Bonanni Paolo, Heo Jung Yeon, Honda Hitoshi, Lee Ping-Ing, Mouliom Aminatou, Leong Hoe Nam, Del Pilar Martin Matos Maria, Dawson Rachel
Department of Health Sciences, University of Florence, Florence, Italy.
Ajou University School of Medicine, Suwon, South Korea.
Infect Dis Ther. 2025 May;14(5):911-932. doi: 10.1007/s40121-025-01135-0. Epub 2025 Apr 10.
Lower respiratory tract infections caused by SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) cause a significant disease burden globally, despite the availability of effective vaccines. Certain populations, such as older adults (≥ 60 years) and individuals of all ages with particular comorbidities, are at increased risk for severe outcomes, including hospitalization and death. National administration schedules for available vaccines against respiratory viruses are not unified, and not all current guidelines are clear and directive, concerning the optimal timing of vaccination. Herein, we formulate an evidence-based position regarding the optimal timing of COVID-19, influenza, and RSV vaccination for older adults and individuals with chronic comorbidities, based on a synthesis of the literature and current guidelines. Vaccination impact and timing were found to be influenced by vaccinee risk factors, including age and comorbidities, and waning vaccine effectiveness and seasonal pathogen burden. Because COVID-19, influenza, and RSV display unique seasonal patterns within and between regions, local epidemiological surveillance of each virus is crucial for determining optimal vaccination timing and guidelines. To maximize the benefits of these respiratory virus vaccines, the timing of peak vaccine effectiveness and period of greatest risk for severe outcomes should be aligned. Thus, COVID-19, influenza, and other recommended vaccines given ahead of the start of the respiratory virus season (or other regionally appropriate time) and co-administered at a single, routine visit represent the optimal approach to protecting at-risk populations. More data will be required to establish the clinical benefit of additional RSV vaccine doses and whether these may be integrated within a seasonal schedule. Coordinated policy decisions that align with strain selection for new and annually reformulated vaccines would enable the timely raising of public health awareness, ultimately leading to enhanced vaccine uptake. Implementation strategies will require engagement of healthcare providers and strong, evidence-based public health recommendations for integrated vaccine schedules.
尽管有有效的疫苗，但由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）、流感病毒和呼吸道合胞病毒（RSV）引起的下呼吸道感染在全球造成了巨大的疾病负担。某些人群，如老年人（≥60岁）以及所有年龄段患有特定合并症的个体，出现严重后果（包括住院和死亡）的风险更高。针对呼吸道病毒的现有疫苗的国家接种计划并不统一，而且并非所有现行指南对于疫苗接种的最佳时机都清晰明确且具有指导性。在此，我们基于文献综述和现行指南，就老年人及患有慢性合并症的个体接种新冠病毒、流感病毒和呼吸道合胞病毒疫苗的最佳时机制定了一项循证立场。研究发现，疫苗接种的效果和时机受接种者风险因素的影响，包括年龄和合并症，以及疫苗效力的减弱和季节性病原体负担。由于新冠病毒、流感病毒和呼吸道合胞病毒在各地区内部和地区之间呈现独特的季节性模式，对每种病毒进行当地流行病学监测对于确定最佳疫苗接种时机和指南至关重要。为了使这些呼吸道病毒疫苗的益处最大化，应使疫苗效力峰值时间与出现严重后果的最高风险期相一致。因此，在呼吸道病毒季节开始之前（或其他适合当地的时间）提前接种新冠病毒、流感病毒及其他推荐疫苗，并在一次常规就诊时同时接种，是保护高危人群的最佳方法。还需要更多数据来确定额外剂量的呼吸道合胞病毒疫苗的临床益处，以及这些剂量是否可以纳入季节性接种计划。与新的和每年重新配制疫苗的毒株选择相一致而做出的协调政策决定，将能够及时提高公众健康意识，最终提高疫苗接种率。实施策略将需要医疗保健提供者的参与以及针对综合疫苗接种计划的强有力的、基于证据的公共卫生建议。
