Vaccines, Vaccine-Preventable Diseases, and Frailty

Infections have important adverse consequences for older adults, particularly those who are frail. In this chapter, we review how age and frailty impact immune responses to infections and vaccines, including through immunosenescence and inflammaging. We discuss infections that are currently vaccine-preventable in the context of vaccines that are available and recommended for older adults. We review existing evidence on how frailty impacts vaccine responses and outcomes (including long-term sequalae) from these infections and note important evidence gaps. We argue for the importance of considering age and frailty in all stages of development, evaluation, regulation, and implementation of current and future vaccines for older adults. Given suboptimal uptake of currently recommended vaccines, we consider barriers and facilitators for older adult immunization. We conclude by underscoring the need for communication of the benefits of vaccination for older frail adults and advocacy for continued focus on immunization to promote optimal aging.