every time we discuss about immunization program in adult and in elderly people , we should consider two important changes that happened in our current society : the increasing ageing of population and a different old age compared with the past .
it has been estimated that since 2005 to 2030 world population over 65 will double ( from 500 million to 1 billion ) . in 2030
elderly people will be 40% of all population and in italy in the next 10 years elderly people will be the double compared with 0 - 14 population .
elderly people showed some social and demographic characteristics in the past decades :   in the end of working life few years remained to live ;   the end or working life coincided with exclusion of every role in social or recreational activities ;   in the most of cases after - work activities were domestic ( particularly for women ) ;   younger generations took care of elderly , usually inside the same home . today
we are witness to a new paradigm : usually a 65 years old person does n't feel old ;   usually life expectancy at the time of retirement is long ;   most of retired people are included in social and recreational activities ;   elderly people claim quality of life ;   over 80 people are increasing in number and usually they live with comorbidity and they represent a high cost for each health service .
every year , influenza is responsible of 40,000 deaths in europe , most of them in elderly people and with chronic diseases .
the economic burden to manage these preventable diseases with adult immunization , other than year - of - life lost , is more than 10 billion dollars every year . in spite of availability of effective and safe vaccines for these diseases
, they are underused . which are the reasons to immunize adult people with vaccines ?
at least one of these issues is a good reason to immunize them : because they did n't have immunization in childhood ;   because at present time new vaccines are available ;   because human immune system gets old and acquired immunity can decline ;   because elderly people and people with chronic diseases have more susceptibility to diseases preventable with vaccines ( influenza , pneumococcal pneumonia ) .
the lists of immunizations for adults and high risks subjects are reported in tables i and ii .
vaccination schedule for adults broken down age group . recommended when there are other risk factors ( chronic disease , occupational , behavior ) .
adult immunizations for high - risk groups and categories . recommended when there are other risk factors ( chronic disease , occupational , behavior ) .
tetanus , diphteria and pertussis ( tdp ) immunization is strongly recommended because in italy the most of cases of tetanus are in adults who did n't receive any other dose after childhood . about pertussis in italy , as in other countries ,
the immunization is very spread in childhood population , but the immunity related to vaccine declined in the next 6 years and so young adults , adults and elderly become susceptible to disease another time .
we recommend that every time patients request tetanus immunization or when we suggest tetanus immunization , we can propose the booster with tdp immunization .
the high degree of antigenic shift and drift in circulating influenza strains leads to the periodic introduction of strains with high susceptibility in the population , resulting in pandemic spread of disease as in 2009 .
influenza vaccine is effective and safe to prevent influenza and complications and to decrease related mortality in high - risk group ( patients with chronic diseases , older people and those in contact with high - risk persons ) .
furthermore , it is important to consider that 2014 - 2015 season quadrivalent influenza vaccine was available to cover incidental mismatching in co - circulating virus b - strains .
streptococcus pneumoniae is a widespread airway transmittable bacterium causing severe diseases as pneumonia and meningitis .
pneumococcal infections can be the complications of other respiratory infections as influenza and they usually occur in wintertime . everyone can take a pneumococcal disease but over 65 and patients with chronic diseases have higher mortality rate .
overall pneumococcal infections offer the growing rate of antibiotic resistance : immunization is one of the main weapon of prevention against these diseases .
one - third of people that had a previous infection with varicella zoster virus , will develop a clinical herpes zoster .
the herpes zoster vaccine is recommended in adults over 60 years and older , regardless of their history of herpes zoster .
in current competences all general practitioners ( gps ) must integrate in their daily practice the immunization policies of the national health service .
regional and local health services organize the mandatory immunization acting in accordance with the national immunization plan .
gps ' duty is to orient , counsel and give recommendations on vaccines characterizing and selecting population groups at high - risk .
we can suggest immunization in adults according to age - group ( young adult , adult or old people ) ( tab i ) or according to risk - group ( patients with chronic disease , immunocompromised conditions , pregnancy ) ( tab .
iii ) or for employment categories ( health care professionals and social care professionals ) or for lifestyle ( international travelers , history of drug abuse or sexual transmitted diseases ) .
it 's possible , in this way , to have agenda about age groups or about risk categories .
the mission of our college works in the following directions :   education to vaccines and immunization policy ;   immunizations belong to gps ' daily practice and their scientific knowledge ;   to offer tools of education and information ;   to invite pharmaceutical industries make information service to primary care doctors ;   to provide gps innovating tools to value own practice , understand the weakness and criticism and supply solving to improve immunizations in adults and in elderly people .
millegpg ( mille general practice governance ) is an informatic tool able to have an active interaction with the most spread electronic patient data record ( millewin ) in italy .
this application has been developed in collaboration with italian college of general practitioners ( simg ) .
millegpg provides gps with a series of " dashboards " by which they can check several performance indicators .
more than 200 performance indicators ( epidemiological , ongoing and outcome ) are embedded millegpg encompassing three main domains ( clinical audit , appropriateness and risk management .
all indicators have been conceived according to international clinical guidelines during several meetings involving gps and specialists .
. when gp wants to analyze the cohorts of patients with chronic disease ( for example patients with chronic obstructive pulmonary disease or with diabetes or with heart failure ) in the domain " risk management & prevention " , it 's possible to have the list of patients under 65 years old that should receive influenza vaccine .
the other can be recall or in a proactive way ( every time patient comes in office for a prescription , the nurse or the doctor receive an alert on the patient record ) or call the patient by mail or e - mail .
this model can be replicated for other immunizations and in this way each gp ( or group ) can act a real governance of immunizations .
gp should adopt a systematic approach to immunization programs that includes educating patients and office staff using reliable sources of information , standing protocols during patient encounters and all practice management resources .
recall and reminder systems have resulted in increases of up to 20 percent in rate of vaccination .
synergic policies of education , information and professional tools can improve the competences and behaviours for benefit to patients and society .
 summaryvaccine - preventable disease significantly contributes to the morbidity and mortality of adults worldwide . 
 the rates of vaccination against influenza , pneumococcal disease and tetanus in adults and in high - risk group of people are far from the optimal coverage as suggested by minister of health . 
 general practitioners ( gps ) can contribute to increase immunization in adults and in elderly people because these age groups attend frequently the surgery of their family doctors for reasons related to their chronic diseases . 
 the gps , on their side , can proactively involve patients through informatics tools that supply lists of specific patients and electronic alerts in patient records . 
Introduction
A different paradigm
Epidemiological scenery
Immunizations in adults and elderly people
Health professional policy commentary
A governance tool for immunizations
Conclusions