Vaccines for older adults; the low-hanging fruit of disease prevention

Abstract Background The COVID-19 pandemic highlighted the significance of vaccination for older adults (OA), however, more health benefits could be gained with vaccination against influenza, pneumococcal disease, herpes zoster and tetanus as their uptake remains rather low. As healthcare professionals (HCP) play an important role in the vaccination decision making of OA, this study identifies obstacles in vaccination communication between HCP and OA. Methods 80 in-depth structured interviews have been conducted with HCPs in Hungary (HU), Italy (IT), the Netherlands (NL) and France (FR). Participants were general practitioners, medical specialists, public health physicians, occupational physicians, pharmacists, geriatricians, specialists elderly care and nurses. The interview included questions on HCPs’ perceptions regarding information provision to OA on vaccines. Data were analyzed cross-country, using thematic analysis. Results Preliminary results reveal that a factor hindering HCPs to initiate conversations with OA on vaccines was lack of time (FR, IT, HU, NL). In hospitals this was often due to (acute) clinical problems taking precedence over discussing vaccines (IT, NL). In ambulatory settings the high number of patients waiting to be seen prevented discussing vaccines with OA (HU). Moreover, HCPs sometimes forgot to discuss vaccines with OA (NL, HU, IT). Patient factors hindering the conversation of HCPs on OA vaccines were a negative attitude (IT, HU) and lack of understanding the information provided (IT, HU). Also, misinformation on vaccines (FR, HU), as well as anti-vax beliefs from patients (NL) or their relatives (FR, IT) hampered the conversation on vaccines. HCPs mentioned their need to learn communication skills to convince OA on vaccines (FR, IT, HU). Conclusions HCPs encounter various obstacles in communicating with OA about vaccines. Lack of time and not recognizing the opportunity to discuss vaccines are important barriers for initiating vaccine conversations. Key messages • Providing HCPs with communication strategies is important to support HCPs in discussing vaccines with OA. • Reminder systems are important to help HCPs remember address vaccination.


Background:
The Elizabethkingia genus is formed by a group of bacteria which are widely distributed in nature. Elizabethkingia is not part of human microbiota, therefore is considered to be an opportunistic pathogen. In the last years, it has become a cause of potentially fatal disease, becoming an emerging bacteria of increasing relevance. The objective of this study is to describe the impact of Elizabethkingia bacteria in infected patients in the ICU of a hospital in Granada. Methods: Descriptive study. Patients who have been isolated in a biological sample of Elizabethkingia miricola throughout the year 2.021 in the ICU of San Cecilio University Hospital in Granada. Date and place of isolation were registered. Other variables registered were sex, age, length of ICU stay, days between ICU admission and bacterium isolation, days between bacterium isolation and death, infection, cause of admission or cause of death. Results: Bacterium was isolated in 15 patients. Cause of admission was COVID-19 in 73.3% of patients. 73.3% were men and 26.6% women.The average age was 56.9 years. The average length of ICU stay was 43.8 days. 4 patients were diagnosed with ventilator-associated pneumonia and 5 patients were diagnosed with tracheobronchitis.The average days between ICU admission and bacterium isolation was 26,4 days. The average days between mechanical ventilation and bacterium isolation was 25.9 days. 53.3% of patients died. The average days between bacteria isolation and death was 18.2 days.

Conclusions:
Elizabethkingia miricola is an emerging bacterium under special vigilance due to its capacity to cause major morbidity and mortality in admitted patients in ICU. The rapid identification and the study of the antibiotic susceptibility is considered of special relevance so they can be correctly managed to avoid infections and complications resulting from this microorganism. Key messages: Elizabethkingia is a special surveillance bacterie due to its morbidity and mortality effects. Elizabethkingia could be a severity indicator in admitted patients to the ICU. Background: The COVID-19 pandemic highlighted the significance of vaccination for older adults (OA), however, more health benefits could be gained with vaccination against influenza, pneumococcal disease, herpes zoster and tetanus as their uptake remains rather low. As healthcare professionals (HCP) play an important role in the vaccination decision making of OA, this study identifies obstacles in vaccination communication between HCP and OA. Methods: 80 in-depth structured interviews have been conducted with HCPs in Hungary (HU), Italy (IT), the Netherlands (NL) and France (FR). Participants were general practitioners, medical specialists, public health physicians, occupational physicians, pharmacists, geriatricians, specialists elderly care and nurses. The interview included questions on HCPs' perceptions regarding information provision to OA on vaccines. Data were analyzed cross-country, using thematic analysis.

Results:
Preliminary results reveal that a factor hindering HCPs to initiate conversations with OA on vaccines was lack of time (FR, IT, HU, NL). In hospitals this was often due to (acute) clinical problems taking precedence over discussing vaccines (IT, NL). In ambulatory settings the high number of patients waiting to be seen prevented discussing vaccines with OA (HU). Moreover, HCPs sometimes forgot to discuss vaccines with OA (NL, HU, IT S. aureus is a widespread pathogen responsible for mild to severe human and animals' infections. The abuse of antimicrobials provides the potential for selection of resistant strains in livestock, which represents a public health concern. S. aureus can carry several virulence factors of which staphylococcal enterotoxins (SEs) play a key role during food poisoning in human populations. The aim of this study is to monitor the prevalence of antimicrobial resistance factors in S. aureus isolates and their ability to produce enterotoxins.

Methods:
Within an ongoing monitoring plan for the assessment of antimicrobial resistance in S. aureus strains, a total of 83 isolates collected from food, and swine and dairy farms, between 2020-2022, were characterized using MLST and then screened for the presence of methicillin resistance and SEs genes. The isolates were tested for susceptibility to a panel of 14 antimicrobial agents using the disc agar diffusion method on Mueller-Hinton agar.

Results:
Among 83 S. aureus isolates, 53% carried at least one SEs gene. Eighteen isolates were methicillin-resistant of which 17 were no-enterotoxigenic strains belonging to ST398, and one was a food origin ST8 strain and harbored SEs genes. Among the ST398 isolates, only one was a food origin strain, while the others were from swine farms. The antibiogram showed that a few isolates were susceptible to nalidixic acid, and 42% resulted multidrug-resistant.

Conclusions:
Our results showed that more than half of S. aureus isolates were enterotoxigenic, the majority belonging to food industries. Numerous tested isolates resulted multidrug-resistant, confirming that antimicrobial resistance is a critical public health threat in a food safety perspective.

Key messages:
The antimicrobial resistance profiles of S. aureus isolates underlines the importance of monitoring plans with a One Health perspective. The prevalence of enterotoxins genes in S. aureus strains in Lombardy confirms the relevance of the microorganism as a foodborne pathogen. For each year,a descriptive analysis was conducted and any differences in scores between the two years were noted.The presence of a contingency and vectors' control plans was also investigated.The assessment was completed respectively for 2020 and 2021 by 24 and 25 airports, 53 and 52 ports. C1 in 2020 resulted on average 89% for airports and 95% for ports, in 2021 respectively 90% and 95%; C2 in 2020 resulted on average 64% for airports and 63% for ports, in 2021 respectively 63% and 64%; C3 in 2020 resulted on average 68% for airports and 61% for ports,in 2021 respectively 63% and 58%.Few differences in scores between 2020 and 2021 were noted in some PoEs. 4 PoEs declared the presence of a contingency plan only in 2021.Few PoEs stated to not have a vectors' control plan in both years.The assessment pointed out a good level of coordination and communication among all the stakeholders involved, including the Italian Red Cross,but it revealed lower scores for the other IHR core capacities. Improvement actions have to be pursued surely.

Key messages:
The specified tool helps cross border and national Authorities to understand strengths and weaknesses in each PoE and leads to develop a specific plan of action to overcome potential gaps. Maintaining a good level of core capacities at points of entry is fundamental to protect national public health.