The shifting global demography and ageing of populations worldwide brings with new challenges for the health care, and an imperative for healthy ageing and preventive health strategies for adults. Immunization is the low hanging fruit for healthy ageing, and yet under-utilized for various reasons, including waning immunity in the elderly, lack of RCT data in this age group, and lack of provider confidence in vaccines for the elderly. The elderly people have a higher incidence of infection and more severe and serious consequences of infection. Diseases such as influenza, pneumococcal disease and herpes zoster have long been recognized as causing a high burden in the elderly, but evidence is also emerging for other infections such as pertussis being a major cause of the morbidity in this age group. Now, there are several vaccines which can prevent major infectious diseases in the elderly. To improve uptake of these vaccines, elderly vaccination should be viewed through a different lens to pediatric vaccination, accepting that vaccines are less immunogenic in the elderly. The population health impact of vaccines in the elderly, despite of immunosenescence and lower immunogenicity, is still likely to be high given the increased disease incidence. Vaccination is an important and readily available means of prevention in the elderly.
 Lutz, W., Sanderson, W. and Scherbov, S. (2008) The coming acceleration of global population ageing. Nature, 451, 716-719. http://dx.doi.org/10.1038/nature06516
 Australian Bureau of Statistics (2008) Future population growth and Aging, Population Projections, Australia, 2006 to 2101. Canberra.
 Gavazzi, G. and Krause, KH. (2002) Ageing and infection. The Lancet Infectious Diseases, 2, 659-666.
 Ridda, I., Yin, J.K., King, C., MacIntyre, C.R. and McIntyre, P. (2012) The importance of pertussis in older adults: A growing case for reviewing vaccination strategy in the elderly. Vaccine, 30, 6745-6752.
 Li, A., Newall, A.T., Britt, H. and Macintyre, C.R. (2012) The cost and disease burden of pneumonia in general practice in Australia. Vaccine, 30, 830-831.
 MacIntyre, C.R., Heywood, A.E., Kovoor, P., Ridda, I., Seale, H., Tan, T., et al. (2013) Ischaemic heart disease, influenza and influenza vaccination: A prospective case control study. Heart.
 Warren-Gash, C., Smeeth, L. and Hayward, AC. (2009) Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: A systematic review. The Lancet Infectious Diseases, 9, 601-610.
 Corrales-Medina, V., Majid, M. and Musher, D. (2010) Role of acute infection in triggering acute coronary syndromes. The Lancet Infectious Diseases, 10, 83-92.
 Vandell, D.L., McCartney, K., Owen, M.T., Booth, C. and Alison, C.-S. (2003) Variations in Child Care by Grandparents during the First Three Years. Journal of Marriage and Family, 65, 375-381.
 Booy, R., Lindley, R.I., Dwyer, D.E., Yin, J., Heron, L., et al. (2012) Treating and preventing influenza in aged care facilities: A cluster randomised controlled trial. PLoS One, 7, Article ID: e46509.
 Kirk, M.D., Moffatt, C.R., Hall, G.V., Becker, N., Booy, R., Heron, L., et al. (2010) The burden of infectious gastroenteritis in elderly residents and staff of long-term care facilities, Australia. Infection Control and Hospital Epidemiology, 31, 860-863.
 Seale, H., Weston, K.M., Dwyer, D.E., Zhu, M., Allchin, L., Booy, R., et al. (2009) The use of oseltamivir during an influenza B outbreak in a chronic care hospital. Influenza and Other Respiratory Viruses, 3, 15-20.
 Dean, A.S., Moffatt, C.R., Rosewell, A., Dwyer, D.E., Lindley, R.I., Booy, R., et al. (2010) Incompletely matched influenza vaccine still provides protection in frail elderly. Vaccine, 28, 864-867.
 Al-Murieb, A., Brown, A.M., Raulli, A., George, C., Gander, C., Forrester, P., et al. (2008) Evidence of pertussis clusters in three aged-care facilities in the former Macquarie Area Health Service, NSW. NSW Public Health Bulletin, 19, 157-160.
 Mertens, P.L., Borsboom, G.J., Richardus and J.H. (2007) A pertussis outbreak associated with social isolation among elderly nuns in a convent. Clinical Infectious Diseases, 44, 266-268. http://dx.doi.org/10.1086/510428
 Ferson, M.J., Morgan, K., Robertson, P.W., Hampson, A.W., Carter, I. and Rawlinson, W.D. (2004) Concurrent summer influenza and pertussis outbreaks in a nursing home in Sydney, Australia. Infection Control and Hospital Epidemiology, 25, 962-966.
 Mertens, P.L., Stals, F.S., Schellekens, J.F., Houben, A.W. and Huisman, J. (1999) An epidemic of pertussis among elderly people in a religious institution in The Netherlands. European Journal of Clinical Microbiology & Infectious Diseases, 18, 242-247.
 Addiss, D.G., Davis, J.P., Meade, B.D., Burstyn, D.G., Meissner, M., Zastrow, J.A., et al. (1991) A pertussis outbreak in a Wisconsin nursing home. The Journal of Infectious Diseases, 164, 704-710.
 Ridda, I., MacIntyre, C.R., Lindley, R.I., McIntyre, P.B., Sullivan, J., Gilbert, G., et al. (2007) Predictors of pneumococcal vaccination uptake in hospitalized patients aged 65 years and over shortly following the commencement of a publicly funded national pneumococcal vaccination program in Australia. Human Vaccines, 3, 83-86.
 Panda, A., Arjona, A., Sapey, E., Bai, F., Fikrig, E., Montgomery, R.R., et al. (2009) Human innate immunosenescence: Causes and consequences for immunity in old age. Trends in Immunology, 30, 325-333.
 Weinberger, B., Herndler-Brandstetter, D., Schwanninger, A., Weiskopf, D. and Grubeck-Loebenstein, B. (2008) Biology of immune responses to vaccines in elderly persons. Clinical Infectious Diseases, 46, 1078-1084.
 Weinberger, B. and Grubeck-Loebenstein, B. (2012) Vaccines for the elderly. Clinical Microbiology and Infection, 18, 100-108.
 Derhovanessian, E. and Pawelec, G. (2012) Vaccination in the elderly. Microbial Biotechnology, 5, 226-232.
 Insinga, R.P., Itzler, R.F., Pellissier, J.M., Saddier, P. and Nikas, A.A. (2005) The incidence of herpes zoster in a United States administrative database. Journal of General Internal Medicine, 20, 748-753.
 Schmader, K.E., Oxman, M.N., Levin, M.J., Johnson, G., Zhang, J.H., Betts, R., et al. (2012) Persistence of the efficacy of zoster vaccine in the shingles prevention study and the short-term persistence substudy. Clinical Infectious Diseases, 55, 1320-1328.
 Ridda, I., MacIntyre, C.R., Lindley, R.I. and Tan, T.C. (2010) Difficulties in recruiting older people in clinical trials: An examination of barriers and solutions. Vaccine, 28, 901-906.
 Ridda, I., Lindley, R. and MacIntyre, C.R. (2008) The challenges of clinical trials in the exclusion zone: The case of the frail elderly. Australasian Journal on Ageing, 27, 61-66.
 Oxman, M.N., Levin, M.J., Johnson, G.R., Schmader, K.E., Straus, S.E., Gelb, L.D., et al. (2005) A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. The New England Journal of Medicine, 352, 2271-2284. http://dx.doi.org/10.1056/NEJMoa051016
 Osterholm, M.T., Kelley, N.S., Sommer, A. and Belongia, E.A. (2012) Efficacy and effectiveness of influenza vaccines: A systematic review and meta-analysis. The Lancet Infectious Diseases, 12, 36-44.
 Jefferson, T., Di Pietrantonj, C., Al-Ansary, L.A., Ferroni, E., Thorning, S. and Thomas, R.E. (2010) Vaccines for preventing influenza in the elderly. Cochrane Database of Systematic Reviews, 17, Article ID: CD004876.
 Talbot, H.K., Griffin, M.R., Chen, Q., Zhu, Y., Williams, J.V., Edwards, K.M. (2011) Effectiveness of seasonal vaccine in preventing confirmed influenza-associated hospitalizations in community dwelling older adults. The Journal of Infectious Diseases, 203, 500-508.
 Kissling, E., Valenciano, M., Cohen, J.M., Oroszi, B., Barret, A-S., Rizzo, C., et al. (2011) I-MOVE multi-centre case control study 2010-11: Overall and stratified estimates of influenza vaccine effectiveness in Europe. PLoS ONE, 6, Article ID: e27622.
 Hara, M., Sakamoto, T. and Tanaka, K. (2008) Influenza vaccine effectiveness among elderly persons living in the community during the 2003-2004 season. Vaccine, 26, 6477-6480. http://dx.doi.org/10.1016/j.vaccine.2008.06.035
 Ridda, I., Lindley, R. and MacIntyre, C.R. (2009) Differences in the attitude and knowledge of hospital health care workers regarding older patient vaccinations. Human Vaccines, 5, 761-764.
 Ridda, I., Motbey, C., Lam, L., Lindley, R., McIntyre, P.B. and MacIntyre, C.R. (2008) Factors associated with Pneumococcal immunization among hospitalised elderly persons: A survey of patient’s perception, attitude, and knowledge. Vaccine, 26, 234-240.
 Falsey, A.R. (2010) New emerging technologies and the intradermal route: The novel way to immunize against influenza. Vaccine, 28, D24-D32.
 O’Brien, K.L. (2009) Pneumococcal conjugate vaccine, polysaccharide vaccine, or both for adults? We’re not there yet. Clinical Infectious Disease, 49, 1326-1328.
 Hak, E., Grobbee, D.E., Sanders, E.A., Verheij, T.J., Bolkenbaas, M., Huijts, S.M., Gruber, W.C., Tansey, S., McDonough, A., Thoma, B., Patterson, S., van Alphen, A.J. and Bonten, M.J. (2008) Rationale and design of CAPITA: A RCT of 13-valent conjugated pneumococcal vaccine efficacy among older adults. Netherlands Journal of Medicine, 66, 378-383.
 PrabhuDas, M., Adkins, B., Gans, H., King, C., Levy, O., Ramilo, O. and Siegrist, C.A. (2011) Challenges in infant immunity: Implications for responses to infection and vaccines. Nature Immunology, 12, 189-194.
 Hull, B.P., Deeks, S.L. and McIntyre, P.B. (2009) The Australian childhood immunisation register—A model for universal immunisation registers? Vaccine, 27, 5054-5060. http://dx.doi.org/10.1016/j.vaccine.2009.06.056
 Chang, M.H., You, S.L., Chen, C.J., Liu, C.J., Lee, C.M., Lin, S.M., Chu, H.C., Wu, T.C., Yang, S.S., Kuo, H.S., Chen, D.S. and the Taiwan Hepatoma Study Group (2009) Decreased incidence of hepatocellular carcinoma in heaptitis B vaccinees: A 20-year follow-up study. Journal of the National Cancer Institute, 101, 1348-1355.
 Beutels, P., Scuffham, P.A. and MacIntyre, C.R. (2008) Funding of drugs: Do vaccines arrant a different approach? Lancet Infectious Diseases, 8, 727-733.