The risk of influenza infection in the elderly and the role of vaccination in the prevention and reduction of complications
Abstract
Introduction
The flu poses a serious threat to the elderly due to a weakened immune system and comorbidities. People over the age of 65 face an increased risk of complications, including hospitalizations, cardiovascular problems, pneumonia, and death. According to the World Health Organization (WHO), influenza causes between 250,000 and 500,000 deaths a year, of which 38,500 are estimated in Europe.
Aim of the paper
To investigate the risks posed by influenza to the elderly population, with a focus on comorbidities and the impact of vaccination in reducing these risks, as well as the benefits of new vaccines for this risk group.
Discussion
The risk of complications increases with age and concomitant diseases. Cardiovascular complications, including heart attacks and worsening heart failure, are often the result of influenza infection. Pneumonia is the leading cause of mortality, occurring in 10% of those infected. Although the immune response to vaccines may be weaker in the elderly, research shows that vaccination significantly reduces the risk of severe outcomes. A new generation of vaccines, such as high-dose and adjuvant vaccines, improve the immune response and protection.
Conclusion
Influenza vaccination provides significant protection for the elderly, reducing the severity of the disease and the mortality rate. Advances in the development of new vaccines improve outcomes in this risk group, making vaccination a key strategy in preventing complications of influenza.
Keywords: influenza virus, influenza, vaccination, aging, complications, vaccine effectiveness
References
2. Ferdinand KC, Nedunchezhian S, Reddy TK. The COVID-19 and influenza “Twindemic”: barriers to influenza vaccination and potential acceptance of SARS-CoV2 vaccination in African Americans. Journal of the National Medical Association. 2020 Dec 1;112(6):681-7.
3. Blank PR, van Essen GA, Ortiz de Lejarazu R, Kyncl J, Nitsch-Osuch A, Kuchar EP, Falup-Pecurariu O, Maltezou HC, Zavadska D, Kristufkova Z, Kassianos G. Impact of European vaccination policies on seasonal influenza vaccination coverage rates: An update seven years later. Human vaccines & immunotherapeutics. 2018 Nov 2;14(11):2706-14.
4. Antonelli Incalzi R, Consoli A, Lopalco P, Maggi S, Sesti G, Veronese N, Volpe M. Influenza vaccination for elderly, vulnerable and high-risk subjects: a narrative review and expert opinion. Internal and Emergency Medicine. 2024 Apr;19(3):619-40.
5. Richter D. Gripa–mikrobiologija, imunologija i epidemiologija za liječnika koji razmišlja o cijepljenju. Liječnički vjesnik. 2018;140(11-12):321-7.
6. Vasileiou, Eleftheria. "Seasonal influenza vaccine effectiveness in asthma." (2019); 59.
7. Jurčević I. Prevencija epidemije uzrokovane virusom influence (Doctoral dissertation, University of Zadar. Department of Health Studies).2019;8-11.
8. Goeijenbier M, Van Sloten TT, Slobbe L, Mathieu C, Van Genderen P, Beyer WE, Osterhaus AD. Benefits of flu vaccination for persons with diabetes mellitus: a review. Vaccine. 2017 Sep 12;35(38):5095-101.
9. Vamos EP, Pape UJ, Curcin V, Harris MJ, Valabhji J, Majeed A, Millett C. Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. Cmaj. 2016 Oct 4;188(14):E342-51.
10. Nguyen JL, Yang W, Ito K, Matte TD, Shaman J, Kinney PL. Seasonal influenza infections and cardiovascular disease mortality. JAMA cardiology. 2016 Jun 1;1(3):274-81.
11. Restivo V, Costantino C, Bono S, Maniglia M, Marchese V, Ventura G, Casuccio A, Tramuto F, Vitale F. Influenza vaccine effectiveness among high-risk groups: A systematic literature review and meta-analysis of case-control and cohort studies. Human vaccines & immunotherapeutics. 2018 Mar 4;14(3):724-35.
12. Nguyen JL, Yang W, Ito K, Matte TD, Shaman J, Kinney PL. Seasonal influenza infections and cardiovascular disease mortality. JAMA cardiology. 2016 Jun 1;1(3):274-81.
13. 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 Aug 26;33(36):4565-71.
14.Costantino C, Vitale F. Influenza vaccination in high-risk groups: a revision of existing guidelines and rationale for an evi- dence-based preventive strategy. J Prev Med Hyg 2016; 57(1): E13-8; PMID:27346934
15.Effectiveness of influenza vaccination in the elderly: a population-based case-crossover study. BMJ Open, 2021. [BMJ Open](https://bmjopen.bmj.com/content/11/8/e049324)
16. Zivkovic I, Muhandes L, Petrusic V, Minić R, Dimitrijevic L. The effect of influenza vaccine immunization on natural antibodies. Arhiv za farmaciju. 2021;71:207-23.
17.Systematic review of the efficacy, effectiveness, and safety of newer and enhanced seasonal influenza vaccines. European Centre for Disease Prevention and Control (ECDC), 2020. [ECDC](https://www.ecdc.europa.eu/en/publications-data/systematic-review-efficacy-effectiveness-and-safety-newer-and-enhanced-seasonal)
18.World Health Organization. "Vaccines against influenza WHO position paper—November 2012." Weekly Epidemiological Record= Relevé épidémiologique hebdomadaire 87.47 (2012): 461-476.
19. Domnich A, Cambiaggi M, Vasco A, Maraniello L, Ansaldi F, Baldo V, Bonanni P, Calabrò GE, Costantino C, de Waure C, Gabutti G. Attitudes and beliefs on influenza vaccination during the COVID-19 pandemic: results from a representative Italian survey. Vaccines. 2020 Nov 30;8(4):711.
20. CDC Director Adopts Preference for Specific Flu Vaccines for Seniors, [internet accessed on 09/08/2024], https://www.cdc.gov/flu/index.htm
21. Morse, Kristen, and Kevin W. Cleveland. "Efficacy of the adjuvanted influenza vaccine compared with the high-dose for older people." The Senior Care Pharmacist 38.4 (2023): 156-160.