Equity in disease prevention: Vaccines for the older adults – a national workshop, Australia 2014

Abstract

On the 20th June, 2014 the National Health and Medical Research Council's Centre for Research Excellence in Population Health "Immunisation in under Studied and Special Risk Populations", in collaboration with the Public Health Association of Australia, hosted a workshop "Equity in disease prevention: vaccines for the older adults". The workshop featured international and national speakers on ageing and vaccinology. The workshop was attended by health service providers, stakeholders in immunisation, ageing, primary care, researchers, government and non-government organisations, community representatives, and advocacy groups. The aims of the workshop were to: provide an update on the latest evidence around immunisation for the older adults; address barriers for prevention of infection in the older adults; and identify immunisation needs of these groups and provide recommendations to inform policy. There is a gap in immunisation coverage of funded vaccines between adults and infants. The workshop reviewed provider misconceptions, lack of Randomised Control Trials (RCT) and cost-effectiveness data in the frail elderly, loss of autonomy, value judgements and ageism in health care and the need for an adult vaccination register. Workshop recommendations included recognising the right of elderly people to prevention, the need for promotion in the community and amongst healthcare workers of the high burden of vaccine preventable diseases and the need to achieve high levels of vaccination coverage, in older adults and in health workers involved in their care. Research into new vaccine strategies for older adults which address poor coverage, provider attitudes and immunosenescence is a priority. A well designed national register for tracking vaccinations in older adults is a vital and basic requirement for a successful adult immunisation program. Eliminating financial barriers, by addressing inequities in the mechanisms for funding and subsidising vaccines for the older adults compared to those for children, is important to improve equity of access and vaccination coverage. Vaccination coverage rates should be included in quality indicators of care in residential aged care for older adults. Vaccination is key to healthy ageing, and there is a need to focus on reducing the immunisation gap between adults and children.

If There were a Vaccine Against Acute Myocardial infarction, Would You Use it?

“…Despite influenza vaccine being recommended in many countries for patients with CVD [22], it has not made its way into practice as a routine measure to protect patients at risk, with vaccination rates in patients with CVD being low [23]. It has been shown that clinicians in general have a low awareness of adult vaccination and are not strong advocates for vaccination in adults [24,25]. Improved clinician awareness of the benefits of influenza vaccine in prevention of CVD events is needed to take advantage of vaccination as low-hanging fruit for prevention of AMI.…”

Pharmacist‐led influenza vaccination services in residential aged care homes: A pilot study

“…This limited the accessibility of vaccination by the RCP for employees working exclusively on weekends, evening shifts and part‐time on days where the RCP was not present. Further, the timing of influenza vaccination is recommended to commence in March and April prior to peak influenza season starting from June . The RCP did not commence employment until late April, limiting opportunities for providing employee education and promotion of the service to overcome perceived lack of vaccine efficacy or necessity as a barrier to uptake .…”

“…Influenza is the leading cause of vaccine‐preventable death and hospitalisations due to notifiable communicable disease in Australia . Older adults living in residential aged care homes (RACHs) are particularly susceptible to influenza‐associated morbidity and mortality due to increased frailty, the presence of multiple chronic medical conditions and impaired response to antiviral drug therapy . The annual number of influenza‐related deaths in Australia was the highest recorded in 2017, with 91% of influenza‐related deaths recorded in people aged over 65 years .…”

Precision Medicine and Vaccination of Older Adults: From Reactive to Proactive (A Mini-Review)

“…Lipid testing and a discussion about lifestyle during consultations are both used to identify risk which is the basis for prescribing cholesterol-lowering medicines which have as their goal a reduced risk of future cardiac disease. A great deal of effort is expended on interventions such as statins or smoking cessation despite observations suggesting that these have significantly less preventative efficacy against cardiac diseases than influenza vaccination [11,[33][34][35]65]. Inexplicably, despite the evidence that influenza vaccination can reduce the risk of cardiac disease [11,[33][34][35], it is not typically prescribed for adults <65 years until after a cardiac event.…”