Influenza control in the 21st century

Optimizing protection of older adults

Arnold S. Monto, Filippo Ansaldi, Richard Aspinall, Janet E. McElhaney, Luis F. Montaño, Kristin L. Nichol, Joan Puig-Barberà, Joe Schmitt, Iain Stephenson

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Older adults (≥65 years of age) are particularly vulnerable to influenza illness. This is due to a waning immune system that reduces their ability to respond to infection, which leads to more severe cases of disease. The majority (∼90%) of influenza-related deaths occur in older adults and, in addition, catastrophic disability resulting from influenza-related hospitalization represents a significant burden in this vulnerable population. Current influenza vaccines provide benefits for older adults against influenza; however, vaccine effectiveness is lower than in younger adults. In addition, antigenic drift is also a concern, as it can impact on vaccine effectiveness due to a mismatch between the vaccine virus strain and the circulating virus strain. As such, vaccines that offer higher and broader protection against both homologous and heterologous virus strains are desirable. Approaches currently available in some countries to meet this medical need in older adults may include the use of adjuvanted vaccines. Future strategies under evaluation include the use of high-dose vaccines; novel or enhanced adjuvantation of current vaccines; use of live attenuated vaccines in combination with current vaccines; DNA vaccines; recombinant vaccines; as well as the use of different modes of delivery and alternative antigens. However, to truly evaluate the benefits that these solutions offer, further efficacy and effectiveness studies, and better correlates of protection, including a precise measurement of the T cell responses that are markers for protection, are needed. While it is clear that vaccines with greater immunogenicity are required for older adults, and that adjuvanted vaccines may offer a short-term solution, further research is required to exploit the many other new technologies.

Original languageEnglish
Pages (from-to)5043-5053
Number of pages11
JournalVaccine
Volume27
Issue number37
DOIs
Publication statusPublished - Aug 13 2009

Fingerprint

influenza
Human Influenza
Vaccines
vaccines
Viruses
live vaccines
recombinant vaccines
viruses
Attenuated Vaccines
Synthetic Vaccines
DNA Vaccines
antigenic variation
Influenza Vaccines
Vulnerable Populations
young adults
Young Adult
Immune System
Hospitalization
immune system
T-lymphocytes

Keywords

  • Influenza
  • Older adults
  • Protection

ASJC Scopus subject areas

  • Immunology and Microbiology(all)
  • Infectious Diseases
  • Public Health, Environmental and Occupational Health
  • veterinary(all)
  • Molecular Medicine

Cite this

Monto, A. S., Ansaldi, F., Aspinall, R., McElhaney, J. E., Montaño, L. F., Nichol, K. L., ... Stephenson, I. (2009). Influenza control in the 21st century: Optimizing protection of older adults. Vaccine, 27(37), 5043-5053. https://doi.org/10.1016/j.vaccine.2009.06.032

Influenza control in the 21st century : Optimizing protection of older adults. / Monto, Arnold S.; Ansaldi, Filippo; Aspinall, Richard; McElhaney, Janet E.; Montaño, Luis F.; Nichol, Kristin L.; Puig-Barberà, Joan; Schmitt, Joe; Stephenson, Iain.

In: Vaccine, Vol. 27, No. 37, 13.08.2009, p. 5043-5053.

Research output: Contribution to journalArticle

Monto, AS, Ansaldi, F, Aspinall, R, McElhaney, JE, Montaño, LF, Nichol, KL, Puig-Barberà, J, Schmitt, J & Stephenson, I 2009, 'Influenza control in the 21st century: Optimizing protection of older adults', Vaccine, vol. 27, no. 37, pp. 5043-5053. https://doi.org/10.1016/j.vaccine.2009.06.032
Monto AS, Ansaldi F, Aspinall R, McElhaney JE, Montaño LF, Nichol KL et al. Influenza control in the 21st century: Optimizing protection of older adults. Vaccine. 2009 Aug 13;27(37):5043-5053. https://doi.org/10.1016/j.vaccine.2009.06.032
Monto, Arnold S. ; Ansaldi, Filippo ; Aspinall, Richard ; McElhaney, Janet E. ; Montaño, Luis F. ; Nichol, Kristin L. ; Puig-Barberà, Joan ; Schmitt, Joe ; Stephenson, Iain. / Influenza control in the 21st century : Optimizing protection of older adults. In: Vaccine. 2009 ; Vol. 27, No. 37. pp. 5043-5053.
@article{982deb989e254b72a9e77e41c63fa2ea,
title = "Influenza control in the 21st century: Optimizing protection of older adults",
abstract = "Older adults (≥65 years of age) are particularly vulnerable to influenza illness. This is due to a waning immune system that reduces their ability to respond to infection, which leads to more severe cases of disease. The majority (∼90{\%}) of influenza-related deaths occur in older adults and, in addition, catastrophic disability resulting from influenza-related hospitalization represents a significant burden in this vulnerable population. Current influenza vaccines provide benefits for older adults against influenza; however, vaccine effectiveness is lower than in younger adults. In addition, antigenic drift is also a concern, as it can impact on vaccine effectiveness due to a mismatch between the vaccine virus strain and the circulating virus strain. As such, vaccines that offer higher and broader protection against both homologous and heterologous virus strains are desirable. Approaches currently available in some countries to meet this medical need in older adults may include the use of adjuvanted vaccines. Future strategies under evaluation include the use of high-dose vaccines; novel or enhanced adjuvantation of current vaccines; use of live attenuated vaccines in combination with current vaccines; DNA vaccines; recombinant vaccines; as well as the use of different modes of delivery and alternative antigens. However, to truly evaluate the benefits that these solutions offer, further efficacy and effectiveness studies, and better correlates of protection, including a precise measurement of the T cell responses that are markers for protection, are needed. While it is clear that vaccines with greater immunogenicity are required for older adults, and that adjuvanted vaccines may offer a short-term solution, further research is required to exploit the many other new technologies.",
keywords = "Influenza, Older adults, Protection",
author = "Monto, {Arnold S.} and Filippo Ansaldi and Richard Aspinall and McElhaney, {Janet E.} and Monta{\~n}o, {Luis F.} and Nichol, {Kristin L.} and Joan Puig-Barber{\`a} and Joe Schmitt and Iain Stephenson",
year = "2009",
month = "8",
day = "13",
doi = "10.1016/j.vaccine.2009.06.032",
language = "English",
volume = "27",
pages = "5043--5053",
journal = "Vaccine",
issn = "0264-410X",
publisher = "Elsevier BV",
number = "37",

}

TY - JOUR

T1 - Influenza control in the 21st century

T2 - Optimizing protection of older adults

AU - Monto, Arnold S.

AU - Ansaldi, Filippo

AU - Aspinall, Richard

AU - McElhaney, Janet E.

AU - Montaño, Luis F.

AU - Nichol, Kristin L.

AU - Puig-Barberà, Joan

AU - Schmitt, Joe

AU - Stephenson, Iain

PY - 2009/8/13

Y1 - 2009/8/13

N2 - Older adults (≥65 years of age) are particularly vulnerable to influenza illness. This is due to a waning immune system that reduces their ability to respond to infection, which leads to more severe cases of disease. The majority (∼90%) of influenza-related deaths occur in older adults and, in addition, catastrophic disability resulting from influenza-related hospitalization represents a significant burden in this vulnerable population. Current influenza vaccines provide benefits for older adults against influenza; however, vaccine effectiveness is lower than in younger adults. In addition, antigenic drift is also a concern, as it can impact on vaccine effectiveness due to a mismatch between the vaccine virus strain and the circulating virus strain. As such, vaccines that offer higher and broader protection against both homologous and heterologous virus strains are desirable. Approaches currently available in some countries to meet this medical need in older adults may include the use of adjuvanted vaccines. Future strategies under evaluation include the use of high-dose vaccines; novel or enhanced adjuvantation of current vaccines; use of live attenuated vaccines in combination with current vaccines; DNA vaccines; recombinant vaccines; as well as the use of different modes of delivery and alternative antigens. However, to truly evaluate the benefits that these solutions offer, further efficacy and effectiveness studies, and better correlates of protection, including a precise measurement of the T cell responses that are markers for protection, are needed. While it is clear that vaccines with greater immunogenicity are required for older adults, and that adjuvanted vaccines may offer a short-term solution, further research is required to exploit the many other new technologies.

AB - Older adults (≥65 years of age) are particularly vulnerable to influenza illness. This is due to a waning immune system that reduces their ability to respond to infection, which leads to more severe cases of disease. The majority (∼90%) of influenza-related deaths occur in older adults and, in addition, catastrophic disability resulting from influenza-related hospitalization represents a significant burden in this vulnerable population. Current influenza vaccines provide benefits for older adults against influenza; however, vaccine effectiveness is lower than in younger adults. In addition, antigenic drift is also a concern, as it can impact on vaccine effectiveness due to a mismatch between the vaccine virus strain and the circulating virus strain. As such, vaccines that offer higher and broader protection against both homologous and heterologous virus strains are desirable. Approaches currently available in some countries to meet this medical need in older adults may include the use of adjuvanted vaccines. Future strategies under evaluation include the use of high-dose vaccines; novel or enhanced adjuvantation of current vaccines; use of live attenuated vaccines in combination with current vaccines; DNA vaccines; recombinant vaccines; as well as the use of different modes of delivery and alternative antigens. However, to truly evaluate the benefits that these solutions offer, further efficacy and effectiveness studies, and better correlates of protection, including a precise measurement of the T cell responses that are markers for protection, are needed. While it is clear that vaccines with greater immunogenicity are required for older adults, and that adjuvanted vaccines may offer a short-term solution, further research is required to exploit the many other new technologies.

KW - Influenza

KW - Older adults

KW - Protection

UR - http://www.scopus.com/inward/record.url?scp=67651026829&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67651026829&partnerID=8YFLogxK

U2 - 10.1016/j.vaccine.2009.06.032

DO - 10.1016/j.vaccine.2009.06.032

M3 - Article

VL - 27

SP - 5043

EP - 5053

JO - Vaccine

JF - Vaccine

SN - 0264-410X

IS - 37

ER -