CDC: Flu Shots Reduce Hospitalizations In The Elderly

Photo Credit - CDC PHIL

 

 

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Although the elderly (> 65) are considered to be the most endangered by influenza infection, they are also the group least likely to be protected by the seasonal flu vaccine (see PLoS One: Limited Effectiveness Of Flu Vaccines In The Elderly & Flu Shots And The Elderly).

 

That isn’t to say the flu vaccine is worthless, or not worth bothering with – only that the amount of protection for the elderly is generally less than for other age cohorts.

 

In 2011,  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.

This report pointed out that 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.

Similarly, over the past couple of years, we’ve seen studies suggesting the flu vaccine may reduce the risk of heart attack and stroke (see JAMA: Flu Vaccine and Cardiovascular Outcomes & Study: Flu Vaccine May Reduce Heart Attack).  .

 

Yesterday, the CDC announced the results of a study published in Clinical Infectious Diseases.  First a link to the study, then some excerpts from the CDC statement.

 

Modeling the effect of different vaccine effectiveness estimates on the number of vaccine prevented influenza associated hospitalizations in older adults

Alicia M. Fry1, Inkyu K. Kim1,2, Carrie Reed1, Mark Thompson1, Sandra S. Chaves1, Lyn Finelli1, and Joseph Bresee1

Abstract

We compared influenza vaccine-prevented hospitalizations in adults aged>65 years for a range of hypothetical effectiveness estimates. During 2012-13, a vaccine with 10% effectiveness (66% coverage)would have averted ∼13,000 hospitalizations and a vaccine with 40% effectiveness would have averted ∼60,000 hospitalizations.Annual vaccination is merited in this vulnerable population.

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This from the http://www.cdc.gov/flu website.

 

CDC Study Concludes Flu Vaccination Prevents Hospitalizations in Older People

Hospitalizations averted even when vaccine effectiveness is lower

May 9, 2014 – A new CDC study shows that flu vaccines prevent flu-associated hospitalizations in people 65 years and older, even during seasons when vaccine effectiveness is low. The study reinforces CDC’s existing recommendation for annual vaccination of adults 65 years and older who are at high risk for serious flu-related complications and often most impacted by serious flu disease each year resulting in hospitalization or death.

The study, published in Clinical Infectious Diseases online on May 6, 2014, used statistical modeling to estimate flu-vaccine-prevented hospitalizations in adults aged 65 years and older for estimates of vaccine effectiveness against medically attended influenza illness ranging from 10% to 70%. Researchers used CDC flu surveillance data collected during the 2011-12 and 2012-13 seasons. The 2011-12 season was considered to be a mild flu season, whereas the 2012-13 season was characterized as moderate to severe. Using data from these two seasons, researchers were able to determine the varying impact that flu vaccination had in terms of hospitalizations prevented.

Findings showed that during the more severe 2012-13 flu season, a flu vaccine with 10% effectiveness (and 66% coverage) would avert about 13,000 hospitalizations, whereas a vaccine with 40% effectiveness would avert about 60,000 hospitalizations. In contrast, during the more mild 2011-12 season, a flu vaccine with the same two effectiveness estimates would avert about 2,000 and 11,000 hospitalizations, respectively.

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Despite disappointing VE (Vaccine Effectiveness) numbers (see CIDRAP: A Comprehensive Flu Vaccine Effectiveness Meta-Analysis) - particularly among the elderly (see BMC Infectious Diseases: Waning Flu Vaccine Protection In the Elderly) - we continue to see evidence of benefit from the shot, even if full protection isn’t conveyed to the recipient.

 

As addressed back in 2012 by CIDRAP: The Need For `Game Changing’ Flu Vaccines, there is obviously a great need for better, more effective, and faster to the market flu vaccines.  But even with their current limitations -  I certainly get one each year -  and I urge others to do the same.

 

Not because it is guaranteed protection . . . .

 

But because – like wearing a seatbelt during a motor vehicle crash  – it substantially improves your odds of a good outcome.

PLoS One: Limited Effectiveness Of Flu Vaccines In The Elderly

 

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A topic we’ve covered often in the past has been the limited effectiveness of influenza vaccines among the elderly (>=65) (see Flu Shots And The Elderly, NFID: The Challenges Of Influenza In Older Adults, BMC Infectious Diseases: Waning Flu Vaccine Protection In the Elderly)  or those with compromised or suppressed immune systems.  Those populations most endangered by influenza are, unfortunately, the least likely to be protected by the flu vaccine.

That isn’t to say the flu vaccine is worthless, or not worth bothering with. 

I get the flu shot every year, and I encouraged my Dad to get one until he died at the age of 87, even knowing its limitations.  When dealing with a potentially life threatening illness . . . some protection beats no protection, any day of the week.  

 

But, like seat belts, flu shots can only offer so much protection.  For healthy adults under the age of 65, flu shots are generally described as being moderately effective. In October of 2011, in CIDRAP: A Comprehensive Flu Vaccine Effectiveness Meta-Analysis, we saw a major review indicating the TIV (Trivalent Influenza Vaccine) - during 8 of 12 flu seasons (67%) – produced a combined efficacy of only 59% among healthy adults (aged 18–65 years).

 

They found the protective effects of the flu vaccine could vary considerably from one season to the next, as well as among different age groups.

 

Also in 2011,  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.

 

 

 

Yesterday the open access journal PLoS One published a new retrospective study conducted in Ontario, Canada that attempts to quantify the level of protection those over the age of 65 received from seasonal influenza vaccination.  Not surprisingly, they found that the VE (vaccine effectiveness) to be considerably lower than what has been seen with younger adults.

 

Research Article

Effectiveness of Inactivated Influenza Vaccines in Preventing Influenza-Associated Deaths and Hospitalizations among Ontario Residents Aged ≥65 Years: Estimates with Generalized Linear Models Accounting for Healthy Vaccinee Effects

Benjamin J. Ridenhour mail,Michael A. Campitelli, Jeffrey C. Kwong, Laura C. Rosella, Ben G. Armstrong, Punam Mangtani, Andrew J. Calzavara, David K. Shay

Abstract

Background

Estimates of the effectiveness of influenza vaccines in older adults may be biased because of difficulties identifying and adjusting for confounders of the vaccine-outcome association. We estimated vaccine effectiveness for prevention of serious influenza complications among older persons by using methods to account for underlying differences in risk for these complications.

Methods

We conducted a retrospective cohort study among Ontario residents aged ≥65 years from September 1993 through September 2008. We linked weekly vaccination, hospitalization, and death records for 1.4 million community-dwelling persons aged ≥65 years. Vaccine effectiveness was estimated by comparing ratios of outcome rates during weeks of high versus low influenza activity (defined by viral surveillance data) among vaccinated and unvaccinated subjects by using log-linear regression models that accounted for temperature and time trends with natural spline functions. Effectiveness was estimated for three influenza-associated outcomes: all-cause deaths, deaths occurring within 30 days of pneumonia/influenza hospitalizations, and pneumonia/influenza hospitalizations.

Results

During weeks when 5% of respiratory specimens tested positive for influenza A, vaccine effectiveness among persons aged ≥65 years was 22% (95% confidence interval [CI], −6%–42%) for all influenza-associated deaths, 25% (95% CI, 13%–37%) for deaths occurring within 30 days after an influenza-associated pneumonia/influenza hospitalization, and 19% (95% CI, 4%–31%) for influenza-associated pneumonia/influenza hospitalizations. Because small proportions of deaths, deaths after pneumonia/influenza hospitalizations, and pneumonia/influenza hospitalizations were associated with influenza virus circulation, we estimated that vaccination prevented 1.6%, 4.8%, and 4.1% of these outcomes, respectively.

Conclusions

By using confounding-reducing techniques with 15 years of provincial-level data including vaccination and health outcomes, we estimated that influenza vaccination prevented ~4% of influenza-associated hospitalizations and deaths occurring after hospitalizations among older adults in Ontario.

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Those whose eyes don’t bleed when reading about complex statistical methods will want to peruse the entire study. In an act of self preservation, I admit I only skimmed those areas. The bottom line is that by using statistical analyses far above my pay grade, these authors have determined that the seasonal flu vaccine had about a 22% VE rating for those over the age of 65.

 

In an accompanying press release from the University of Notre Dame, we get the following summation.

 

Notre Dame researchers look at benefits of flu vaccines in the elderly

Sarah Craig

October 16, 2013

(EXCERPT)

In their central findings of the research, the authors said, “By combining health data with climate data and developing novel statistical analyses, we found that vaccination was 19 percent effective at preventing pneumonia- or influenza-related hospitalizations and 25 percent effective at preventing death occurring subsequent to a pneumonia- or influenza-related hospitalization.”

The results indicate that, over a long time period, the influenza vaccine has performed worse than expected in elderly individuals, thus proving the need for improvements in influenza vaccine development.

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If that last observation sounds familiar, it is likely because it echo’s the sentiments of last year’s major report (see CIDRAP: The Need For `Game Changing’ Flu Vaccines).

 

The Compelling Need for Game-Changing Influenza Vaccines

An Analysis of the Influenza Vaccine Enterprise and Recommendations for the Future

Michael T. Osterholm, PhD, MPH, Nicholas S. Kelley, PhD, Jill M. Manske, PhD, MPH, Katie S. Ballering, PhD, Tabitha R. Leighton, MPH, Kristine A. Moore, MD, MPH

 

For those not ready to commit to reading a 160-page report, there is a 12-page Executive summary available.

 

While today’s study provides a disappointing result, and highlights the need for developing better influenza vaccines, the bottom line is that the current vaccine was found to be  `25 percent effective at preventing death occurring subsequent to a pneumonia- or influenza-related hospitalization’. 

 

Given the toll that influenza takes on the elderly, that 25% survival advantage has to be viewed as being better than no advantage at all.

BMC Infectious Diseases: Waning Flu Vaccine Protection In the Elderly

 

 

 

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The standard advice for getting the seasonal flu vaccine is to get it as soon as it becomes available in the fall, as explained in the following excerpt from the CDC’s Misconceptions about Seasonal Flu and Flu Vaccines (updated May 2013).

 

Should I wait to get vaccinated so that my immunity lasts through the end of the season?

No. CDC recommends that influenza vaccination begin as soon as flu vaccine becomes available and continues throughout the flu season. The flu season is unpredictable, and since it takes about two weeks after vaccination for antibodies to develop in the body that protect against influenza virus infection, it is best that people get vaccinated early so they are protected before influenza begins spreading in their community. While immunity can vary by person, previously published studies suggest that immunity lasts through a full flu season. Although adults 65 and older typically have a reduced immune response to flu vaccination compared with young healthy adults, their immune protection still extends through one flu season. In addition, a review of published studies concluded that no clear evidence exists that immunity declines more rapidly in the elderly. Note: The high-dose vaccine for people aged 65 and older is intended to create a stronger immune response in this age group.

Challenging this conventional wisdom is a new study that appears in BMC Infectious Diseases that finds – at least among those over the age of 65 – the protective effects of a flu shot begins to diminish rapidly after four months.  This study, which was conducted in Spain, involved  a relatively small group of subjects, and so its results must be interpreted with caution.

First a link to the open access study, followed by a link to a CIDRAP NEWS article which nicely summarizes the results, after which I’ll return with more.

 

 

Effectiveness of influenza vaccine against laboratory-confirmed influenza, in the late 2011--2012 season in Spain, among population targeted for vaccination

Silvia Jiménez-Jorge, Salvador de Mateo, Concha Delgado-Sanz, Francisco Pozo, Inmaculada Casas, Manuel Garcia-Cenoz, Jesús Castilla, Esteban Pérez, Virtudes Gallardo, Carolina Rodriguez, Tomás Vega, Carmen Quiñones, Eva Martínez, Juana María Vanrell, Jaume Giménez, Daniel Castrillejo, María del Serrano, Julián Mauro Ramos and Amparo Larrauri

Abstract (provisional)

Background

In Spain, the influenza vaccine effectiveness (VE) was estimated in the last four seasons using the observational study cycEVA conducted in the frame of the existing Spanish Influenza Sentinel Surveillance System. To estimate influenza vaccine effectiveness (VE) against medically attended, laboratory-confirmed influenza-like illness (ILI) among the target groups for vaccination in Spain in the 2011--2012 season. We also studied influenza VE in the early (weeks 52/2011-7/2012) and late (weeks 8-14/2012) phases of the epidemic and according to time since vaccination.

Methods

Medically attended patients with ILI were systematically swabbed to collect information on exposure, laboratory outcome and confounding factors. Patients belonging to target groups for vaccination and who were swabbed <8 days after symptom onset were included. Cases tested positive for influenza and controls tested negative for any influenza virus. To examine the effect of a late season, analyses were performed according to the phase of the season and according to the time between vaccination and symptoms onset.

Results

The overall adjusted influenza VE against A(H3N2) was 45% (95% CI, 0--69). The estimated influenza VE was 52% (95% CI, -3 to 78), 40% (95% CI, -40 to 74) and 22% (95% CI, -135 to 74) at 3.5 months, 3.5-4 months, and >4 months, respectively, since vaccination. A decrease in VE with time since vaccination was only observed in individuals aged >= 65 years. Regarding the phase of the season, decreasing point estimates were only observed in the early phase, whereas very low or null estimates were obtained in the late phase for the shortest time interval.

Conclusions

The 2011--2012 influenza vaccine showed a low-to-moderate protective effect against medically attended, laboratory-confirmed influenza in the target groups for vaccination, in a late season and with a limited match between the vaccine and circulating strains. The suggested decrease in influenza VE with time since vaccination was mostly observed in the elderly population. The decreasing protective effect of the vaccine in the late part of the season could be related to waning vaccine protection because no viral changes were identified throughout the season.

From CIDRAP NEWS.

Study: Flu vaccine effectiveness may drop within a few months

The effectiveness of the influenza vaccine dropped from 52% at 3.5 months after vaccination to 22% more than 4 months after vaccination during the 2011-12 season, according to a study out of Spain today in BMC Infectious Diseases whose power was limited by a small sample size.

 

Researchers analyzed data from 342 primary care patients across the country who had influenza-like illness and for whom vaccination status and timing were known. Of these, 226 had lab-confirmed flu and 116 served as test-negative controls.

<SNIP>

The waning immunity appeared to be entirely tied to immune response in elderly patients. The researchers found the adjusted VE dropped from 85% (95% CI, 18 to 97) for patients older than 65 who were vaccinated 3 months before symptom onset to a null estimate for those in that age-group who were vaccinated more than 4 months before symptom onset. The trend, however, was not statistically significant.

The team did not find decreased VE with time in patients younger than 65 years.

(Continue . . . )

 

In the interest of full disclosure, I get the flu vaccine every year and I’ve already had mine earlier this month (see NPM13: Giving Preparedness A Shot In The Arm), yet I’m fully aware that flu vaccines are not a panacea against influenza.  

As we’ve discussed often, flu vaccines – while considered very safe – most years only offer a moderate level of protection against influenza, and that their VE (vaccine effectiveness) can vary widely between flu shot recipients, and is often substantially reduced among those older than 65 or with immune problems.

 

As an example, in October of 2011, in CIDRAP: A Comprehensive Flu Vaccine Effectiveness Meta-Analysis, we saw a major review indicating the TIV (Trivalent Influenza Vaccine) - during 8 of 12 flu seasons (67%) – produced a combined efficacy of only 59% among healthy adults (aged 18–65 years).

 

They found the protective effects of the flu vaccine could vary considerably from one season to the next, as well as among different age groups (see Study: Flu Vaccines And The Elderly).

 

Still, given their safety record, and relative low cost, I consider them to be good insurance against what can sometimes be a serious illness – particularly as I’m getting older.  As an added incentive, we recently saw a study - that while far from conclusive - suggesting that the Flu Vaccine May Reduce Heart Attack Risk.

 

There is no doubt there is a pressing need for better flu vaccines (see CIDRAP: The Need For `Game Changing’ Flu Vaccines) - but until they can be developed - the flu shots we have –  when coupled with good `flu hygiene’ (washing hands, covering coughs, staying home when ill)  remain the best preventative actions you can take against the flu.

NFID: The Challenges Of Influenza In Older Adults

 

 

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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.

MMWR On High Dose Flu Vaccine For Seniors

 

 

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Proving that timing is everything, several hours before the CDC released their weekly MMWR which contained information on the new high dose Fluzone vaccine for seniors, I wrote a blog entitled Flu Shots And The Elderly. 

 

In it, I mentioned the new high-dose Fluzone vaccine for seniors, but we’ve a bit more information today.

 

Since not everyone reads the MMWR each week, and this is a new vaccination option available to those over 65, I thought it deserved special mention today.

 

This new high-dose flu vaccine contains 4 times the normal amount of antigen; 60 µg of each of the three recommended strains, instead of the normal  15 µg.  A trivalent shot, like this year’s regular flu shot, it contains antigens from A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like influenza viruses.

 

 

Excerpts follow, but you may wish to follow the link to read the entire article.   I’ve reformatted some of the paragraphs for easier online reading.

 

 

 

Licensure of a High-Dose Inactivated Influenza Vaccine for Persons Aged ≥65 Years (Fluzone High-Dose) and Guidance for Use --- United States, 2010

Weekly

April 30, 2010 / 59(16);485-486

Persons aged ≥65 years are at greater risk for hospitalization and death from seasonal influenza compared with other age groups (1,2), and they respond to vaccination with lower antibody titers to influenza hemagglutinin (an established correlate of protection against influenza) compared with younger adults (3).

 

On December 23, 2009, the Food and Drug Administration (FDA) licensed an injectable inactivated trivalent influenza vaccine (Fluzone High-Dose, Sanofi-Pasteur) that contains an increased amount of influenza virus hemagglutinin antigen compared with other inactivated influenza vaccines such as Fluzone.

 

Fluzone High-Dose is licensed as a single dose for use among persons aged ≥65 years and will be available beginning with the 2010--11 influenza season. The Advisory Committee on Immunization Practices (ACIP) reviewed data from prelicensure clinical trials on the safety and immunogenicity of Fluzone High-Dose and expressed no preference for the new vaccine over other inactivated trivalent influenza vaccines (4).

 

<SNIP>

 

ACIP Guidance for Use of Fluzone High-Dose

 

Fluzone High-Dose may be used for persons aged ≥65 years. All persons aged ≥6 months are recommended for annual influenza vaccination beginning with the 2010--11 influenza season.

 

ACIP has not expressed a preference for any specific licensed inactivated trivalent influenza vaccine, including Fluzone High-Dose, for use in persons aged ≥65 years (4).

 

Data demonstrating greater protection against influenza illness after vaccination with Fluzone High-Dose are needed to evaluate whether Fluzone High-Dose is a more effective vaccine for persons aged ≥65 years.

 

A 3-year postlicensure study of the vaccine effectiveness of Fluzone High-Dose compared with standard dose inactivated influenza vaccine (Fluzone) was begun in 2009 and should be completed in 2012.

As with other inactivated influenza vaccines, Fluzone High-Dose should not be administered to anyone with a known hypersensitivity to egg proteins or influenza vaccine. Adverse events after receipt of any vaccine should be reported to the Vaccine Adverse Event Reporting System at http://vaers.hhs.gov.

Flu Shots And The Elderly

 

 

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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.

 

FDA PRESS RELEASE

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.