Vaccination strategies for at-risk adults in General Practice

Vaccination in general practice: how primary care practitioners can protect high-risk adult groups.

Why risk groups matter

In the German healthcare system, general practitioners (GPs) play a pivotal role in vaccinating adult patients, especially those belonging to clinical risk groups. While childhood immunisation is well structured through paediatric care and public health services, protecting vulnerable adults requires proactive counselling, documentation and administration by GPs. 

In Germany, only about 43 % of adults aged ≥ 60 years were vaccinated against influenza in 2021–22, while vaccination coverage for pneumococcus and herpes zoster remains below 10 % in at-risk groups. Across Europe, influenza coverage among the elderly dropped from 59 % in 2020/21 to 45,7 % in 2023/24, with declines ranging between 3 % and 10 % in many countries. Given the persistently low vaccination rates for certain target groups, it is essential to reinforce knowledge, communication and myth-busting at the point of care.

Patients with comorbidities, immunosenescence or weakened immune systems are more likely to experience severe outcomes from common viral or bacterial infections. Hospitalisations, functional decline and long-term complications can often be prevented through timely vaccination. The Robert Koch Institute’s Standing Committee on Vaccination (STIKO) regularly updates its recommendations to reflect evolving epidemiological and clinical evidence. For GPs, translating these guidelines into patient-centred decisions remains a daily responsibility.

Pneumococcal vaccination

Pneumococcal infections are a major cause of pneumonia, bacteraemia and meningitis in older adults. STIKO recommends a single dose of the 20-valent conjugate vaccine (PCV20) for:

  1. All adults aged ≥60 years;
  2. Individuals aged ≥18 with chronic heart, lung, liver or kidney disease, diabetes, or other immunocompromising conditions.

For patients who previously received PPSV23, a follow-up dose of PCV20 should be given after a minimum of six years. The most common adverse events are mild local reactions. The benefit–risk profile is clearly favourable: vaccination reduces the incidence of invasive pneumococcal disease and related hospitalisations.

Herpes Zoster vaccination

Herpes zoster (shingles) can cause significant morbidity, especially in elderly and immunocompromised individuals. The recombinant subunit vaccine (Shingrix®) is recommended for:

  1. All adults ≥60 years;
  2. Those ≥50 years with increased risk (e.g. diabetes, cancer, autoimmune disease).

Administered in two doses 2–6 months apart, Shingrix provides over 90% efficacy and long-term protection against zoster and post-herpetic neuralgia. Side effects include injection-site pain, fatigue or low-grade fever. As with pneumococcal vaccination, the burden of disease justifies routine immunisation.

Influenza vaccination

Seasonal influenza remains an underestimated threat to at-risk adults, especially in the elderly and patients with cardiovascular or respiratory comorbidities. STIKO recommends annual vaccination:

  1. For all adults aged ≥60 years;
  2. For individuals with chronic diseases;
  3. For pregnant women and healthcare workers.

The preferred product is the high-dose quadrivalent vaccine (e.g. Efluelda®) or an adjuvanted version. Vaccination should ideally take place between October and December. Despite misconceptions, influenza vaccines do not cause flu, and their protection significantly reduces hospitalisations and mortality in risk groups.

RSV vaccination

Respiratory syncytial virus (RSV) has gained increasing attention as a cause of severe lower respiratory tract infection in older adults. In 2024, STIKO updated its guidance to recommend one-time RSV vaccination with Arexvy® or Abrysvo® for:

  1. Adults aged ≥75 years;
  2. Those aged 60–74 years with high-risk conditions (e.g. COPD, heart failure, diabetes).

Clinical trials have shown substantial reductions in medically attended RSV illness and hospitalisation. Tolerability is good, with adverse effects similar to those of influenza vaccines. GPs should actively identify eligible patients and address common doubts, especially as RSV remains less well known among the general public.

Addressing vaccine hesitancy and myths

Misconceptions continue to undermine vaccine uptake, particularly among elderly or chronically ill patients. Many refuse vaccines because they "never get sick", fear long-term side effects, or distrust new products. Others recall mild adverse reactions in the past and generalise them to all future vaccinations. GPs frequently encounter beliefs such as:

There is also widespread confusion between temporal and causal relationships, such as flu-like symptoms after influenza vaccination, or zoster outbreaks coinciding with vaccination dates.

GPs should address these concerns with empathy, clarity and evidence. Explaining that vaccines are rigorously tested, that mild side effects are expected signs of immune activation, and that serious adverse events are extremely rare helps to reframe the conversation. Sharing real patient cases, using analogies, and correcting myths without judgement often builds trust more effectively than raw data alone.

GPs can rebuild vaccine confidence

In addition to the vaccines we have listed here, primary care physicians also play an important role in promoting other vaccinations. For example, HPV vaccination among adolescents and young adults, especially in cases where vaccination was not carried out during childhood. Ensuring protection at all stages of life is a responsibility that begins, and often remains, in family medical practice.

The COVID-19 pandemic has left a deep mark not only on public health, but also on public trust in science and medical institutions. General practitioners, who maintain long-term relationships with their patients, are ideally placed to rebuild confidence through consistent, transparent communication. In a time where social media amplify both misinformation and reliable science, GPs can choose to be a credible voice - not only in the consultation room, but also online. By sharing evidence-based messages, debunking myths, and engaging openly with the public, physicians can help shape a culture of trust and prevention.

Sources and further reading
  1. STIKO. Recommendations of the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute – 2025. Epid Bull. 2025;4:1–36. 
  2. Van Buynder PG, et al. The efficacy of high-dose influenza vaccine in older adults: a systematic review. Vaccine. 2022 Jan 3;40(2):389–396. doi:10.1016/j.vaccine.2021.11.027
  3. Lal H, et al. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med. 2015 May 28;372(22):2087–2096. doi:10.1056/NEJMoa1501184
  4. Essink B, et al. Efficacy and safety of an RSV prefusion F vaccine in older adults. Lancet. 2023 Jan 7;401(10390):115–125. doi:10.1016/S0140-6736(22)01899-2
  5. Bonten MJ, et al. Polysaccharide and conjugate vaccines against pneumococcal disease in adults: a meta-analysis. JAMA.2015 May 12;313(18):1806–1816. doi:10.1001/jama.2015.4564
  6. ECDC. Survey report: Seasonal influenza vaccination recommendations and coverage in EU/EEA. Stockholm: European Centre for Disease Prevention and Control; 2024. 
  7. Ehlers J, et al. Adult vaccination coverage in Germany: analysis of the 2021 GEDA survey. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2023 Mar;66(3):320–331. doi:10.1007/s00103-022-03607-0
  8. Verger P, et al. Vaccine hesitancy in the post-COVID era: trends and determinants in Europe. Euro Surveill. 2023 Jun;28(25):2300123. doi:10.2807/1560-7917.ES.2023.28.25.2300123
  9. Betsch C, et al. Opportunities and challenges of digital communication in vaccination: a perspective from Germany. Hum Vaccin Immunother. 2021 Jul;17(7):2044–2050. doi:10.1080/21645515.2020.1847584