Vaccination Of Older Adults Research Articles

Immunogenicity and Safety of the Higher Valent Pneumococcal Conjugated Vaccine Compared to the 13-Valent Pneumococcal Conjugated Vaccine in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract Introduction The immunogenicity of PCV15 and PCV20 in older adults was approved based on comparative data with PCV13, though their relative immunogenicity and safety in this population remain undetermined. A systematic review and meta-analysis were conducted to provide insights, addressing the lack of large-scale efficacy studies. Methods A phrase 2 or 3 randomized controlled trials evaluating immunogenicity of a single dose of either PCV15 or PCV20 in older adults by the opsonophagocytic assay (OPA) geometric mean titer (GMT) response at 1-month postvaccination compared to PCV13 were included in analysis. Results In total, eight trials were eligible. PCV15 group demonstrated superior immunogenicity compared to PCV13 among older adults (GMTR: 1.11, 95% CI: 1.02–1.20). The PCV20 group demonstrated non-inferiority (exceeded 0.5 at one-month post-vaccination) in immunogenicity compared to PCV13 (GMTR: 0.84, 95% CI: 0.81–0.87). The incidence of local and systemic reactions was higher in the PCV15 group compared to the PCV13 group, with risk ratios (RR) of 1.23 (95% CI: 1.14, 1.32) and 1.15 (95% CI: 1.02, 1.29), respectively. PCV20 are well tolerated and exhibit a comparable rate of local and systemic reactions to PCV13 group. Conclusions These findings support the immunogenicity and safety of PCV15 and PCV20 for pneumococcal vaccination in older adults. Given its superior immune response, PCV15 may address the gaps left by PCV13. Despite higher antibody levels, the clinical effectiveness of these vaccines remains uncertain. Ongoing surveillances are essential to evaluate both vaccines impact on remaining vaccine-type pneumococcal disease.

Neutralizing antibody responses to three XBB protein vaccines in older adults

The ongoing COVID-19 pandemic has underscored the importance of strong immune defenses against emerging SARS-CoV-2 variants. While COVID-19 vaccines containing XBB subvariants have proven effective in neutralizing new SARS-CoV-2 variants, a gap remains in knowledge regarding neutralizing antibody responses in older adults aged >65 years against these newly emerged variants. This study was therefore undertaken to investigate and compare neutralizing antibody responses to three XBB-containing protein-based vaccines (trivalent XBB.1.5 vaccine, bivalent Omicron XBB vaccine, and tetravalent XBB.1 vaccine) head-to-head in 90 individuals aged >65 years. The results showed that all three XBB-containing vaccines substantially enhanced the neutralizing antibody response, with 100% of vaccinees having detectable antibody titers against ancestral D614G and variants BA.5, XBB.1.5, JN.1, KP.2, and KP.3 after booster immunization. Subsequent analysis indicated that the trivalent XBB.1.5 and tetravalent XBB.1 vaccines elicited higher levels of neutralizing antibodies compared to the bivalent Omicron XBB vaccine. The KP.2 and KP.3 variants displayed antibody resistance comparable to the JN.1 variant. Older adults produce similar neutralizing antibody responses to the vaccines regardless of their underlying medical conditions. These findings indicate that booster vaccination with XBB-containing vaccines can effectively elicit strong neutralizing responses against a number of SARS-CoV-2 variants in older adults over 65 years, which will help guide vaccine strategies in this elderly population.

P-600. Efficacy of a Bivalent RSVpreF Vaccine in Older Adults Across a Second RSV Season

Abstract Background In May 2023, the FDA approved RSVpreF [ABRYSVO™] for prevention of lower respiratory tract infection (LRTI) caused by RSV in adults ≥60 years of age. Here we present the vaccine efficacy (VE) data from the pivotal phase 3 global RENOIR study (NCT05035212) for an understanding of VE persistence through 2 RSV seasons and its impact on healthcare utilization (HCU).Figure 1RSVpreF vaccine efficacy against LRTI-RSV through 2 RSV seasons Methods Participants ≥60 years were randomized 1:1 to receive bivalent RSVpreF or placebo and were followed over two RSV seasons (Season 1 [S1]: N=36124; Season 2 [S2]: N=32223). VE was evaluated for RSV-LRTI with ≥3 symptoms (3+ LRTI-RSV), ≥2 symptoms (2+ LRTI-RSV), RSV-ARI, and by RSV subgroups, age, and at-risk conditions. HCU was evaluated by LRTI-RSV events that prompted any medically attended (MA) visit (hospitalization, primary care practitioner (PCP), urgent care (UC), emergency room (ER), specialist, other).Figure 2.Cumulative case accrual curve from day of vaccination, first episode of LTRI-RSV with ≥3 symptoms from Day 15 through end of Season 2 Results The average acute respiratory illness (ARI) surveillance period within S1 and S2 was 7.1 and 7.6 months, respectively. Among the participants who contributed to the VE in S2, the average time from vaccination through the end of surveillance was 17.6 months. VE for 3+ LRTI-RSV was 88.9% (53.6, 98.7) in S1 and 77.8% (51.4, 91.1) in S2; VE across 2 seasons was 81.5% (63.3, 91.6). VE was ≥80% for both RSV A and B subgroups across S1 and S2. VE trended similarly by age, at-risk conditions, 2+ LRTI-RSV and RSV-ARI. VE for MA 3+ LRTI-RSV was 84.6 (32.0, 98.3) in S1, 72.0% (33.4, 89.8) in S2 and across 2 seasons was 76.3% (50.2, 89.9). 75% and 73% of all 3+ LRTI-RSV cases required a HCU visit in S1 and S2 respectively; placebo cases accounted for 87% of all 3+ LRTI-RSV related HCU visits in S1 and 78% in S2. Across both seasons, there were 4 hospitalizations: 1 RSVpreF compared to 3 placebo and 66 outpatient visits: 11 RSVpreF (ER = 9%, UC = 45%, PCP = 18%, specialist = 9%, other = 18%) compared to 55 placebo (ER = 18%, UC = 16%, PCP = 44%, specialist = 7%, other = 4%). Table 1. Vaccine efficacy of RSVpreF through 2 seasons, and across 2 seasons Conclusion Bivalent RSVpreF remains efficacious against severe RSV-LRTI and continued to reduce RSV-related healthcare burden in older adults through a second RSV season. Consistent VE was demonstrated by age and at-risk individuals and across the RSV A and B subgroups supporting durable seasonal protection irrespective of RSV strain and the potential benefit to a bivalent RSV vaccine.Table 2Healthcare Resource Utilization Associated With RSV Cases by RSV Season Disclosures Edward E. Walsh, MD, Enanta: Advisor/Consultant|Enanta: Honoraria|GSK: Advisor/Consultant|Janssen: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support John Woodside, PhD, Pfizer: Stocks/Bonds (Public Company)|Pfizer, Inc.: salary|Pfizer, Inc.: Stocks/Bonds (Public Company) Gonzalo Perez Marc, MD, Cassará: Expert Testimony|Cassará: Honoraria|Merck: Grant/Research Support|Moderna: Expert Testimony|Pfizer, Inc.: Advisor/Consultant|Pfizer, Inc.: Expert Testimony|Pfizer, Inc.: Grant/Research Support|Pfizer, Inc.: Clinical research|Sanofi: Grant/Research Support Daniel P. Eiras, MD, MPH, Pfizer. Inc: Employee|Pfizer. Inc: Stocks/Bonds (Private Company) Qin Jiang, PhD, Pfizer: Salary|Pfizer: Stocks/Bonds (Public Company) Conrado J. Llapur, MD, Pfizer, Inc: Grant/Research Support Tarek Mikati, MD,MPH, Pfizer, Inc.: salary|Pfizer, Inc.: Stocks/Bonds (Public Company) Michael Patton, B.Sc., Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Agnieszka Zareba, MD PhD, Pfizer, Inc.: salary|Pfizer, Inc.: Stocks/Bonds (Public Company) Kumar Ilangovan, MD, MSPH, MMCi, Pfizer, Inc.: salary|Pfizer, Inc.: Stocks/Bonds (Public Company) Maria Maddalena Lino, PhD, Pfizer: Stocks/Bonds (Private Company) Elena Kalinina, PhD, Pfizer, Inc.: Salary|Pfizer, Inc.: Stocks/Bonds (Public Company) David Cooper, PhD, Pfizer, Inc.: Employee|Pfizer, Inc.: Stocks/Bonds (Public Company) Kena A. Swanson, Ph.D., Pfizer: Employee of Pfizer|Pfizer: Stocks/Bonds (Public Company) Annaliesa S. Anderson, PhD, Pfizer, Inc.: Employee|Pfizer, Inc.: Stocks/Bonds (Public Company) Alejandra C. Gurtman, M.D., Pfizer, Inc.: Employee|Pfizer, Inc.: Stocks/Bonds (Public Company) Iona Munjal, MD, Pfizer: Salaried employee|Pfizer: Stocks/Bonds (Public Company)

P-21. Comparison of Three RSV Vaccine Lower Respiratory Tract Disease Primary Endpoint Definitions for Adult Vaccine

Abstract Background Despite their public health importance, a consensus definition for lower respiratory tract disease (LRTD), or illness (LRTI) is lacking. Clinical trials of three respiratory syncytial virus (RSV) vaccines for older adults used different LRTI/LRTD definitions for vaccine efficacy (VE). We hypothesize differences between definitions could bias product comparisons.Table 1.Variation of signs or symptoms included in criteria to meet case definition of LRTI or LRTD in three RSV vaccine clinical trials Methods We reviewed case definitions for LRTI/LRTD in RSV vaccine clinical trials conducted in older adults.Table 2.Specified values for symptoms/signs included in LRTI/LRTD criteria definitions for three RSV vaccine clinical trials Results Two of three published RSV vaccine clinical trials from Pfizer and Moderna used two outcomes (LRTI/LRTD with ≥2 signs/symptoms or ≥3 signs/symptoms) to measure VE, while the third trial from GlaxoSmithKline (GSK) used one (combining ≥2 and ≥3 signs/symptoms) (Table 1). The Pfizer trial included 5 signs/symptoms as components of LRTI; three of these (tachypnea, wheezing, shortness of breath) suggest lower airway involvement and two (cough and self-reported sputum production) could also result from upper airway infection. At interim analysis, 29 of 45 cases had only 2 symptoms (64.4%). Of these 29, 25 had only cough and sputum production (86.2%). The GSK trial, by contrast, required all LRTD cases to include at least one sign, all of which indicated lower airway involvement (Table 2). The Moderna trial included 10 signs/symptoms, including the potential for subjects to have only cough and sputum production. Even within signs/symptoms, definitions differed (e.g., tachypnea cutoff ranged from 20 to 25 breaths per minute; Table 2). When using comparable definitions, full season 1 VEs for Pfizer and GSK products were similar while the point estimate for the Pfizer product was higher during season 2 (Table 3).Table 3.Vaccine efficacy for three RSV vaccine clinical trials using study LRTI/LRTD definitions Conclusion Lack of standard case definitions limit ability to compare results across trials. Some ≥2 LRTI events for Pfizer and Moderna may not have involved the lower respiratory tract but rather the upper respiratory tract only. The most comparable case definitions likely are ≥3 signs/symptoms LRTI in the Pfizer and Moderna trials, and LRTD in the GSK trial. Disclosures Sarah E. Williams, MD, MPH, Pfizer, Inc: Salary|Pfizer, Inc: Stocks/Bonds (Private Company) Elizabeth Begier, MD, M.P.H., Pfizer Vaccines: Employee|Pfizer Vaccines: Stocks/Bonds (Private Company) Kumar Ilangovan, MD, MSPH, MMCi, Pfizer, Inc.: salary|Pfizer, Inc.: Stocks/Bonds (Public Company) Cassandra Hall-Murray, PharmD, Pfizer, Inc.: employee|Pfizer, Inc.: Stocks/Bonds (Public Company) Bradford D. Gessner, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company)

P-52. Modeling the Epidemiological Impact of Different Adult Vaccination Strategies in the United Kingdom

Abstract Background Pneumococcal conjugate vaccines (PCVs) were first introduced in the pediatric United Kingdom (UK) immunization program in 2006 and subsequently led to a significant decline in invasive pneumococcal disease (IPD) for vaccine type serotypes (STs). Although pediatric PCVs provide some indirect protection to adults, a significant IPD burden remains in older adults. Here, we compared three adult vaccines in the 65+ year-old population: the current recommendation of PPV23, the recently licensed-in-adults PCV20, and a new adult-focused 21-valent PCV, V116. All scenarios assumed continued PCV13 vaccination in pediatrics. Methods A population-level compartmental dynamic transmission model was adapted to the UK setting. The model described Streptococcus pneumoniae (SP) carriage transmission dynamics and disease progression in the presence of age- and ST-specific pneumococcal vaccines. We calibrated the model to age- and ST-specific IPD data in the UK. We used the calibrated model to make epidemiological projections under the three different vaccination scenarios. Results After 10 years, preliminary results show the routine use of V116 or PCV20 in 65+ year-olds resulted in 17.7% and 13.9% reductions in IPD incidence from current values, respectively. The continued use of PPV23 resulted in a 0.6% increase in IPD incidence. Under the V116 vaccination scenario, we projected a 15.5% reduction in IPD incidence in STs included in V116 but not PCV20 (9N, 15A, 15C [generated from deOAc-15B], 16F, 17F, 20A, 23A, 23B, 24F, 31, and 35B) in 65+ year-olds, compared to 14.5% and 10.7% increases in incidence with PCV20 or PPV23 vaccination, respectively. For STs included in PCV20 but not V116 (1, 4, 5, 6B, 9V, 14, 15B 18C, 19F, and 23F), 10-year projections revealed decreases of 27.4%, 49.2%, and 32% in IPD incidence from the current incidence values with V116, PCV20, or PPV23 vaccination in the 65+ year-old population. Conclusion Routine vaccination with V116 in older adults led to greater reductions in IPD among the 65+ year-old population compared to PCV20 and PPV23 vaccination. The model projected that with V116 vaccination in older adults, there would be no resurgence of the STs included in PCV20 but not V116 due to indirect protection offered by the pediatric vaccination program. Disclosures Rachel Oidtman, PhD, Merck & Co., Inc.: Full time employee|Merck & Co., Inc.: Stocks/Bonds (Public Company) Giulio Meleleo, PhD, Merck & Co., Inc.: Vendor Ian Matthews, PhD, MSD (UK) Ltd., Value, Access, and Devolved Nations (VAD): Full time employee|MSD (UK) Ltd., Value, Access, and Devolved Nations (VAD): Stocks/Bonds (Public Company) Dionysios Ntais, n/a, MSD (UK) Ltd., Value, Access, and Devolved Nations (VAD): Full time employee|MSD (UK) Ltd., Value, Access, and Devolved Nations (VAD): Stocks/Bonds (Public Company) Robert Nachbar, PhD, Merck & Co., Inc.: US 7,219,020, US 5,292,741|Merck & Co., Inc.: Vendor|Merck & Co., Inc.: Stocks/Bonds (Public Company) Oluwaseun Sharomi, MSc, PhD, Merck & Co., Inc.: Full time employee|Merck & Co., Inc.: Stocks/Bonds (Public Company) Kevin Bakker, PhD, Merck & Co., Inc.: Grant/Research Support|Merck & Co., Inc.: Stocks/Bonds (Public Company)

P-675. Online Clinician Education Curriculum Results in Performance Changes in Clinical Practice for Recommending Available Respiratory Syncytial Virus Vaccines in Older Adults

Abstract Background This study examined whether online continuing medical education (CME/CE) focused on evidence-based best practices for recommending available respiratory syncytial virus (RSV) vaccines would result in improved understanding of adults disproportionally affected by RSV, the clinical guidance of available vaccines, and communication strategies to encourage older adults to get vaccinated for RSV. Methods Clinicians who participated across a curriculum of 3, live and online, 30-minute CME/CE video discussions between experts. Performance was assessed by inviting learners to complete a survey 30-60 days post-education, identifying practice changes and the degree to which clinicians experience barriers to those changes. The data was collected from 12/29/2023 to 04/04/2023. Results There were 13,232 learners consisting of PCPs, Pharmacists, Advanced Practice Providers, and others who completed the survey. The analyses from the program showed that ∼90% of learners made a practice change or had practices reinforced due to education. Five key practice changes to recommending available RSV vaccines included: Educate eligible patients/caregivers on the risk of RSV in older adults (93% PCPs, 93% Pharm, 95% NPs/Nurses, 92% PAs) Recommending available RSV vaccines for older adults (93% PCPs, 93% Pharm, 95% NPs/Nurses, 93% PAs) Use alternative communication methodologies with patients (15% PCPs, 21% Pharm, 14% NPs/Nurses, 16% PAs) Collaborate with different members of the patient’s care team (11% PCPs, 22% Pharm, 13% NPs/Nurses, 16% PAs) Some of the practice barriers identified by the learners include: Lack of clear recommendations from evidence-based guidelines Lack of time to educate patients on the importance of getting vaccinated for RSV Patient concerns/questions regarding available RSV vaccines Organizational limitations to providing the vaccine Conclusion The practice changes identified in this assessment provide compelling evidence that participation in online CME/CE prompts adoption of changes in practice related to RSV vaccination. Future education is needed to address the barriers identified in this assessment. Acknowledgement: This education was supported by an independent educational grant from Pfizer Inc. and in partnership with Immunize.org Disclosures All Authors: No reported disclosures

Respiratory syncytial virus vaccination in older adults and patients with chronic disorders: A position paper from the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine.

Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract infection, hospitalisation and death in adults. Based on evidence regarding the impact of RSV on adult populations at risk for severe infection and the efficacy and safety of RSV vaccines, the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine endorses this position paper with recommendations to prevent RSV-associated disease and its complications in adults through vaccination. The RSV vaccine is recommended for people aged ≥50 years with risk factors (chronic obstructive pulmonary disease, asthma, heart failure, coronary artery disease, diabetes, chronic kidney disease, chronic liver disease, immunocompromise, frailty, dementia, and residence in a nursing home) and all persons aged ≥60 years. If it cannot be made available to this population, then the vaccine should be prioritised for individuals aged ≥75 years and those aged ≥50 years with risk factors. The vaccine should preferably be given between September and November and can be co-administered with the influenza vaccine. Ongoing studies on RSV vaccines may justify extending these recommendations in the future.

Safety Assessment of Influenza Vaccination for Neurological Outcomes Among Older Adults in Japan: A Self-Controlled Case Series Study.

To assess adverse neurological risks following influenza vaccination in older adults. Using a linked database of healthcare administrative claims data and vaccination records from an urban city in Japan (April 1, 2014, to March 31, 2020), we conducted an observational study utilizing a self-controlled case series design. We identified individuals aged ≥ 65 years who experienced adverse neurological outcomes, defined as hospitalizations related to epilepsy, paralysis, facial paralysis, neuralgia, neuritis, optic neuritis, migraine, extrapyramidal disorders, Guillain-Barre syndrome, or narcolepsy. We used conditional Poisson regression to analyze within-subject incidence rate ratios, comparing the risk of these outcomes during risk periods following influenza vaccination (0-6 days and 7-29 days after each vaccination) with nonvaccination periods. Our analysis was adjusted for age and season groups as time-varying covariates. We enrolled 3283 eligible individuals (men: 1643; mean [standard deviation] age: 76 [7.3] years). The incidence rate ratio for the outcome during the risk periods was 0.93 (95% confidence interval, 0.66-1.30) in risk period 1 (0-6 days after vaccination) and 1.14 (0.96-1.35) in risk period 2 (7-29 days after vaccination), respectively. We found no evidence that the risk of adverse neurological events was increased after influenza vaccination in older adults. These results may help reassure older adults who are hesitant to receive influenza vaccination because of concerns regarding adverse neurological outcomes.

RSVPreF3 OA respiratory syncytial virus vaccine in older adults: a profile of its use

RSVPreF3 OA respiratory syncytial virus vaccine in older adults: a profile of its use

Anti-HBs Positivity Related to Past HBV Infection and Vaccination in Older Adults in Polish Population-Cohort-Based Study.

In Poland, a national hepatitis B (HBV) immunization program was introduced for neonates in 1996, and between 2000 and 2011, those born from 1986 to 1995 were vaccinated. Little is known about vaccination rates among adults born before 1986. This study aimed to determine the frequency of anti-HBs seropositivity rates related to vaccination and past HBV infection in older Poles. The HBV serological status was analyzed in 5781 (96.6%) of the PolSenior2 population-based cohort (60+) by assessing serum seropositivity for HBs antigen, anti-HBs, and anti-HBc antibodies. The survey was performed in 2018-2019 and included medical and socio-economic questionnaires, anthropometric measurements, and comprehensive geriatric assessment. Serological status implying past hepatitis B and serological profile consistent with anti-HBV vaccination corresponded to 15.2% (95% CI: 13.4-17.0) and 25.2% (95% CI: 23.4-27.0) prevalences, respectively. Female gender, living in a town or city, having better education, and suffering from coronary artery disease, or depression independently increased the rate of past hepatitis B. On the other hand, being 'white collar' and self-reliant, having the ability to use the Internet, and past surgical procedures in the last 5-year period were factors associated with a higher vaccination rate. More than 15% of older adults in Poland present serological profiles suggesting past hepatitis B, and one-fourth anti-HBV vaccination. Being functionally independent, 'white collar', using the Internet, and having past surgical procedures are factors associated with a higher chance of being vaccinated. Nevertheless, a large group of older adults should be prophylactically vaccinated due to increased exposure to medical procedures.

Estimated Vaccine Effectiveness for Respiratory Syncytial Virus–Related Lower Respiratory Tract Disease

Clinical trials have demonstrated high vaccine efficacy (VE) against lower respiratory tract disease (LRTD) but enrolled a smaller proportion of persons aged 75 years or older and those with comorbidities than seen in highest-risk populations in clinical practice settings. Additionally, VE against respiratory syncytial virus (RSV)-related hospitalizations and emergency department (ED) visits is not yet fully described. To estimate Respiratory Syncytial Virus Prefusion F (RSVpreF) effectiveness in older adults. This was a retrospective case-control study with a test negative design. Cases were adults aged 60 years or older with hospitalizations or ED visits at Kaiser Permanente of Southern California for LRTD from November 24, 2023, to April 9, 2024, who had respiratory swabs collected and tested for RSV. Two control definitions were prespecified: (1) strict controls included RSV-negative LRTD events that were negative for human metapneumovirus, SARS-CoV-2, and influenza, and positive for a nonvaccine preventable cause (primary) and (2) broad controls included all RSV-negative LRTD events (sensitivity analysis). Enhanced specimen collection was conducted to salvage clinical respiratory swabs not tested for RSV during routine care. Data were analyzed from May to September 2024. RSVpreF vaccine receipt during the first RSV season after licensure and 21 or more days before LRTD event. Estimated VE against first episode of RSV-related LRTD hospitalization or ED visit. A total of 7047 LRTD-related hospitalizations or ED encounters with RSV testing results were included. The mean (SD) age was 76.8 (9.6) years; 3819 (54.2%) were female; 839 (11.9%) were non-Hispanic Asian or Pacific Islander, 2323 (33.0%) were Hispanic, 1197 (17.0%) were non-Hispanic Black, and 2602 (36.9%) were non-Hispanic White; 998 (14.2%) were immunocompromised; and 6573 (93.3%) had 1 or more Charlson comorbidity. Using strict controls, estimated adjusted VE was 91% (95% CI, 59%-98%). Using broad controls, estimated adjusted VE was 90% (95% CI, 59%-97%). In a high-risk, general population, RSVpreF vaccination conferred protection against RSV-related LRTD in the hospital and ED settings among US adults aged 60 years or older, the majority of whom were aged 75 years or older and had comorbidities. These data support use of this vaccine in older adults.

Cost-effectiveness and public health impact of 24-valent pneumococcal conjugate vaccine compared to recommended pneumococcal vaccines in older adults

IntroductionThe potential impact of an in-development 24-valent pneumococcal conjugate vaccine (PCV24) compared to currently recommended vaccines in older adults is unclear. Similar to most currently available PCVs, PCV24’s formulation is based on childhood pneumococcal disease epidemiology. Decision analysis techniques were used to estimate PCV24 cost-effectiveness and public health effects in US older adults. MethodsA Markov model compared PCV24 to currently recommended US pneumococcal vaccination strategies in older adults (aged ≥65 years) and to no vaccination. Age-, race-, and chronic medical condition-specific pneumococcal illness risks and serotype-specific disease risks were obtained from CDC data. Vaccine effectiveness was estimated using Delphi panel and clinical trial data. Vaccination and pneumococcal illness costs were from US databases. Scenario analyses examined indirect effects of childhood pneumococcal vaccination on adult disease. Data were collected and analyses performed in 2024. ResultsPCV24 prevented fewer pneumococcal disease cases and deaths than the recently recommended 21-valent pneumococcal conjugate vaccine (PCV21), which is formulated based on adult pneumococcal disease serotypes. In cost-effectiveness analyses, PCV21 was economically favorable compared to PCV24 and all other vaccination strategies, both without and with consideration of potential childhood vaccination indirect effects. These findings were robust and consistent in deterministic and probabilistic sensitivity analyses. ConclusionIn older adults, PCV24 was clinically and economically unfavorable compared to PCV21, which covers more adult disease-causing pneumococcal serotypes and is less susceptible to childhood vaccination indirect effects.

Vaccinations in older adults: Optimization, strategies, and latest guidelines.

This article is a summary of the first AGS Symposium entitled "Update on Vaccination Strategies for Older Adults: Matching the Approach to the Individual and the Care Setting." Given declines in host defenses and immune function with aging, vaccinations play a pivotal role in fortifying older adults against preventable infections, resulting diseases, disability, and death. Current guidelines generally list recommendations applicable for an average older adult of a given chronological age. However, growing evidence indicates that heterogeneity in terms of factors as varied as biological sex, frailty, functional status, and multimorbidity may impact vaccine responses and clinical outcomes. As a result, clinicians will increasingly need to take these additional factors into consideration as they seek to improve outcomes through improved targeting of such aging-related heterogeneity. Moreover, efforts at protecting older citizens through vaccination must also include strategies to overcome barriers to the adoption of vaccine recommendations in varied settings including long-term care. This 2023 AGS Plenary Symposium sought to commence a broader dialogue across AGS and beyond on optimizing vaccinations for older adults, ensuring not only extended lifespans but also healthier and more active lives. This report is not a systematic review, and thus should not be considered comprehensive.

Immediate post-discharge care among US adults hospitalized with respiratory syncytial virus infection

BackgroundRespiratory Syncytial Virus (RSV) is an important pathogen causing acute respiratory illnesses in adults. RSV infection can lead to severe outcomes, including hospitalizations and even death. Despite the increased recognition of the burden in older adults, immediate post-discharge care needs among adults hospitalized with RSV are not well characterized and have not been compared to other serious medical conditions (such as influenza, acute myocardial infarction (MI), and stroke) for which there have been long-standing disease prevention efforts.ObjectivesThis study aims to describe the immediate post-discharge care needs among adults hospitalized with RSV in the United States and descriptively compare it to those hospitalized with influenza, acute MI, or stroke.DesignRetrospective observational cohort study.PatientsAdults aged ≥ 18 years, hospitalized with a primary diagnosis of RSV, influenza, acute MI, or stroke from January 01, 2016, to December 31, 2019, were identified from the Premier Healthcare Database using the International Classification of Diseases (ICD-10) codes.Main measuresImmediate post-discharge care was categorized into three different levels of care based on the discharge dispositions. Descriptive analyses were performed.Key resultsIn total, 3,629 RSV, 303,577 influenza, 388,682 acute MI, and 416,750 stroke hospitalizations were identified, the majority occurred among patients aged ≥ 65 years. Professional home care needs were the highest for RSV hospitalizations (19.1%), followed by influenza (17.7%), stroke (15.4%), and acute MI (9.8%). Additionally, institutional care needs immediately following discharge were similar for RSV, influenza, and acute MI hospitalizations (14.2%, 15.8%, and 14.1%, respectively).ConclusionsImmediate post-discharge care needs among adults hospitalized with RSV, especially in older adults, can be considerable and comparable to influenza and acute MI discharges. With recently approved RSV vaccines, efforts to increase vaccination in older adults are needed to prevent RSV and associated healthcare consequences.

Respiratory syncytial virus prevention is finally here: An overview of safety.

A number of respiratory syncytial virus (RSV) prevention products have recently been approved in Australia. These products focus on highest risk groups, aiming to prevent RSV disease in young infants and older adults. While not currently included in the National Immunisation Program (NIP), an RSV vaccine (Arexvy, GlaxoSmithKline [GSK]) isavailable privately for adults ≥60 years, and some Australian jurisdictions have commenced RSV monoclonal antibody (nirsevimab) programs for infants in 2024. This article summarises safety data regarding RSV prevention products approved in Australia, including vaccines for adults ≥60 years, maternal vaccines and monoclonal antibodies for infants. Clinical trial data found these products were largely well tolerated, with most local and systemic reactions being mild-moderate and short-lived. Proportions of serious adverse events were low. While very rare, potential safety signals being further assessed include risk of preterm birth following the maternal vaccine (Abrysvo, Pfizer) and Guillain-Barré syndrome (GBS) following RSV vaccines in older adults (Abrysvo and Arexvy). Close monitoring of these adverse events of special interest via post-licensure surveillance is underway.

Three doses of Sars-CoV-2 mRNA vaccine in older adults result in similar antibody responses but reduced cellular cytokine responses relative to younger adults

ObjectivesBooster COVID-19 vaccinations are used to protect the elderly, a group vulnerable to severe disease. We compared humoral and cellular immunity in older versus younger adults up to eight months after administering a BNT16b2 booster vaccine dose. Next, we analyzed the plasma levels of soluble T cell activation/exhaustion markers. MethodsHome-dwelling older adults (n = 68, median age 86) and younger healthcare workers (n = 35, median age 39), previously vaccinated with two doses of BNT162b2, were given a booster dose at ten months after the initial dose. Our analysis consisted of spike-specific IgG, neutralizing antibodies, memory B cells, IFN-γ and IL-2 secreting T cells and soluble T cell exhaustion/activation markers. ResultsFollowing the initial two doses, the elderly cohort exhibited lower humoral and IFN-γ responses compared to younger adults. The booster dose increased the humoral responses in both older and younger adults. At two months after the booster dose, older and younger vaccinees had comparable levels of antibodies and the responses were maintained up to 18 months. The younger cohort elicited an increase in the cellular response, while no increase was detected in the elderly. The elderly had higher plasma levels of soluble forms of the T cell activation/exhaustion markers CD25 and TIM-3, which inversely correlated with age and T-cell cytokine responses. This suggests that these markers may be related to the observed dysfunctional cellular cytokine response in older adults. However, both elderly and younger adults who experienced breakthrough infections after booster vaccination, elicited more robust humoral and IFN-γ responses. ConclusionsThe booster dose elicited neutralizing and spike-specific antibody responses in the elderly that were comparable with that of the younger cohort. However, the lack of a strong cellular cytokine response to the third dose in the elderly may explain their vulnerability to severe infection and may be a consequence of exhausted or senescent T cell responses. (https://clinicaltrials.gov/study/NCT04706390).

Relative effectiveness of adjuvanted versus non-adjuvanted influenza vaccines in older adults with risk factors for influenza complications during the 2019–2020 U.S. influenza season

This study estimated the relative vaccine effectiveness (rVE) of the MF59®-adjuvanted trivalent influenza vaccine (aTIV) versus standard-dose nonadjuvanted egg-based quadrivalent influenza vaccines (QIVe) for the prevention of influenza-related medical encounters (IRMEs), outpatient IRMEs, and influenza- and pneumonia-related hospitalizations during the 2019–2020 US influenza season among adults ≥65 years of age who had ≥1 high-risk condition. A secondary objective evaluated the rVE of aTIV versus QIVe in preventing these outcomes among older adults with specific high-risk conditions. This retrospective cohort study included US adults ≥65 years of age vaccinated with aTIV or QIVe between August 1, 2019, and January 31, 2020. Exposures, covariates, risk factors, and outcomes were captured from a linked dataset comprised of electronic health records (EHR) (Veradigm Network EHR) linked to insurance claims (Komodo Healthcare Map). A doubly robust approach was applied wherein multivariable-adjusted odds ratios were derived using inverse probability of treatment-weighted samples to calculate rVEs and 95 % confidence interval independently for individuals ≥1 high-risk condition and those with specific high-risk conditions. The study included 954,707 aTIV and 719,125 QIVe recipients. For all outcomes, aTIV was more effective than QIVe among adults ≥65 years of age who had ≥1 high-risk condition (any IMRE: 23.6 % [20.9 %–26.1 %]), outpatient IRME: 23.3 % [20.4 %–26.1 %], and influenza- or pneumonia-related hospitalizations: 19.0 % [16.3 %–21.6 %]), during the 2019–2020 influenza season. Similarly, aTIV was more effective than QIVe at preventing outcomes among individuals with specific high-risk conditions except for body mass index ≥40. This study demonstrated higher effectiveness of aTIV versus QIVe in preventing any IRMEs, outpatient IRMEs, and influenza- or pneumonia-related hospitalizations among adults ≥65 years of age who had ≥1 high-risk condition.

Respiratory syncytial virus vaccination in older adults.

Respiratory syncytial virus vaccination in older adults.

Ocular Adverse Events After Influenza Vaccination in Older Adults: Self-Controlled Case Series Using a Large Database in Japan

ABSTRACT Background To clarify the risk of adverse ocular events following influenza vaccination. Methods This self-controlled case series study used a claims database linked to vaccination records of a large city in Japan between April 2014 and September 2021. Individuals aged ≥ 65 years who developed adverse ocular events during the follow-up period were included. The exposure was influenza vaccination. The primary outcome was defined as the occurrence of at least one of the following five eye diseases: uveitis, scleritis, retinal vein occlusion, retinal artery occlusion, or optic neuritis. Conditional Poisson regression was used to estimate the within-subject incidence rate ratio of ocular adverse events during the risk period (0–56 days after vaccination) compared to the control period. Results A total of 4,527 cases were eligible for the study (median age, 74 years; male, 42%). The incidence rate ratio for the outcome during the risk period was 0.99 (95% confidence interval, 0.87 to 1.14). No increased risk was observed for individual components of the outcome either; the incidence rate ratio was 0.94 (0.78 to 1.13) for uveitis, 1.17 (0.86 to 1.59) for scleritis, 0.98 (0.76 to 1.27) for retinal vein occlusion, 0.89 (0.42 to 1.87) for retinal artery occlusion, and 0.87 (0.44 to 1.70) for optic neuritis. Conclusions This self-controlled case series showed no apparent increase in the risk of adverse ocular events after influenza vaccination among older adults. These results mitigate the concerns of older adults who may hesitate to receive influenza vaccination for fear of adverse ocular events. Abbreviation HR = hazard ratio; CI = confidence interval; RVO = retinal vein occlusion; SCCS = self-controlled case series

Relative Effectiveness of High-Dose vs. Standard-Dose Quadrivalent Influenza Vaccine in Older Adults with Cardiovascular Disease: A Prespecified Analysis of the DANFLU-1 Randomized Clinical Trial.

Background: Influenza vaccination reduces the risk of adverse outcomes in patients with cardiovascular disease (CVD). We sought to evaluate whether the presence of CVD modified the relative effectiveness of high-dose (QIV-HD) vs. standard-dose (QIV-SD) quadrivalent influenza vaccine in this prespecified analysis of the DANFLU-1 trial. Methods: DANFLU-1 was a pragmatic, open-label, randomized feasibility trial of QIV-HD vs. QIV-SD in adults aged 65-79 years during the 2021/2022 influenza season in Denmark. Vaccines were allocated in a 1:1 ratio. Baseline and follow-up data regarding diagnoses and mortality were obtained from Danish national registers. The trial is registered at Clinicaltrials.gov: NCT05048589. The CVDs assessed included heart failure (HF), ischemic heart disease (IHD), atrial fibrillation, and a combined group denoted "chronic CVD" consisting of the aforementioned diseases, among others. Prespecified outcomes included hospitalizations for pneumonia or influenza, respiratory disease, CVD, cardiorespiratory disease, all-cause hospitalizations, and mortality. Effect modification was tested using interaction terms. Results: The final study population included 12,477 participants (mean age 71.7±3.9 years, 5,877 (47.1%) female), of whom 2,540 (20.4%) had chronic CVD. QIV-HD vs. QIV-SD was associated with a lower incidence of hospitalizations for pneumonia or influenza (IRR 0.30 (95%-CI 0.14-0.64)) and all-cause mortality (IRR 0.51 (0.30-0.86)) regardless of chronic CVD (p for interaction=0.57 and 0.49, respectively). The relative effectiveness of QIV-HD vs. QIV-SD against all-cause hospitalizations was modified in participants with chronic CVD (Overall: IRR 0.87 (0.76-0.99); no chronic CVD: 0.79 (0.67-0.92); chronic CVD: 1.11 (0.88-1.39); p for interaction=0.026). No other effect modification was observed by the presence of chronic CVD, HF, IHD, or atrial fibrillation. Conclusions: The relative effectiveness of QIV-HD vs. QIV-SD was consistent against hospitalizations for pneumonia or influenza and all-cause mortality regardless of chronic CVD. However, the relative effectiveness against all-cause hospitalizations was modified by the presence of chronic CVD. These results should be considered hypothesis-generating.