Direct and Indirect Benefits of a Comprehensive Approach to Vaccinating Adults with Influenza and Pneumococcal Vaccines, Especially in Patients with Chronic Diseases

  • Litjen TanEmail author
  • Christian Theilacker
Part of the Practical Issues in Geriatrics book series (PIG)


Despite the worldwide population ageing phenomenon, less attention is paid to adult immunization than to childhood immunization, even in developed countries with strong public health infrastructures. The global burden of adult vaccine-preventable disease (VPD) is considerable, and influenza (flu) and pneumococcal disease are major contributors to morbidity and mortality in older populations. The estimated cost burden (both direct and indirect) from VPDs is also enormous, exceeding 15 billion USD annually for flu, pneumococcal disease, zoster and pertussis in those aged 65 years and over. Indirect effects of vaccination include aspects that are not often covered in clinical trials, namely, the prevention of the consequences of infection, or herd protection, for example. To justify, sustain and improve adult immunization programmes, we need to have systems that can monitor and measure the impact of vaccination programmes, for example, by providing data on coverage rates. Available surveillance data indicate that globally, vaccination rates are poor and stagnant and not meeting WHO goals. The impact of vaccines is dependent on improving coverage rates, and public awareness, as well as improving clinicians’ willingness to give the vaccine, the public’s ability to get access to vaccines, and improving surveillance.


Vaccination Coverage Surveillance Influenza Pneumococcal disease Direct costs Indirect costs Herd protection 


  1. 1.
    Immunization coverage factsheet. 2017. Accessed 04 Oct 2017.
  2. 2.
    SAATI Partnership. Adult vaccination: a key component of healthy ageing. The benefits of life-course immunisation in Europe. 2013. Accessed 04 Oct 2017.
  3. 3.
    Centers for Disease Control and Prevention. Bacterial Core Surveillance Report, Emerging Infections Program Network, Streptococcus pneumoniae. Accessed 04 Oct 2017.
  4. 4.
    Centers for Disease C, Prevention. Estimates of deaths associated with seasonal influenza—United States, 1976–2007. MMWR Morb Mortal Wkly Rep. 2010;59(33):1057–62.Google Scholar
  5. 5.
    Centers for Disease Control and Prevention. 2015 Final Pertussis Surveillance Report. Accessed 04 Oct 2017.
  6. 6.
    Centers for Disease Control and Prevention. Surveillance for Viral Hepatitis—United States. 2014. Accessed 04 Oct 2017.
  7. 7.
    Harpaz R, Ortega-Sanchez IR, Seward JF, Advisory Committee on Immunization Practices Centers for Disease C, Prevention. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2008;57(RR-5):1–30; quiz CE2-4.Google Scholar
  8. 8.
    McLaughlin JM, McGinnis JJ, Tan L, Mercatante A, Fortuna J. Estimated human and economic burden of four major adult vaccine-preventable diseases in the United States, 2013. J Prim Prev. 2015;36(4):259–73.CrossRefGoogle Scholar
  9. 9.
    Simonsen L, Taylor RJ, Viboud C, Miller MA, Jackson LA. Mortality benefits of influenza vaccination in elderly people: an ongoing controversy. Lancet Infect Dis. 2007;7(10):658–66.CrossRefGoogle Scholar
  10. 10.
    Jackson LA, Jackson ML, Nelson JC, Neuzil KM, Weiss NS. Evidence of bias in estimates of influenza vaccine effectiveness in seniors. Int J Epidemiol. 2006;35(2):337–44.CrossRefGoogle Scholar
  11. 11.
    Jackson LA, Nelson JC, Benson P, Neuzil KM, Reid RJ, Psaty BM, et al. Functional status is a confounder of the association of influenza vaccine and risk of all cause mortality in seniors. Int J Epidemiol. 2006;35(2):345–52.CrossRefGoogle Scholar
  12. 12.
    Glezen WP, Simonsen L. Commentary: benefits of influenza vaccine in US elderly–new studies raise questions. Int J Epidemiol. 2006;35(2):352–3.CrossRefGoogle Scholar
  13. 13.
    Palache A. Seasonal influenza vaccine provision in 157 countries (2004–2009) and the potential influence of national public health policies. Vaccine. 2011;29(51):9459–66.CrossRefGoogle Scholar
  14. 14.
    Kyaw MH, Rose CE Jr, Fry AM, Singleton JA, Moore Z, Zell ER, et al. The influence of chronic illnesses on the incidence of invasive pneumococcal disease in adults. J Infect Dis. 2005;192(3):377–86.CrossRefGoogle Scholar
  15. 15.
    Barnes M, Heywood AE, Mahimbo A, Rahman B, Newall AT, Macintyre CR. Acute myocardial infarction and influenza: a meta-analysis of case-control studies. Heart. 2015;101(21):1738–47.CrossRefGoogle Scholar
  16. 16.
    Udell JA, Zawi R, Bhatt DL, Keshtkar-Jahromi M, Gaughran F, Phrommintikul A, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA. 2013;310(16):1711–20.CrossRefGoogle Scholar
  17. 17.
    Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, Holmes DR Jr, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(24):e139–228.CrossRefGoogle Scholar
  18. 18.
    Rasmussen SA, Jamieson DJ, Uyeki TM. Effects of influenza on pregnant women and infants. Am J Obstet Gynecol. 2012;207(Suppl. 3):S3–8.CrossRefGoogle Scholar
  19. 19.
    Gessner BD, Feikin DR. Vaccine preventable disease incidence as a complement to vaccine efficacy for setting vaccine policy. Vaccine. 2014;32(26):3133–8.CrossRefGoogle Scholar
  20. 20.
    Leventer-Roberts M, Feldman BS, Brufman I, Cohen-Stavi CJ, Hoshen M, Balicer RD. Effectiveness of 23-valent pneumococcal polysaccharide vaccine against invasive disease and hospital-treated pneumonia among people aged >/=65 years: a retrospective case-control study. Clin Infect Dis. 2015;60(10):1472–80.CrossRefGoogle Scholar
  21. 21.
    Dominguez A, Soldevila N, Toledo D, Torner N, Force L, Perez MJ, et al. Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain. PLoS One. 2017;12(2):e0171943.CrossRefGoogle Scholar
  22. 22.
    Moberley S, Holden J, Tatham DP, Andrews RM. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev. 2013;1:CD000422.Google Scholar
  23. 23.
    Bonten MJ, Huijts SM, Bolkenbaas M, Webber C, Patterson S, Gault S, et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med. 2015;372(12):1114–25.CrossRefGoogle Scholar
  24. 24.
    Cornu C, Yzebe D, Leophonte P, Gaillat J, Boissel JP, Cucherat M. Efficacy of pneumococcal polysaccharide vaccine in immunocompetent adults: a meta-analysis of randomized trials. Vaccine. 2001;19(32):4780–90.CrossRefGoogle Scholar
  25. 25.
    Hutchison BG, Oxman AD, Shannon HS, Lloyd S, Altmayer CA, Thomas K. Clinical effectiveness of pneumococcal vaccine. Meta-analysis. Canadian family physician Medecin de famille canadien, vol. 45; 1999. p. 2381–93.Google Scholar
  26. 26.
    Melegaro A, Edmunds WJ. The 23-valent pneumococcal polysaccharide vaccine. Part I. Efficacy of PPV in the elderly: a comparison of meta-analyses. Eur J Epidemiol. 2004;19(4):353–63.CrossRefGoogle Scholar
  27. 27.
    Schiffner-Rohe J, Witt A, Hemmerling J, von Eiff C, Leverkus FW. Efficacy of PPV23 in preventing pneumococcal pneumonia in adults at increased risk—a systematic review and meta-analysis. PLoS One. 2016;11(1):e0146338.CrossRefGoogle Scholar
  28. 28.
    Kraicer-Melamed H, O’Donnell S, Quach C. The effectiveness of pneumococcal polysaccharide vaccine 23 (PPV23) in the general population of 50 years of age and older: a systematic review and meta-analysis. Vaccine. 2016;34(13):1540–50.CrossRefGoogle Scholar
  29. 29.
    Conaty S, Watson L, Dinnes J, Waugh N. The effectiveness of pneumococcal polysaccharide vaccines in adults: a systematic review of observational studies and comparison with results from randomised controlled trials. Vaccine. 2004;22(23–24):3214–24.CrossRefGoogle Scholar
  30. 30.
    Huss A, Scott P, Stuck AE, Trotter C, Egger M. Efficacy of pneumococcal vaccination in adults: a meta-analysis. CMAJ. 2009;180(1):48–58.CrossRefGoogle Scholar
  31. 31.
    Diao WQ, Shen N, Yu PX, Liu BB, He B. Efficacy of 23-valent pneumococcal polysaccharide vaccine in preventing community-acquired pneumonia among immunocompetent adults: a systematic review and meta-analysis of randomized trials. Vaccine. 2016;34(13):1496–503.CrossRefGoogle Scholar
  32. 32.
    Darvishian M, van den Heuvel ER, Bissielo A, Castilla J, Cohen C, Englund H, et al. Effectiveness of seasonal influenza vaccination in community-dwelling elderly people: an individual participant data meta-analysis of test-negative design case-control studies. Lancet Respir Med. 2017;5(3):200–11.CrossRefGoogle Scholar
  33. 33.
    Kristensen M, van Lier A, Eilers R, McDonald SA, Opstelten W, van der Maas N, et al. Burden of four vaccine preventable diseases in older adults. Vaccine. 2016;34(7):942–9.CrossRefGoogle Scholar
  34. 34.
    Loeb M, Russell ML, Moss L, Fonseca K, Fox J, Earn DJ, et al. Effect of influenza vaccination of children on infection rates in Hutterite communities: a randomized trial. JAMA. 2010;303(10):943–50.CrossRefGoogle Scholar
  35. 35.
    Mertz D, Fadel SA, Lam PP, Tran D, Srigley JA, Asner SA, et al. Herd effect from influenza vaccination in non-healthcare settings: a systematic review of randomised controlled trials and observational studies. Euro Surveill. 2016;21(42).Google Scholar
  36. 36.
    Morens DM, Taubenberger JK, Fauci AS. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J Infect Dis. 2008;198(7):962–70.CrossRefGoogle Scholar
  37. 37.
    Centers for Disease Control and Prevention (CDC). Estimates of deaths associated with seasonal influenza—United States, 1976–2007. MMWR Morb Mortal Wkly Rep. 2010;59(33):1057–62.Google Scholar
  38. 38.
    McCullers JA. Insights into the interaction between influenza virus and pneumococcus. Clin Microbiol Rev. 2006;19(3):571–82.CrossRefGoogle Scholar
  39. 39.
    Gilchrist SA, Nanni A, Levine O. Benefits and effectiveness of administering pneumococcal polysaccharide vaccine with seasonal influenza vaccine: an approach for policymakers. Am J Public Health. 2012;102(4):596–605.CrossRefGoogle Scholar
  40. 40.
    Honkanen PO, Keistinen T, Kivela SL. Reactions following administration of influenza vaccine alone or with pneumococcal vaccine to the elderly. Arch Intern Med. 1996;156(2):205–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Immunization Action CoalitionSaint PaulUSA
  2. 2.National Adult and Influenza Immunization SummitSaint PaulUSA
  3. 3.Medical Development and Scientific Affairs International Developed Markets, PfizerParisFrance

Personalised recommendations