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The burden of influenza in older adults: meeting the challenge

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Abstract

Influenza is an acute respiratory infection for which vaccination is our best prevention strategy. Small seasonal changes in circulating influenza viruses (antigenic drift) result in the need for annual influenza vaccination, in which the vaccine formulation is updated to better match the predominant circulating influenza viruses that have undergone important antigenic changes. Although the burden of influenza infection and its complications is the highest in older adults, vaccine effectiveness is the lowest in this vulnerable population. This is largely due to waning of the immune response with age known as “immune senescence”, and presents an important, unmet challenge. Possible strategies to tackle this include adjuvant and high-dose vaccines, and herd immunity induced by greater vaccine uptake.

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References

  1. Cox RJ, Brokstad KA, Ogra P (2004) Influenza virus: immunity and vaccination strategies. Comparison of the immune response to inactivated and live, attenuated influenza vaccines. Scand J Immunol 59:1–15

    CAS  PubMed  Google Scholar 

  2. Moorthy M, Castronovo D, Abraham A et al (2012) Deviations in influenza seasonality: odd coincidence or obscure consequence? Clin Microbiol Infect 18:955–962

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Jennings L, Huang QS, Barr I et al (2018) Literature review of the epidemiology of influenza B disease in 15 countries in the Asia-Pacific region. Influenza Other Respir Viruses 12:383–411

    PubMed  PubMed Central  Google Scholar 

  4. Cowling BJ, Caini S, Chotpitayasunondh T et al (2017) Influenza in the Asia-Pacific region: findings and recommendations from the global influenza initiative. Vaccine 35:856–864

    PubMed  Google Scholar 

  5. Jennings LC (2013) Influenza vaccines: an Asia-Pacific perspective. Influenza Other Respir Viruses 7:44–51

    PubMed  PubMed Central  Google Scholar 

  6. Kim H, Webster RG, Webby RJ (2018) Influenza virus: dealing with a drifting and shifting pathogen. Viral Immunol 31:174–183

    CAS  PubMed  Google Scholar 

  7. Iuliano AD, Roguski KM, Chang HH et al (2018) Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet 391:1285–1300

    PubMed  Google Scholar 

  8. Thompson WW, Shay DK, Weintraub E et al (2004) Influenza-associated hospitalizations in the United States. JAMA 292:1333–1340

    CAS  PubMed  Google Scholar 

  9. Mertz D, Kim TH, Johnstone J et al (2013) Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ 347:f5061

    PubMed  PubMed Central  Google Scholar 

  10. Kwong JC, Schwartz KL, Campitelli MA et al (2018) Acute myocardial infarction after laboratory-confirmed influenza infection. NEJM 378:345–353

    PubMed  Google Scholar 

  11. Warren-Gash C, Blackburn R, Whitaker H et al (2018) Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland. Eur Respir J 51:170794

    Google Scholar 

  12. Fulop T, Larbi A, Witkowski JM et al (2010) Aging, frailty and age-related diseases. Biogerontology 11:547–563

    CAS  PubMed  Google Scholar 

  13. Jergović M, Contreras NA, Nikolich-Žugich J (2019) Impact of CMV upon immune aging: facts and fiction. Med Microbiol Immunol 208:263–269. https://doi.org/10.1007/s00430-019-00605-w

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Pawelec G (2018) Immune parameters associated with mortality in the elderly are context-dependent: lessons from Sweden, Holland and Belgium. Biogerontology 19:537–545

    CAS  PubMed  Google Scholar 

  15. Haq K, Fulop T, Tedder G et al (2017) Cytomegalovirus seropositivity predicts a decline in the T cell but not the antibody response to influenza in vaccinated older adults independent of type 2 diabetes status. J Gerontol A Biol Sci Med Sci 72:1163–1170

    CAS  PubMed  Google Scholar 

  16. Johnstone J, Parsons R, Botelho F et al (2017) T-cell phenotypes predictive of frailty and mortality in elderly nursing home residents. J Am Geriatr Soc 65:153–159

    PubMed  Google Scholar 

  17. Harding AT, Heaton NS (2018) Efforts to improve the seasonal influenza vaccine. Vaccines (Basel) 6:19. https://doi.org/10.3390/vaccines6020019

    Article  CAS  Google Scholar 

  18. Centers for Disease Control and Prevention (CDC) (2018) Influenza (Flu) vaccine supply for 2018–2019 season. <https://www.cdc.gov/flu/prevent/vaxsupply.htm>. Accessed 12 July 2019

  19. De Serres G, Skowronski DM, Wu XW et al (2013) The test-negative design: validity, accuracy and precision of vaccine efficacy estimates compared to the gold standard of randomised placebo-controlled clinical trials. Euro Surveill 18:1–9

    Google Scholar 

  20. Osterholm MT, Kelley NS, Sommer A et al (2012) Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis 12:36–44

    PubMed  Google Scholar 

  21. Belongia EA, Simpson MD, King JP et al (2016) Variable influenza vaccine effectiveness by subtype: a systematic review and meta-analysis of test-negative design studies. Lancet Infect Dis 16:942–951

    CAS  PubMed  Google Scholar 

  22. De Villiers PJT, Steele AD, Hiemstra LA et al (2009) Efficacy and safety of a live attenuated influenza vaccine in adults 60 years of age and older. Vaccine 28:228–234

    PubMed  Google Scholar 

  23. Kissling E, Valenciano M, Falcao J et al (2009) “I-MOVE” towards monitoring seasonal and pandemic influenza vaccine effectiveness: lessons learnt from a pilot multi-centric case-control study in Europe, 2008–9. Euro Surveill 14:19388

    PubMed  Google Scholar 

  24. Savulescu C, Valenciano M, de Mateo S et al (2010) Estimating the influenza vaccine effectiveness in elderly on a yearly basis using the Spanish influenza surveillance network—pilot case-control studies using different control groups, 2008–2009 season, Spain. Vaccine 28:2903–2907

    PubMed  Google Scholar 

  25. Rondy M, El Omeiri N, Thompson MG et al (2017) Effectiveness of influenza vaccines in preventing severe influenza illness among adults: a systematic review and meta-analysis of test-negative design case-control studies. J Infect 75:381–394

    PubMed  PubMed Central  Google Scholar 

  26. Andrew MK, Bowles SK, Pawelec G et al (2019) Influenza vaccination in older adults: recent innovations and practical applications. Drugs Aging 36:29–37

    PubMed  Google Scholar 

  27. Schaffner W, Chen WH, Hopkins RH et al (2018) Effective immunization of older adults against seasonal influenza. Am J Med 131:865–873

    PubMed  Google Scholar 

  28. Schaffner W, van Buynder P, McNeil S et al (2018) Seasonal influenza immunisation: strategies for older adults. Int J Clin Pract 72:e13249

    PubMed  Google Scholar 

  29. Domnich A, Arata L, Amicizia D et al (2017) Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: a systematic review and meta-analysis. Vaccine 35:513–520

    CAS  PubMed  Google Scholar 

  30. Wilkinson K, Wei Y, Szwajcer A et al (2017) Efficacy and safety of high-dose influenza vaccine in elderly adults: a systematic review and meta-analysis. Vaccine 35:2775–2780

    CAS  PubMed  Google Scholar 

  31. Gravenstein S, Davidson HE, Taljaard M et al (2017) Comparative effectiveness of high-dose versus standard-dose influenza vaccination on numbers of US nursing home residents admitted to hospital: a cluster-randomised trial. Lancet Respir Med 5:738–746

    PubMed  Google Scholar 

  32. Izurieta HS, Thadani N, Shay DK et al (2015) Comparative effectiveness of high-dose versus standard-dose influenza vaccines in US residents aged 65 years and older from 2012 to 2013 using Medicare data: a retrospective cohort analysis. Lancet Infect Dis 15:293–300

    PubMed  PubMed Central  Google Scholar 

  33. Shay DK, Chillarige Y, Kelman J et al (2017) Comparative effectiveness of high-dose versus standard-dose influenza vaccines among US medicare beneficiaries in preventing postinfluenza deaths during 2012–2013 and 2013–2014. J Infect Dis 215:510–517

    PubMed  Google Scholar 

  34. Izurieta HS, Chillarige Y, Kelman J et al (2018) Relative effectiveness of cell-cultured and egg-based influenza vaccines among elderly persons in the United States, 2017–2018. JID. https://doi.org/10.1093/infdis/jiy716

    Article  Google Scholar 

  35. Dunkle LM, Izikson R, Patriarca P et al (2017) Efficacy of recombinant influenza vaccine in adults 50 years of age or older. NEJM 376:2427–2436

    CAS  PubMed  Google Scholar 

  36. Simonsen L, Taylor RJ, Viboud C et al (2007) Mortality benefits of influenza vaccination in elderly people: an ongoing controversy. Lancet Infect Dis 7:658–666

    PubMed  Google Scholar 

  37. Jackson LA, Jackson ML, Nelson JC et al (2006) Evidence of bias in estimates of influenza vaccine effectiveness in seniors. Int J Epidemiol 35:337–344

    PubMed  Google Scholar 

  38. Fiore A, Uyeki T, Broder K et al (2010) Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep 59:1–62

    PubMed  Google Scholar 

  39. Burney LE (1960) Influenza immunization: statement. Public Health Rep 75:944 (Washington, DC: 1896)

    PubMed  PubMed Central  Google Scholar 

  40. Clarke TC, Norris T, Schiller JS (2017) Early release of selected estimates based on data from 2016 National Health Interview Survey. National Center for Health Statistics. Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/nhis.htm. Accessed 27 Apr 2019

  41. Thomas RE, Lorenzetti DL (2018) Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database Syst Rev 5:CD005188

    PubMed  Google Scholar 

  42. Mertz D, Fadel SA, Lam PP et al (2016) Herd effect from influenza vaccination in non-healthcare settings: a systematic review of randomised controlled trials and observational studies. Euro Surveill 21:30378

    PubMed Central  Google Scholar 

  43. Kim TH, Johnstone J, Loeb M (2011) Vaccine herd effect. Scand J Infect Dis 43:683–689

    PubMed  PubMed Central  Google Scholar 

  44. Loeb M, Russell ML, Moss L et al (2010) Effect of influenza vaccination of children on infection rates in Hutterite communities: a randomized trial. JAMA 303:943–950

    CAS  PubMed  Google Scholar 

  45. Ghendon YZ, Kaira AN, Elshina GA (2006) The effect of mass influenza immunization in children on the morbidity of the unvaccinated elderly. Epidemiol Infect 134:71–78

    CAS  PubMed  Google Scholar 

  46. Arden NH (2000) Control of influenza in the long-term-care facility: a review of established approaches and newer options. Infect Control Hosp Epidemiol 21:59–64

    CAS  PubMed  Google Scholar 

  47. Ahmed F, Lindley MC, Allred N et al (2014) Effect of influenza vaccination of healthcare personnel on morbidity and mortality among patients: systematic review and grading of evidence. CID 58:50–57

    Google Scholar 

  48. Patriarca PA, Weber JA, Parker RA et al (1986) Risk factors for outbreaks of influenza in nursing homes. A case-control study. Am J Epidemiol 124:114–119

    CAS  PubMed  Google Scholar 

Download references

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Correspondence to Mark Loeb.

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Dr. Loeb has received funding from CIHR, NIH, WHO, as well as from Sanofi Pasteur, Seqirus, and Pfizer, as well as honoraria for advising or speaking for these companies.

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Bartoszko, J., Loeb, M. The burden of influenza in older adults: meeting the challenge. Aging Clin Exp Res 33, 711–717 (2021). https://doi.org/10.1007/s40520-019-01279-3

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