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S174
Symposia / European Geriatric Medicine 6S1 (2015) S157
–
S176
Prof Joahn Flamaing (Belgium) Prof Stefania Maggi (Italy), Prof G
Gavazzi (France) and Dr Jacques Gaillat (France) will present the 4
following topics:
– Pneumococcal vaccine: What to do after CAPITA? (JF)
– Flu vaccine in elderly population: What to do after the Cochrane
review? (SM)
– Health care workers flu vaccine: What to do after the Cochrane
review? (GG)
– Recent and future vaccine: Zoster vaccine as an exemple (JG)
Outlines:
Pneumococcal vaccine, What to do after CAPITA?
(Prof Joahn
Flamaing, Division of Gerontology and Geriatrics, dept. Clinical
and Experimental Medicine, KU Leuven, Belgium): Streptococcus
pneumoniae is the most important bacterial cause of pneumonia.
Children, immunocompromised individuals, persons with comorbid
disease and the older population are susceptible to pneumococcal
disease. Pneumococcal infections are treated with antimicrobials.
For decades the 23-valent pneumococcal polysaccharide vaccines
(PPV23) was the only vaccine available for the prevention
of pneumococcal disease in adults. PPV23 prevents invasive
pneumococcal disease (IPD) in healthy adults, but there is no hard
evidence that non-invasive disease is prevented, nor that it prevents
IPD in high-risk populations and the elderly.
The pneumococcal conjugate vaccines (PCV7 and subsequently
PCV13) have demonstrated a high efficacy in preventing both IPD
and non-IPD in children. Moreover, prevention of IPD occurred
in the adult and older population by vaccinating children (herd
effect).
PCV13 is now available for the prevention of IPD and pneumonia
in adults. In contrast to the PPV23 PCV13 induces a boostable
immunological memory and also protects against pneumococcal
pneumonia (CAPITA trial).
The pneumococcal serotype epidemiology, influenced by direct
and indirect effects of pneumococcal vaccination must guide the
choice of pneumococcal vaccine strategies. Until new vaccines
(protein and/or whole cell vaccines) become available, combining
the advantages of the PCV13 with the broad coverage of PPV23 can
be preferred.
This lecture gives the audience insight in the complex interaction
between pneumococcal serotype epidemiology and pneumococcal
vaccination. The attendees will be able to value pneumococcal
vaccination guidelines and to adopt pneumococcal vaccination
strategies with more knowledge.
Flu vaccine in elderly population: What to do after the Cochrane
review?
Prof Stefania Maggi, Institute of Neuroscience, National
Research Council, Italy): Influenza vaccination of elderly individuals
is recommended worldwide as people aged 65 and older are at
a higher risk of complications, hospitalizations and deaths from
influenza. Trivalent inactivated vaccines are the most commonly
used influenza vaccines and their public health safety profile
appears to be acceptable. We will present the evidence from
experimental and non-experimental studies carried out in older
individuals, taking into account the biases affecting observational
studies. We will discuss:
1. The recommendations by Jefferson (Cochrane review, 2010) that
an adequately powered publicly-funded, placebo-controlled RCT
needs to be conducted over several influenza seasons, and
2. The interventions to increase influenza vaccination rates of those
60 years and older in the community, recommended in the
review by Lorenzetti (Cochrane review, 2014)
Health care workers flu vaccine: What to do after the Cochrane
review?
(Prof G. Gavazzi, Department of geriatric Medicine,
University of Grenoble-Alpes, and University hospital of Grenoble,
France): As Flu vaccine in elderly population is less effective
than in younger population, and as flu is one of the first cause
of death, directly and indirectly, the idea of protection of the
most susceptible elderly population (Nursing home, Hospitalized
population) vaccinating health care workers against flu has been
proposed for decades (so called “herd immunity”). Although several
studies demonstrated its interest particularly in nursing home, a
recent Cochrane review (Thomas RE, et al. Cochrane Database Syst
Rev 2013) stated to the inefficiency of HCW vaccination to prevent
flu in elderly population living in long-term care facilities. Data eist
also in other facilities and need further analysis.
In the present lecture, we will discuss the limitations of published
data and the latest statement of the Cochrane review in this field. In
order to be able to participate to the implementations of flu vaccine
programs we will also provide factors associated with acceptance
and refusal of flu vaccine by Health care workers.
Recent and future vaccine: Zoster vaccine as an example
(Dr
Jacques Gaillat, Division of Infectious Diseases, Hospital of Annecy-
Genevois, France): Behind the two killers, influenza virus and
Streptococcus pneumoniae, Herpes zoster virus (HZV) is probably
the third plague for the elderly. The burden of disease is important
with an annual HZ incidence throughout Europe, varying by country
from 2.0 to 4.6/1 000 person-years with no clearly observed
geographic trend. Shingles are not commonly life threatening but
they can be complicated. Postherpetic neuralgia (PHN), the most
common complication of herpes zoster, may have a serious impact
on quality of life and functional ability, particularly in the elderly.
The risk of zoster itself and the risk of post zoster pain increase with
age, sharply after 50 years. The social and economical consequences
are also a reason of concern. Antiviral drugs prescribed early
improve the acute phase of infection but there impact on the
reduction of post zoster pain is a subject of debate.
Shingles developed as a result of reactivation of latent chickenpox
virus (VZV). In this context a prophylactic vaccine against VZV
represents a promising clinical approach to limit the debilitating
complications of herpes zoster, including PHN.
Two kinds of vaccines have emerged, one with an attenuated live
varicella virus, already licensed in Europe and the US (Zostavax
®
),
and a candidate Herpes Zoster subunit (HZ/su) vaccine (GSK).It
combines gE, a protein found on the HZ virus, with an adjuvant
system, AS01.
In this presentation we will review the burden of illness, the vaccine
efficacy and safety and cost-effectiveness of vaccination.
Conclusions:
Though different levels of evidences, flu vaccine are
still recommended and need to be better implemented in elderly
population, and in health care workers providing care for elderly
population; there are requirements for modifications of pneumo-
coccal vaccine and zoster vaccine outlines in many countries.
The educational goals of the symposium are: (1) to enhance
knowledge regarding recent studies about vaccinations in elderly
population, (2) to give the audience the opportunity to better
challenge with controversial data, (3) to better adapt the
implementation of available vaccines in target populations,
(4) to encourage geriatricians participating in Public health advisory
board for vaccine.
SIG Symposium
S-21
Palliative medicine
S. Pautex
University Hospital Geneva, Geneva, Switzerland
Ninety per cent of deaths across the EU occur among people over 65
years old. Furthermore, unexpected death has largely been replaced
by diseases with an elongated end-of-life trajectory such as cancer,
cardiovascular diseases or neurodegenerative diseases as dementia.
Treating these patients’ complex medical, social, psychological and