clinical practice
clinical practice
Immunosenescence addressed
The Australian Immunisation Handbook preferentially recommends high dose and adjuvanted influenza vaccines over standard influenza vaccines for older adults
How to improve flu vaccines for older people
By Paul Van Buynder and Michael Woodward
In Australia , influenza-associated mortality and hospitalisation rates are highest among older adults aged over 65 years .
It is estimated that each year , flu causes more than 3,000 deaths and more than 13,500 hospitalisations among Australians aged over 50 years . Influenza can have a severe and long-term impact on older adults .
In 2020 , measures taken to suppress the Covid-19 pandemic – such as temporary lockdowns , mask-wearing , social distancing , enhanced personal hygiene , reduced travel and increased influenza vaccine uptake – reduced flu cases . This continued into 2021 with almost no influenza notifications seen .
In 2022 , however , the lifting of these non-pharmaceutical interventions , coupled with the opening of external borders , led to an early intense influenza season with over
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230,000 notifications in Australia , the third highest number on record .
In most years , older adults with flu are four to six times more likely to be hospitalised compared to younger adults . Hospitalisation in older adults due to acute respiratory illness , including influenza , can cause a decline in mobility and function .
Recovery following hospitalisation is also poor in these individuals , with a substantial proportion of older adults not returning to their prior baseline of health and functional status . This decline in mobility and function , and poor recovery following hospitalisation in older adults is associated with greater reliance on community care and increased risk of mortality .
In older adults , avoiding hospitalisation by preventing and managing acute respiratory illnesses ( including influenza ) is therefore important .
VACCINATION IS ONE OF THE BEST DEFENCES AGAINST INFLUENZA Vaccinating older adults could reduce hospitalisations from influenza . Annual revaccination is recommended as immunity declines during the year after vaccination , and circulating strains of the influenza virus change from year to year .
When considering flu vaccination for older adults , it is important to note that the antibody response to flu vaccination diminishes with age .
Older adults experience an age-related decline in the immune system known as immunosenescence , impairing their ability to fight natural infections . This can lead to decreased immunogenicity ( the ability of an antigen to provoke an immune response in the body ) and reduced vaccine effectiveness in older adults . Therefore , vaccines that can address immunosenescence are required to provide adequate protection in older adults .
STRATEGIES TO ADDRESS IMMUNOSENESCENCE FOR INFLUENZA VACCINE High-dose influenza vaccines ( i . e ., increasing the dose of antigen with the aim of improving antibody response to vaccination )
High-dose influenza vaccines contain three to four times the dose of each of