Extending Immunization Prevention to High-Risk Populations in an Aging Society

(Source: Shanghai Observer)

During the 8th CIIE, a roundtable event hosted by GSK with the theme "Three Highs and One Rash: Discussing New Frontiers of Medical-Preventive Collaboration" revealed that aging population, high incidence of chronic diseases, and their increasing prevalence among younger individuals have become the "new normal" for China’s public health system. In response to this complex and severe situation, experts proposed that the scope of immune prevention should be further extended to key high-risk groups such as the elderly and those with chronic illnesses.

Sun Xiaodong, Deputy Director of the Shanghai Municipal Center for Disease Control and Prevention, stated: "Immune prevention" needs to be endowed with new connotations and broader boundaries. It is important to recognize that patients with chronic diseases are more susceptible to co-infections such as herpes zoster, influenza, and pneumonia due to their weakened immune function, which in turn can further exacerbate the progression of their underlying chronic conditions, creating a vicious cycle.

Herpes zoster (commonly known as "缠腰龙", "蛇缠腰", or "生蛇") is an infectious skin disease caused by the varicella-zoster virus. Over 90% of adults have this virus latent in their bodies, and about one-third of people will develop herpes zoster in their lifetime. Age is the most important risk factor for herpes zoster. People aged 50 and above are the susceptible population, and the risk of developing herpes zoster increases sharply after the age of 50. Studies show that patients with cardiovascular diseases such as hypertension, hyperlipidemia, and coronary heart disease have a 39% higher risk of developing herpes zoster compared to the general population. Additionally, patients with herpes zoster face a 68% increased risk of myocardial infarction in the short term, and a 78% increased risk of cerebral hemorrhage and stroke.

Dr. Zou Dajin, Chief Physician of the Endocrinology Department at Shanghai Tongren Hospital and Honorary Chairman of the Diabetes Society of the Shanghai Medical Association, reminds: Compared with the general population, diabetes patients face a 60% higher risk of developing shingles. After contracting shingles, diabetes patients are at an increased risk of postherpetic neuralgia, which tends to be more severe and prolonged. Diabetes management requires attention to both blood glucose control and infection prevention. During routine follow-ups, doctors should help patients establish proactive prevention awareness while adjusting medications, diet, and exercise interventions. For instance, providing timely vaccination guidance to eligible patients can not only reduce the risk of co-existing infectious diseases but also assist chronic disease patients in transitioning from passive treatment to proactive health management.

Zhang Yi, Director of the Scientific Research Department and Director of the Hypertension Center/Pan-Vascular Center at Shanghai Tenth People's Hospital, stated that health management for patients with chronic diseases is not only about controlling blood pressure, blood lipids, and blood sugar but also focusing on maintaining immunity, making "prevention" truly a part of "treatment." For patients with cardiovascular diseases, infectious diseases such as shingles are hidden health risks. These patients often suffer from relatively weak immune functions, making them more susceptible to the double blow of infections. If preventive measures, such as getting vaccinated against shingles during periods of stable condition, can be taken in advance, the risk of infection can be effectively reduced, avoiding the addition of new health risks on top of existing chronic conditions.

With the guidance of policies and the continuous accumulation of practical experience, the collaboration between medical treatment and prevention is turning from an idea into action. As the "last mile" of the public health system, communities should play a crucial role in promoting the integration of medical treatment and prevention. In recent years, Shanghai has been innovating in exploring the construction of community prevention and control systems, focusing on "shifting prevention forward and extending services downward." This has gradually formed a comprehensive prevention and control model that combines health education, vaccination, and chronic disease management.

GSK China Vaccine Medical Director and Yunhe Peng added that expanding the boundaries of immunization means allowing scientific innovation to benefit more people. People with chronic diseases are not contraindicated for vaccination; instead, they should place greater emphasis on the protective value of vaccines for health. Middle-aged and elderly individuals, especially those with "three highs" (high blood pressure, high cholesterol, and high blood sugar), can receive vaccinations during periods of stable condition to reduce the risk of herpes zoster infection. They should consult a doctor before vaccination to ensure scientific protection.

It is also reported that during this year’s CIIE, GSK focused on product innovation and health education as two core strategies to further promote the concept of "medical prevention synergy" from idea to practice, assisting in the improvement and upgrade of China's adult vaccine ecosystem. The much-anticipated "CIIE baby" Shingrix received approval from China's National Medical Products Administration (NMPA) in October this year to expand its indications for use in individuals aged 18 years and above who are at increased risk of shingles due to immunodeficiency or immunosuppression caused by known diseases or treatments (such as autologous hematopoietic stem cell transplantation). This is the first and currently the only vaccine approved by the NMPA for the prevention of shingles in this population. It also represents an extension of the previous indication for adults aged 50 years and above, marking that the prevention and control of shingles is moving from elderly disease management towards proactive immunity throughout the entire life cycle.

Original Title: "Aging Society Should Extend Immunization Coverage to Key High-Risk Populations"

Source: Author: Jiefang Daily, Gu Yong