In the past two years, even the most skeptical should have learned this. Non-drug prevention measures – masks, social distancing, hand hygiene – have a significant impact in limiting the spread of viruses and bacteria. But if you aim to defeat infectious diseases from their origins, there is no more effective tool than vaccinations. And this also falls for adults. “There are two chapters in the National Vaccine Prevention Plan: one dedicated to adults and one to the elderly – he reasons Giovanni Gabutti, coordinator of the working group dedicated to vaccines and vaccination policies of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI), meeting until Saturday 1 October in Padua for the national congress -. However, we are still far from an adequate level of awareness: both in citizenship and among some categories of specialists “.
When it comes to vaccines, the tendency is often to associate them with an early age. It is no coincidence that the greatest investment in vaccination campaigns concerns the age groups between 0 and 6 years. In reality there is another large category that would need more investment and it is that of the elderly. In addition to the flu one (to be repeated annually), from the age of 65 the vaccination calendars drawn up by the Ministry recommend (and offer) vaccination to combat Herpes zoster (responsible for the Shingles) and that against Pneumococcus (cause of bacterial pneumonia).
An aid against antibiotic resistance
“These vaccines represent a great opportunity against infections with serious consequences – he stresses Claudio Mastroianni, director of the UOC of Infectious Diseases at the Policlinico Umberto I in Rome and president of the Italian Society of Infectious and Tropical Diseases (Simit) – Intervening in the limitation of these diseases can be an additional weapon also to limit resistance to antibiotics: most significant threat of the coming decades. We must work to foster the development of a vaccine culture, which involves all doctors: from general practitioners to infectious diseases, without forgetting all those specialists who follow the frail patients whose vaccination can save their lives. I am thinking above all of oncologists, hematologists, geriatricians and nephrologists “.
Awareness of the importance of flu prophylaxis has also grown thanks to the pandemic: with family doctors now ready to signal the importance of this vaccination to their patients. Far less, however, is the knowledge about the other two. “Pneumococcus is a bacterium that determines an increase in hospitalizations and contributes to increasing the number of deaths caused by pneumonia – specifies Gabutti, former professor of Hygiene and Preventive Medicine at the University of Ferrara -. Pneumococcal vaccination can be carried out at any time of the year, but in this phase it is indicated to receive it together with the anti-flu: with one injection for each arm. After an initial decline, dictated by the closure of vaccination services, the arrival of the pandemic has increased the response to this vaccination . Overall, awareness of the importance of preventing respiratory infections has grown. But we are still far from the national goal: vaccinating at least 75 per cent of the elderly “.
Two doses for the elderly
A consideration that is obtained by putting together a “puzzle” on a national scale, since there are still no ministerial data on the spread of prophylaxis against pneumococcus. Vaccination in the elderly – an aspect not always known – consists of two doses. The first with the 13 valent conjugate vaccine, the same that is administered through three injections in the first years of life, to trigger the response and promote the formation of an immunological memory. This, after at least two months, must be followed by the second, with the 23 valent vaccine: essential for broadening the spectrum of coverage towards a greater number of pathogens. But there is something new on the horizon: the arrival of two other conjugate vaccines, capable of protecting against 15 and 20 pneumococcal strains. Both the European Agency (EMA) and the Italian Medicines Agency (AIFA) have already approved them. The Regions are preparing the tenders for purchases, but they will hardly move before the ok to the new Vaccine Prevention Plan: one of the most urgent deadlines that awaits the next Minister of Health.
Before reaching the third age, vaccinations are also important in adulthood. In fact, every ten years the one that protects against diphtheria, tetanus and pertussis should be recalled. Considering the increase in cases recorded in recent years, it is also important to check coverage against measles. Hence the indication to vaccinate adults – prophylaxis also covers mumps, rubella and chicken pox – who have never been protected during childhood or have contracted the disease. Between the ages of 19 and 64, vaccination against four meningococcal strains (A, C, W, Y) and against HPV, the main sexually transmitted infection and the primary cause of cervical cancer, are also indicated.
A session of the congress was dedicated to prophylaxis in adult women. “We are talking about a vaccine that is recommended and offered free of charge to 12-year-olds of both sexes, but whose effectiveness is now also proven among 25-year-old women,” she explains. Giancarlo Icardidirector of the hygiene laboratory of the San Martino hospital in Genoa and member of the SItI vaccine working group. All the Italian Regions today offer it at least up to the age of majority: both to girls and to boys. And many also to older women (not men, who are still exposed to the risk of cancers of the penis, anus, head and neck) who have had an infection. “We know that the coverage in this case does not last a lifetime. This is why it is useful to get vaccinated even after coming into contact with HPV.”
The vaccine also to prevent relapse
There are 15 Regions that offer vaccination to women already treated for an injury to the cervix from HPV: with the exception of Piedmont, Calabria (which however also guarantee it for 25 year olds), Valle d’Aosta, the Autonomous Province of Bolzano and Abruzzo. “The target is represented by women who have already received gynecological treatment for the removal of a preneoplastic lesion, type CIN 2 or CIN 3. By administering them three doses, in the month following the operation, the risk of relapse can be reduced up to 80 percent “. Although it is a sexually transmitted infection, it is important to know that behind a contagion there is not always the habit of having sex with several partners. “We are talking about a ubiquitous virus, with which 7 out of 10 girls come into contact one year after the start of sexual activity – concludes Icardi -. Not all, of course, are destined to get cancer. Indeed, the fact that the infection often remains silent it favors its circulation: even within stable couples “. All the more reason to protect yourself with vaccination.