{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:04:23Z","timestamp":1791594263406,"version":"4.3.4"},"reference-count":131,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T00:00:00Z","timestamp":1692835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>With the progressive lengthening of the average age of the population, especially in some countries such as Italy, vaccination of the elderly is a fixed point on which most of the public health efforts are concentrating as epidemic infectious diseases, especially those of the winter, have a major impact on the progression of severe disease, hospitalization, and death. The protection of the elderly against acute infectious diseases should not only limit mortality but also have a positive impact on the fragility of these people in terms of less disability and fewer care needs. However, vaccination of the elderly population differs in efficacy and safety compared to that of other population categories since aging and the consequent loss of efficiency of the immune system lead to a reduction in the immunogenicity of vaccines without achieving a lasting antibody coverage. There are various strategies to avoid the failure of immunization by vaccines such as resorting to supplementary doses with adjuvant vaccines, increasing the dosage of the antigen used, or choosing to inoculate the serum relying on various routes of administration of the vaccine. Vaccination in the elderly is also an important factor in light of growing antibiotic resistance because it can indirectly contribute to combating antibiotic resistance, reducing theoretically the use of those agents. Furthermore, vaccination in old age reduces mortality from infectious diseases preventable with vaccines and reduces the same rate of resistance to antibiotics. Given the importance and complexity of the topic, in this review, we will deal with the main aspects of vaccination in the elderly and how it can influence mortality and healthcare costs, especially in those countries where population aging is more evident. Therefore, we conducted a systematic literature search in PubMed to identify all types of studies published up to 31 May 2023 that examined the association between vaccination and the elderly. Data extraction and quality assessment were conducted by two reviewers (PC and TC) who independently extracted the following data and assessed the quality of each study.<\/jats:p>","DOI":"10.3390\/vaccines11091412","type":"journal-article","created":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T10:06:48Z","timestamp":1692871608000},"page":"1412","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Efficacy and Safety of Vaccinations in Geriatric Patients: A Literature Review"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3917-1478","authenticated-orcid":false,"given":"Tiziana","family":"Ciarambino","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hospital of Marcianise, ASL Caserta, 81031 Caserta, Italy"},{"name":"Direzione di Staff Direzione Generale Tutela per la Salute Regione Campania, 80143 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Crispino","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital of Latina, ASL Latina, 04100 Latina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Buono","sequence":"additional","affiliation":[{"name":"Direzione di Staff Direzione Generale Tutela per la Salute Regione Campania, 80143 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Giordano","sequence":"additional","affiliation":[{"name":"UOD 02 Prevenzione Regione Campania, 80143 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo","family":"Trama","sequence":"additional","affiliation":[{"name":"Direzione di Staff Direzione Generale Tutela per la Salute Regione Campania, 80143 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Iodice","sequence":"additional","affiliation":[{"name":"ASL Caserta, Direttore Sanitario Aziendale, 81100 Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Leoncini","sequence":"additional","affiliation":[{"name":"ASL Caserta, Direttore Sanitario, P.O. Marcianise, 81025 Marcianise, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Giordano","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Science, University of Campania, L. Vanvitelli, 81100 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.arr.2010.10.008","article-title":"Influenza vaccine responses in older adults","volume":"10","author":"McElhaney","year":"2011","journal-title":"Ageing Res. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1038\/ni.2588","article-title":"Understanding immunosenescence to improve responses to vaccines","volume":"14","author":"Goronzy","year":"2013","journal-title":"Nat. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s00281-016-0602-0","article-title":"The origin of DCs and capacity for immunologic tolerance in central and peripheral tissues","volume":"39","author":"Devi","year":"2017","journal-title":"Semin. Immunopathol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.clim.2006.09.012","article-title":"Peripheral blood dendritic cells and monocytes are differently regulated in the elderly","volume":"122","author":"Bierti","year":"2007","journal-title":"Clin. Immunol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Aiello, A., Ligotti, M.E., Garnica, M., Accardi, G., Calabr\u00f2, A., Pojero, P., Arasanz, H., Bocanegra, A., Blanco, E., and Chocarro, L. (2022). How Can We Improve Vaccination Response in Old People? Part I: Targeting Immunosenescence of Innate Immunity Cells. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23179880"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1093\/intimm\/dxs006","article-title":"Enumeration of human peripheral blood dendritic cells throughout the life","volume":"24","author":"Orsini","year":"2012","journal-title":"Int. Immunol."},{"key":"ref_7","first-page":"392","article-title":"Compromised interferon gamma (IFN-gamma) production in the elderly to both acute and latent viral antigen stimulation: Contribution to the immune risk phenotype?","volume":"13","author":"Ouyang","year":"2002","journal-title":"Eur. Cytokine Netw."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1080\/1744666X.2022.2106217","article-title":"An immunologist\u2019s guide to immunosenescence and its treatment","volume":"18","author":"Caruso","year":"2022","journal-title":"Expert. Rev. Clin. Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.3389\/fimmu.2019.02247","article-title":"Immunosenescence and Its Hallmarks: How to Oppose Aging Strategically? A Review of Potential Options for Therapeutic Intervention","volume":"10","author":"Aiello","year":"2019","journal-title":"Front. Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.exger.2006.11.016","article-title":"Aging and T-cell diversity","volume":"42","author":"Goronzy","year":"2007","journal-title":"Exp. Gerontol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1006710","DOI":"10.3389\/fimmu.2022.1006710","article-title":"Cellular senescence is a key mediator of lung aging and susceptibility to infection","volume":"13","author":"Torrance","year":"2022","journal-title":"Front. Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1189\/jlb.0306190","article-title":"High interleukin-10 production is associated with low antibody response to influenza vaccination in the elderly","volume":"80","author":"Corsini","year":"2006","journal-title":"J. Leukoc. Biol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1007\/978-0-387-09789-3_21","article-title":"Immune receptor signaling, aging, and autoimmunity","volume":"640","author":"Larbi","year":"2008","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"8077","DOI":"10.1016\/j.vaccine.2010.10.023","article-title":"Intrinsic defects in B cell response to seasonal influenza vaccination in elderly humans","volume":"28","author":"Frasca","year":"2010","journal-title":"Vaccine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"iqab007","DOI":"10.1093\/oxfimm\/iqab007","article-title":"Vaccine responses in ageing and chronic viral infection","volume":"2","author":"McCoy","year":"2021","journal-title":"Oxf. Open Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1007\/s10522-011-9353-4","article-title":"B cell immunosenescence: Different features of naive and memory B cells in elderly","volume":"12","author":"Buffa","year":"2011","journal-title":"Biogerontology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1038\/nri2785","article-title":"FOXP3+ regulatory T cells in the human immune system","volume":"10","author":"Sakaguchi","year":"2010","journal-title":"Nat. Rev. Immunol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1111\/j.1365-2249.2011.04334.x","article-title":"Interleukin-7 matures suppressive CD127+ forkhead box P3 (FoxP3)+ T cells into CD127- CD25high FoxP3+ regulatory T cells","volume":"165","author":"Phillips","year":"2011","journal-title":"Clin. Exp. Immunol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.4049\/jimmunol.181.3.1835","article-title":"Functional Regulatory T Cells Accumulate in Aged Hosts and Promote Chronic Infectious Disease Reactivation","volume":"181","author":"Lages","year":"2008","journal-title":"J. Immunol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.mad.2009.06.003","article-title":"Aging and human CD4(+) regulatory T cells","volume":"130","author":"Hwang","year":"2009","journal-title":"Mech. Ageing Dev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1016\/j.immuni.2022.10.006","article-title":"Regulatory T cells as metabolic sensors","volume":"55","author":"Procaccini","year":"2022","journal-title":"Immunity"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1586\/erv.09.12","article-title":"Prevention of infectious diseases in older adults through immunization: The challenge of the senescent immune response","volume":"8","author":"McElhaney","year":"2009","journal-title":"Expert Rev. Vaccines"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s40266-018-0597-4","article-title":"Influenza Vaccination in Older Adults: Recent Innovations and Practical Applications","volume":"36","author":"Andrew","year":"2018","journal-title":"Drugs Aging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2706","DOI":"10.1080\/21645515.2021.1875761","article-title":"Factors influencing the immunogenicity of influenza vaccines","volume":"17","author":"Wen","year":"2021","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_25","first-page":"1","article-title":"Age-associated changes in the impact of sex steroids on influenza vaccine responses in males and females","volume":"4","author":"Potluri","year":"2019","journal-title":"NPJ Vaccines"},{"key":"ref_26","unstructured":"Caruso, C., and Candore, G. (2021). Human Aging, Academic Press."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1111\/j.1751-7915.2011.00283.x","article-title":"Vaccination in the elderly","volume":"5","author":"Derhovanessian","year":"2012","journal-title":"Microb. Biotechnol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Quach, H.Q., and Kennedy, R.B. (2022). Enhancing Immunogenicity of Influenza Vaccine in the Elderly through Intradermal Vaccination: A Literature Analysis. Viruses, 14.","DOI":"10.3390\/v14112438"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12879-023-08158-3","article-title":"Factors affecting the immunogenicity of influenza vaccines in human","volume":"23","author":"Xu","year":"2023","journal-title":"BMC Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Buondonno, I., Sassi, F., Cattaneo, F., and D\u2019Amelio, P. (2022). Association between Immunosenescence, Mitochondrial Dysfunction and Frailty Syndrome in Older Adults. Cells, 12.","DOI":"10.3390\/cells12010044"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Garnica, M., Aiello, A., Ligotti, M.E., Accardi, G., Arasanz, H., Bocanegra, A., Blanco, E., Calabr\u00f2, A., Chocarro, L., and Echaide, M. (2022). How Can We Improve the Vaccination Response in Older People? Part II: Targeting Immunosenescence of Adaptive Immunity Cells. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23179797"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.jinf.2017.09.010","article-title":"Effectiveness of Influenza Vaccines in Preventing Severe Influenza Illness among Adults: A Systematic Review and Meta-Analysis of Test-Negative Design Case-Control Studies","volume":"75","author":"Rondy","year":"2017","journal-title":"J. Infect."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1093\/cid\/civ686","article-title":"The Impact of Age on the Efficacy of 13-Valent Pneumococcal Conjugate Vaccine in Elderly","volume":"61","author":"Huijts","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Lu, Y.J., Gross, J., Bogaert, D., Finn, A., Bagrade, L., Zhang, Q., Kolls, J.K., Srivastava, A., Lundgren, A., and Forte, S. (2008). Interleukin-17A Mediates Acquired Immunity to Pneumococcal Colonization. PLoS Pathog., 4.","DOI":"10.1371\/journal.ppat.1000159"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3577","DOI":"10.1016\/j.vaccine.2013.04.085","article-title":"Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine compared to a 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naive adults","volume":"31","author":"Jackson","year":"2013","journal-title":"Vaccine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1001\/jama.294.16.2043","article-title":"Changing Epidemiology of Invasive Pneumococcal Disease Among Older Adults in the Era of Pediatric Pneumococcal Conjugate Vaccine","volume":"294","author":"Lexau","year":"2005","journal-title":"JAMA"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1056\/NEJM199111213252101","article-title":"The Protective Efficacy of Polyvalent Pneumococcal Polysaccharide Vaccine","volume":"325","author":"Shapiro","year":"1991","journal-title":"N. Engl. J. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1001\/archpedi.161.12.1162","article-title":"Health care utilization for pneumonia in young children after routine pneumococcal conjugate vaccine use in the United States","volume":"161","author":"Zhou","year":"2007","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1016\/S0140-6736(07)60564-9","article-title":"Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: A time-series analysis","volume":"369","author":"Grijalva","year":"2007","journal-title":"Lancet"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1086\/651199","article-title":"Influence of Age Nature of Primary Infection on Varicella-Zoster Virus\u2014Specific Cell-Mediated Immune Responses","volume":"201","author":"Weinberg","year":"2010","journal-title":"J. Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Liu, X., Chang, S., Wang, R., Xiao, Y., Li, F., Xu, Q., Zhang, S., Chen, X., Zhang, S., and Zhang, M. (2022). Immunogenicity and Safety of an Inactivated Enterovirus 71 Vaccine Administered Simultaneously with Hepatitis B Virus Vaccine, Group A Meningococcal Polysaccharide Vaccine, Measles-Rubella Combined Vaccine and Japanese Encephalitis Vaccine: A Multi-Center, Randomized, Controlled Clinical Trial in China. Vaccines, 10.","DOI":"10.3390\/vaccines10060895"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"n1088","DOI":"10.1136\/bmj.n1088","article-title":"Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on covid-19 related symptoms, hospital admissions, and mortality in older adults in England: Test negative case-control study","volume":"373","author":"Bernal","year":"2021","journal-title":"BMJ"},{"key":"ref_43","first-page":"1337","article-title":"Comparative Effectiveness of Moderna, Pfizer-BioNTech, and Janssen (Johnson & Johnson) Vaccines in Preventing COVID-19 Hospitalizations Among Adults Without Immunocompromising Conditions\u2014United States, March\u2013August 2021. MMWR. Morb. Mortal","volume":"70","author":"Self","year":"2021","journal-title":"Wkly. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1007\/s15006-018-0029-8","article-title":"Risikoimpfungen im Alter [Vaccinations in the elderly-who, when and which vaccine to use]","volume":"160","author":"Forstner","year":"2018","journal-title":"MMW Fortschr. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1097\/ACI.0000000000000855","article-title":"Anaphylaxis in elderly people","volume":"22","author":"Ventura","year":"2022","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.coi.2013.07.008","article-title":"Perspectives on vaccine development for the elderly","volume":"25","author":"Li","year":"2013","journal-title":"Curr. Opin. Immunol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss7003a1","article-title":"Surveillance of Vaccination Coverage Among Adult Populations\u2014United States, 2018","volume":"70","author":"Lu","year":"2021","journal-title":"MMWR Surveill. Summ."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"5819","DOI":"10.1016\/j.vaccine.2018.08.041","article-title":"Vaccination of 50+ adults to promote healthy ageing in Europe: The way forward","volume":"36","author":"Esposito","year":"2018","journal-title":"Vaccine"},{"key":"ref_49","first-page":"1777","article-title":"Recommended immunization schedules for adults: Clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid)","volume":"12","author":"Esposito","year":"2016","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e004898","DOI":"10.1136\/bmjgh-2020-004898","article-title":"Vaccine safety issues at the turn of the 21st century","volume":"6","author":"Conklin","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e003403","DOI":"10.1136\/bmjgh-2020-003403","article-title":"Evolving pharmacovigilance requirements with novel vaccines and vaccine components","volume":"6","author":"Zuber","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.autrev.2019.05.006","article-title":"Myalgia and chronic fatigue syndrome following immunization: Macrophagic myofasciitis and animal studies support linkage to aluminum adjuvant persistency and diffusion in the immune system","volume":"18","author":"Gherardi","year":"2019","journal-title":"Autoimmun. Rev."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.vaccine.2018.11.045","article-title":"Causal relationship between immunological responses and adverse reactions following vaccination","volume":"37","author":"Nakayama","year":"2019","journal-title":"Vaccine"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12879-018-2984-1","article-title":"Mortality estimates among adult patients with severe acute respiratory infections from two sentinel hospitals in southern Arizona, United States, 2010\u20132014","volume":"18","author":"Barnes","year":"2018","journal-title":"BMC Infect. Dis."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12879-023-08015-3","article-title":"Excess hospitalizations and mortality associated with seasonal influenza in Spain, 2008\u20132018","volume":"23","author":"Pumarola","year":"2023","journal-title":"BMC Infect. Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1007\/s15010-019-01299-1","article-title":"Utility of predictive tools for risk stratification of elderly individuals with all-cause acute respiratory infection","volume":"47","author":"Bloom","year":"2019","journal-title":"Infection"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1007\/s40520-019-01375-4","article-title":"Infections in the older population: What do we know?","volume":"33","author":"Schoevaerdts","year":"2021","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12877-021-02049-5","article-title":"Frailty and hospitalization-associated disability after pneumonia: A prospective cohort study","volume":"21","author":"Park","year":"2021","journal-title":"BMC Geriatr."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"690328","DOI":"10.3389\/fimmu.2021.690328","article-title":"B-Cell Immunophenotyping to Predict Vaccination Outcome in the Immunocompromised\u2014A Systematic Review","volume":"12","author":"Diks","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"41","DOI":"10.3389\/fimmu.2016.00041","article-title":"T-Cell Immunity to Influenza in Older Adults: A Pathophysiological Framework for Development of More Effective Vaccines","volume":"7","author":"McElhaney","year":"2016","journal-title":"Front. Immunol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e001233","DOI":"10.1136\/bmjresp-2022-001233","article-title":"Functional status recovery trajectories in hospitalised older adults with pneumonia","volume":"9","author":"Park","year":"2022","journal-title":"BMJ Open Respir. Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12877-023-04029-3","article-title":"Prognostic significance of frailty in hospitalized elderly patients with community-acquired pneumonia: A retrospective cohort study","volume":"23","author":"Zhao","year":"2023","journal-title":"BMC Geriatr."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s12979-021-00249-6","article-title":"Vaccination of older adults: Influenza, pneumococcal disease, herpes zoster, COVID-19 and beyond","volume":"18","author":"Weinberger","year":"2021","journal-title":"Immun. Ageing"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1056\/NEJMoa051016","article-title":"A Vaccine to Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults","volume":"352","author":"Oxman","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1111\/jgs.16917","article-title":"Recombinant Zoster Vaccine Is Efficacious and Safe in Frail Individuals","volume":"69","author":"Curran","year":"2020","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1093\/infdis\/jiy514","article-title":"Persistence of Varicella-Zoster Virus Cell-Mediated Immunity After the Administration of a Second Dose of Live Herpes Zoster Vaccine","volume":"219","author":"Weinberg","year":"2018","journal-title":"J. Infect. Dis."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12879-021-05992-1","article-title":"Informing the public health response to COVID-19: A systematic review of risk factors for disease, severity, and mortality","volume":"21","author":"Flook","year":"2021","journal-title":"BMC Infect. Dis."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jinf.2021.05.004","article-title":"Epidemiology and organ specific sequelae of post-acute COVID19: A narrative review","volume":"83","author":"Korompoki","year":"2021","journal-title":"J. Infect."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"M\u00fcller, L., and Di Benedetto, S. (2021). How Immunosenescence and Inflammaging May Contribute to Hyperinflammatory Syndrome in COVID-19. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms222212539"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Rivera-Torres, J., Gir\u00f3n, N., and Jos\u00e9, E.S. (2023). COVID-19: A Comprehensive Review on Cardiovascular Alterations, Immunity, and Therapeutics in Older Adults. J. Clin. Med., 12.","DOI":"10.3390\/jcm12020488"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Ciarambino, T., Crispino, P., Minervini, G., and Giordano, M. (2023). COVID-19 and Frailty. Vaccines, 11.","DOI":"10.3390\/vaccines11030606"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"29","DOI":"10.13105\/wjma.v11.i1.29","article-title":"Post-COVID-19 cholangiopathy: A systematic review","volume":"11","author":"Zippi","year":"2023","journal-title":"World J. Meta-Anal."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1038\/s41586-021-03739-1","article-title":"Age-related immune response heterogeneity to SARS-CoV-2 vaccine BNT162b2","volume":"596","author":"Collier","year":"2021","journal-title":"Nature"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Booth, A., Reed, A.B., Ponzo, S., Yassaee, A., Aral, M., Plans, D., Labrique, A., and Mohan, D. (2021). Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0247461"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.idc.2022.11.002","article-title":"Vaccines for the Prevention of Coronavirus Disease 2019 in Older Adults","volume":"37","author":"Oyebanji","year":"2023","journal-title":"Infect Dis. Clin. North Am."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1056\/NEJMoa2034577","article-title":"Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine","volume":"383","author":"Polack","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1056\/NEJMoa2035389","article-title":"Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine","volume":"384","author":"Baden","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.1056\/NEJMoa2101544","article-title":"Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19","volume":"384","author":"Sadoff","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1016\/S0140-6736(21)00790-X","article-title":"COVID-19 vaccine coverage in health-care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): A prospective, multicentre, cohort study","volume":"397","author":"Hall","year":"2021","journal-title":"Lancet"},{"key":"ref_80","first-page":"2100452","article-title":"Working Group for the surveillance and control of COVID-19 in Spain Effectiveness of mRNA COVID-19 vaccines in preventing SARS-CoV-2 infections and COVID-19 hospitalisations and deaths in elderly long-term care facility residents, Spain, weeks 53 2020 to 13 2021","volume":"26","author":"Mazagatos","year":"2021","journal-title":"Wkly. Releases (1997\u20132007)"},{"key":"ref_81","first-page":"2100563","article-title":"Efficacy and effectiveness of COVID-19 vaccines against SARS-CoV-2 infection: Interim results of a living systematic review, 1 January to 14 May 2021","volume":"26","author":"Harder","year":"2021","journal-title":"Wkly. Releases (1997\u20132007)"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"12896","DOI":"10.1073\/pnas.1721095115","article-title":"Impact of existing vaccines in reducing antibiotic resistance: Primary and secondary effects","volume":"115","author":"Klugman","year":"2018","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"2215149","DOI":"10.1080\/21645515.2023.2215149","article-title":"Economic and cost-effectiveness aspects of vaccines in combating antibiotic resistance","volume":"19","author":"Yemeke","year":"2023","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_84","unstructured":"Antimicrobial Resistance Collaborators (2022). Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet, 399, 629\u2013655. Erratum in Lancet2022, 400, 1102."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1080\/14760584.2018.1488590","article-title":"Escherichia coli and Staphylococcus aureus: Leading bacterial pathogens of healthcare-associated infections and bacteremia in older-age populations","volume":"17","author":"Poolman","year":"2018","journal-title":"Expert. Rev. Vaccines"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1080\/03009734.2016.1195900","article-title":"Antimicrobial resistance-a threat to the world\u2019s sustainable development","volume":"121","author":"Littmann","year":"2016","journal-title":"Ups. J. Med. Sci."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"278","DOI":"10.3201\/eid0803.010192","article-title":"The Relationship between Antimicrobial Use and Antimicrobial Resistance in Europe","volume":"8","author":"Bronzwaer","year":"2002","journal-title":"Emerg. Infect. Dis."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/j.cmi.2017.06.011","article-title":"Is antimicrobial stewardship cost-effective? A narrative review of the evidence","volume":"23","author":"Naylor","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_90","first-page":"CD003543","article-title":"Interventions to improve antibiotic prescribing practices for hospital inpatients","volume":"2017","author":"Davey","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_91","first-page":"103","article-title":"Adjuvants","volume":"428","author":"Carter","year":"2020","journal-title":"Curr. Top. Microbiol. Immunol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/978-1-0716-1884-4_2","article-title":"Principles in Immunology for the Design and Development of Vaccines","volume":"2410","author":"Meyer","year":"2022","journal-title":"Methods Mol. Biol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1159\/000504490","article-title":"Vaccines to Protect Older Adults against Pneumococcal Disease","volume":"43","author":"Knol","year":"2020","journal-title":"Interdiscip. Top. Gerontol. Geriatr."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"103044","DOI":"10.1016\/j.ebiom.2020.103044","article-title":"Exploring the pathophysiology of post-sepsis syndrome to identify therapeutic opportunities","volume":"61","author":"An","year":"2020","journal-title":"EBioMedicine"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s40266-013-0060-5","article-title":"Preventing pneumococcal disease in the elderly: Recent advances in vaccines and implications for clinical practice","volume":"30","year":"2013","journal-title":"Drugs Aging"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"81","DOI":"10.7774\/cevr.2021.10.2.81","article-title":"Impact of vaccination on carriage of and infection by antibiotic-resistant bacteria: A systematic review and meta-analysis","volume":"10","author":"Wang","year":"2021","journal-title":"Clin. Exp. Vaccine Res."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Mullins, L.P., Mason, E., Winter, K., and Sadarangani, M. (2023). Vaccination is an integral strategy to combat antimicrobial resistance. PLoS Pathog., 19.","DOI":"10.1371\/journal.ppat.1011379"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s13756-023-01272-6","article-title":"The impact of influenza and pneumococcal vaccination on antibiotic use: An updated systematic review and meta-analysis","volume":"12","author":"Paget","year":"2023","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/S0140-6736(15)00473-0","article-title":"Understanding the mechanisms and drivers of antimicrobial resistance","volume":"387","author":"Holmes","year":"2016","journal-title":"Lancet"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13756-021-00929-4","article-title":"Barriers to implementing antimicrobial stewardship programs in three low- and middle-income country tertiary care settings: Findings from a multi-site qualitative study","volume":"10","author":"Rolfe","year":"2021","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.cmi.2021.09.036","article-title":"Immunological and clinical efficacy of COVID-19 vaccines in immunocompromised populations: A systematic review","volume":"28","author":"Galmiche","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"e125","DOI":"10.1093\/cid\/ciz1090","article-title":"Herpes Zoster Risk in Immunocompromised Adults in the United States: A Systematic Review","volume":"71","author":"McKay","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1186\/s13054-019-2539-x","article-title":"Influenza virus-related critical illness: Pathophysiology and epidemiology","volume":"23","author":"Kalil","year":"2019","journal-title":"Crit. Care"},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Sprenger, R., H\u00e4ckl, D., Kossack, N., Schiffner-Rohe, J., Wohlleben, J., and von Eiff, C. (2022). Pneumococcal vaccination rates in immunocompromised patients in Germany: A retrospective cohort study to assess sequential vaccination rates and changes over time. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0265433"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1963","DOI":"10.3389\/fimmu.2018.01963","article-title":"New Vaccine Technologies to Combat Outbreak Situations","volume":"9","author":"Rauch","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"4161","DOI":"10.1016\/j.vaccine.2015.04.036","article-title":"Vaccine hesitancy: Definition, scope and determinants","volume":"33","author":"MacDonald","year":"2015","journal-title":"Vaccine"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"5013","DOI":"10.1016\/j.vaccine.2016.08.029","article-title":"Vaccine hesitancy among healthcare workers in Europe: A qualitative study","volume":"34","author":"Karafillakis","year":"2016","journal-title":"Vaccine"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"2079344","DOI":"10.1080\/21645515.2022.2079344","article-title":"Associations between vaccination and quality of life among Taiwan general population: A comparison between COVID-19 vaccines and flu vaccines","volume":"18","author":"Lin","year":"2022","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1111\/psyg.12376","article-title":"Predictors of health related-quality of life among elderly with disabilities","volume":"19","author":"Janjusevic","year":"2019","journal-title":"Psychogeriatrics"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss6611a1","article-title":"Surveillance of Vaccination Coverage among Adult Populations\u2014United States, 2015","volume":"66","author":"Williams","year":"2017","journal-title":"MMWR Surveill. Summ."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"155","DOI":"10.3390\/pathophysiology30020014","article-title":"Challenges in the Vaccination of the Elderly and Strategies for Improvement","volume":"30","author":"Soegiarto","year":"2023","journal-title":"Pathophysiology"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1080\/21645515.2019.1581540","article-title":"How to promote vaccinations: A pilot study in the North-West of Italy","volume":"15","author":"Baratta","year":"2019","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_113","unstructured":"International Pharmaceutical Federation (FIP) (2016). An Overview of Current Pharmacy Impact on Immunization A Global Report, International Pharmaceutical Federation."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/j.vaccine.2019.01.038","article-title":"Corrigendum to \u2018A report on the status of vaccination in Europe\u2019 [Vaccine 36 (2018) 4979\u20134992]","volume":"37","author":"Sheikh","year":"2019","journal-title":"Vaccine"},{"key":"ref_115","first-page":"w20105","article-title":"Measles in Switzerland-progress made, but communication challenges lie ahead","volume":"149","author":"Tarr","year":"2019","journal-title":"Swiss Med. Wkly."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1007\/s11096-016-0255-z","article-title":"Who uses pharmacy for flu vaccinations? Population profiling through a UK pharmacy chain","volume":"38","year":"2016","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_117","first-page":"1","article-title":"Perceptions of interprofessional collaboration of general practitioners and community pharmacists\u2014A qualitative study","volume":"17","author":"Koudmani","year":"2017","journal-title":"BMC Health Serv. Res."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"e053163","DOI":"10.1136\/bmjopen-2021-053163","article-title":"\u201cVaccination needs to be easy for the people, right?\u201d: A qualitative study of the roles of physicians and pharmacists regarding vaccination in Switzerland","volume":"11","author":"Jusufoska","year":"2021","journal-title":"BMJ Open"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1370\/afm.1542","article-title":"Vaccinations administered during off-clinic hours at a national community pharmacy: Implications for increasing patient access and convenience","volume":"11","author":"Goad","year":"2013","journal-title":"Ann. Fam. Med."},{"key":"ref_120","unstructured":"World Health Organization (WHO) (2023, July 31). Guide to Cost-Effectiveness Analysis of Immunization Programs. Available online: https:\/\/www.who.int\/immunization\/documents\/Elsevier_Vaccine_Cost_effectiveness.pdf."},{"key":"ref_121","unstructured":"Meltzer, M.I., and Graham, J.D. (2001). Vaccines, Elsevier. [6th ed.]."},{"key":"ref_122","unstructured":"Centers for Disease Control and Prevention (CDC) (2023, July 31). Economic Evaluation of Vaccination Programs: An Introduction, Available online: https:\/\/www.cdc.gov\/vaccines\/hcp\/acip-recs\/general-recs\/economic-impact.html."},{"key":"ref_123","first-page":"2006","article-title":"Vaccine economics: What can it teach us?","volume":"36","author":"Laxminarayan","year":"2017","journal-title":"Health Aff."},{"key":"ref_124","first-page":"1877","article-title":"Economic evaluations of varicella vaccination programs: A review of the literature","volume":"10","author":"Bilcke","year":"2011","journal-title":"Expert Rev. Vaccines"},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1056\/NEJMsa0806477","article-title":"Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases","volume":"360","author":"Omer","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1093\/cid\/cir007","article-title":"Herd immunity\u201d: A rough guide","volume":"52","author":"Fine","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1542\/peds.2013-0698","article-title":"Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009","volume":"133","author":"Zhou","year":"2014","journal-title":"Pediatrics"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1001\/jama.2020.14828","article-title":"Vaccine Refusal and Measles Outbreaks in the US","volume":"324","author":"Phadke","year":"2020","journal-title":"JAMA"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1586\/14760584.2015.964212","article-title":"Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: Influence, impact and implications","volume":"14","author":"Vivion","year":"2015","journal-title":"Expert. Rev. Vaccines"},{"key":"ref_130","first-page":"1691","article-title":"Travel-associated measles following a domestically acquired case, Oregon, 2016","volume":"23","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_131","first-page":"e275","article-title":"Achieving and sustaining measles elimination","volume":"19","author":"Patel","year":"2019","journal-title":"Lancet Infect. Dis."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/11\/9\/1412\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:38:07Z","timestamp":1760128687000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/11\/9\/1412"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,24]]},"references-count":131,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["vaccines11091412"],"URL":"https:\/\/doi.org\/10.3390\/vaccines11091412","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,24]]}}}