every time we discuss about immunization program in adult and in elderly people , we should consider two important changes that happened in our current society : the increasing ageing of population and a different old age compared with the past . it has been estimated that since 2005 to 2030 world population over 65 will double ( from 500 million to 1 billion ) . in 2030 elderly people will be 40% of all population and in italy in the next 10 years elderly people will be the double compared with 0 - 14 population . elderly people showed some social and demographic characteristics in the past decades :   in the end of working life few years remained to live ;   the end or working life coincided with exclusion of every role in social or recreational activities ;   in the most of cases after - work activities were domestic ( particularly for women ) ;   younger generations took care of elderly , usually inside the same home . today we are witness to a new paradigm : usually a 65 years old person does n't feel old ;   usually life expectancy at the time of retirement is long ;   most of retired people are included in social and recreational activities ;   elderly people claim quality of life ;   over 80 people are increasing in number and usually they live with comorbidity and they represent a high cost for each health service . every year , influenza is responsible of 40,000 deaths in europe , most of them in elderly people and with chronic diseases . the economic burden to manage these preventable diseases with adult immunization , other than year - of - life lost , is more than 10 billion dollars every year . in spite of availability of effective and safe vaccines for these diseases , they are underused . which are the reasons to immunize adult people with vaccines ? at least one of these issues is a good reason to immunize them : because they did n't have immunization in childhood ;   because at present time new vaccines are available ;   because human immune system gets old and acquired immunity can decline ;   because elderly people and people with chronic diseases have more susceptibility to diseases preventable with vaccines ( influenza , pneumococcal pneumonia ) . the lists of immunizations for adults and high risks subjects are reported in tables i and ii . vaccination schedule for adults broken down age group . recommended when there are other risk factors ( chronic disease , occupational , behavior ) . adult immunizations for high - risk groups and categories . recommended when there are other risk factors ( chronic disease , occupational , behavior ) . tetanus , diphteria and pertussis ( tdp ) immunization is strongly recommended because in italy the most of cases of tetanus are in adults who did n't receive any other dose after childhood . about pertussis in italy , as in other countries , the immunization is very spread in childhood population , but the immunity related to vaccine declined in the next 6 years and so young adults , adults and elderly become susceptible to disease another time . we recommend that every time patients request tetanus immunization or when we suggest tetanus immunization , we can propose the booster with tdp immunization . the high degree of antigenic shift and drift in circulating influenza strains leads to the periodic introduction of strains with high susceptibility in the population , resulting in pandemic spread of disease as in 2009 . influenza vaccine is effective and safe to prevent influenza and complications and to decrease related mortality in high - risk group ( patients with chronic diseases , older people and those in contact with high - risk persons ) . furthermore , it is important to consider that 2014 - 2015 season quadrivalent influenza vaccine was available to cover incidental mismatching in co - circulating virus b - strains . streptococcus pneumoniae is a widespread airway transmittable bacterium causing severe diseases as pneumonia and meningitis . pneumococcal infections can be the complications of other respiratory infections as influenza and they usually occur in wintertime . everyone can take a pneumococcal disease but over 65 and patients with chronic diseases have higher mortality rate . overall pneumococcal infections offer the growing rate of antibiotic resistance : immunization is one of the main weapon of prevention against these diseases . one - third of people that had a previous infection with varicella zoster virus , will develop a clinical herpes zoster . the herpes zoster vaccine is recommended in adults over 60 years and older , regardless of their history of herpes zoster . in current competences all general practitioners ( gps ) must integrate in their daily practice the immunization policies of the national health service . regional and local health services organize the mandatory immunization acting in accordance with the national immunization plan . gps ' duty is to orient , counsel and give recommendations on vaccines characterizing and selecting population groups at high - risk . we can suggest immunization in adults according to age - group ( young adult , adult or old people ) ( tab i ) or according to risk - group ( patients with chronic disease , immunocompromised conditions , pregnancy ) ( tab . iii ) or for employment categories ( health care professionals and social care professionals ) or for lifestyle ( international travelers , history of drug abuse or sexual transmitted diseases ) . it 's possible , in this way , to have agenda about age groups or about risk categories . the mission of our college works in the following directions :   education to vaccines and immunization policy ;   immunizations belong to gps ' daily practice and their scientific knowledge ;   to offer tools of education and information ;   to invite pharmaceutical industries make information service to primary care doctors ;   to provide gps innovating tools to value own practice , understand the weakness and criticism and supply solving to improve immunizations in adults and in elderly people . millegpg ( mille general practice governance ) is an informatic tool able to have an active interaction with the most spread electronic patient data record ( millewin ) in italy . this application has been developed in collaboration with italian college of general practitioners ( simg ) . millegpg provides gps with a series of " dashboards " by which they can check several performance indicators . more than 200 performance indicators ( epidemiological , ongoing and outcome ) are embedded millegpg encompassing three main domains ( clinical audit , appropriateness and risk management . all indicators have been conceived according to international clinical guidelines during several meetings involving gps and specialists . . when gp wants to analyze the cohorts of patients with chronic disease ( for example patients with chronic obstructive pulmonary disease or with diabetes or with heart failure ) in the domain " risk management & prevention " , it 's possible to have the list of patients under 65 years old that should receive influenza vaccine . the other can be recall or in a proactive way ( every time patient comes in office for a prescription , the nurse or the doctor receive an alert on the patient record ) or call the patient by mail or e - mail . this model can be replicated for other immunizations and in this way each gp ( or group ) can act a real governance of immunizations . gp should adopt a systematic approach to immunization programs that includes educating patients and office staff using reliable sources of information , standing protocols during patient encounters and all practice management resources . recall and reminder systems have resulted in increases of up to 20 percent in rate of vaccination . synergic policies of education , information and professional tools can improve the competences and behaviours for benefit to patients and society .