Skip to main content

Vaccines, Vaccine-Preventable Diseases, and Frailty

  • Chapter
  • First Online:
Frailty

Abstract

Infections have important adverse consequences for older adults, particularly those who are frail. In this chapter, we review how age and frailty impact immune responses to infections and vaccines, including through immunosenescence and inflammaging. We discuss infections that are currently vaccine-preventable in the context of vaccines that are available and recommended for older adults. We review existing evidence on how frailty impacts vaccine responses and outcomes (including long-term sequalae) from these infections and note important evidence gaps. We argue for the importance of considering age and frailty in all stages of development, evaluation, regulation, and implementation of current and future vaccines for older adults. Given suboptimal uptake of currently recommended vaccines, we consider barriers and facilitators for older adult immunization. We conclude by underscoring the need for communication of the benefits of vaccination for older frail adults and advocacy for continued focus on immunization to promote optimal aging.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. McElhaney JE, Effros RB. Immunosenescence: what does it mean to health outcomes in older adults? Curr Opin Immunol. 2009;21(4):418–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Haq K, McElhaney JE. Immunosenescence: influenza vaccination and the elderly. Curr Opin Immunol. 2014;29:38–42.

    Article  CAS  PubMed  Google Scholar 

  3. Allen JC, Toapanta FR, Chen W, Tennant SM. Understanding immunosenescence and its impact on vaccination of older adults. Vaccine. 2020;38(52):8264–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Franceschi C, Capri M, Monti D, Giunta S, Olivieri F, Sevini F, et al. Inflammaging and anti-inflammaging: a systemic perspective on aging and longevity emerged from studies in humans. Mech Ageing Dev. 2007;128(1):92–105.

    Article  CAS  PubMed  Google Scholar 

  5. Loeb N, Andrew MK, Loeb M, Kuchel GA, Haynes L, McElhaney JE, et al. Frailty is associated with increased hemagglutinin-inhibition titres in a 4-year randomized trial comparing standard and high dose influenza vaccination. Open Forum Infect Dis. 2020;7(5):ofaa148. https://doi.org/10.1093/ofid/ofaa148. eCollection 2020 May. https://pubmed.ncbi.nlm.nih.gov/32500087/. PMID: 32500087

  6. Moehling KK, Nowalk MP, Lin CJ, Bertolet M, Ross TM, Carter CE, et al. The effect of frailty on HAI response to influenza vaccine among community-dwelling adults >/= 50 years of age. Hum Vaccin Immunother. 2018;14(2):361–7.

    Article  PubMed  Google Scholar 

  7. Fulop T, McElhaney J, Pawelec G, Cohen AA, Morais JA, Dupuis G, et al. Frailty, inflammation and Immunosenescence. Interdiscip Top Gerontol Geriatr. 2015;41:26–40.

    Article  PubMed  Google Scholar 

  8. Collerton J, Martin-Ruiz C, Davies K, Hilkens CM, Isaacs J, Kolenda C, et al. Frailty and the role of inflammation, immunosenescence and cellular ageing in the very old: cross-sectional findings from the Newcastle 85+ study. Mech Ageing Dev. 2012;133(6):456–66.

    Article  CAS  PubMed  Google Scholar 

  9. Thomas-Crusells J, McElhaney JE, Aguado MT. Report of the ad-hoc consultation on aging and immunization for a future WHO research agenda on life-course immunization. Vaccine. 2012;30(42):6007–12.

    Article  PubMed  Google Scholar 

  10. Kahn AL, Steffen CA, Henaff L, MacDonald NE, Morgan C, Faden R, et al. COVID-19 vaccine policy development in a sample of 44 countries—key findings from a December 2021 survey of National Immunization Technical Advisory Groups (NITAGs). Vaccine. 2023;41(3):676–83.

    Article  PubMed  PubMed Central  Google Scholar 

  11. PHAC. Canadian Immunization Guide https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-3-vaccination-specific-populations/page-2-immunization-of-adults.html 2023.

  12. PHAC. Provincial and territorial routine vaccination programs for healthy, previously immunized adults https://www.canada.ca/en/public-health/services/provincial-territorial-immunization-information/routine-vaccination-healthy-previously-immunized-adult.html 2023.

  13. World Health Organization: Seasonal influenza fact sheet 2023. Available from: http://www.who.int/mediacentre/factsheets/fs211/en/.

  14. Reichert TA, Simonsen L, Sharma A, Pardo SA, Fedson DS, Miller MA. Influenza and the winter increase in mortality in the United States, 1959–1999. Am J Epidemiol. 2004;160(5):492–502.

    Article  PubMed  Google Scholar 

  15. Iuliano AD, Roguski KM, Chang HH, Muscatello DJ, Palekar R, Tempia S, et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet. 2017;

    Google Scholar 

  16. Andrew MK, Bowles SK, Pawelec G, Haynes L, Kuchel GA, McNeil SA, et al. Influenza vaccination in older adults: recent innovations and practical applications. Drugs Aging. 2019;36(1):29–37.

    Article  PubMed  Google Scholar 

  17. DiazGranados CA, Dunning AJ, Robertson CA, Talbot HK, Landolfi V, Greenberg DP. Efficacy and immunogenicity of high-dose influenza vaccine in older adults by age, comorbidities, and frailty. Vaccine. 2015;33(36):4565–71.

    Article  CAS  PubMed  Google Scholar 

  18. Bauer JM, De Castro A, Bosco N, Romagny C, Diekmann R, Benyacoub J, et al. Influenza vaccine response in community-dwelling German prefrail and frail individuals. Immun Ageing. 2017;14:17.

    Article  PubMed  PubMed Central  Google Scholar 

  19. McElhaney JE, Verschoor CP, Andrew MK, Haynes L, Kuchel GA, Pawelec G. The immune response to influenza in older humans: beyond immune senescence. Immun Ageing. 2020;17:10.

    Article  PubMed  PubMed Central  Google Scholar 

  20. McElhaney JE, Xie D, Hager WD, Barry MB, Wang Y, Kleppinger A, et al. T cell responses are better correlates of vaccine protection in the elderly. J Immunol. 2006;176(10):6333–9.

    Article  CAS  PubMed  Google Scholar 

  21. Murasko DM, Bernstein ED, Gardner EM, Gross P, Munk G, Dran S, et al. Role of humoral and cell-mediated immunity in protection from influenza disease after immunization of healthy elderly. Exp Gerontol. 2002;37(2–3):427–39.

    Article  CAS  PubMed  Google Scholar 

  22. Talbot HK, Nian H, Chen Q, Zhu Y, Edwards KM, Griffin MR. Evaluating the case-positive, control test-negative study design for influenza vaccine effectiveness for the frailty bias. Vaccine. 2016;34(15):1806–9.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ferdinands JM, Gaglani M, Martin ET, Middleton D, Monto AS, Murthy K, et al. Prevention of influenza hospitalization among adults in the United States, 2015-2016: results from the US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN). J Infect Dis. 2019;220(8):1265–75.

    Article  PubMed  Google Scholar 

  24. Petrie JG, Ohmit SE, Cheng CK, Martin ET, Malosh RE, Lauring AS, et al. Influenza vaccine effectiveness against antigenically drifted influenza higher than expected in hospitalized adults: 2014-2015. Clin Infect Dis. 2016;63(8):1017–25.

    Article  PubMed  Google Scholar 

  25. Segaloff HE, Petrie JG, Malosh RE, Cheng CK, McSpadden EJ, Ferdinands JM, et al. Severe morbidity among hospitalised adults with acute influenza and other respiratory infections: 2014-2015 and 2015-2016. Epidemiol Infect. 2018;146(11):1350–8.

    Article  CAS  PubMed  Google Scholar 

  26. Andrew MK, Shinde V, Ye L, Hatchette T, Haguinet F, Dos Santos G, et al. The importance of frailty in the assessment of influenza vaccine effectiveness against influenza-related hospitalization in elderly people. J Infect Dis. 2017;216(4):405–14.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Torres A, Blasi F, Dartois N, Akova M. Which individuals are at increased risk of pneumococcal disease and why? Impact of COPD, asthma, smoking, diabetes, and/or chronic heart disease on community-acquired pneumonia and invasive pneumococcal disease. Thorax. 2015;70(10):984–9.

    Article  PubMed  Google Scholar 

  28. Chalmers JD, Campling J, Dicker A, Woodhead M, Madhava H. A systematic review of the burden of vaccine preventable pneumococcal disease in UK adults. BMC Pulm Med. 2016;16(1):77.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ridda I, Macintyre CR, Lindley R, Gao Z, Sullivan JS, Yuan FF, et al. Immunological responses to pneumococcal vaccine in frail older people. Vaccine. 2009;27(10):1628–36.

    Article  CAS  PubMed  Google Scholar 

  30. MacIntyre CR, Ridda I, Trent MJ, McIntyre P. Persistence of immunity to conjugate and polysaccharide pneumococcal vaccines in frail, hospitalised older adults in long-term follow up. Vaccine. 2019;37(35):5016–24.

    Article  CAS  PubMed  Google Scholar 

  31. Schmader K. Herpes Zoster. Clin Geriatr Med. 2016;32(3):539–53.

    Article  PubMed  Google Scholar 

  32. Schmader KE, Johnson GR, Saddier P, Ciarleglio M, Wang WW, Zhang JH, et al. Effect of a zoster vaccine on herpes zoster-related interference with functional status and health-related quality-of-life measures in older adults. J Am Geriatr Soc. 2010;58(9):1634–41.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kawai K, Gebremeskel BG, Acosta CJ. Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open. 2014;4(6):e004833.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352(22):2271–84.

    Article  CAS  PubMed  Google Scholar 

  35. Cunningham AL, Lal H, Kovac M, Chlibek R, Hwang SJ, Diez-Domingo J, et al. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. N Engl J Med. 2016;375(11):1019–32.

    Article  CAS  PubMed  Google Scholar 

  36. Lal H, Cunningham AL, Godeaux O, Chlibek R, Diez-Domingo J, Hwang SJ, et al. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med. 2015;372(22):2087–96.

    Article  PubMed  Google Scholar 

  37. Curran D, Kim JH, Matthews S, Dessart C, Levin MJ, Oostvogels L, et al. Recombinant zoster vaccine is efficacious and safe in frail individuals. J Am Geriatr Soc. 2021;69(3):744–52.

    Article  PubMed  Google Scholar 

  38. Choi JY, Kang MG, Park KU, Park WB, Kim KI, Kim ES, et al. Immunogenicity of the varicella-zoster vaccine in community-dwelling non-robust elderly individuals compared to robust elderly individuals: a prospective cohort study. J Gerontol A Biol Sci Med Sci. 2019;74(8):1225–30.

    Article  CAS  PubMed  Google Scholar 

  39. Geriatric Medicine Research C, Covid C, Welch C. Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study. Age Ageing. 2021;50(3):617–30.

    Article  Google Scholar 

  40. Lee YK, Motwani Y, Brook J, Martin E, Seligman B, Schaenman J. Predictors of COVID-19 outcomes: interplay of frailty, comorbidity, and age in COVID-19 prognosis. Medicine (Baltimore). 2022;101(51):e32343.

    Article  CAS  PubMed  Google Scholar 

  41. Simon NR, Jauslin AS, Rueegg M, Twerenbold R, Lampart M, Osswald S, et al. Association of frailty with adverse outcomes in patients with suspected COVID-19 infection. J Clin Med. 2021;10:11.

    Article  Google Scholar 

  42. Andrew MK, Godin J, LeBlanc J, Boivin G, Valiquette L, McGeer A, et al. Older age and frailty are associated with higher mortality but lower ICU admission with COVID-19. Can Geriatr J. 2022;25(2):183–96.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Pott Junior H, Cominetti MR. Comorbidities predict 30-day hospital mortality of older adults with COVID-19. Geriatr Nurs. 2021;42(5):1024–8.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Passarelli-Araujo H, Pott-Junior H, Susuki AM, Olak AS, Pescim RR, Tomimatsu M, et al. The impact of COVID-19 vaccination on case fatality rates in a city in southern Brazil. Am J Infect Control. 2022;50(5):491–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Tang F, Hammel IS, Andrew MK, Ruiz JG. COVID-19 mRNA vaccine effectiveness against hospitalisation and death in veterans according to frailty status during the SARS-CoV-2 delta (B.1.617.2) variant surge in the USA: a retrospective cohort study. Lancet Healthy Longev. 2022;3(9):e589–e98.

    Article  PubMed  PubMed Central  Google Scholar 

  46. 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.

    Article  CAS  PubMed  Google Scholar 

  47. Kwong JC, Schwartz KL, Campitelli MA, Chung H, Crowcroft NS, Karnauchow T, et al. Acute myocardial infarction after laboratory-confirmed influenza infection. N Engl J Med. 2018;378(4):345–53.

    Article  PubMed  Google Scholar 

  48. Grau AJ, Fischer B, Barth C, Ling P, Lichy C, Buggle F. Influenza vaccination is associated with a reduced risk of stroke. Stroke. 2005;36(7):1501–6.

    Article  PubMed  Google Scholar 

  49. Chen CI, Kao PF, Wu MY, Fang YA, Miser JS, Liu JC, et al. Influenza vaccination is associated with lower risk of acute coronary syndrome in elderly patients with chronic kidney disease. Medicine (Baltimore). 2016;95(5):e2588.

    Article  CAS  PubMed  Google Scholar 

  50. Mulpuru S, Andrew MK, Ye L, Hatchette T, LeBlanc J, El-Sherif M, et al. Impact of respiratory viral infections on mortality and critical illness among hospitalized patients with chronic obstructive pulmonary disease. Influenza Other Respir Viruses. 2022;16(6):1172–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Canadian Diabetes Association Clinical Practice Guidelines Expert C, Husein N, Woo V. Influenza and pneumococcal immunization. Can J Diabetes. 2013;37(Suppl 1):S93.

    Google Scholar 

  52. Leibovici L. Long-term consequences of severe infections. Clin Microbiol Infect. 2013;19(6):510–2.

    Article  CAS  PubMed  Google Scholar 

  53. Andrew MK, MacDonald S, Godin J, McElhaney JE, LeBlanc J, Hatchette TF, et al. Persistent functional decline following hospitalization with influenza or acute respiratory illness. J Am Geriatr Soc. 2021;69(3):696–703.

    Article  PubMed  Google Scholar 

  54. Godin J, Theou O, Black K, McNeil SA, Andrew MK. Long-term care admissions following hospitalization: the role of social vulnerability. Healthcare (Basel). 2019;7(3):91.

    Article  PubMed  Google Scholar 

  55. Lees C, Godin J, McElhaney JE, McNeil SA, Loeb M, Hatchette TF, et al. Frailty hinders recovery from influenza and acute respiratory illness in older adults. J Infect Dis. 2020;

    Google Scholar 

  56. Walsh EE, Perez Marc G, Zareba AM, Falsey AR, Jiang Q, Patton M, et al. Efficacy and safety of a bivalent RSV prefusion F vaccine in older adults. N Engl J Med. 2023;388(16):1465–77.

    Article  CAS  PubMed  Google Scholar 

  57. Papi A, Ison MG, Langley JM, Lee DG, Leroux-Roels I, Martinon-Torres F, et al. Respiratory syncytial virus prefusion F protein vaccine in older adults. N Engl J Med. 2023;388(7):595–608.

    Article  CAS  PubMed  Google Scholar 

  58. Kobayashi M, Farrar JL, Gierke R, Britton A, Childs L, Leidner AJ, et al. Use of 15-valent pneumococcal conjugate vaccine and 20-valent pneumococcal conjugate vaccine among U.S. adults: updated recommendations of the advisory committee on immunization practices—United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(4):109–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Stratoberdha D, Gobis B, Ziemczonek A, Yuen J, Giang A, Zed PJ. Barriers to adult vaccination in Canada: a qualitative systematic review. Can Pharm J (Ott). 2022;155(4):206–18.

    Article  PubMed  Google Scholar 

  60. PHAC. COVID-19 vaccination in Canada. https://health-infobase.canada.ca/covid-19/vaccination-coverage/ 2023.

  61. PHAC. Vaccine uptake in Canadian adults 2021. https://www.canada.ca/en/public-health/services/immunization-vaccines/vaccination-coverage/highlights-2020-2021-seasonal-influenza-survey/full-report.html 2021.

  62. Adhikari K, Yang H, Teare GF. Patterns of up-to-date status for colorectal cancer screening in Alberta: a cross-sectional study using survey data. CMAJ Open. 2022;10(1):E203–E12.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Volesky KD, Villeneuve PJ. Examining screening mammography participation among women aged 40 to 74. Can Fam Physician. 2017;63(6):e300–e9.

    PubMed  PubMed Central  Google Scholar 

  64. Andrew MK, Schmader KE, Rockwood K, Clarke B, McElhaney JE. Considering frailty in SARS-CoV-2 vaccine development: how geriatricians can assist. Clin Interv Aging. 2021;16:731–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. International Federation on Ageing. Vaccines4Life. https://www.vaccines4life.com 2021.

  66. Canadian Frailty Network. AVOID frailty. https://www.cfn-nce.ca/frailty-matters/avoid-frailty/: Canadian Frailty Network; 2019.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Melissa K. Andrew .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Pott, H., Andrew, M.K. (2024). Vaccines, Vaccine-Preventable Diseases, and Frailty. In: Ruiz, J.G., Theou, O. (eds) Frailty. Springer, Cham. https://doi.org/10.1007/978-3-031-57361-3_46

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-57361-3_46

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-57360-6

  • Online ISBN: 978-3-031-57361-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics