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Background: Immunosenescence leads to an increasing susceptibility to infections. Therefore, vaccination is an essential element of prevention. The recommendations of the permanent vaccination commission (STIKO), a committee at the Robert-Koch-Institute, affiliated to the German Government, are updated every year and include a particular section dealing with older adults., Current Developments: Immunosenescence reduces vaccine effectiveness. Thus, older adults and patients with multimorbidity are in need of more immunogenic vaccines. Cell culture derived quadrivalent influenza vaccine, trivalent adjuvanted vaccine and a high dose influenza vaccine show higher immune response in these groups. STIKO actually recommends an adjuvanted herpes zoster subunit vaccine to all adults in the age of 60 and above because of its vaccine effectiveness of 90 % in all age groups. The increasing travel activities of older adults require travel vaccination advice that takes into account travel destination as well as multimorbidity. Adjusted vaccination schedules and controlling of antibody titers have to be considered., Outlook: New vaccines are under development, that are more immunogenic and therefore more effective (e. g. pneumococcal vaccine) or that prevent infections for which a vaccine was previously not available (e. g. norovirus vaccine)., Competing Interests: A. Kwetkat gibt Forschungsunterstützung des Forschungskollegs Geriatrie der Robert-Bosch-Stiftung und der Pfizer Pharma GmbH an sowie Vortragshonorare von Pfizer Pharma GmbH, Fa. MSD, Fa. Novartis, Fa. Daiichi-Sankyo, Fa. Bristol-Myers Squibb und Beratungstätigkeit als Mitglied im Advisory Board PCV-13 Adult, Pfizer Pharma GmbH, Mitglied Advisory Board Prävention Herpes Zoster, GlaxoSmithKline GmbH & Co. KG und Mitglied Projekt Grippeschutz, Seqirus.A.-S. Endres gibt keine Interessenkonflikte an.A. Leischker gibt Vortragshonorare und Beratertätigkeit für die Firmen Sanofi und GSK an.H.J. Heppner gibt Forschungsunterstützung des Forschungskollegs der Robert-Bosch-Stiftung, GB-A Innovationsfond sowie Vortragshonorare von Pfizer, Bayer Health Care, Novartis und AO Trauma Europe an., (© Georg Thieme Verlag KG Stuttgart · New York.)

The following chapter is focused on the impact of comorbidities on the effectiveness of vaccination in older persons. Relevant comorbidities are cardiovascular diseases like hypertension, coronary artery disease or congestive heart failure, which lead to reduction of vaccine immunogenicity; or chronic obstructive pulmonary disease with a decline in lung function and a higher risk for pneumonia or infections due to influenza. End-stage renal disease has a high impact on developing infections and causes immune dysfunction over all parts of the immune system. Depression and dementia as well as psychological stress are associated with poor antibody response and a higher range of inflammation markers. Chronic inflammatory processes like rheumatoid arthritis also alter the immune system. In addition, geriatric syndromes and lowered functional status have implications for the vaccination response. Malnutrition is characterized by depletion of structural and functional proteins. This leads to a low antibody response. Negative immunomodulatory effects are also observed in vitamin D insufficiency. Frailty as well is associated with immunological changes and lowered performance in the activities of daily living, but moderate physical activity improves immune function., (© 2020 S. Karger AG, Basel.)

Background: Despite annual updates of vaccination recommendations by the German Standing Committee on Vaccination (STIKO) at the Robert Koch Institute, diseases preventable by vaccination still cause a relevant burden of disease in the elderly., Objectives: A comparison of the vaccination status of the elderly in Bavaria and Thuringia was carried out., Material and Methods: Medical settlement data from the first quarter of 2007 to the second quarter of 2008 from the association of panel doctors in Bavaria and Thuringia for insured persons aged 60 years and above were analyzed concerning vaccinations, age, gender and multimorbidity. The vaccination rates for influenza were calculated., Results: The use of all recommended vaccinations in this age group was greater in Thuringia (eastern federal state) than in Bavaria (western federal state). In both states the administration rates of tetanus and diphtheria vaccines were lower in individuals with higher comorbidity and age. Protection rates against diphtheria were incomplete as a result of inadequate use of combination vaccines. In both states the administration of pneumococcal vaccine was higher in subjects with more comorbidities. In Bavaria administration rates increased with age. Influenza vaccination rates increased in association with age and comorbidity in both states. In elderly individuals influenza vaccination was used more often in the third quarter of 2007., Conclusion: Old age and multimorbidity are often insufficiently taken into consideration in studies on vaccination rates. The data from this study confirmed the relevant findings from other studies and emphasize the deficient implementation of standard vaccinations in primary prevention. In this study very old patients were differentiated and considered according to age groups for the first time.

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