Since 2017 they are included in the essential levels of assistance (Lea) and therefore i vaccines for adults and the elderly they are today a prevention tool of primary importance for the protection of public health in all respects. But on the cultural level there is still a lot to do.
“Italy has been a pioneer, having offered the adult and elderly population a richer offer than many other countries with the National Plan of vaccination prevention 2017-2019 “, declares Andrea Poscia, medical director at the Hygiene and Public Health UOC – Prevention and surveillance of infectious and chronic-degenerative diseases at ASUR Marche, in the operational headquarters in Jesi. “A vision prevailed that today is even more central, that of active and healthy aging, a concept to be protected and that the pandemic has highlighted its importance even more”.
The rationale of the national plan is to prevent specific pathologies in the elderly population, which are joined by frail subjects, regardless of age. “For the elderly we are talking about four basic vaccinations, of which the one against diphtheria, tetanus and pertussis provides a single vaccine with a decennial booster. Tetanus in particular is now a typical pathology of the unvaccinated elderly, while pertussis is often underdiagnosed and constitutes a problem not only for the subject, but also for unprotected grandchildren – specifies Poscia -. In addition, for years the anti-flu vaccination has been introduced from the age of 65 and up, anticipated after the appearance of Covid at the age of 60. Another important vaccine for the elderly is the anti-pneumococcus against pneumonia and requires two administrations one year apart, and is expected from the age of 65. The same modality of offer concerns the vaccine against herpes zoster: being able to defend oneself from the shingles is important to avoid the appearance of disabling manifestations, sometimes with painful aftermath, such as postherpetic neuralgia, for which there is no satisfactory therapy “.
The inclusion of vaccines in Lea means that they are collectable by the citizens, but still on the informational level there is a lot to do so that the population is aware of them. “The active call, which is one of the main tools implemented by the local health authorities, does not always manage to involve all citizens who are entitled to it”, underlines Poscia, who is also a contract professor of Hygiene at the University of the Sacred Heart of Milan. “Even in the face of a letter sent by the ASL it is not taken for granted that the citizen perceives its importance. For this reason, various scientific societies, in particular those involved in the Calendar for Life board, alongside associations committed to promoting active aging, such as Happyageing and Italia Longeva, or Cittadinanza Attiva and some trade unions, carry out promotional initiatives for health professionals. and citizens. These are efforts to be implemented, keeping in mind that the first reference of the elderly subject is his general practitioner who, together with any specialists consulted for chronic diseases, must explain the importance of vaccination prevention and address the person ” .
In order to reach citizens in the best possible way, the pandemic has led to the activation of known tools and also to innovation. Modalities that can be useful even now, when it is time to improve reduced coverage during the Covid emergency. “Versus herpes zoster, flu, pneumococcal pneumonia you can do campaigns with large numbers, in large locations that guarantee distancing. A central aspect of population vaccination is that it involves not only health institutions, but also local administrations and the third sector, elements that promote vaccination culture. This also applies to the more traditional equipped campers, with which to propose anti-Covid administration and information in the squares and places close to citizens’ daily lives. We must also improve the service for patients with chronic and disabling diseases, who can take advantage of the home or hospital service, both in terms of information and as a vaccination center “.
Co-administration of vaccines can be one of the keys to increasing coverage and managing spending better. “Administering more than one vaccine in a single session is to be considered a good, safe and effective practice, which guarantees citizens the quickest possibility of protecting themselves against dangerous diseases”, highlights Poscia.
Among the preventable diseases, herpes zoster does not play a secondary role: in severe cases it can lead to diseases of the cranial nerves with auricular or ophthalmic herpes. There are not rare cases in which the pathology evolves into post herpetic neuralgia, very painful and difficult to cure, with evident deficits in the quality of life. Since 2017, vaccination has been offered free of charge for the population cohort that turns 65 and is recommended after the age of 50 if you have risk conditions such as diabetes, chronic cardiovascular and respiratory diseases, or in view of immunosuppressive therapy. “Now we have two vaccines available: the new formulation introduced in Italy has excellent efficacy data precisely in the elderly population and allows administration from the age of 18 onwards, if fragile, and can be used in immunocompromised patients – specific Poscia -. At the moment, however, there may be inequalities in access due to the lack of clarity about the offer to the citizen. Indications of a regional nature are gradually coming out, but we hope that the next National Plan will be able to standardize them throughout the Italian territory “.
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