Immunofitness in the elderly: The role of vaccination in promoting healthy aging.

José Gomez Rial, Esther Redondo, Irene Rivero-Calle, Enrique Mascarós, Daniel Ocaña, Isabel Jimeno, Ángel Gil, Manuel Linares, María Ángeles Onieva-García, Fernando González-Romo, José Yuste, Federico Martinón-Torres

Journal: Human vaccines & immunotherapeutics 2026;22(1):2624234

PMID: 41665459

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Abstract

Aging reshapes immunity through immunosenescence and inflammaging, increasing susceptibility to infection, exacerbating chronic conditions, and blunting vaccine responses. This review frames "immunofitness" as a practical goal of healthy aging and examines how adult vaccination builds immune resilience. Vaccination strengthens adaptive memory, leverages adjuvants to optimize antigen presentation, and can reprogramme innate cells (trained immunity), yielding heterologous benefits beyond target pathogens. We integrate evidence in older adults for influenza, respiratory syncytial virus, pneumococcal, COVID-19, and recombinant zoster vaccines, including reductions in respiratory events, cardiovascular outcomes, hospitalization, and mortality. We highlight emerging platforms and precision vaccinology to tailor schedules by immune age, comorbidity, and frailty. Integrating routine, age-appropriate vaccination with lifestyle measures is a feasible, high-impact strategy to promote immunofitness.

Address: Immunology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.; Infectious, Migrant, Vaccines, and Preventive Activities Group of SEMERGEN, International Healthcare Centre of the City Council of Madrid, Madrid, Spain.; Translational Paediatrics and Infectious Diseases Section, Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.; Genetics, Vaccines, and Infections Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, University of Santiago de Compostela, Santiago de Compostela, Spain.; CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Health Department, Hospital la Fe, Primary Care Centre Arquitecto Tolsá, Valencia, Spain.; Primary Care, Health Care Centre Algeciras, Algeciras, Spain.; Primary Care Health Centre Isla de Oza, Vaccine Responsible of SEMG, Madrid, Spain.; CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; Preventive and Public Health, Rey Juan Carlos University, Madrid, Spain.; Specialist in Primary Care and Clinical Microbiology, Infectious Diseases Group SEMERGEN, Fundación Io, Madrid, Spain.; Preventive Medicine and Public Health Unit, Hospital Universitario Reina Sofia, Cordoba, Spain.; Preventive Medicine and Public Health Research Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain.; Department of Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain.; Clinical Microbiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain/Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain.; CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.; National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.

DOI: 10.1080/21645515.2026.2624234

MeSH Terms: Humans, Aged, Vaccination, Healthy Aging, Immunosenescence, COVID-19 Vaccines, COVID-19, Influenza Vaccines, Aged, 80 and over, Pneumococcal Vaccines, Aging