Vaccini, Lopalco: “For influence we have an armory of options”

“The history of influenza vaccines has changed a lot in history: today’s vaccines are completely new. Today we don’t have a flu shot, but we actually have an armory of possibilities and giving the right patient the right vaccine is not immediate. In vaccination policies, scientific evidence in different populations is important “, to make the right choices. So Pietro Luigi Lopalco, full professor of Hygiene and preventive medicine, University of Salento, at this morning’s event in Brindisi, entitled ‘Successful aging: role of vaccines and lifestyles’, organized by HappyAgeing (Italian Alliance for active aging) with the Mediterranean Diet Foundation, thanks to the patronage of the Municipality of Brindisi and Federsanità Anci Puglia and with the non-conditioning contribution of Sanofi. The following also took part in the discussion on the issue of the importance of the personalization of vaccination in the elderly patient as the main tool for active aging: Raffaele Antonelli Incalzi, director of Uoc Gerontology, Campus Bio-Medico University Hospital and former president of Sigg (Italian Society of Geriatrics and gerontology), Stefania Maggi, president of the Mediterranean Diet Foundation and Cnr research director of the Institute of Neuroscience, Padua-Aging section; Nehludoff Albano, section Promotion of health and well-being, Puglia Region and Michele Conversano, president of Cts HappyAgeing. There are several anti-flu products available. In addition to the quadrivalent vaccine (increasingly used) for the elderly and frail the ‘strengthened’: adjuvanted quadrivalent; quadrivalent grown on cell cultures (moult less); recombinant quadrivalent; quadrivalent high dose and the live attenuated nasal spray vaccine (Laiv). “We were amazed – says Lopalco – with Covid, that we had an effective vaccine in one year: a surprise for everyone, with a new technology against a new virus. On the one hand, research and, on the other, an accelerated bureaucratic process that has been reduced to 18 days from 18 months, have made the difference. In reality, for the flu it always happens that in less than a year a vaccine is produced and registered, the production cycle of the flu is very fast. In February the strain is known, in June there is the approval process and the start of production. The registration is based on immunogenicity, that is the production of antibodies “. When it comes to vaccination efficacy” we are not referring only to the antibody response – recalls the expert – but also to protection from infection, disease and serious illness. Therefore we need the data on the efficacy on complications and hospitalization. If after vaccination you are hospitalized less than if you are not vaccinated, it means that it is effective. To evaluate effectiveness – he adds – we have two ways: the gold standard and effectiveness. The main element of effectiveness is the matching with the circulating strain, which changes quickly due to the flu ”. In the case of the gold standard, we proceed with a randomized clinical study (trial) on a defined population, randomly divided into two groups to which the vaccine is administered or not and its effectiveness is measured. Effectiveness measures effectiveness in current use, they are real-life data. A clinical trial is perfect for verifying the direct effect of vaccination. Effectiveness studies with different vaccines in different age groups make it possible to evaluate the cases of disease avoided in the population and therefore not only evaluate the direct but also the indirect effect of the vaccines. In aid for the personalization of vaccination there is scientific evidence, in particular the Grade method which, once the systematic review of the literature has been evaluated, also defines the ‘grade’, i.e. the level of evidence. “The American Center for Disease Control (CDC) in a pragmatic way – explains Lopalco – has a simple message: for the elderly over 65 the new vaccines are used because in the elderly the vaccine that is not strengthened / strengthened works less”. The European Center for Disease Control (ECDC) applies the Grade method: for each vaccine and population it indicates not only how well it works, but also how reliable or not this conclusion is. For example, he points out that “there is a lack of high-quality studies comparing adjuvanted and non-adjuvanted vaccines – points out Lopalco – The strongest message is for the high-dose vaccine which, compared to the standard, with very high evidence, has a relative effect 24% more, regardless of the circulating strain. In the case of vaccines grown on cells – he underlines – we see that they have a positive ‘grade’ with a relative protective effect, compared to the unvaccinated, of 70-80%. We don’t know if it does better than its competitor, but it is very high. Finally, the recombinant, compared to the unvaccinated, has a 30% higher efficacy level ”, he concludes.