Rapid population aging has become a major challenge in the industrialized world and progressive aging is a key reason for making improvement in vaccination a cornerstone of public health strategy. An increase in age-related disorders and conditions is likely to be seen in the near future, and these are risk factors for the occurrence of a number of vaccine-preventable diseases. An improvement in infectious diseases prevention specifically aimed at adults and the elderly can therefore also decrease the burden of these chronic conditions by reducing morbidity, disability, hospital admissions, health costs, mortality rates and, perhaps most importantly, by improving the quality of life. Among adults, it is necessary to identify groups at increased risk of vaccine-preventable diseases and highlight the epidemiological impact and benefits of vaccinations using an evidence-based approach. This document provides clinical practice guidance on immunization for adults in order to provide recommendations for decision makers and healthcare workers in Europe. Although immunization is considered one of the most impactful and cost-effective public health measures that can be undertaken, vaccination coverage rates among adults are largely lower than the stated goal of ≥ 95% among adults, and stronger efforts are needed to increase coverage in this population. Active surveillance of adult vaccine-preventable diseases, determining the effectiveness of the vaccines approved for marketing in the last 5 y, the efficacy and safety of vaccines in immunocompromised patients, as well as in pregnant women, represent the priorities for future research.

b Department of Health Sciences University of Florence Florence Italy

c CNR Institute of Neuroscience Aging Branch Center for Research Padua Italy

Division of Infection Control and Hospital Epidemiology Department of Infectious Diseases Heidelberg University Heidelberg Germany

e Department of Health Sciences University of Genoa IRCCS San Martino IST University Teaching Hospital Genoa Italy

f Unit of Public Health University of Bari Bari Italy

g Pediatric Infectious Disease Unit Soroka University Medical Center and the Faculty of Health Sciences Ben Gurion University Beer Sheva Israel

h Geriatric Department Geneva University Geneva Switzerland

i Vaccine and Infectious Disease Institute Antwerp University Wilrijk Belgium

Immunization Action Coalition St Paul MN USA

j Department of Infectious Disease Annecy France

k Department of Social Medicine Faculty of Medicine Charles University Sokolska Hradec Kralove Czech Republic

l Vaccine Research Center Tampere University Hospital Tampere Finland

m Clinic of Infectious Diseases University of Modena and Reggio Emilia Modena Italy

o University of Veterinary Medicine Hannover Hannover Germany

p European Centers for Disease Control and Prevention Stockholm Sweden

Pediatric Highly Intensive Care Unit University of Milan Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

q Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy

r University Clinic of Geriatric Medicine University Hospital of Grenoble and GREPI University of Grenoble Alpes Grenoble France

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