title: Vaccination of special populations: Protecting the vulnerable.
abstract: One of the strategic objectives of the 2011-2020 Global Vaccine Action Plan is for the benefits of immunisation to be equitably extended to all people. This approach encompasses special groups at increased risk of vaccine-preventable diseases, such as preterm infants and pregnant women, as well as those with chronic and immune-compromising medical conditions or at increased risk of disease due to immunosenescence. Despite demonstrations of effectiveness and safety, vaccine uptake in these special groups is frequently lower than expected, even in developed countries with vaccination strategies in place. For example, uptake of the influenza vaccine in pregnancy rarely exceeds 50% in developed countries and, although data are scarce, it appears that only half of preterm infants are up-to-date with routine paediatric vaccinations. Many people with chronic medical conditions or who are immunocompromised due to disease or aging are also under-vaccinated. In the US, coverage among people aged 65years or older was 67% for the influenza vaccine in the 2014-2015 season and 55-60% for tetanus and pneumococcal vaccines in 2013, while the coverage rate for herpes zoster vaccination among those aged 60years or older was only 24%. In most other countries, rates are far lower. Reasons for under-vaccination of special groups include fear of adverse outcomes or illness caused by the vaccine, the inconvenience (and in some settings, cost) of vaccination and lack of awareness of the need for vaccination or national recommendations. There is also evidence that healthcare providers' attitudes towards vaccination are among the most important influences on the decision to vaccinate. It is clear that physicians' adherence to recommendations needs to be improved, particularly where patients receive care from multiple subspecialists and receive little or no care from primary care providers.
authors.affiliation: GSK Vaccines, Avenue Fleming 20, Parc de la Noire Epine, B-1300 Wavre, Belgium. Electronic address: mark.x.doherty@gsk.com.
authors.forename: Mark
authors.initials: M
authors.lastname: Doherty
authors.affiliation: GSK Vaccines, Avenue Fleming 20, Parc de la Noire Epine, B-1300 Wavre, Belgium. Electronic address: ruprecht.r.schmidt-ott@gsk.com.
authors.forename: Ruprecht
authors.initials: R
authors.lastname: Schmidt-Ott
authors.affiliation: Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico. Electronic address: joseignaciosantos56@gmail.com.
authors.forename: Jose Ignacio
authors.initials: JI
authors.lastname: Santos
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY, USA; New York-Presbyterian/Morgan Stanley Children's Hospital, New York, NY, USA. Electronic address: lrs2155@cumc.columbia.edu.
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Stanberry
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA, USA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA. Electronic address: amh2162@columbia.edu.
authors.forename: Annika M
authors.initials: AM
authors.lastname: Hofstetter
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: slr2154@mail.cumc.columbia.edu.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Rosenthal
authors.affiliation: Westmead Institute, The Centre for Virus Research, 176 Hawkesbury Road, NSW 2145, Australia. Electronic address: tony.cunningham@sydney.edu.au.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Cunningham
mesh_terms: D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D014943:Global Health; D006801:Humans; D014611:Vaccination / Q000706:statistics & numerical data*; D035862:Vulnerable Populations
keywords: Adolescent; Immunocompromised; Older adults; Pregnancy; Preterm; Special group