Respiratory infections: rethinking prevention policies for the elderly and frail
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It’s a lesson we’ve (hopefully) learned. In fact, Covid has taught us that people with chronic diseases are more at risk in case of respiratory infections, both for serious illness and for mortality. And they are also the ones that more than others can benefit from vaccination. We should have learned this already with the flu, from season to season, to be honest, because well before the arrival of the coronavirus, the flu was a public health problem. With Covid, however, we found ourselves battling multiple respiratory emergencies together at one point, as coronavirus cases coupled with flu season and the spread of respiratory syncytial virus, increased the strain on already strained healthcare systems. Stress largely preventable, by adhering to vaccination campaigns and strategies, which should however be rethought, underlining the urgency of guaranteeing adequate coverage especially for the most fragile in the population.
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Infections that attack the lungs
All this was told by some experts gathered in Rome on the occasion of the World Public Health Congress, in a session dedicated precisely to the impact that respiratory diseases have on health systems and to the increased risk for people with comorbidities in case of infection . Indeed, as Carlos Robalo Cordeiro, president of the European Respiratory Society (ERS), recalled, every year, worldwide, there are an estimated one billion cases of influenza, over 60 million respiratory syncytial virus infections, to which are added pandemic 760 million cases from Covid-19. Not to mention the cases of pneumococcal infection.
Syncytial virus, FDA-approved vaccine for the elderly in the United States
Respiratory diseases: who is at greater risk
“The risk associated with these infections increases in some conditions, in the event that cardiovascular diseases, metabolic diseases such as diabetes, or respiratory diseases are present – explained Cordeiro – for example the risk of pneumococcal pneumonia can increase up to 70% for those who already suffer from chronic lung disease. The same is true for RSV infections: people with lung disease, heart disease or immunosuppressed are more likely to develop disease symptoms and complications. And again for the flu, the expert recalled, showing the data from the BARI (Burden of Acute Respiratory Infections) study, relating to the impact in Portugal in past years: people with comorbidities are more at risk of both hospitalization and death . One more confirmation.
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Goal: -33% mortality from respiratory diseases by 2030
The data shown at the congress by Cordeiro serves only as a reminder of how much vaccines against preventable diseases and complications can help lift the burden on health systems and health. And it is also for this reason that, recognizing the gaps that still exist in the field of respiratory health, brought to light above all by the pandemic, the European Respiratory Society and other bodies have launched the International Respiratory Coalition (IRC). Focused for the moment in Europe – explained Cordeiro – the IRC aims to reduce deaths from respiratory diseases by a third by 2030, thanks to advocacy activities in the various countries based primarily on data. Because it’s not enough to say that vaccines can save lives: we need to show it and thus influence health promotion plans at the local level.
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Vaccination coverage still too low
And the data, when the data is there, shows that coverage is still far from being desirable. As Jane Barratt, secretary general for the International Federation of Aging (IFA), has shown, if the Covid vaccinations, at least in Western countries, have been a success (at least for the first doses), the same has not occurred with the vaccinations recommended by always to the most fragile populations, such as the flu population. Less people were vaccinated for the flu than for Covid, at least this was the case for several European countries.
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We need a change of pace
On the other hand, before the arrival of Covid, efforts have historically been focused on the pediatric population, Barratt recalled. “And that’s right, but equally we should focus on older people and those who have chronic diseases.” All the more considering that ours is a society of adults and the elderly, that three people out of four at the age of 85 are destined to have chronic diseases and that the benefits of vaccinations are measured in the reduction of hospital visits, lost days of work (even of caregivers), hospitalizations and deaths, concluded the expert.
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