ADVICE for a healthier life: Adult Vaccination Campaign in Europe


      • Adults and elderly do need vaccines within a lifelong immunization schedule.
      • Communicable diseases are on the rise with aging population, globalization and immunity gaps.
      • Data for adult vaccination rates in Europe is incomplete. There are no targets except for influenza.
      • There is a lack of international consensus on adult vaccination guidelines on a European basis.
      • ‘ADVICE’ is Europe wide initiative of EFIM to raise awareness of adult vaccination.


      Immunization is one of the most effective public health measures to prevent disease. Despite relatively good vaccination rates in childhood in many parts of the world, vaccines to prevent diseases are underused in the adult population and adult vaccination rates are still far below the target. The European Federation of Internal Medicine (EFIM), declared that ‘internal medicine must focus on better care for individuals, better health care for populations and lower costs’. Adult vaccination is a good example of a public health initiative aimed at reducing morbidity and mortality, but awareness of the need for adult vaccination and uptake of the programs across Europe is variable. The Adult Vaccination Campaign in Europe (ADVICE) was developed with an aim to raise awareness for adult vaccination and to understand the dynamics of the vaccination practices and the possible barriers against achieving targeted vaccination rates in Europe. In order to reach vaccination targets, we need evidence based, up to date guidelines; recommendations at national and international levels; surveillance for vaccination rates; and opportunities to provide vaccines more readily. Leadership at a European level and a firm research and action agenda are crucial. The European Federation of Internal Medicine can take the lead as it declared its interest on ‘better care for individuals, better health care for populations’. Hence, we consider ADVICE a very timely and very valuable initiative to draw a roadmap to improve adult vaccination rates in Europe.


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      1. Wkly Epidemiol Rec. 2006; 81: 190-195
        • Pham H.
        • Geraci S.A.
        • Burton M.J.
        Adult immunizations: update on recommendations.
        Am J Med. 2011; 124: 698-701
      2. VPD surveillance manual.
        5th ed. 2011
        • Pascual F.B.
        • et al.
        Tetanus surveillance—United States, 1998–2000.
        MMWR Surveill Summ. 2003; 52: 1-8
      3. Confirmed pertussis in England and Wales continues to increase.
        in: Health protection report. The UK Government Web Archive, 2012
        • Carrillo-Santisteve P.
        • Lopalco P.L.
        Measles still spreads in Europe: who is responsible for the failure to vaccinate?.
        Clin Microbiol Infect. 2012; 18: 50-56
        • World Health Organization Recommended Routine Immunization
        Date: 2015
        ([27 February 2015 [cited 2015 23 November]; Available from:])
        • Kim D.K.
        • Bridges C.B.
        • Harriman K.H.
        Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older—United States, 2016.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 88-90
        • Australian Government's Immunise Australia Program, National Immunisation Program Schedule
        Date: June 2015
        (Available from:)
        • Austrian Vaccination Schedule
        Date: 2015
        ([cited 2015 23 November]; Available from:])
        • Canadian Immunization Guide
        Recommended immunization for Adults.
        Date: August 2013
        (Available from:)
      4. Calendrier des vaccinations et recommandations vaccinales 2015.
        Date: 2015
        ([cited 2015 23 November]; Available from:])
      5. German Standing Committee on Vaccination (STIKO) recommendations, 2014.
        Date: August 2014
        (Available from:)
      6. Vaccinations for adults recommended in Iceland.
        (Available from:)
      7. Vacunación de adultos recomendaciones ano 2004. 2015 2009 [cited 2015 23 November]; Available from:

      8. The routine immunisation schedule 2015.
        Date: 2015
        (Available from:)
      9. D.o.E.a.S.A.P.D. United Nations World population ageing 1950–2050. United Nations Publishing, NewYork2002
        • Poland G.A.
        • Jacobson R.M.
        • Ovsyannikova I.G.
        Trends affecting the future of vaccine development and delivery: the role of demographics, regulatory science, the anti-vaccine movement, and vaccinomics.
        Vaccine. 2009; 27: 3240-3244
        • Christensen K.
        • et al.
        Ageing populations: the challenges ahead.
        Lancet. 2009; 374: 1196-1208
        • Doyle Y.
        • et al.
        Meeting the challenge of population ageing.
        BMJ. 2009; 339: b3926
        • Lang P.O.
        • et al.
        Immunosenescence: Implications for vaccination programmes in adults.
        Maturitas. 2011; 68: 322-330
        • Rechel B.
        • et al.
        Ageing in the European Union.
        Lancet. 2013; 381: 1312-1322
        • Gushulak B.
        • Weekers J.
        • Macpherson D.
        Migrants and emerging public health issues in a globalized world: threats, risks and challenges, an evidence-based framework.
        Emerg Health Threats J. 2009; 2e10
        • Boraschi D.
        • Italiani P.
        Immunosenescence and vaccine failure in the elderly: strategies for improving response.
        Immunol Lett. 2014;
        • Siedler A.
        • et al.
        Closer to the goal: efforts in measles elimination in Germany 2010.
        J Infect Dis. 2011; 204: S373-S380
        • Halperin S.A.
        Pertussis—a disease and vaccine for all ages.
        N Engl J Med. 2005; 353: 1615-1617
        • Zepp F.
        • et al.
        Rationale for pertussis booster vaccination throughout life in Europe.
        Lancet Infect Dis. 2011; 11: 557-570
        • Muscat M.
        • et al.
        The state of measles and rubella in the WHO European Region, 2013.
        Clin Microbiol Infect. 2014; 20: 12-18
        • European Centre for Disease Prevention and Control
        Annual epidemiological report 2014 — vaccine-preventable diseases.
        ECDC, Stockholm2014
        • Gonzalez-Escalada A.
        • et al.
        Seroprevalence of antibodies against measles, rubella, mumps, varicella-zoster, and B. Pertussis in young adults of Madrid, Spain.
        Hum Vaccin Immunother. 2013; 9: 1918-1925
        • Tanriover M.D.
        • et al.
        Low seroprevalance of diphtheria, tetanus and pertussis in ambulatory adult patients: the need for lifelong vaccination.
        Eur J Intern Med. 2014; 25: 528-532
        • Kanitz E.E.
        • et al.
        Variation in adult vaccination policies across Europe: an overview from VENICE network on vaccine recommendations, funding and coverage.
        Vaccine. 2012; 30: 5222-5228
        • Rozenbaum M.H.
        • et al.
        Modelling the impact of extended vaccination strategies on the epidemiology of pertussis.
        Epidemiol Infect. 2012; 140: 1503-1514
        • Lavine J.
        • et al.
        Imperfect vaccine-induced immunity and whooping cough transmission to infants.
        Vaccine. 2010; 29: 11-16
        • Bechini A.
        • et al.
        Acellular pertussis vaccine use in risk groups (adolescents, pregnant women, newborns and health care workers): a review of evidences and recommendations.
        Vaccine. 2012; 30: 5179-5190
        • Ortac Ersoy E.
        • et al.
        Severe measles pneumonia in adults with respiratory failure: role of ribavirin and high-dose vitamin A.
        Clin Respir J. 2015;
        • Rodriguez M.L.
        • et al.
        Seroprevalence of measles, rubella, mumps and varicella in health workers in the Community of Madrid.
        Rev Esp Quimioter. 2014; 27: 98-101
        • Heininger U.
        • Cherry J.D.
        Pertussis immunisation in adolescents and adults—Bordetella pertussis epidemiology should guide vaccination recommendations.
        Expert Opin Biol Ther. 2006; 6: 685-697
        • Cilloniz C.
        • Amaro R.
        • Torres A.
        Pneumococcal vaccination.
        Curr Opin Infect Dis. 2016; 29: 187-196
        • Isturiz R.
        • Webber C.
        Prevention of adult pneumococcal pneumonia with the 13-valent pneumococcal conjugate vaccine: CAPiTA, the community-acquired pneumonia immunization trial in adults.
        Hum Vaccin Immunother. 2015; 11: 1825-1827
        • Pilishvili T.
        • Bennett N.M.
        Pneumococcal disease prevention among adults: strategies for the use of pneumococcal vaccines.
        Vaccine. 2015; 33: D60-D65
        • Haverkate M.
        • et al.
        Assessing vaccination coverage in the European Union: is it still a challenge?.
        Expert Rev Vaccines. 2011; 10: 1195-1205
        • The Council of the European Union
        Council recommendation on seasonal influenza vaccination.
        (Available from:)
        • European Centre for Disease Prevention and Control
        Seasonal influenza vaccination in Europe — overview of vaccination recommendations and coverage rates in the EU Member States for the 2012–13 influenza season.
        ECDC, Stockholm2015
        • European Centre for Disease Prevention and Control
        Surveillance of invasive bacterial diseases in Europe, 2012.
        ECDC, Stockholm2015
        • Dorleans F.
        • et al.
        The current state of introduction of human papillomavirus vaccination into national immunisation schedules in Europe: first results of the VENICE2 2010 survey.
        Euro Surveill. 2010; 15
        • U.S. Department of Health and Human Services
        Office of disease prevention and health promotion. Healthy People 2020. Washington, DC.
        ([Available at]) ([Accessed 25.11.2015])
      10. MMWR Morb Mortal Wkly Rep. 1995; 44 ([513-5]): 506-507
        • Singleton J.A.
        • et al.
        Influenza, pneumococcal, and tetanus toxioid vaccination of adults—United States, 1993–7.
        MMWR CDC Surveill Summ. 2000; 49: 39-62
      11. National Immunization Survey-Flu (NIS-Flu) and Behavioral Risk Factor Surveillance System (BRFSS). Flu vaccination coverage, United States, 2014–15 influenza season.
        ([Available at:]) ([Accessed November 2015])
        • Williams W.W.
        • et al.
        Vaccination coverage among adults, excluding influenza vaccination — United States, 2013.
        MMWR Morb Mortal Wkly Rep. 2015; 64: 95-102
        • Petrosky E.
        • et al.
        Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices.
        MMWR Morb Mortal Wkly Rep. 2015; 64: 300-304
        • Bertin M.
        • et al.
        Novel use of the intranet to document health care personnel participation in a mandatory influenza vaccination reporting program.
        Am J Infect Control. 2007; 35: 33-37
        • Kramer M.H.
        • et al.
        The changing face of internal medicine: patient centred care.
        Eur J Intern Med. 2014; 25: 125-127