Department of Pathophysiology, Infectiology, and Immunology, Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria.
Front Immunol. 2020 Apr 23;11:717. doi: 10.3389/fimmu.2020.00717. eCollection 2020.
Infectious diseases are a major cause for morbidity and mortality in the older population. Demographic changes will lead to increasing numbers of older persons over the next decades. Prevention of infections becomes increasingly important to ensure healthy aging for the individual, and to alleviate the socio-economic burden for societies. Undoubtedly, vaccines are the most efficient health care measure to prevent infections. Age-associated changes of the immune system are responsible for decreased immunogenicity and clinical efficacy of most currently used vaccines in older age. Efficacy of standard influenza vaccines is only 30-50% in the older population. Several approaches, such as higher antigen dose, use of MF59 as adjuvant and intradermal administration have been implemented in order to specifically target the aged immune system. The use of a 23-valent polysaccharide vaccine against has been amended by a 13-valent conjugated pneumococcal vaccine originally developed for young children several years ago to overcome at least some of the limitations of the T cell-independent polysaccharide antigens, but still is only approximately 50% protective against pneumonia. A live-attenuated vaccine against herpes zoster, which has been available for several years, demonstrated efficacy of 51% against herpes zoster and 67% against post-herpetic neuralgia. Protection was lower in the very old and decreased several years after vaccination. Recently, a recombinant vaccine containing the viral glycoprotein gE and the novel adjuvant AS01B has been licensed. Phase III studies demonstrated efficacy against herpes zoster of approx. 90% even in the oldest age groups after administration of two doses and many countries now recommend the preferential use of this vaccine. There are still many infectious diseases causing substantial morbidity in the older population, for which no vaccines are available so far. Extensive research is ongoing to develop vaccines against novel targets with several vaccine candidates already being clinically tested, which have the potential to substantially reduce health care costs and to save many lives. In addition to the development of novel and improved vaccines, which specifically target the aged immune system, it is also important to improve uptake of the existing vaccines in order to protect the vulnerable, older population.
传染病是老年人群发病率和死亡率的主要原因。在未来几十年，人口结构变化将导致老年人口数量不断增加。为了确保个人健康老龄化，并减轻社会的社会经济负担，预防感染变得越来越重要。毫无疑问，疫苗是预防感染的最有效医疗措施。与年龄相关的免疫系统变化导致大多数当前在老年人群中使用的疫苗的免疫原性和临床疗效降低。标准流感疫苗在老年人群中的有效性仅为 30-50%。为了专门针对老年免疫系统，已经采取了几种方法，例如增加抗原剂量、使用 MF59 作为佐剂和皮内给药。多年前，为幼儿开发的 13 价结合型肺炎球菌疫苗已对 多糖疫苗进行了修正，以克服 T 细胞非依赖性多糖抗原的至少一些局限性，但对肺炎的保护作用仍约为 50%。一种针对带状疱疹的减毒活疫苗已经上市多年，对带状疱疹的疗效为 51%，对带状疱疹后神经痛的疗效为 67%。在非常高龄的人群中保护作用较低，并且在接种疫苗后几年内会下降。最近，一种含有病毒糖蛋白 gE 和新型佐剂 AS01B 的重组疫苗已获得许可。III 期研究表明，即使在接种两剂后年龄最大的组中，对带状疱疹的疗效也约为 90%，现在许多国家建议优先使用这种疫苗。仍然有许多传染病在老年人群中造成大量发病率，目前还没有针对这些疾病的疫苗。目前正在进行广泛的研究，以开发针对新型靶标的疫苗，已有几种疫苗候选物正在进行临床测试，这些候选物有可能大幅降低医疗保健成本并挽救许多生命。除了开发专门针对老年免疫系统的新型和改进疫苗外，提高现有疫苗的接种率以保护弱势老年人群也很重要。
