Vaccine responsiveness in the elderly: best practice for the clinic

Abstract

The success of vaccines developed since the beginning of the 20th century, has enabled the conquest of several childhood diseases preventing death and or disability for millions of children. But, globally, the number of children will soon be surpassed by the number of adults over the age of 65. The active lifestyle of these older individuals, coupled with a degree of immune deficiency recognised within this population will lead to a change in the profile of diseases affecting the elderly. The challenge for policy makers and also those involved in primary healthcare is how to protect this population from communicable diseases and keep them healthy, autonomous and independent when vaccines in the main have been developed for use on children and young adults.

Keywords::

• aging
• immune profiling
• immunity
• immunosenescence
• vaccination

Financial & competing interests disclosure

R Aspinall is an academic at Cranfield University and POL at the Clinique of Genolier, and this paper was written in between normal duties. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The mean age of the global population is increasing because of a reduction in the number of children and more people living longer.

• More individuals among the older section of the population travel more frequently and more widely than previous generations and so have greater exposure to familiar and unfamiliar pathogens.

• Many older individuals are immunocompromised, respond poorly to vaccination and are more susceptible to infection.

• Some individuals may spend one-third of their lifespan over the age of 65 years, and this population represents too great an age range for generalizations to be useful.

• Many vaccines were developed with a view to preventing mortality in children from communicable diseases.

• None of the current vaccines aimed at those over 65 years provide a 100% success rate of protection in all older individuals with some falling further from this target figure than others.

• Introducing a system of immune profiling for older individuals would facilitate approaches to improve vaccine design and development.

• Provision of protection through vaccination for older individuals requires both improvements in vaccine formulation and improvements in restoring immune capacity.