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The year ahead for the World Coalition on Adult Vaccination

The World Coalition on Adult Vaccination is going strong in 2017! The Coalition continues to add new members and remains committed to furthering engagement with experts and expertise in the fields of adult vaccination and ageing.  

Two Adult Vaccination meeting reports, the Latin American Immunization Advocacy Summit Report and the Asia Pacific Adult Immunization Meeting Report are set to be released in the coming months, with a focus on actionable goals for 2017 and beyond.

The Coalition has also been active through social media. The Adult Vaccination Twitter account has been gaining momentum since early January.  The World Coalition encourages organisations to share information to be tweeted to the Coalition network as a means of promoting adult vaccination globally.  Additionally, The World Coalition appreciates every follow and retweet! 

The Coalition looks forward to further discussion and developments and to the addition of new members in 2017!
Asia Pacific Immunization Meeting - December 2016
The International Federation on Ageing (IFA), in collaboration with Friends of IFA (FOIFA) Japan, convened the Asia Pacific Immunization Meeting on 1-2 December, 2016 in Tokyo, Japan.  This international, high-level knowledge exchange platform attracted twenty key stakeholders and opinion leaders from Australia, New Zealand, Singapore, Hong Kong, South Korea, Japan, Canada and the United States. 

The overall goal of this meeting was to share the most up-to-date information on adult vaccination from a scientific and public health viewpoint; learn from key opinion leaders (KOLs) the process for approval and studies conducted to improve awareness and rates of vaccinations; better understand the barrier s to improving uptake rates of adult vaccination; and discuss and agree on actions to be taken at a national level.

All contributions demonstrated how the many barriers, such as: ageism, lack of awareness, health care professional communication, and preconceived beliefs can be addressed to raise awareness of the importance of adult vaccination and increase adult vaccination uptake rates.

The IFA's Asia Pacific Immunization Meeting report is forthcoming. Be on the lookout for further information.

To learn more and keep up-to-date on IFA's work in the field of Adult Vaccination , please visit the IFA website.
World Coalition on Adult Vaccination 
Member Updates 
Coming Soon!  Quem é Sênior Vacina,The Brazilian Society of Immunizations (SBIm) Communications Campaign

SBIm is working on an exciting new initiative, a communications campaign called Quem é Sênior Vacina aimed at promoting adult vaccination and increasing uptake rates for vaccination among older people.  

Find out more about the campaign by clicking here.
Valuing Vaccinations Across Generations Expands International Efforts 

Generations United is excited to be gaining momentum and expanding its international footprint with its awareness campaign,
Valuing Vaccinations Across Generations .   
The campaign - which launched in 2016 with The Gerontological Society of America and The American Academy of Pediatrics, with funding from Pfizer  - aims to bridge the importance of immunizations within segmented groups into an intergenerational conversation within families and among different generations. In its first year, the campaign produced compelling and sharable content including an informational infographic and discussion guide about the critical importance of vaccinations across generations.
The initiative is now expanding its international efforts with the addition of new partners such as the Japan Geriatric Society  and Japan Intergenerational Unity Association as well as the Spanish Society on Geriatrics & Gerontology and University of Grenada, among others. The partners in Japan and Spain are working to adapt existing materials and develop new, culturally appropriate resources for their respective countries.
To learn more about this important initiative visit
USMP - Centro de Investigación del Envejecimiento

As part of the existing evidence and the commitments made at the Faculty of Human Medicine of the University of San Mart­ín de Porres
 have reinforced the contents and attitudes on the subject in the course of Undergraduate Geriatrics, in the programs of Postgraduate courses such as medical residency in Geriatrics and we have developed health literacy activities through media and social networks and we have developed health literacy activities through media and social networks 

In CIEN, research is being carried out on the state of vaccination in older adults and factors to improve it.

Also, our teachers participated in the ALMA course on Prevention in the Elderly  , where we spent a whole morning to analyze the evidence and utility of vaccines. The contents and conclusions of this course have been organized in a book on the subject that will be launched at regional level in alliance with PALTEX and PAHO.
New Vaccines Today website

Vaccines Today
, a founding member of the World Coalition on Adult Vaccination, has a new-look website. The revamped site is more user-friendly, highly visual and optimised for mobile devices - but is still at the same address: 

The website includes a page on vaccination for people of all ages , with short sections dedicated to adults and older people.

In recent weeks, Vaccines Today has reported from the European Public Health Conference in Vienna. Among the speakers at a session on the value of life-course immunisation was Dr Jane Barratt, Secretary General of the International Federation on Ageing.

Another of the headline-grabbing talks at this high-profile annual event came from Professor David Bloom, a Harvard Economist, who said the  full value of vaccination had been 'underestimated' . He also said that adult vaccination will play a crucial role in keeping us healthier for longer.

Greek health economist Dr Kostas Athanasakis, also on the panel, shared the surprising  story of how Greece expanded its vaccination schedule in the midst of the deepest economic crisis every recorded in the developed world.

Vaccines Today has produced a new video on the role of vaccines in tackling antimicrobial resistance. Watch to find out how vaccines against flu and pneumococcal disease - often used by older people - reduce hospitalisation and antibiotic use. 
Older Adults Vaccination in Singapore: 
Experience from the National University Hospital

In Singapore, the older adult population will double in 2030 and the present focus is on prevention and population health. Hospital admissions lead to catastrophic disability amongst older adults, and pneumonia is one of the major causes of hospitalisation and mortality. 

At the National University Hospital, there are many missed opportunities to vaccinate older people against influenza and pneumococcal when they were hospitalised for related or unrelated conditions. Vaccinating older adults is one of the least explored and probably one of the most cost effective paths to successful aging and maintaining a healthy workforce. The older one is, the more important it is to focus on preventive aspects such vaccination and falls prevention.

Since July 2016, a quality improvement initiative has been launched at the National University Hospital to improve inpatient and outpatient vaccination rates especially for those with chronic disease and above 65 years old. Common barriers to improving vaccination uptake have been identified, including doctor factors, patient factors and system factor including lack of public knowledge on vaccination. In addition to physicians, pharmacists and nursing staff are involved in a new intiative.  All eligible patients admitted to Geriatric and Internal Medicine wards has a standardised vaccination checklist clipped to their parameters board with regular education for nursing staff and residents. Besides involving multidisciplinary team members, one of the main focuses as an academic institution is to educate future doctors across the 5 years of their curriculum and work closely with immediate & long term care (ILTC) team members.  Continuing education to the Singaporean population through media and publications plays an important role. 

Submitted by: Professor Reshma Merchant,  Head of Division of Geriatric Medicine,
University Medicine Cluster
Adult Immunization at the 1st "Infectología Hoy" Symposium 

The international symposium on Infectious Diseases, HIV and Vaccines was held last November 24-25 in Buenos Aires City (Argentina). It was organized by Helios Salud Foundation and Foundation Center for Infectious Disease Studies (FUNCEI), both chaired by Daniel Stamboulian, MD.
During this scientific meeting an Adult Vaccination Symposium was held. Subjects discussed included the burden of Pneumococcal infections, Influenza, Hepatitis B, Herpes Zoster and their prevention through vaccination.  Communication strategies for improving adult immunization were also outlined.  Chaired by Dr. Pablo Elmassian the symposium comprised the following expert speakers: Dr. Pablo Bonvehí, Dr. Hebe Vázquez and Dr. Carla Vizzotti (ex Director of the National Immunization Program) and journalist Ana Paula Cordero.
Pneumococcal Awareness Month
During November, the Adult Vaccination Working Group of the Fundación Centro de Estudios Infectológicos/Foundation Center for Infectious Disease Studies (FUNCEI) developed a media campaign to join in the activities for World Pneumonia Day.  The key messages aimed to provide health information for the community and to raise awareness about pneumonia in the elderly and people with chronic diseases. Vaccination is a key preventive measure that FUNCEI is committed to promoting. 

The campaign included social media messages, banners, a press conference and articles in local newspapers such as:

The campaign is available at:  

Shingles vaccination uptake falling (UK)
Responding to the news of decreased uptake rates of the shingles vaccination, the International Longevity Centre UK (ILC-UK) has urged a change in the eligibility guidelines.

Public Health England has reported a decline in the uptake of the Shingles vaccination in both the routine (70 year old) and catch up (78 years old) cohorts (from 61.8% in 2013/14 to 54.9% in 2015/16 and from 57.8% in 2014/15 to 55.5% in 2015/16, respectively).

In 2013, ILC-UK published "Immune Response", calling for a lifecourse approach to immunisation and making 30 plus recommendations for policy action.

In 2015, ILC-UK launched a European Adult Immunisation Hub, which seeks to provide information and news about adult immunisation across Europe.

David Sinclair, Director, ILC-UK and Editor of the European Adult Immunisation Hub said:

"Vaccination is not just for kids. In an ageing society we need a much greater focus on improving awareness and uptake of vaccination among adults.

Anything we can do to reduce likelihood of pain is of huge importance in old age, with 6 in 10 people in their mid-70s suffering from pain.

Shingles can be a significant cause of pain in old age and vaccination is an effective way of reducing the likelihood that we will suffer from it. We must ensure that older people eligible for the Shingles vaccination take up their right to receive it.

Some parts of the country have very low coverage of the Shingles vaccine among eligible people. It is important that Public Health England and the Department of Health work to ensure that we don't see emerging a postcode lottery in access to the vaccine.

The complexity of the age of eligibility guidelines for shingles will no doubt be hampering the ability to communicate uptake to relevant individuals. Perhaps now is the time to extend eligibility to everyone between 70 and 80, after all, all of these people are at risk and would benefit from vaccination."

See the European Adult Immunisation Website for more information about the latest figures for Shingles uptake.
European Adult Immunisation Hub - Update

The European Adult Immunisation Hub now hosts a series of databases on immunisation providers in France, Germany, Portugal, Spain, the Netherlands, and the UK.  This new resource can be used by members of the public to find a local service provider; immunisation advocates can also signpost the database to highlight the ease at which adults can protect themselves and their families through vaccination.

The most popular articles on the Hub for the period 21st December - 21st January concern the impact of austerity policy on vaccination rates; vaccine provider databases; and the role of vaccination in addressing the challenge of antimicrobial resistance (AMR).

Since the last IFA update, Hub Editors Dave Eaton and David Sinclair have participated in roundtable discussions with healthcare providers and immunisation advocates in Brussels and Paris, to consider how best to deliver the resources advocates need to make the case for a life course approach to immunisation.

ILC have also hosted an event in London on the threat posed by the rise of AMR, and the role of vaccination in reducing unnecessary antibiotic usage. The presentations delivered at the event can be downloaded here, and an information report detailing the relationship between vaccination and AMR will be produced and uploaded to the Hub shortly.

If you have any resources that you would like to share with the Hub, please contact Dave Eaton at [email protected].
Adult vaccination: Prevention of Flu and Pneumonia

As every year, the peak of flu season is here. Influenza has an important impact in people with chronic diseases, especially the elderly, due to respiratory problems, hospitalizations and deaths. It also produces an overload in the health-care services.

Although not all the flu-like syndromes are caused by influenza viruses, nor all lower respiratory tract infection are caused by Streptococcus Pneumoniae, the vaccines we have, prevent serious respiratory infections. If vaccine coverage was not so poor, the clinical effectiveness could be clearly greater so all of us should be engaged in improving the uptake rate of adult vaccinations.  

Flu vaccination is the single best way to prevent the flu and its complications. V accination efforts should focus on  patients at high risk, especially people with certain morbidities and older adults. In these groups, the vaccine halves the risk of complications.  

There are 2 types of vaccines against pneumococcal infection, polysaccharide (VNP-23v) and conjugate vaccines (VNC-13v and VNC-10v, the latter only indicated for  adults and children 5 years or older). Currently the conjugate vaccines are being widely used in the systematic vaccination of children and have shown that high coverage in the infant population produces an indirect benefit among old people.

Spanish Society of Family and Community Medicine (semFYC)- Infectious Diseases Group and Infection Prevention Group PAPPS
French  patients' groups coalition (AVNIR Group) is supporting adult vaccination 

AVNIR group*, a coalition of 11 Patients Associations Groups (PAGs of immunocompromised patients) in France, launched a reflection on vaccination, as a tool of public health and healthy aging, with a particular focus on at risk (and immunocompromised) patients.

AVNIR projects aim to enhance vaccination coverage by providing relevant information to HCP's, PAG, and policy makers on the needs of patients concerning vaccination. 

Studies reported that France has a very low level of confidence in vaccines. As a result, the Ministry of Health set up in 2016 a national debate to identify actions to convince on vaccination, as a key-prevention act.
AVNIR consequently engaged with policy makers to support key recommendations aimed at simplifying the patient pathway, and increase communication and information on vaccination.
Their recommendations were based on a survey
conducted by AVNIR in 2013 and submitted to the members of those 11 associations to better understand their attitudes, knowledge and needs regarding vaccination. The study shows that despite specific recommendations regarding immunocompromised patients, vaccination rates do not reach recommended levels. It also highlights the lack of information about vaccination and recommendations and the fact that a majority of patients need more information.

The survey is published in Vaccine (Loubet et al., Vaccine 33 (2015) 3703-3708)
(* institutional support by Pfizer France)
The Subsidy Approach on Vaccines for Seniors in Japan

Japan ranks among the world leaders in the health of its citizens. In stark contrast to many positive health indicators, the country is known to have a persistently high rate of vaccine-preventable diseases. 

The current immunization program was established under the Japanese Immunization Law. Its purpose is to carry out immunization to prevent the outbreak of infectious diseases. To enhance the system, it undergoes several reforms through redefinition of target diseases and target populations. In 2002, a system was introduced that requires municipalities to provide subsidies for the influenza vaccine to seniors aged 65 or over. In 2014, the system was extended to the pneumococcal vaccine. In Akita Prefecture for instance, the subsidy scheme is as follows:

Although the Akita municipality subsidizes these vaccines, costs vary among health centers. A hospital or clinic might decide to administer a vaccine cheaper than the standard rate. Nevertheless, uptake rates are still relatively low, partly driven by lack of awareness especially of the new policy on pneumococcal vaccine. Also, doctors alone as licensed vaccinators are not enough to maximize access to vaccines.

Although many barriers still and do exist, the government is continuously seeking out strategies to close the 'vaccine gap' with great hope for progress.

Click here for further reference on the vaccination policy in Japan.
Vaccinating Healthcare Workers: Level of Implementation, Barriers and Proposal for Evidence-Based Policies in Turkey.

Whilst, the role of healthcare workers (HCWs) in 'lifelong vaccination' is indisputable, vaccination rates among HCWs remain far below targets. The obstacles to being vaccinated or recommending vaccination may include universal factors such as outlined in the Table below.

Our research aimed to gain an overview of vaccination strategies for HCWs, to assess the coverage rates and make in-depth analyses of the potential barriers to vaccination and potential factors to motivate HCWs for vaccination in Turkey; then to compare them with the global picture in order to improve implementation policies. 

According to the data for 2013, by the General Directorate of Healthcare Services, the number of HCWs in Turkey reached 698,518. Approximately 150, 000 are physicians and dentists, while nurses, midwives, pharmacists and other auxiliary medical personnel make up the rest.  These figures are helpful in determining the number of HCWs who should be vaccinated and considering the very low vaccination rates among HCWs there is a long way to go to reach the targets.  Recommendations based on this new evidence in Turkey include:
  • Development of a Healthcare Worker Vaccination Manual applicable to Turkey, with specific priorities
  • Setting realistic objectives regarding the vaccination rates of HCWs, building on the existing state of affairs
  • Setting up a system to enable assessment and monitoring of vaccination rates,
  • Inclusion of a quality benchmark concerning vaccination rates of HCWs among the accreditation standards of the Ministry of Health (starting with hepatitis B and influenza)
  • Communication of social messages at the Government and Ministry of Health level, to encourage adult vaccination in general, and HCWs' vaccination in particular
  • Setting target rates and applying positive incentives for influenza, hepatitis B, and Tdap/Tdap-IPV cocoon
  • Development of systems to provide accurate, objective and scientific information to the public, and to check announcements playing on media attention, in a manner which communicates inaccurate information that can harm public health and to lead people to wrong conclusions
Table. Barriers to vaccination of healthcare workers for influenza, in light of the studies carried out in Turkey 

Doubts about the effectiveness/protection capabilities of the vaccine 
Fears about the side effects of the vaccine/lack of trust in the vaccine 
Negative news items about vaccines 
Ruling politicians' refusal to be vaccinated 
Believing to have had and recovered from influenza 
Believing to be safe from the risk of influenza / lack of contact with patients with high influenza risk 
Opinion about influenza not being a serious illness / assuming to have resistance to influenza 
Using other methods as protection against influenza 
Failure to access / forgetting to have the vaccine 
Assuming contraindications due to existing health issues 

Submitted By: Ozisik L, Tanriover MD, Altınel S, Unal S.
Seroprevalence of rubella virus in adult population in Portugal

The seroprevalence to rubella virus was determined in a sample of adults (aged 20 to 55 years or older) resident in Portugal. The analysed sample was calculated to be nationally representative and corresponding to 1175 individuals, 583 male and 592 female distributed by the seven territorial units (NUTII) of Portugal (North Centre, Lisbon Alentejo, Algarve, Madeira and Azores).

Rubella IgG antibodies were detected in 1032 individuals corresponding to 87.8%: 85.2% in male and 90.4% in female. Due to the risk of rubella infection in pregnant women the results were also analysed in the group of women of childbearing age. This analysis showed that women between 20 and 44 years have a rubella seroprevalence of 93.2% with values above 95% in all regions of Portugal mainland while Madeira presented a percentage of 92.3% and Azores 86%.

The results of this study showed a high seroprevalence to rubella virus mainly in women at childbearing age in all regions with exception of Azores. These results were however lower in comparison to the previous NSS 2000-2002 and the values of MMR vaccination coverage especially in males. This study indicated that rubella prevention cannot be minimized specially in certain regions and population groups. 

Click here for more information on this topic. 

Submitted by:  Paula Palminha, Department of Infectious Diseases, National Institute of Health, Lisbon, Portugal
If you are an NGO, academic, scientist or government decision maker working in the field of adult vaccination, ageing and public health and would like to learn more about the World Coalition on Adult Vaccination, please contact  Ms Jessica Rochman-Fowler at [email protected] .

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