Written by Eleni Giamarellou Infectious Disease Director of the 1st Pathology-Infectious Disease Clinic HYGEIA
Why vaccines in adults?
(a) Immunity to some germs weakens with age and a booster dose is needed (eg tetanus, diphtheria, whooping cough). (b) Some vaccines did not exist when today’s adults were children (eg, chicken pox, pneumococcal, shingles). (c) Adults, once over 60 years of age, are more susceptible to certain infections, such as influenza and pneumococcal infections, as a consequence of “immune aging”. (d) Vulnerable immunocompromised patients are constantly increasing (eg, hematological malignancies, neoplasms, administration of antineoplastic drugs, cortisone). (e) The pool of unvaccinated people increases (moving populations, economic migrants, refugees).
So which newer vaccines are recommended for adults?
The influenza vaccine, the new monovalent updated JN.1 vaccine against COVID-19, the new 20-valent pneumococcal vaccine, the vaccine against respiratory syncytial virus (RSV) as well as herpes zoster.
Why is special vaccination prophylaxis required against influenza, such a common virus?
Every year it is estimated that at least for EU countries ~50 million people will get sick, while 15,000 – 70,000 will die. In our country from 2012 – 2018, 11,341 people were hospitalized with flu in the ICU, while 44% ended up being 78-92% unvaccinated or unvaccinated and immunosuppressed! So, vaccination is necessary since the vaccine is active and harmless, even more so since last year (2023-24) a new quadrivalent vaccine, inactivated and 4 times stronger, was released for the >65-year-olds, so that it can be overcome due to “immune aging” the reduced response in old age.
It is emphasized that the flu vaccine differs every year while it only protects for 6 months, so it must be repeated in our country at the beginning of November each year. The high-risk groups that should be vaccinated against influenza are described in the enclosed table.
With regard to the vaccine against the COVID-19 infection, the monovalent, updated COMIRNATY JN.1 (Pfizer) vaccine, active against all “currently” circulating O strains of the SARS-CoV-2 virus, is currently indicated. Vaccination is strongly indicated, regardless of previous vaccinations with the older vaccines, for persons >60 years of age, as well as immunosuppressed persons regardless of age, high-risk groups due to underlying diseases (e.g. heart diseases, lung diseases), health professionals as well as pregnant (from the first trimester). It is recalled and emphasized that the anti-COVID-19 vaccine protects very little against infection and mild illness, but it protects >80% against severe infection, hospitalization in the ICU and against death itself.
A new active vaccine has recently been released against Pneumococcus which is the main cause of bacterial pneumonia, as well as the often fatal pneumococcal meningitis. The high-risk individuals for pneumococcal infection are almost similar to those reported for influenza. The vaccine, called APEXXNAR, contains 20 pneumococcal serotypes, is given once and replaces all previous ones, as long as they were given at least one year ago.
Against the respiratory syncytial virus (RSV) which is responsible for serious respiratory infections that often lead to the ICU, not only in children but now also in the elderly, two vaccines have recently been released in our country [το Abrysvo (Pfizer) και το Arexvy (GSK)]. They are given to those >60 years old, while only Abrysvo is also given in pregnancy between the 32nd and 36th week of pregnancy so that the newborn has already been protected through their mother with ready antibodies.
It is important to realize that those who have had varicella and are unvaccinated are not exempt, as 90% of adults aged ≥50 years remain carriers of the virus which will cause 25% of them to develop herpes zoster (ZZ) at some point in their lives resulting in extremely painful rash, especially after the age of 50 in 2/3 of cases. At the same time, underlying chronic diseases, such as type I – II diabetes mellitus and underlying immunosuppression, increase the incidence of EZ. The most common complication, however, concerns postherpetic neuralgia in ~20% of those affected, with zosteroid pain, extremely intense and persistent even 3 months after the rash has healed. At the same time, the incidence of stroke or myocardial infarction increases by approximately 50% and 25% respectively, at least in the first month after the attack attributed to an autoimmune mechanism. Until recently, the Zostavax vaccine from a live attenuated virus was available in our country, which was replaced by Shingrix, an inactivated, recombinant vaccine, which is also administered to the immunocompromised, with an effectiveness exceeding 90% in adults ≥50 years of age. It is safe and given in 2 doses (2-6 months apart), even in previous chickenpox or EZ or previous Zostavax administration (2-3 months after) provided the skin lesions have resolved.
And the question remains: So do adults need to be vaccinated? Surely no answer is needed since it is now understandable!
Source :Skai
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