Antonelli Incalzi Raffaele, Consoli Agostino, Lopalco Pierluigi, Maggi Stefania, Sesti Giorgio, Veronese Nicola, Volpe Massimo
Gerontology Unit, Department of Internal Medicine and Geriatrics, Campus Bio-Medico University and Teaching Hospital, Rome, Italy.
Department of Medicine and Aging Sciences, "G. d'Annunzio" University, Chieti, Italy.
Intern Emerg Med. 2024 Apr;19(3):619-640. doi: 10.1007/s11739-023-03456-9. Epub 2023 Oct 27.
Influenza is associated with a substantial health burden, especially in high-risk subjects such as older adults, frail individuals and those with underlying chronic diseases. In this review, we summarized clinical findings regarding the impact of influenza in vulnerable populations, highlighted the benefits of influenza vaccination in preventing severe illness and complications and reviewed the main evidence on the efficacy, effectiveness and safety of the vaccines that are best suited to older adults among those available in Italy. The adverse outcomes associated with influenza infection in elderly and frail subjects and those with underlying chronic diseases are well documented in the literature, as are the benefits of vaccination (mostly in older adults and in patients with cardiovascular diseases, diabetes and chronic lung disease). High-dose and adjuvanted inactivated influenza vaccines were specifically developed to provide enhanced immune responses in older adults, who generally have low responses mainly due to immunosenescence, comorbidities and frailty. These vaccines have been evaluated in clinical studies and systematic reviews by international immunization advisory boards, including the European Centre for Disease Prevention and Control. The high-dose vaccine is the only licensed influenza vaccine to have demonstrated greater efficacy versus a standard-dose vaccine in preventing laboratory-confirmed influenza in a randomized controlled trial. Despite global recommendations, the vaccination coverage in high-risk populations is still suboptimal. All healthcare professionals (including specialists) have an important role in increasing vaccination rates.
流感会带来沉重的健康负担，尤其是在老年人、体弱个体以及患有基础慢性病等高危人群中。在本综述中，我们总结了有关流感对脆弱人群影响的临床研究结果，强调了流感疫苗在预防重症和并发症方面的益处，并回顾了意大利现有疫苗中最适合老年人的疫苗在效力、效果和安全性方面的主要证据。文献中充分记录了老年人、体弱个体以及患有基础慢性病者感染流感后的不良后果，以及接种疫苗的益处（主要是在老年人以及患有心血管疾病、糖尿病和慢性肺病的患者中）。高剂量和佐剂化灭活流感疫苗是专门为增强老年人的免疫反应而研发的，老年人通常由于免疫衰老、合并症和身体虚弱而免疫反应较低。这些疫苗已经在包括欧洲疾病预防控制中心在内的国际免疫咨询委员会进行的临床研究和系统评价中得到评估。高剂量疫苗是唯一一种在随机对照试验中被证明在预防实验室确诊流感方面比标准剂量疫苗更有效的获许可流感疫苗。尽管有全球建议，但高危人群的疫苗接种覆盖率仍然不理想。所有医疗保健专业人员（包括专科医生）在提高疫苗接种率方面都发挥着重要作用。
