Immunosenescence (decreased autoimmunity associated with aging) is also related to the mitigation of vaccine immunological stimulus and subsequently to a decrease in their effectiveness in the elderly. Infectious diseases that can be prevented through vaccination are a significant cause of morbidity and mortality in the elderly, compromising a healthy aging. Infections and decompensation of pre-existing comorbidities are associated with the need for hospital admission, deterioration of functional capacity and frailty with reduced quality of life and risk of institutionalisation. Currently, vaccination is one of the most important cost-effective strategies in the primary prevention of infectious diseases, constituting a growing public health priority.
The availability of vaccines with a good safety profile, effective and well tolerated together with evidence of their benefit to the elderly, justifies their integration in clinical practice focused on the needs of the elderly. This will reduce the prevalence of infectious diseases and of the care and economic burden on health services. Despite this, an important number of the elderly population are still not adequately immunised according to current recommendations, resulting in a low rate of vaccination coverage in this age group.
Considering the age group, the National Immunisation Programmme recommends only lifelong vaccination against tetanus and diphtheria. However, the Directorate-General for Health also recommends vaccination against influenza in individuals aged 60 or over. Based on the current recommendations of the Advisory Committee on Immunisation Practices, the Centre for Geriatric Studies of the Portuguese Society of Internal Medicine also advises the vaccination of the elderly against infections by Streptococcus pneumoniae and herpes zoster.
Serious adverse reactions known to be associated with vaccines are either rare or very rare, as are contraindications to vaccination. However, there is the possibility of lipothymia (fainting or loss of strength) or, very rarely, anaphylactic reaction (about 1 case per million vaccines administered). For this reason, it is recommended that people wait for at least 30 minutes before they leave. The most common adverse reactions associated with vaccines are mild injection site reactions, with systemic reactions such as fever, which is less frequent.
Unlike children, for whom there are well-defined immunisation programmes, for the elderly there has not been a specific national vaccination plan. This has resulted in a low rate of vaccination coverage in this age group.
Infectious diseases are a significant cause of morbidity and mortality in the elderly population and some can be prevented through vaccines. Lower respiratory tract infections are the fourth leading cause of death in developed countries, three times more frequent in people over the age of 60. In particular, pneumococcal pneumonia is a leading cause of death in the elderly, and vaccines prevent the most serious forms of this disease.
Currently available vaccines have sufficient potential to lower the burden of infectious diseases in the elderly, regardless of whether they live at home or not. The object is to prevent hospital admissions and functional deterioration with subsequent decrease in quality of life.
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