This study addresses the challenges and advances in the vaccination of older adults in a context of global population aging, evaluating its effectiveness in the prevention of serious infectious diseases. Immunosenescence and comorbidities in this population may affect the response to vaccines, decreasing their efficacy. Through a systematic review, we analyzed recent studies evaluating various vaccine formulations and strategies such as high doses, natural adjuvants (e.g., probiotics and nondigestible polysaccharides), and vaccine coadministration to optimize immunogenicity in the elderly. The results show that high-dose quadrivalent vaccines (QIV-HD) and formulations with natural adjuvants improve immune response and reduce hospitalizations compared to standard doses. Coadministration of vaccines, such as influenza and COVID-19, is a safe practice that does not compromise the efficacy of each vaccine and facilitates vaccination in this high-risk population. The findings support the use of tailored vaccination strategies and underscore the need for additional studies to establish evidence-based recommendations for immunization in older adults.
References
Organización Mundioal de la Salud. Envejecimiento. Organ Mundioal Salud 2024. https://www.who.int/es/health-topics/ageing (accedido 1 de noviembre de 2024).
Organización Mundioal de la Salud. WHO: Number of people over 60 years set to double by 2050; major societal changes required. Organ Mundioal Salud 2015. https://www.who.int/news/item/30-09-2015-who-number-of-people-over-60-years-set-to-double-by-2050-major-societal-changes-required (accedido 1 de noviembre de 2024).
King JC. Influenza vaccines. Pediatr Ann 2000;29:692-7. https://doi.org/10.3928/0090-4481-20001101-09.
Youhanna J, Tran V, Hyer R, Domnich A. Immunogenicity of Enhanced Influenza Vaccines Against Mismatched Influenza Strains in Older Adults: A Review of Randomized Controlled Trials. Influenza Other Respir Viruses 2024;18:e13286. https://doi.org/10.1111/irv.13286.
Rivetti D, Jefferson T, Thomas R, Rudin M, Rivetti A, Di Pietrantonj C, et al. Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev 2006:CD004876. https://doi.org/10.1002/14651858.CD004876.pub2.
Comber L, O Murchu E, Jordan K, Hawkshaw S, Marshall L, O’Neill M, et al. Systematic review of the efficacy, effectiveness and safety of high-dose seasonal influenza vaccines for the prevention of laboratory-confirmed influenza in individuals ≥18 years of age. Rev Med Virol 2023;33:e2330. https://doi.org/10.1002/rmv.2330.
Addario A, Célarier T, Bongue B, Barth N, Gavazzi G, Botelho-Nevers E. Impact of influenza, herpes zoster, and pneumococcal vaccinations on the incidence of cardiovascular events in subjects aged over 65 years: a systematic review. GeroScience 2023;45:3419-47. https://doi.org/10.1007/s11357-023-00807-4.
Fiore AE, Bridges CB, Cox NJ. Seasonal influenza vaccines. Curr Top Microbiol Immunol 2009;333:43-82. https://doi.org/10.1007/978-3-540-92165-3_3.
Jefferson T, Di Pietrantonj C, Al-Ansary LA, Ferroni E, Thorning S, Thomas RE. Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev 2010:CD004876. https://doi.org/10.1002/14651858.CD004876.pub3.
Osterholm MT, Kelley NS, Sommer A, Belongia EA. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis 2012;12:36-44. https://doi.org/10.1016/S1473-3099(11)70295-X.
Kim Y-H, Hong K-J, Kim H, Nam J-H. Influenza vaccines: Past, present, and future. Rev Med Virol 2022;32:e2243. https://doi.org/10.1002/rmv.2243.
Domnich A, de Waure C. Comparative effectiveness of adjuvanted versus high-dose seasonal influenza vaccines for older adults: a systematic review and meta-analysis. Int J Infect Dis IJID Off Publ Int Soc Infect Dis 2022;122:855-63. https://doi.org/10.1016/j.ijid.2022.07.048.
Tanner AR, Dorey RB, Brendish NJ, Clark TW. Influenza vaccination: protecting the most vulnerable. Eur Respir Rev Off J Eur Respir Soc 2021;30:200258. https://doi.org/10.1183/16000617.0258-2020.
Lee JKH, Lam GKL, Shin T, Samson SI, Greenberg DP, Chit A. Efficacy and effectiveness of high-dose influenza vaccine in older adults by circulating strain and antigenic match: An updated systematic review and meta-analysis. Vaccine 2021;39 Suppl 1:A24-35. https://doi.org/10.1016/j.vaccine.2020.09.004.
Curran D, Matthews S, Cabrera ES, Pérez SN, Breva LP, Rämet M, et al. The respiratory syncytial virus prefusion F protein vaccine attenuates the severity of respiratory syncytial virus-associated disease in breakthrough infections in adults ≥60 years of age. Influenza Other Respir Viruses 2024;18:e13236. https://doi.org/10.1111/irv.13236.
Ison MG, Papi A, Athan E, Feldman RG, Langley JM, Lee D-G, et al. Efficacy and Safety of Respiratory Syncytial Virus (RSV) Prefusion F Protein Vaccine (RSVPreF3 OA) in Older Adults Over 2 RSV Seasons. Clin Infect Dis Off Publ Infect Dis Soc Am 2024;78:1732-44. https://doi.org/10.1093/cid/ciae010.
Toback S, Galiza E, Cosgrove C, Galloway J, Goodman AL, Swift PA, et al. Safety, immunogenicity, and efficacy of a COVID-19 vaccine (NVX-CoV2373) co-administered with seasonal influenza vaccines: an exploratory substudy of a randomised, observer-blinded, placebo-controlled, phase 3 trial. Lancet Respir Med 2022;10:167-79. https://doi.org/10.1016/S2213-2600(21)00409-4.
Shimada K, Morinaga H, Kiyanagi T, Miyazaki T, Nishitani-Yokoyama M, Okai I, et al. Safety and Efficacy of Simultaneous Inoculations of Pneumococcal and Influenza Vaccines in Patients with Coronary Artery Disease. J Atheroscler Thromb 2021;28:826-34. https://doi.org/10.5551/jat.58297.
Gögenur M, Balsevicius L, Bulut M, Colak N, Justesen TF, Fiehn A-MK, et al. Neoadjuvant intratumoral influenza vaccine treatment in patients with proficient mismatch repair colorectal cancer leads to increased tumor infiltration of CD8+ T cells and upregulation of PD-L1: a phase 1/2 clinical trial. J Immunother Cancer 2023;11:e006774. https://doi.org/10.1136/jitc-2023-006774.
Johansen ND, Modin D, Skaarup KG, Nealon J, Samson S, Dufournet M, et al. Effectiveness of high-dose versus standard-dose quadrivalent influenza vaccine against recurrent hospitalizations and mortality in relation to influenza circulation: A post-hoc analysis of the DANFLU-1 randomized clinical trial. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 2024;30:1453-9. https://doi.org/10.1016/j.cmi.2024.01.017.
Hadigal S, Colombo L, Haughie S. Reply letter to «Immunogenicity and safety of a quadrivalent high-dose inactivated influenza vaccine compared with a standard-dose quadrivalent influenza vaccine in healthy people aged 60 years or older: a randomized Phase III trial». Hum Vaccines Immunother 2022;18:2085470. https://doi.org/10.1080/21645515.2022.2085470.
Leroux-Roels I, Waerlop G, Tourneur J, De Boever F, Maes C, Bruhwyler J, et al. Randomized, Double-Blind, Reference-Controlled, Phase 2a Study Evaluating the Immunogenicity and Safety of OVX836, A Nucleoprotein-Based Influenza Vaccine. Front Immunol 2022;13:852904. https://doi.org/10.3389/fimmu.2022.852904.
Alvarez FP, Chevalier P, Borms M, Bricout H, Marques C, Soininen A, et al. Cost-effectiveness of influenza vaccination with a high dose quadrivalent vaccine of the elderly population in Belgium, Finland, and Portugal. J Med Econ 2023;26:710-9. https://doi.org/10.1080/13696998.2023.2194193.
Shimizu S, Tanaka R, Itoh E, Maekawa-Matsuura M, Iwase Y. Performance and usability evaluation of novel intradermal injection device ImmuciseTM and reanalysis of intradermal administration trials of influenza vaccine for the elderly. Vaccine 2022;40:873-9. https://doi.org/10.1016/j.vaccine.2021.12.061.
Christensen J, Johansen ND, Janstrup KH, Modin D, Skaarup KG, Nealon J, et al. Time of day for vaccination, outcomes, and relative effectiveness of high-dose vs. standard-dose quadrivalent influenza vaccine: A post hoc analysis of the DANFLU-1 randomized clinical trial. J Infect 2024;89:106276. https://doi.org/10.1016/j.jinf.2024.106276.
Wall N, Godlee A, Geh D, Jones C, Faustini S, Harvey R, et al. Latent Cytomegalovirus Infection and Previous Capsular Polysaccharide Vaccination Predict Poor Vaccine Responses in Older Adults, Independent of Chronic Kidney Disease. Clin Infect Dis Off Publ Infect Dis Soc Am 2021;73:e880-9. https://doi.org/10.1093/cid/ciab078.
Uthoff SAK, Zinkevich A, Franiel D, Below M, Splieth H, Iwen J, et al. A complex intervention on vaccination uptake among older adults (≥ 60 years) in Germany - a study protocol with a mixed methods design. BMC Prim Care 2023;24:148. https://doi.org/10.1186/s12875-023-02101-w.
Eto T, Okubo Y, Momose A, Tamura H, Zheng R, Callendret B, et al. A Randomized, Double-Blind, Placebo-Controlled, Phase 1 Study to Evaluate the Safety, Reactogenicity, and Immunogenicity of Single Vaccination of Ad26.RSV.preF-Based Regimen in Japanese Adults Aged 60 Years and Older. Influenza Other Respir Viruses 2024;18:e13336. https://doi.org/10.1111/irv.13336.
Tuthill CW, Awad A, Parrigon M, Ershler WB. A pilot trial of Thymalfasin (Ta1) to prevent covid-19 infection and morbidities in renal dialysis patients: Preliminary report. Int Immunopharmacol 2023;117:109950. https://doi.org/10.1016/j.intimp.2023.109950.
Yu L, Han Y, Zhang Z. Research on h-index Optimization Considering the Amount of Papers ———hq2-index; [考虑载文量影响的 h 指数优化研究———hq2 指数]. J Mod Inf 2020;40:114-21. https://doi.org/10.3969/j.issn.1008-0821.2020.02.013.
Sandionigi A, De Giani A, Tursi F, Michelotti A, Cestone E, Giardina S, et al. Effectiveness of Multistrain Probiotic Formulation on Common Infectious Disease Symptoms and Gut Microbiota Modulation in Flu-Vaccinated Healthy Elderly Subjects. BioMed Res Int 2022;2022:3860896. https://doi.org/10.1155/2022/3860896.
Laue C, Stevens Y, van Erp M, Papazova E, Soeth E, Pannenbeckers A, et al. Adjuvant Effect of Orally Applied Preparations Containing Non-Digestible Polysaccharides on Influenza Vaccination in Healthy Seniors: A Double-Blind, Randomised, Controlled Pilot Trial. Nutrients 2021;13:2683. https://doi.org/10.3390/nu13082683.
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Copyright (c) 2023 Yasmin González (Author)