Introduction
Vaccine-preventable respiratory infections (VPRI) including those caused by Streptococcus pneumoniae, influenza, respiratory syncytial virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pose substantial challenges to health and social care systems. In the UK, routine adult respiratory vaccination programs are in place. The objective of this article is to review the current evidence on the impact of four seasonal VPRIs in adults risk group definitions and to explore the strengths and limitations of current recommendations, and to identify evidence gaps for further research.

Areas covered
Relevant evidence on UK data from surveillance systems, observational studies and publicly available government documents is collated and reviewed, as well as selected global data.

Expert opinion
Disparities exist between adult risk group categories for different respiratory vaccination programs as defined in the current vaccination guidance. The burden of multiple respiratory pathogens signifies importance of routine multi-pathogen testing with the need for a resilient and large-scale national surveillance system. Further understanding of epidemiological trends and disease burden will help guide decision-making and planning of targeted strategies for disease prevention and control. Addressing inequalities in disease burden and vaccine coverage particularly in clinical risk groups, and promoting equitable vaccine access remain a priority.