Opportunity for healthy ageing: lessening the burden of adult pneumococcal disease in Central and Eastern Europe, and Israel.

REVIEW AND ANALYSIS OF THE PROBLEM SUMMARY The population of the Region (Central Europe, Eastern Europe, and Israel) is ageing, necessitating preventative programmes to maintain a healthy and active lifestyle in older age groups. Invasive pneumococcal disease (including bacteremic pneumonia, bacteremia without a focus, and meningitis) has higher incidence, morbidity and mortality in older adults and is a substantial public health burden in the ageing population. Surveillance in the Region establishes a significant burden in older adults of invasive pneumococcal disease (IPD), which still appears to be under-estimated as compared with other countries, and this warrants an improvement in surveillance systems. The largest proportion of IPD in adults is bacteremic pneumonia. Community-acquired pneumonia (CAP), largely attributable to S. pneumoniae, can be bacteremic or non-bacteremic; the non-bacteremic forms of CAP also represent a significant burden in the Region. The burden of pneumococcal disease can be reduced with programmes of effective vaccination. Recommendations on pneumococcal vaccination in adults vary widely across the Region. The main barrier to implementation of vaccination programmes is low awareness among healthcare professionals on serious heatlh consequences of adult pneumococcal disease and of vaccination options. The Expert Panel calls on healthcare providers in the Region to improve pneumococcal surveillance, optimize and disseminate recommendations for adult vaccination, and support awareness and education programmes about adult pneumococcal disease. Key words: invasive pneumococcal disease (IPD), community-acquired pneumonia (CAP), Central and Eastern Europe (CEE), Israel, pneumococcal vaccines, vaccination, elderly adults Healthy Ageing: a Growing Public Health Issue The proportion of adults in the Region (Central Europe, Eastern Europe, and Israel) over the age of 50 years has nearly doubled in the past six decades (Fig. 1) and is forecasted to double again by 2040 (1). As a consequence, the Region will increasingly face the issue of "healthy ageing" (i.e. maintaining the general level of health, quality of life and active lifestyle in an ageing population). Public health should target preventable diseases associated with older age and related co-morbidities (2) by programmes ranging from already established initiatives for reduction of cardiovascular risks to currently less utilized options for adult vaccination. Adult Vaccination - the Neglected Solution? The public health value of prevention through vaccination (i.e. lowering disease incidence in the target population) is well documented in paediatric populations and likewise in adults. The value can expand beyond direct effects like an impact on the incidence of invasive pneumococcal disease (IPD) cases in the target population. For instance, successful pneumococcal vaccination in paediatric programmes has associated individual and economic benefits, such as an impact on the patterns of antibiotic therapy, thus reducing the number of treatment failures linked to antibiotic resistance (3). In adults, pneumococcal vaccination, in addition to its protective effect against pneumococcal disease, may prevent pneumonia-associated cardiovascular events (4) and, when co-administered with influenza vaccination, may reduce the risk of myocardial infarction and stroke in the elderly (5). However, the preventative value of vaccination in adults is under-recognised. Healthcare providers traditionally associate vaccination programmes with paediatric practice. "Vaccination for kids" is the current paradigm that needs to be transformed to address the substantial but not fully appreciated public health needs of the ageing population. Preventive potential of adult pneumococcal vaccination is particularly neglected in the Region, due to low awareness of the burden of pneumococcal disease in adults and under-recognition of the potential of preventive measures (6). …