[Vaccination against respiratory infections in older adults: Covid-19, respiratory syncytial virus, influenza and pneumococcus].

Abstract

Population aging increases the risk of severe respiratory infections and their complications in older adults, largely because of immunosenescence. Beyond pneumonia, these infections can lead to cardiac and respiratory decompensation, acute cardiovascular events, loss of functional independence, and institutionalization. Vaccination remains the cornerstone of prevention. This review provides an update on four vaccine-preventable respiratory infections that are particularly common or severe in older adults: coronavirus disease 2019 (COVID-19), respiratory syncytial virus (RSV) infection, seasonal influenza, and pneumococcal disease. For each infection, we review the epidemiological burden, associated complications-particularly cardiovascular and functional outcomes-as well as recent real-world evidence on vaccine effectiveness and the 2026 French recommendations. The evidence is consistent: safe and effective vaccines are available for all four infections, yet vaccination coverage remains far below target among older adults and is even lower among healthcare workers, a situation that has worsened since the COVID-19 pandemic. The pandemic has durably reshaped attitudes towards vaccination, shifting from initial acceptance to growing hesitancy. Improving information and education for both the public and healthcare professionals, particularly those working in geriatric care settings, appears to be the most effective strategy for reducing this preventable burden. Clear, consistent communication and the integration of vaccination into personalized care plans are essential to translate well-established recommendations into effective protection.