Aging Clin Exp Res, Vol. 21, No. 3 258 Key words: Adults, barriers to vaccinate, life course, vaccines, vaccine incentives. Correspondence: Michael K. Gusmano, PhD, Assistant Professor of Health Policy and Management, State University of New York, Down- state Medical Center, Brooklyn, NY 11203, USA. E-mail: Michael.Gusmano@downstate.edu Received March 20, 2009; accepted in revised form April 20, 2009. Life course vaccination and healthy aging Aging Clinical and Experimental Research Michael K. Gusmano 1 and Jean-Pierre Michel 2 1 Department of Health Policy and Management, State University of New York, Downstate Medical Center, Brooklyn, NY, USA, 2 Department of Rehabilitation and Geriatrics, Geneva Medical School and University Hospitals, Thonex-Geneve, Switzerland ABSTRACT. The authors notice the low vaccine cov- erage rate among European citizens and inventory the multiple reasons leading to the non-use of pre- ventable infectious diseases vaccines in adults whose mortality consequences represent an important and un- expected burden of diseases. These facts are in close re- lation with the disruption of vaccine recommenda- tions after the childhood vaccine program, the poor lit- eracy knowledge concerning vaccines among the gen- eral population, but also unfortunately among physi- cians and other health care workers. Popular beliefs, fear of side-effects, fear of needles facilitated the con- stitution of active non-vaccine groups which conduct to the reappearance in non-vaccinated adults and with dramatic consequences of preventable childhood in- fectious diseases. This careful analysis of the current preventable infectious disease vaccine coverage in old adults leads to propose a life course vaccine pro- gramme including adult vaccinations as part of healthy aging as well as old adults’ vaccine guidelines inte- grated in health prevention programs. (Aging Clin Exp Res 2009; 21: 258-263) © 2009, Editrice Kurtis should be part of a comprehensive strategy to promote healthy aging, a priority for the European Commission and policy-makers throughout Europe (1). With the ex- ception of the flu vaccine, many people believe that vac- cination is relevant only for children, but vaccines can help to protect adults against a host of infectious, and some- times deadly, diseases. Indeed, more adults die from vac- cine-preventable diseases each year than children (2). These include influenza, pneumococcal disease, tetanus, diphtheria, pertussis (whooping cough), polio, Herpes zoster, hepatitis A and B, and some tropical diseases. Although vaccination is particularly important for per- sons aged 60 years and older, as well as persons with chronic diseases and other high-risk conditions, such as compromised immune systems, we argue below that vaccine programs to promote healthy aging should start at age 50, before age-related immunological decline has begun. Not only does vaccination prevent morbidity and mor- tality due to pneumococcal disease and influenza-related complications (3); it also reduces costly hospitalizations and admissions to long-term care facilities. Older adults who receive influenza vaccination are less likely to be admitted to hospital during the influenza season, and those who are admitted tend to have shorter in-patient stays. The use of pneumococcal vaccine also reduces hospital admissions for pneumococcal pneumonia – and, when influenza and pneumococcal vaccination are used in combination, there appears to be an additive effect (4). Together with reducing mortality and morbidity asso- ciated with influenza and pneumonia, vaccines can also re- duce complications associated with chronic illness. For ex- ample, pneumococcal vaccine not only reduces adverse outcomes associated with pneumococcal disease; it may also help to prevent congestive heart failure (5). Vaccination may also have an indirect effect on reducing the transmission of the pathogens they are designed to combat in the environment. In a few European coun- INTRODUCTION The twentieth century saw a dramatic increase in life expectancy, which was largely the result of improved living and working conditions, healthcare advances and the control of infectious diseases. Vaccinations have been a particular success story, with children being a key bene- ficiary of this technology. Immunization has become a standard element in preventive healthcare regimes world- wide. However, there is a widely held perception that vac- cination is largely an issue for early life, vaccinations for older persons being understood as voluntary options re- lated to lifestyle (travel, exposure risks) or the specific vul- nerability of older people (influenza). The promotion of vaccination among older persons © 2009, Editrice Kurtis FOR PERSONAL USE ONLY