Which vaccinations are recommended for healthy ageing?

Annual influenza vaccination is the cornerstone of preventive vaccination in later life. The German vaccination committee STIKO recommends a specially formulated high-dose influenza vaccine for everyone aged 60 and older. Of all infectious diseases, influenza causes the most deaths in the general population, and older adults are particularly vulnerable because the immune system functions less effectively with age. Yet no Western country meets the WHO target of 75% vaccination coverage in older adults¹.

RSV vaccination is a relatively new but well-supported addition. RSV is a respiratory virus that causes serious lung infections and hospitalisations in older adults. A meta-analysis shows that RSV vaccines reduce the risk of a respiratory tract infection in older adults by approximately 78% and the risk of severe illness by more than 86%, without significantly more serious side effects than placebo. The evidence is rated as 'moderate'². Several Portuguese professional associations recommend the vaccine from the age of 60, and from as early as 50 for at-risk groups such as people with COPD, heart failure, diabetes, kidney disease or frailty. When supply is limited, priority goes to those aged 75 and older and those aged 50 and older with risk factors³.

Whether RSV vaccination is also cost-effective from a societal perspective depends strongly on age. Decision-analytic research estimates the cost per healthy life year gained at approximately 147,000 to 386,000 dollars, depending on age and vaccine type. For those aged 65 and older, those costs are considerably lower (approximately 147,000 to 162,000 dollars) than for those aged 60 to 64 (approximately 331,000 to 386,000 dollars). An important uncertainty remains how long the protection lasts, as long-term data are still lacking⁴.

A whooping cough booster also deserves attention. Immunity from earlier vaccinations wanes over the years. In older adults, whooping cough is often not recognised because the symptoms are atypical or milder. In people with chronic conditions, the disease can still take a serious course. Specific evidence for the effectiveness of the booster dose in older adults is limited, but monitoring vaccination coverage in at-risk groups and recognising the disease are recommended⁵.

Administering multiple vaccines at once during a single visit is safe and increases vaccination coverage. For older adults, an annual combination of influenza, pneumococcal and shingles vaccination is recommended; the RSV vaccine can be added to that as well. In children and travellers this approach is already standard practice, but in adults it is still underused. Note: several authors of the study on this topic have ties to vaccine manufacturer GSK, which should be taken into account when weighing those conclusions⁶.