Immunosenescence: implications for vaccination programs in the elderly

Abstract Background and Aims It is evident that Chronic Kidney Disease (CKD) influences the risk of developing AKI (Acute Kidney Injury) and recent studies suggest that CKD patients who experienced an episode of AKI are more likely to progress to end stage renal disease (ESRD) than patients without CKD. AKI-CKD association might originate from common comorbidities associated with both AKI and CKD, such as diabetes and/or hypertension, and concurrent increase in interventions leading to frequent exposure to various nephrotoxins. AKI in the elderly has been shown to increase the risk of progression to CKD to ESRD. AKI is common in critically ill patients, and those patients with the most severe form of AKI, requiring RRT, have a mortality rate of 50–80 %. Patients with an eGFR <45 ml/min per 1.73m2 who experienced an episode of dialysis-requiring AKI were at very high risk for impaired recovery of renal function. Our aim was to determine the reasons that initiate hemodialysis (renal decompensation) in patients with regular follow-up in the low clearance polyclinic without renal replacement treatment (RRT). Method The retrospective study included predialysis CKD patients who had followed up regularly and had undergone RRT in recent 4 years. Data on baseline characteristics and medical history were obtained from patient hospital records. Results Of the 228 patients, 155 (68%) were male and 73 (32%) were female. The mean age was 58 years (45-66). Diabetes Mellitus was the first in the etiology of CKD (26,3 %), the second was unknown (12,7 %), the third was hypertension (11,8 %). 145 patients (63,6%) underwent regular hemodialysis (HD) (62 years, 55-69), 25 patients (11%) began peritoneal dialysis (PD), 58 patients (25%) had renal transplantation. 52 patients underwent HD with renal decompensation, 22 (%42,3) had working arteriovenous fistula (AVF). There was no decompensation in patients with PD or transplantation plan. 34 patients started HD because of infections (65%), 8 patients (15%) after operations (4 was Coronary Artery Bypass Grafting-CABG), 6 patients (%11,5) after coronary angiography, 4 patients (7,5%) with cardiac decompensation. 2 patients died during the hospitalisation for infections. Of 145 HD patients, 89 (%61,4) had AVF. The patients who had renal decompensation were more older 63 (58-70), have lower Hgb 9,7 g/L (9,1-10,7) and albumin 3,5 g/L (3,2-3,9) level (p<0,05). There was no difference in eGFR at the beginning of HD between renal decompensation and other HD patients. 42 patients did not undergo HD at the time we suggested during visits. Of them 9 patients (%21) had renal decompensation (6 infections,3 CABG), 17 patients (%40) had AVF. 3 of them died. The others underwent HD for uremic complications. Conclusion We have shown that infections are as the leading cause of renal decompensation. Most of our patients who started to RRT from our low clearance outpatient clinic have chosen HD for RRT. Prevention of infections via vaccination programs or early diagnosis at regular policlinic or telephone visits, and informing patients adequately about nephrotoxic drugs or the conditions that may cause renal decompensation are among the first tasks of the predialysis outpatient clinic. Transition of CKD patients to RRTs, with proper preparation, neither late nor early- at the most appropriate time- should be among in our goals. This may reduce the cost of ESRD patients.

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Public Views on Priority Groups for COVID-19 Vaccination: A Survey from Iran

Shiraz E-Medical Journal ◽

10.5812/semj.113359 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Najmeh Moradi ◽

Seyyed Taghi Heydari ◽

Leila Zarei ◽

Jalal Arabloo ◽

Aziz Rezapour ◽

...

Keyword(s):

Online Survey ◽

Univariate Analysis ◽

Random Order ◽

The Elderly ◽

Iranian Population ◽

Vulnerable Groups ◽

Vaccination Programs ◽

The Family ◽

Key Factor ◽

Allocation Strategies

Background: In the initial coronavirus disease 2019 (COVID-19) vaccination program, prioritizing vulnerable groups is inevitable due to limited supply. Currently, most of the allocation strategies are focused on individuals’ characteristics. Objectives: The present study aimed to assess the opinions of Iranian population in specifying high-priority individuals and groups for COVID-19 vaccination. Methods: An online survey was conducted using some popular social media in Iran. The data was collected from Iranian population (878 individuals) aged 18 years and older during the COVID-19 pandemic (2 - 20 May 2020) to investigate their opinions towards vaccine allocation strategies at the family and society levels. In vaccine prioritizing within family three option and in vaccine prioritizing within society, seven population groups were introduced by the respondents in a random order, respectively. To analyze the data, mean rank and univariate analysis was used. Results: Healthcare workers, high-risk patients, and the elderly were the first priority groups for a vaccination with a mean rank of 2.8, 2.8, and 3.8, respectively. The least priority group was policymakers and executive managers (mean rank = 5.75). At the family level, 64% of the respondents introduced one of the family members as the first priority for vaccination, followed by their children (29%) and themselves (7%). No significant relationship was observed between respondents’ characteristics and their prioritization in vaccine prioritizing within society. Conclusions: Although involving public preference in decision-making is a key factor for the success of policies, careful design and implementation of vaccination programs through considering risk-benefit assessment is strongly recommended.

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Cost-effective policy option in launching a community-based pneumococcal vaccination program among the elderly in Japan

Ageing Research ◽

10.4081/ar.2012.e8 ◽

2012 ◽

Vol 3 (1) ◽

pp. 8

Author(s):

Shu-Ling Hoshi ◽

Masahide Kondo ◽

Ichiro Okubo

Keyword(s):

Cost Effectiveness ◽

Incremental Cost ◽

Vaccine Development ◽

Pneumococcal Vaccination ◽

Cost Effective ◽

The Elderly ◽

Policy Option ◽

Vaccination Program ◽

Markov Modelling ◽

Vaccination Programs

In Japan, some municipalities introduced a publicly funded pneumococcal vaccination program for the elderly. The expansion of such program has become one of the current topics in the health policy arena. We aim to appraise the value for money of expanding such programs, or starting one in a municipality without a program. We conducted a cost-effectiveness analysis with Markov modelling and calculated incremental cost-effectiveness ratio value of starting such a program with 36 different design options, 3 minimum age criteria for the entitlement to the subsidy and 12 levels of co-payment. We found that the introduction of vaccination programs costs more and gains more regardless of targeting ages and co-payment levels. Estimated incremental cost-effectiveness ratios range from ¥ 8,263,340 per year-of-life-saved (targeting age 65 or over, setting co-payment level at ¥ 0) to ¥ 10,351,324 per year-of-lifesaved (targeting age 75 or over, setting co-payment level at ¥ 5000). According to cost-effectiveness acceptability curves, the probability that a vaccination program is less than ¥ 10,000,000 (US $ 1 = ¥ 100) per life-year gained ranges from 28.5% to 57.5%. By adopting the threshold of the Committee to Study Priority for Vaccine Development in the US, US $ 100,000 per quality adjusted life year gain, all the programs are almost certainly judged cost-effective as vaccination strategies.

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External validity of phase III trials on vaccines against SARS-CoV-2 to a middle-aged and elderly Western European population

European Journal of Epidemiology ◽

10.1007/s10654-021-00729-5 ◽

2021 ◽

Author(s):

Natalie Terzikhan ◽

Albert Hofman ◽

Jaap Goudsmit ◽

Mohammad Arfan Ikram

Keyword(s):

High Risk ◽

The Elderly ◽

European Population ◽

Phase Iii ◽

Exclusion Criterion ◽

Vaccination Programs ◽

Vaccine Trials ◽

Phase Iii Trials ◽

Age Range ◽

Ongoing Phase

AbstractInitial results from various phase-III trials on vaccines against SARS-CoV-2 are promising. For proper translation of these results to clinical guidelines, it is essential to determine how well the general population is reflected in the study populations of these trials. This study was conducted among 7162 participants (age-range: 51–106 years; 58% women) from the Rotterdam Study. We quantified the proportion of participants that would be eligible for the nine ongoing phase-III trials. We further quantified the eligibility among participants at high risk to develop severe COVID-19. Since many trials were not explicit in their exclusion criterion with respect to ‘acute’ or ‘unstable preexisting’ diseases, we performed two analyses. First, we included all participants irrespective of this criterion. Second, we excluded persons with acute or ‘unstable preexisting’ diseases. 97% of 7162 participants was eligible for any trial with eligibility for separate trials ranging between 11–97%. For high-risk individuals the corresponding numbers were 96% for any trial with separate trials ranging from 5–96%. Importantly, considering persons ineligible due to ‘acute’ or ‘unstable pre-existing’ disease drastically dropped the eligibilities for all trials below 43% for the total population and below 36% for high-risk individuals. The eligibility for ongoing vaccine trials against SARS-CoV-2 can reduce by half depending on interpretation and application of a single unspecified exclusion criterion. This exclusion criterion in our study would especially affect the elderly and those with pre-existing morbidities. These findings thus indicate the difficulty as well as importance of developing clinical recommendations for vaccination and applying these to the appropriate target populations. This becomes especially paramount considering the fact that many countries worldwide have initiated their vaccination programs by first targeting the elderly and most vulnerable persons.

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The Unknown Health Burden of Herpes Zoster Hospitalizations: The Effect on Chronic Disease Course in Adult Patients ≥50 Years

Vaccines ◽

10.3390/vaccines8010020 ◽

2020 ◽

Vol 8 (1) ◽

pp. 20 ◽

Cited By ~ 1

Author(s):

Maria Francesca Piazza ◽

Chiara Paganino ◽

Daniela Amicizia ◽

Cecilia Trucchi ◽

Andrea Orsi ◽

...

Keyword(s):

Herpes Zoster ◽

Cardiovascular Diseases ◽

Chronic Conditions ◽

Risk Groups ◽

The Elderly ◽

Disease Course ◽

Vaccine Preventable Disease ◽

Substantial Impact ◽

Vaccination Programs ◽

Health Burden

The effect of severe Herpes Zoster (HZ) on chronic diseases is a component of the real burden of this vaccine-preventable disease that is not commonly considered. A retrospective cohort study was conducted to assess the health burden of severe HZ in adults ≥50 years residing in Liguria Region from 2015 to 2017. Subjects hospitalized with and without HZ were matched (1:6 ratio). 437 subjects in the HZ cohort and 2622 subjects in the non-HZ cohort were enrolled. Previous immunodeficiency, autoimmune, and rare diseases are identified as main chronic conditions related to HZ hospitalization. Higher incidences of autoimmune (1.4% vs. 0.22%, p = 0.002) and gastrointestinal (7.04% vs. 3.62%, p = 0.015) diseases after hospitalization were observed in the HZ cohort compared to the non-HZ cohort. Significantly higher incidences were found after hospitalization versus the previous period for cardiovascular diseases (11.17% vs. 2.09%, p < 0.001), cerebral vasculopathy (6.13% vs. 0.60%, p < 0.001), non-arrhythmic myocardiopathy (4.31% vs. 0.59%, p = 0.002), and neuropathy (2.62% vs. 0.56%, p = 0.033). The HZ cohort showed a relative risk 10-fold higher for cerebral vasculopathy, 5-fold higher for cardiovascular diseases, and 7-fold higher for non-arrhythmic myocardiopathy. HZ causes a substantial impact on the chronic conditions. These data could suggest an implementation of HZ vaccination programs in the elderly and in high-risk groups.

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Burden of severe illness associated with laboratory confirmed influenza in adults aged 50-64 years: a rapid review

10.22541/au.163871937.74680730/v1 ◽

2021 ◽

Author(s):

Dong Kim ◽

Allison McGeer ◽

Elizabeth Uleryk ◽

Brenda Coleman

Keyword(s):

Seasonal Influenza ◽

Burden Of Illness ◽

Grey Literature ◽

Case Fatality ◽

The Elderly ◽

Mortality Rates ◽

Population Based ◽

Rapid Review ◽

Severe Illness ◽

Vaccination Programs

Background: While the high burden of illness caused by seasonal influenza in children and the elderly is well-recognized, less is known about the burden in adults 50-64 years of age. The lack of data for this age group is a key challenge in evaluating the cost-effectiveness of vaccination programs. We aimed to assess influenza-associated hospitalization and mortality rates, and case fatality rates for hospitalized cases among adults aged 50-64 years. Methods: This review was conducted according to the PRISMA: we searched MEDLINE, EMBASE, Cochrane, Web of Science, and grey literature for articles and reports published since 2010. Studies reporting rates of hospitalization and/or mortality associated with laboratory-confirmed influenza among adults 50-64 or 45-64 years of age for the 2010-11 through 2019-20 seasons were included. Results: Twenty studies from 13 countries were included. Reported hospitalization rates associated with laboratory-confirmed influenza 5.7 to 112.8 per 100,000. Rates tended to be higher in 2015-2019 compared to 2010-2014, and were higher in studies reporting data from high income versus low and middle-income countries. Mortality rates were reported in only one study, with rates ranging from 0.8-3.5 per 100,000 in four different seasons. The case fatality rate among those hospitalized with influenza, as reported by population-based studies, ranged from 1.3% to 5.6%. Conclusions: Seasonal influenza imposes a significant burden of morbidity in adults 50-64 years of age, but with high heterogeneity across seasons and geographic regions. Ongoing surveillance is required to improve estimates of burden to better inform influenza vaccination and other public health policy.

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Recent advances in influenza vaccines

F1000Research ◽

10.12688/f1000research.22611.1 ◽

2020 ◽

Vol 9 ◽

pp. 305 ◽

Cited By ~ 2

Author(s):

Graham Pawelec ◽

Janet McElhaney

Keyword(s):

Public Health Problem ◽

The Elderly ◽

Lessons Learned ◽

Vaccine Uptake ◽

Influenza Vaccines ◽

Major Public Health Problem ◽

Vaccination Programs ◽

Wide Availability ◽

Clinical Protection ◽

The One

Seasonal influenza remains a major public health problem, responsible for hundreds of thousands of deaths every year, mostly of elderly people. Despite the wide availability of vaccines, there are multiple problems decreasing the effectiveness of vaccination programs. These include viral variability and hence the requirement to match strains by estimating which will become prevalent each season, problems associated with vaccine and adjuvant production, and the route of administration as well as the perceived lower vaccine efficiency in older adults. Clinical protection is still suboptimal for all of these reasons, and vaccine uptake remains too low in most countries. Efforts to improve the effectiveness of influenza vaccines include developing universal vaccines independent of the circulating strains in any particular season and stimulating cellular as well as humoral responses, especially in the elderly. This commentary assesses progress over the last 3 years towards achieving these aims. Since the beginning of 2020, an unprecedented international academic and industrial effort to develop effective vaccines against the new coronavirus SARS-CoV-2 has diverted attention away from influenza, but many of the lessons learned for the one will synergize with the other to mutual advantage. And, unlike the SARS-1 epidemic and, we hope, the SARS-CoV-2 pandemic, influenza will not be eliminated and thus efforts to improve influenza vaccines will remain of crucial importance.

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Pharmacoeconomic evaluation of influenza vaccination programs in elderly in Italy

Farmeconomia Health economics and therapeutic pathways ◽

10.7175/fe.v10i2.164 ◽

2009 ◽

Vol 10 (2) ◽

pp. 59-72 ◽

Cited By ~ 1

Author(s):

Sergio Iannazzo ◽

Viola Sacchi

Keyword(s):

Elderly Population ◽

Hospital Admissions ◽

Influenza Infection ◽

Demographic Data ◽

Cost Savings ◽

Vaccination Strategy ◽

The Elderly ◽

Underlying Disease ◽

Pharmacoeconomic Evaluation ◽

Vaccination Programs

Background: influenza infection is an important cause of morbidity and mortality in the elderly population, especially in the presence of underlying disease. Vaccination has proven effective in the reduction of influenza-like illness (ILI) cases and influenza-related hospitalizations, drug consumption, primary care consultations and death. The aim of this study is to assess the economic impact in Italy of different prophylactic strategies (vaccination with a standard vaccine, with the innovative MF59® adjuvated vaccine and no vaccination) comparing their costs and outcomes in the elderly population. Methods: a pharmacoeconomic simulation model to estimate costs and consequences of influenza with the three intervention strategies has been developed. Health economics and demographic data are taken from specific Italian sources, and vaccine effectiveness data are taken from published literature. Direct sanitary costs are considered according to current prices and tariffes. Results: it was estimated that 9,800,000 of the about 12,000,000 people with at least 65 years currently resident in Italy can be considered at high risk for influenza complications because of underlying chronic diseases. Absence of vaccination could lead to more than 2 millions of ILI cases, and 30,000 related deaths. The reduction of cases attainable with the implementation of a vaccination program would lead to an estimated 1.5 million cases with a standard vaccine, and to 1.3 million with a strategy based on the MF59® adjuvated vaccine. The standard vaccination strategy could produce a moderate total cost increase of about € 45,000,000 (+4.3%), whereas the use of the adjuvated vaccine would lead to an estimated saving of about € 80,000,000 (-7.9%), both compared to the null option. Cost savings are mainly related to hospital admissions avoided with the use of vaccines. Incremental cost-effectiveness ratio (ICER) of the standard vaccine versus no vaccination strategy is of € 85.68 for each ILI episode avoided, and of € 4,411.42 for death avoided. The strategy based on the MF59® adjuvated vaccine dominates the other two options. Conclusions: vaccination with the MF59® adjuvated vaccine (Fluad®) results more effective and cost saving when compared with the standard vaccination or the no vaccination, thus representing the strategy of choice for the elderly population. Moreover, the standard vaccine proved to be largely cost effective with respect to the null option.

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Gender differences in vaccine therapy: where are we in COVID-19 pandemic?

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2021.1669 ◽

2021 ◽

Author(s):

Tiziana Ciarambino ◽

Elena Barbagelata ◽

Graziamaria Corbi ◽

Immacolata Ambrosino ◽

Cecilia Politi ◽

...

Keyword(s):

Gender Differences ◽

Viral Infections ◽

The Elderly ◽

Mortality And Morbidity ◽

Vaccination Programs ◽

Vaccine Trials ◽

Post Menopausal ◽

Recognition And Response ◽

The Impact ◽

Successful Prevention

Vaccination is one of the greatest achievements of public health. Vaccination programs have contributed to the decline in mortality and morbidity of various infectious diseases. This review aims to investigate the impact of sex/gender on the vaccine acceptance, responses, and outcomes. The studies were identified by using PubMed, until 30th June 2020. The search was performed by using the following keywords: SARS-CoV-2, COVID-19, gender, sex, vaccine, adverse reaction. Clinical trials, retrospective and prospective studies were included. Studies written in languages other than English were excluded. Studies were included if gender differences in response to vaccination trials were reported. All selected studies were qualitatively analyzed. Innate recognition and response to viruses, as well as, adaptive immune responses during viral infections, differ between females and males. Unfortunately, a majority of vaccine trials have focused on healthy people, with ages between 18 to 65 years, excluding the elderly, pregnant women, post-menopausal female and children. In conclusion, it is apparent that the design of vaccines and vaccine strategies should be sex-specific, to reduce adverse reactions in females and increase immunogenicity in males. It should be mandatory to examine sex-related variables in pre-clinical and clinical vaccine trials, such as their crucial role for successful prevention of pandemic COVID-19.

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Influenza Vaccination in Long-Term–Care Facilities: Structuring Programs for Success

Infection Control and Hospital Epidemiology ◽

10.1086/501659 ◽

1999 ◽

Vol 20 (7) ◽

pp. 499-503 ◽

Cited By ~ 24

Author(s):

Margaret A. McArthur ◽

Andrew E. Simor ◽

Beverly Campbell ◽

Allison McGeer

Keyword(s):

Influenza Vaccination ◽

Long Term Care ◽

The Elderly ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Term Care ◽

Vaccination Programs ◽

Vaccination Rates ◽

Care Facilities

Objectives:To determine which influenza vaccination program characteristics were associated with high resident vaccination rates in Canadian long-term–care facilities (LTCFs).Design:A cross-sectional survey consisting of a mailed questionnaire conducted in spring 1991.Participants:All 1,520 Canadian LTCFs for the elderly with at least 25 beds.Results:The mean overall influenza vaccination rate in the 1,270 (84%) responding facilities was 79%. In multivariate analysis, the variables significantly associated with increased vaccination rates were: a single nonphysician staff person organizing the program, having more program aspects covered by written policies, the offering of vaccine to all residents, a policy of obtaining consent on admission that was durable for future years rather than repeating consent annually, and automatically administering vaccine to residents whose guardians could not be contacted for consent. Any encouragement to staff to be vaccinated had a significant impact on staff vaccination rates.Conclusion:Well-organized influenza vaccination programs increase the influenza vaccination rates of residents in Canadian LTCFs. Facilities need to develop resident vaccination programs further and to focus on vaccinating staff.

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