CID Study: Effectiveness Of 2010-11 Flu Vaccine

 

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While influenza vaccines are considered to be the best protection against catching the flu, we know that their effectiveness can vary widely from one year to the next, and by the age and immune response of individual recipients.

 

It has long been problematic that flu shots must be formulated 6 months before they can be rolled out, and during that time the flu viruses in circulation can change antigenically, making the vaccine a less exact match.

 

In truth, we really don’t know how well any particular flu vaccine will work until the flu season is over, and the data is analyzed.

 

Last year, in CIDRAP: A Comprehensive Flu Vaccine Effectiveness Meta-Analysis, we took an extended look at a study conducted by researchers at CIDRAP, along with colleagues from  the Marshfield Clinic Research Foundation and Johns Hopkins University.

 

After an exhaustive examination of more than 5,700 published studies - going back to 1967 - fewer than 3 dozen studies met their (admittedly strict) criteria.

 

While large gaps in the data remain, they were able to determine:

 

TIV showed efficacy in preventing influenza during 8 of 12  flu seasons (67%) with a combined efficacy of 59% among healthy adults (aged 18–65 years).

 

And among children aged 2-7, the LAIV proved even more protective, showing efficacy in 9 out of 12 flu seasons (75%) with a pooled efficacy of 83%. 

 

While finding flu vaccines `moderately protective’, the study’s authors cautioned that their findings should be seen as a clarion call for the development of more effective influenza vaccines.

 

Today, another study, this time appearing in the journal Clinical Infectious Diseases, that attempts to put a VE (Vaccine Effectiveness) rating on the flu vaccine for the the 2010-11 flu season.

 

Based on a case–controlled study of nearly 4,800 patients, they compared vaccination histories and positive RT-PCR testing for influenza, and came up with an overall adjusted VE of 60% (95% [CI], 53%–66%).

Children aged 6-months to 8 years came in with a VE of 69% (95% CI, 56%–77%) while adults > 65 came in at a disappointing 38% (95% CI, −16% to 67%).

 

 

Effectiveness of Seasonal Influenza Vaccines in the United States During a Season With Circulation of All Three Vaccine Strains

John J. Treanor, H. Keipp Talbot, Suzanne E. Ohmit, Laura A. Coleman, Mark G. Thompson, Po-Yung Cheng, Joshua G. Petrie, Geraldine Lofthus1, Jennifer K. Meece, John V. Williams, LaShondra Berman, Caroline Breese Hall, Arnold S. Monto, Marie R. Griffin, Edward Belongia, David K. Shay

Conclusions. The US 2010–2011 influenza vaccines were moderately effective in preventing medically attended influenza during a season when all 3 vaccine strains were antigenically similar to circulating viruses. Continued monitoring of influenza vaccines in all age groups is important, particularly as new vaccines are introduced.

 

While a 38% effectiveness in those over 65 is disappointing, it is not unexpected. We’ve known for some time that as we get older, our immune response from the flu vaccine declines.

 

A couple of earlier blogs on this topic include:

 

Study: Flu Vaccines And The Elderly

Flu Shots For The Elderly May Have Limited Benefits

 

Which is not to say that they have no value, only that those over 65 – who are normally at greatest risk from influenza – may get less protection than do younger adults from the shot.

 

Last year, NFID - the National Foundation for Infectious Diseases - convened a group of experts to address the issues of influenza and the elderly. From that panel a 5-page brief has emerged, called: Understanding the Challenges and Opportunities in Protecting Older Adults from Influenza.

 

While the elderly generally see less protection from the flu vaccine, they state that older individuals may still mount a robust immune response. In populations 65 and older, the brief points out that:

 

• Hospitalization rates for influenza and pneumonia are lower in community-dwelling adults who received the seasonal influenza vaccine.
• Immunization is associated with reduced hospitalization of older patients for cardiac, respiratory, and cerebrovascular diseases.

 

While the goal of vaccinating the younger population is to prevent infection, the authors point out that:

 

. . . the goal in older adults is to prevent severe illness, including exacerbation of underlying conditions, hospitalization, and mortality.

 

In other words, even if the vaccine doesn’t always prevent infection in the elderly, studies suggest that the vaccine may blunt the seriousness of the illness in those over 65.

 

The authors also point out that new vaccine technologies are being tested including the new high-dose influenza vaccine (see MMWR On High Dose Flu Vaccine For Seniors, Vaccines: Sometimes You Just Need A Bigger Hammer),  Intradermally administered flu vaccines, and in Europe, the inclusion of adjuvants.

 

While everyone wishes the flu vaccine were 100% effective for 100% of the population, the bottom line remains:

 

Influenza is not a trivial illness, and causes much sickness and death every year.

 

While not 100% effective, the flu vaccine has an excellent safety record and can significantly reduce your odds of catching the flu.

 

So despite lackluster VE ratings, I’ll be rolling up my sleeve again this year.  And so should you.

NFID: The Challenges Of Influenza In Older Adults

 

 

# 5665

 

 

NFID is the National Foundation for Infectious Diseases -- a non-profit organization founded in 1973 – that describes its mission as: “educating the public and healthcare professionals about the causes, treatment and prevention of infectious diseases.”

 

NFID is a resource rich website with information fact sheets on a variety of infectious diseases, continuing medical education (CME) links, information on conferences and courses, and publications.

 

While influenza can strike people of any age, it is the elderly who experience the greatest health burden from the illness. Those over 65 are more likely to be hospitalized, or die, as a result of the flu.

 

(Credit NFID)

 

The immune system of those over 65 is often  less robust than their younger counterparts, and they may be dealing with underlying chronic conditions such as heart disease, COPD, and diabetes that further increase their risks.

 

Complicating matters, the influenza vaccine may be less effective in the elderly as well (see Study: Flu Vaccines And The Elderly, Flu Shots For The Elderly May Have Limited Benefits).

 

Earlier this year NFID convened a panel of experts to address the issues of influenza and the elderly that included such familiar names in public health as Arnold Monto, MD; Kristin Nichol, MD, MPH; H. Keipp Talbot, MD, MPH; and William Schaffner, MD.

 

From that panel a 5-page brief has emerged, called: Understanding the Challenges and Opportunities in Protecting Older Adults from Influenza.

 

Although the elderly generally see less protection from the flu vaccine, older individuals may still mount a robust immune response. In populations 65 and older, the brief points out that:

 

• Hospitalization rates for influenza and pneumonia are lower in community-dwelling adults who received the seasonal influenza vaccine.
• Immunization is associated with reduced hospitalization of older patients for cardiac, respiratory, and cerebrovascular diseases.

 

While the goal of vaccinating the younger population is to prevent infection, the authors point out that:

 

. . . the goal in older adults is to prevent severe illness, including exacerbation of underlying conditions, hospitalization, and mortality.

 

In other words, even if the vaccine doesn’t always prevent infection in the elderly, studies suggest that the vaccine may blunt the seriousness of the illness in those over 65.

 

The authors also point out that new vaccine technologies are being tested including the new high-dose influenza vaccine (see MMWR On High Dose Flu Vaccine For Seniors, Vaccines: Sometimes You Just Need A Bigger Hammer),  Intradermally administered flu vaccines, and in Europe, the inclusion of adjuvants.

 

The authors write:

Health care providers should stay alert for the introduction of these new vaccines, learn their benefits for specific populations, and consider all options when planning ahead for the influenza season. In settings with large numbers of frail elderly, such as nursing homes, familiarity with the different options for preventing and managing influenza is especially important.

 

In addition to embracing universal vaccination for everyone over the age of 6 months and keeping up with the latest technology, the authors urge that health care providers:

 

Demonstrate a Personal Commitment to Influenza Vaccination

Health care providers can set a good example—and protect themselves and their patients— by receiving the influenza vaccine every year and by encouraging their colleagues and all members of their staff to do so too. Until the health care community as a whole attains a near universal influenza vaccination rate, there is room for much progress to be made in this area.

 

 

Although this brief is very brief, it is well footnoted for those who would like to follow up on the statements within.

 

The bottom line is pretty simple.  Quoting again from the brief:

 

The public must become aware that influenza is far more serious than the common cold, especially for older people, and that the vaccine is both safe and beneficial.

 

This brief, along with the other offerings on the NFID site, are well worth taking the time to peruse.

NFID Influenza Poll

 

 

 

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For a society that has just only recently emerged from a year-long influenza pandemic – one that consumed cable, broadcast, and print news coverage for months – our level of influenza awareness remains dismally low.

 

At least, if we are to go by the results of a recent poll conducted on behalf of the NFID (National Foundation for Infectious Diseases).

 

According to this national poll conducted in November of last year, nearly seven out of 10 Americans (68%) did not realize that flu viruses can travel five to six feet from a sneeze or a cough.

 

My first response was, `You have to be kidding. Right?”

 

But apparently, they aren’t kidding. 

 

Worse, two-thirds (66%) admitted to going to work, school, or pursuing their regular daily activities even when they have flu symptoms.

 

If influenza were just a temporary inconvenience, a benign misery from which everyone recovers, then this would simply be inexcusably bad manners.  

 

But influenza – even in a `normal’ flu season -  kills thousands of people each year.

 

Yet somehow, we take it lightly.  We treat covering our coughs and sneezes in public, or staying home when we are likely contagious, as optional.

 

In the fall of 2009 (see Take the Pledge), during the peak of the pandemic, west coast preparedness advocate @CarolDn tweeted:

 

If you get sick, pledge to yourself: "This germ stops with me" Don't pass it forward.

 

I liked the sentiment so much, I featured it repeatedly over that winter.   Carol had the right idea then, and it remains the right idea every flu season.

 

In their ongoing attempt to try to convince Americans to take influenza seriously, the NFID has launched a new winter influenza awareness campaign.

 

You can read more about this survey, and the campaign, in this press release.

 

 

ARE YOU READY TO FACE “THAT GUY” THIS FLU SEASON?

National Foundation for Infectious Diseases launches Are You That Guy? campaign to urge Americans to see a doctor and limit contact with others when flu symptoms strike

BETHESDA, MD, January 25, 2011 /PRNewswire/ — Have you ever ventured out of the house, gone to a business meeting or traveled by air when you thought you might have the flu? If you answered yes, you are among a majority of Americans who fessed up in a recent survey to being “that guy” who goes about his or her day despite experiencing the sudden onset of fever, aches and chills – commonly recognized symptoms of the flu.

 

As the U.S. flu season peaks, the National Foundation for Infectious Diseases (NFID) has launched Are You That Guy?, a national influenza educational campaign that encourages personal and social responsibility by raising awareness of how easily the flu virus spreads.

 

According to a recent national poll, almost seven out of 10 Americans (68%) did not realize that flu viruses can travel five to six feet from a sneeze or a cough, and two-thirds (66%) admitted to going about their daily activities despite experiencing flu symptoms.

 

“It’s easy to downplay the signs of influenza, particularly when daily obligations call,” said Dr. Susan J. Rehm, NFID medical director and vice chairman of the Department of Infectious Diseases at the Cleveland Clinic. “While many of us feel we can power through the flu without getting others sick by avoiding shared objects or shaking hands, it’s important to remember that the influenza virus is commonly spread through the air and can travel up to six feet away when someone coughs, sneezes or even speaks.”

 

“Influenza is serious and highly-contagious,” added Dr. Rehm. “Vaccination and good hygiene habits are important steps to avoid getting the flu. If you have flu symptoms, it’s important to act quickly, see a doctor and follow your doctor’s advice. No one wants to be ‘that guy’ who puts others at risk for flu.”

(Continue . . . )

NFID News Conference

 

 

 

# 4966

 

 

The annual influenza news conference by the NFID (National Foundation for Infectious Diseases) has just concluded at the Washington Press club, with presentations by some names that are surely familiar to many of my readers.

 

 
William Schaffner, MD, President, National Foundation for Infectious Diseases (NFID); Vanderbilt University School of Medicine
 
Thomas R. Frieden, MD, MPH, Director, Centers for Disease Control and Prevention (CDC)
 
Daniel Jernigan, MD, MPH, Deputy Director, CDC Influenza Division 
 
Judith S. Palfrey, MD, FAAP, Immediate Past-President, American Academy of Pediatrics (AAP)

Stephan L. Foster, Pharm.D, American Pharmacists Association, (APhA)

 

In addition to short presentations on the importance of yearly flu vaccination, and a Q&A session, this news conference also distributed roughly 2 dozen handouts on influenza, pneumococcal disease, and vaccinations to the press.

 

This year, everyone over the age of 6 months is being encouraged to get the flu vaccine, and more seasonal vaccine is available this year than any year in the past.

 

Dr. Dan Jernigan made special mention of the H3N2 virus that has been circulating around the world over the past few months, and reminded reporters that years when H3N2 was the dominate strain tended to see more severe cases.

 

In a limited survey, 92 percent of physicians stated they discuss the vaccine with their patients and 95% said they plan to get vaccinated themselves (numbers that are, admittedly, higher than I’ve seen published in the past). 

 

 

• More than 5 percent of physicians had already been vaccinated when the survey was fielded on
September 15, 2010; 90 percent more said they are likely to get vaccinated this season

• A small percentage (3 percent) remains uncertain; less than 2 percent definitively stated they would not get the vaccine this season

 

Dr. William Schaffner stressed the personal and ethical responsibility for health care workers to voluntarily get vaccinated. 

 

Cheryl Matheis, senior vice president for health strategy at AARP, stressed the need for older adults and seniors to get the pneumococcal vaccine.

 

Some excerpts from the Understanding Pneumococcal Disease handout include:

 

Pneumococcal disease is a serious infection caused by bacteria called Streptococcus pneumoniae.
Pneumococcal bacteria can cause different illnesses depending on which area of the body they invade,
including:

•  Pneumonia — infection in the lungs
•  Meningitis — infection in the covering of the brain
•  Bacteremia — infection in the bloodstream

• There were 43,500 cases of invasive pneumococcal disease (bacteremia, meningitis) in 2009, resulting in 5,000 deaths.

 

You can expect a fair amount of media coverage over the next few days coming out of this news conference, as this year’s flu vaccination campaign moves into full swing.  

 

I got my flu shot a month ago, and hopefully by now have grown a healthy set of antibodies to all three strains of flu expected this year.

 

If you haven’t gotten yours yet, supplies are ample and with practically every chain pharmacy and grocery store offering shots, finding a vendor has never been easier.