Elder Health – Evidence for Action

Background Implementation of additional targeted vaccinations to prevent infectious diseases in the older adults is under discussion in different countries. When considering the added value of such preventive measures, insight into the current disease burden will assist in prioritization. The aim of this study was derive the first estimates of the disease burden in adults aged 50 years or over in the Netherlands for influenza, pertussis, pneumococcal disease and herpes zoster. Methods The average annual disease burden for these four diseases in the Netherlands was calculated for the period 2010–2013 using the disability-adjusted life years (DALY) measure. Disease models and parameters were obtained from previous research. Where possible we adapted these models specifically for older adults and applied age-specific parameters derived from literature. The disease burden based on these adapted models and parameters was compared with the disease burden based on the general population models. Results The estimated average annual disease burden was from high to low: pneumococcal disease (37,223 DALYs/year), influenza (7941 DALYs/year), herpes zoster (942 DALYs/year), and pertussis (812 DALYs/year). The adaptation of models and parameters specifically for the elderly resulted in a higher disease burden compared to the use of general population models. Conclusions Among older adults, the disease burden in the period 2010–2013 was highest for pneumococcal disease, mostly because of high mortality, followed by influenza. Disease burden of herpes zoster and pertussis was relatively low and consisted mostly of years lived with disability. Better information on the course of infectious diseases and long-term consequences would enable more accurate estimation of disease burden in older adults. BMC Public Health http://bmcpublichealth.biomedcentral.com/articles (Accessed 6 February 2016) Research article Determinants of tetanus, pneumococcal and influenza vaccination in the elderly: a representative cross-sectional study on knowledge, attitude and practice (KAP) Severity and incidence of vaccine-preventable infections with influenza viruses, s. pneumoniae and c. tetani increase with age. Furthermore, vaccine coverage in the elderly is often insufficient. The aim of this ... Carolina J. Klett-Tammen, Gérard Krause, Linda Seefeld and Jördis J. Ott BMC Public Health 2016 16:121 Published on: 4 February 2016 Abstract Background Severity and incidence of vaccine-preventable infections with influenza viruses, s. pneumoniae and c. tetani increase with age. Furthermore, vaccine coverage in the elderly is often insufficient. The aim of this study is to identify socio-economic and knowledge-, attitudeand practice(KAP)-related determinants of vaccination against influenza, pneumococcal disease and tetanus in the older German population. Methods We analysed data from a German nationally representative questionnaire-based KAP-survey on infection prevention and hygiene behavior in the elderly (n = 1223). We used logistic regressions to assess impacts of socio-demographicand KAP-related variables on vaccine uptake in general and on tetanus-, influenzaand pneumococcal vaccination. To generate KAPscores, we applied factor analyses and analysed scores as predictors of specific vaccinations. Results A low rated personal health status was associated with a higher uptake of influenza vaccine whereas place of residence within Germany strongly impacted on pneumococcal vaccination. For tetanus and influenza vaccination, the strongest single vaccination predictor was attituderelated, i.e., the perceived importance of the vaccine (OR = 18.1, 95 % CI = 4.5–71.8; OR = 23.0, 95 % CI = 14.9–35.3, respectively). Pneumococcal vaccination was mostly knowledge-associated, i.e., knowing the recommendation predicted uptake (OR = 17.1, 95 % CI = 9.5–30.7). Regarding the generated KAP-scores, the practice-score reflecting vaccine related behavior such as having a vaccination record, was predictive for all vaccines considered. The knowledge-score was associated with influenza (OR = 1.3, 95 % CI = 1.0–1.6) and pneumococcal vaccination (OR = 1.2, 95 % CI = 1.0–1.5). Uniquely for influenza vaccination, the attitude-score was linked to vaccine uptake (OR = 1.1, 95 % CI = 1.0–1.1). Conclusions Our results indicate that predictors of vaccination uptake in the elderly strongly depend on vaccine type and that scores of KAP are useful and valid to condense information from numerous individual KAP-variables. While awareness for vaccinations against influenza and tetanus is fairly high already it might have to be increased for vaccinations against pneumocoocal infection. Journal of Infectious Diseases Volume 213 Issue 3 February 1, 2016 http://jid.oxfordjournals.org/content/current First published online: February 9, 2016 Declining effectiveness of herpes zoster vaccine in adults 60 years and older Hung Fu Tseng1, Rafael Harpaz2, Yi Luo1, Craig M. Hales2, Lina S. Sy1, Sara Y. Tartof1, Stephanie Bialek2, Rulin C. Hechter1 and Steven J. Jacobsen1 Author Affiliations 1Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA 2Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA Abstract Understanding long term effectiveness of herpes zoster (HZ) vaccine is critical for determining vaccine policy. 176,078 members of Kaiser Permanente ≥60 years vaccinated with HZ vaccine and three matched unvaccinated members were included. Hazard ratio (HR) and 95% confidence interval (CI) associated with vaccination at each year following vaccination was estimated by Cox regression model. The effectiveness of HZ vaccine decreased from 68.7% (95% CI, 66.3%-70.9%) in the first year to 4.2 % (95% CI, -24.0%-25.9%) in the eighth. This rapid decline in effectiveness of HZ vaccine suggests that a revaccination strategy may be needed, if feasible. European Geriatric Medicine http://www.sciencedirect.com/science/journal/18787649 Available online 12 February 2016 In Press, Corrected Proof The role of vaccination in successful independent ageing JE McElhaney, G Gavazzi, J Flamaing, J Petermans Abstract Ageing increases the risk and severity of infectious diseases, especially when chronic diseases are present. Healthcare providers generally view vaccination as a childhood intervention and consider vaccination of the elderly not to be sufficiently effective due to immunosenescence. However, the burden of frequent vaccine-preventable diseases, such as influenza, pneumococcal disease and herpes zoster, increases with age, so that the perceived lower vaccine effectiveness should be considered in the context of this higher burden. Vaccination can prevent infection and mortality hospitalization and functional decline, and their consequences thereby having a positive impact. The use of medications will be reduced (e.g. antibiotics, analgesics) and therefore the iatrogenic risk would be lower. This contributes to an improved quality of life and to successful ageing. Many countries recommend influenza and pneumococcal vaccination in the elderly and, more recently, some recommend the live-attenuated herpes zoster vaccine. However, better guidelines and recommendations, especially for frail individuals are needed. Protection may be improved by offering vaccination to younger, fitter individuals, before they become frail. In addition, offering vaccination to caregivers and others who are in contact with the elderly could also improve protection. Many studies have demonstrated that influenza, pneumococcal and herpes zoster vaccinations in the elderly are cost-effective and can even be cost-saving. Healthcare providers and public health decision-makers need to understand more fully the value of vaccination and to consider it as an important preventive tool in the promotion of successful ageing. THE NATIONAL ADULT IMMUNIZATION PLAN (NAIP) U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL VACCINE PROGRAM OFFICE February 2016 :: 67n pages Pdf: http://www.hhs.gov/nvpo/national-adult-immunization-plan/naip.pdf EXECUTIVE SUMMARY Vaccination is considered one of the most important public health achievements of the 20th century and continues to offer great promise in the 21st century. Vaccines save lives and improve the quality of life by preventing serious infectious diseases and their consequences. However, the benefits of vaccination are not realized equally across the U.S. population. Adult vaccination rates remain low in the United States, and significant racial and ethnic disparities also exist. The U.S. Department of Health and Human Services National Vaccine Plan (NVP), released in 2010, is a road map for vaccines and immunization programs for the decade 2010–2020. While the NVP provides a vision for improving protection from vaccinepreventable diseases across the lifespan, vaccination coverage levels among adults are not on track to meet Healthy People 2020 targets. The National Vaccine Advisory Committee and numerous stakeholder groups have emphasized the need for focused attention on adult vaccines and vaccination.1 The National Adult Immunization Plan (NAIP) outlined here results from the recognition that progress has been slow and that there is a need for a national adult immunization strategic plan. As a national plan, the NAIP will require engagement from a wide range of stakeholders to achieve its full vision. The plan emphasizes collaboration and prioritization of efforts that will have the greatest impact. The NAIP also aims to leverage the unique opportunity presented by the implementation of the Affordable Care Act. The NAIP is intended to facilitate coordinated action by federal and nonfederal partners to protect public health and achieve optimal prevention of infectious diseases and their consequences through vaccination of adults. The NAIP includes indicators to draw attention to and track progress against core goals. These indicators will measure progress against set standards and inform future implementation and quality improvement efforts. The plan establishes four key goals, each of which is supported by objectives and strategies to guide implementation through 2020: Goal 1: Strengthen the adult immunization infrastructure. Goal 2: Improve access to adult vaccines. Goal 3: Increase community demand for adult immunizations. Goal 4: Foster innovation in adult vaccine development and vaccination-related technologies.