CORDIS

One of today’s major challenges in the management of Infectious Diseases (ID) of aging adults is to improve efficacy and efficiency of prevention by vaccines to protect the growing ageing population. The VITAL project aims to address this challenge by (1) assessing the ID burden, (2) identifying the mechanisms of decline of immune responses with age, (3) developing methods to evaluate the most efficient prevention strategies against ID, and (4) efficiently communicating the findings to healthcare professionals (HCPs) as well as to aging adults to increase impact of future interventions. This should result in a framework that forms the basis for designing, implementing and regularly updating vaccination schemes for ageing adults. VITAL will thereby give an important impetus to a more precise immunization program for aging adults in the European Union (EU) thus enhancing healthy aging.

The aim of the epidemiological studies of VITAL (WP1) is to investigate in two pilot regions the full ID burden in aging adults using protocols that can evaluate retrospectively healthcare databases. In addition, we will obtain missing information through prospective study-designed protocols.
To gain knowledge of factors that hamper the immune response in aging adults, WP2 will analyze in-depth the different immune components involved in inducing an effective immune response to two vaccines (influenza and pneumococcal) in the ageing host in a clinical vaccine study.
The aim of the economic assessment in VITAL (WP3) is to investigate the full economic impact of the current management of ID in aging adults and new preventative interventions including new vaccines to reach maximum gains in health outcomes but working under constraints of budget, logistics, tax payment, and demographic changes.

To communicate the information collected in WP1, 2, and 3 to HCPs who need to bring the VITAL ambition to the people, WP4 is building a framework of innovative educational and training activities taking into account the viewpoint of the aging adults, ensuring high performance and sustainability of the training activities and incorporating continuous medical education in existing relevant courses.

WP1 performed a detailed review of methods to investigate the burden of disease (BoD) and data sources that capture the burden of (Potential) Vaccine Preventable ((P)VP) diseases in the ageing population, allowing for the identification of data collection needs. To assess the ability of studying specific diseases, a preliminary case count study was performed. This led to the development of a roadmap for BoD-estimation with recommendations to use BoD outcome measures such as Quality and Disability-Adjusted Life Year (QALY and DALY) and to select Streptococcus pneumoniae and extra-intestinal pathogenic E. coli as diseases of interest for in-depth analysis.

WP2 initiated a clinical vaccine study to understand the mechanisms underlying vaccine response in different age groups against two vaccines. We included 326 healthy participants across 3 age groups: adults (age 25-49), middle aged adults (aged 49-54) and aging adults (aged >65) and collected data (lifestyle, health, frailty) and biological samples (serum, cells, faeces, saliva, nose- and oropharyngeal swabs) to measure vaccine immune responses before and at several time points after vaccination. We collected in total over 1300 blood samples, stored isolated cells in 8000 vials and performed 854 real time analyses of cell constitution.

To present cost-efficient prevention strategies, WP3 (1) performed a literature review of existing models on ID with economic evaluations; (2) defined the necessary factors that identify heterogeneity to be captured in the economic models; (3) used a method to identify patient flows and hotspots of ID spread in society and in the health care system; (4) made an inventory of different options for implementing prevention strategies among aging adults against infections.

WP4 was dedicated to understanding how the aging adults view vaccination. This included the collection of data on perceptions, attitude and intention towards vaccination, as well as an assessment of the needs and preferences of this group regarding the provision of information: content, channel, and source. This assessment was performed with focus group studies in 4 countries (Hungary, France, Italy, The Netherlands). Furthermore, data were collected regarding the networks of HCPs and HC Workers (HCW) around aging adults during the focus group studies.

WP5 concerns the project management of the VITAL project. UMCU (WP5 lead) along with the support of GSK provided overall scientific and administrative leadership for the VITAL consortium during this reporting period.

WP1 developed a searchable catalogue web application, allowing an easy and fast view of existing data sources for specific ID known for their high disease burden in aging adults. The aim is to consolidate the information collected during the study period in a central database that will be regularly updated and could be consulted by different decision makers in the EU. This could become a critical source of medical data that can predict the increase in ID burden over time related to the demographic shifts. In addition, this could be an interesting tool in pre-clinical drug development for those interested in knowing the extent of specific ID burden.
WP2 initiated a valuable biobank for current and future studies of immunological mechanisms of vaccine responses. This can be used to support system vaccinology approaches and identification of correlates of protection. Assays used to determine the constitution of the cell subset can help to enhance stratification (in addition to age) of the population and may contribute to biomarker profiles for response to vaccination to be used to predict vaccine response in specific populations.
One of the new initiatives taken by WP3, is the possibility to capture hotspot and patient flows in specifically determined geographical areas linked to time-periods of observation. This is new because the demographically changing population (increase in elderly people) will result in more absolute chronic disease conditions, which will require more health care support, as their immune response is weaker. There will be more susceptibility and prevalence to ID leading to more exposure to and a higher transmission of infections. This instrument of hotspot and patient flow will be able to capture these conditions through seasonal concentrations and situations of reduced quality of care. It will be a big incentive for decision makers to improve control of the spread of infection in aging adults through a well-developed and cost-efficient prevention program.
The focus group research performed under the umbrella of WP4 among aging adults conducted in 4 countries (Netherlands, France, Italy and Hungary), provided insight in recruitment difficulties in older age-groups, in depth of knowledge of factors that influence aging adults’ adherence to vaccinations and insights in the networks of HCW around the older adults.