Thursday, April 29, 2010

Flu Shots And The Elderly



# 4532



Seasonal influenza (as opposed to pandemic flu) traditionally takes its biggest toll among the oldest and frailest members of society. Of the 36,000 estimated deaths flu-related deaths in the United States each year, the vast majority occur in those over the age of 65.


According to one recent study, 90% of seasonal flu related deaths “occur in people over 65 years and the mean age of influenza-related deaths is estimated at 76 yrs.”


Which is why those over the age of 65 have been routinely urged to get a flu shot every year.  Something I’ve recommended to my (now 85 yr old) father since the 1990s.


And since I’m approaching `middle age’ myself (assuming, of course, I manage to live to be 112), I get the flu shot every year as well.


The problem is, the elderly - who are most at risk from dying from seasonal influenza - appear to derive the least amount of protection from our current flu shot formulations. 



While this is hardly a secret, is isn’t exactly advertised on billboards outside of your doctor’s office either.  


You’ll find a number of blogs here, going back several years on this topic, including:


ACIP Provisional Influenza Vaccine Recommendations
Why Vaccines Matter
Vaccines: Sometimes You Just Need A Bigger Hammer

Another Study: Flu Vaccines Do Not Reduce Mortality Rates In The Elderly

Study: Flu Vaccines And The Elderly

Flu Shots For The Elderly May Have Limited Benefits


Since the level of protection induced by the flu shot likely varies widely between elderly recipients, and since a little protection is assumed to be better than none, there is a natural reluctance among some health care providers not to go into a lot detail about the relative degree of protection afforded to the elderly by the vaccine.



And to be clear here, the evidence doesn’t say there is no benefit to giving those over 65 a flu shot.


0nly that those with the weakest immune systems – and therefore most apt to die from the flu – don’t appear to be any less likely to die if they’ve been vaccinated.



A factoid I’ve shared with my father every fall for several years now, as I dutifully remind him to get the vaccine.  But as they say, a little protection beats none at all . . .


Which brings us to an article (hat tip CIDRAP News) which appears on Minnesota public radio’s website, featuring CIDRAP’s director Michael Osterholm.



Research suggests flu vaccine doesn't prevent deaths among the elderly

by Lorna Benson, Minnesota Public Radio

April 27, 2010

St. Paul, Minn. — If the main point of the nation's influenza vaccination program is to reduce deaths from flu, then the program has failed, at least among people over 65.


A growing body of research shows that because our immune systems age, flu vaccines don't work as well in the elderly - the group of people most likely to die from flu-related causes.


The revelation has been so unsettling that public health officials have not shared the information widely with the public - even though some of the early findings have been a part of the scientific literature for several years now.


Michael Osterholm, who directs the University of Minnesota's Center for Infectious Disease Research and Policy, Tuesday told a national conference on vaccine research that it's time to be more open about the flu vaccine and its lack of protection for the elderly.


Osterholm also urged his colleagues to support attempts to create a new, effective vaccine.

(Continue . . . )


This is a very good article, with a lot of background on the studies that have been conducted trying to understand the effect and effectiveness of flu vaccination in the elderly.  


Last December the FDA approved a new, high-dose Fluzone flu shot for those over 65, that contains 4 times the normal amount of antigen.



For Immediate Release: Dec. 23, 2009

FDA Approves A High Dose Seasonal Influenza Vaccine Specifically Intended for People Ages 65 and Older

Accelerated approval process used in vaccine approval

The U.S. Food and Drug Administration today approved Fluzone High-Dose, an inactivated influenza virus vaccine for people ages 65 years and older to prevent disease caused by influenza virus subtypes A and B.


People in this age group are at highest risk for seasonal influenza complications, which may result in hospitalization and death. Annual vaccination remains the best protection from influenza, particularly for people 65 and older.

(Continue . . . )


In March, ACIP announced that this new formulation would be available along with standard flu shots this fall, but did not announce a preference for one shot over the other. Those interested should discuss this option with their family physician.


While early testing has been promising, it will probably take a year or two of field use before we have any idea of the relative impact of this new flu vaccine.  


In the meantime, doctors and public health officials are left in a quandary over how to best present this information without discouraging the uptake of the flu vaccine by the elderly.  


Most researchers believe that – at least among those seniors who are reasonably healthy – the flu shot provides some level of protection.


How much varies from year-to-year and from person-to-person.


Which, ultimately, may be the simplest and most honest way to `sell’ seniors on the idea of getting the shot every year.   


It is what I used with my Dad, and he was fine with it.