Fighting Infectious Diseases in Emerging Countries (FIDEC), University of Miami, Miami, Florida, USA.
Rev Panam Salud Publica. 2013 Jun;33(6):446-52.
Influenza exacts a heavy burden on the elderly, a segment of the population that is estimated to experience rapid growth in the near future. In the past decade most developed and several developing countries have recommended influenza vaccination for those > 65 years of age. The World Health Organization (WHO) set a goal of 75% influenza vaccination coverage among the elderly by 2010, but it was not achieved. In 2011, the Technical Advisory Group at the Pan American Health Organization, Regional Office of WHO for the Americas, reiterated the influenza vaccine recommendation for older adults. Relatively little information has been compiled on the immunological aspect of aging or on reducing its impact, information particularly relevant for clinicians and gerontologist with firsthand experience confronting its effects. To fill this data gap, in 2012 the Americas Health Foundation (Washington, D.C., United States) and the nonprofit, Fighting Infectious Diseases in Emerging Countries (Miami, Florida, United States), convened a panel of Latin American clinicians and gerontologists with expertise in influenza to discuss key issues and develop a consensus statement. The major recommendations were to improve influenza surveillance throughout Latin America so that its impact can be quantified; and to conduct laboratory confirmation of influenza for all patients who have flu-like symptoms and are frail, immunosuppressed, have comorbidities, are respiratory compromised, or have been admitted to a hospital. The panel also noted that: since evidence for antivirals in the elderly is unclear, their use should be handled on a case-by-case basis; despite decreased immunological response, influenza vaccination in older adults is still crucial; indirect immunization strategies should be encouraged; and traditional infection control measures are essential in long-term care facilities.
流感给老年人带来了沉重的负担,预计未来这一人群将迅速增长。在过去十年中,大多数发达国家和一些发展中国家都建议为 65 岁以上的老年人接种流感疫苗。世界卫生组织(WHO)设定了到 2010 年老年人流感疫苗接种率达到 75%的目标,但并未实现。2011 年,WHO 美洲区域办事处泛美卫生组织技术咨询小组重申了为老年人推荐流感疫苗的建议。关于衰老的免疫学方面或减轻其影响的信息相对较少,这些信息对于有应对其影响第一手经验的临床医生和老年病学家特别重要。为了填补这一数据空白,2012 年,美洲健康基金会(美国华盛顿特区)和非营利组织抗击新兴国家传染病(美国佛罗里达州迈阿密)召集了一批拉丁美洲临床医生和老年病学家,他们在流感方面具有专业知识,以讨论关键问题并制定共识声明。主要建议是改善拉丁美洲各地的流感监测,以便量化其影响;并对所有出现流感样症状且身体虚弱、免疫抑制、患有合并症、呼吸功能受损或已住院的流感患者进行流感实验室确诊。专家组还指出:由于老年人使用抗病毒药物的证据尚不明确,应根据具体情况使用;尽管免疫反应下降,老年人接种流感疫苗仍然至关重要;应鼓励间接免疫策略;长期护理机构中应采取传统的感染控制措施。