Flu shots in elderly questioned

Researchers are questioning how much the flu vaccine prevents flu-related deaths among older people, saying it may provide less protection starting around age 70, as immune systems decline with age.

In a review article in the October issue of Lancet Infectious Diseases, researchers including Dr. Lisa Jackson, a senior investigator at the Group Health Center for Health Studies, say evidence that all older people should get flu vaccines is weak.

Still, the researchers recommended that seniors should get flu shots, noting that they are basically harmless. The study looked only at the relationship between flu shots and deaths from flu; it did not address the relationship of flu vaccines and coming down with the flu but surviving.

In the article, researchers say that only observational studies, not gold-standard clinical trials, have been used to defend the benefits of older people getting flu vaccines. They cite past studies, including those conducted by the Centers for Disease Control and Prevention, that show that despite a jump in vaccinations in the elderly from 15 percent to 65 percent since 1980, flu deaths among elderly people increased during the 1980s and 1990s. A similar study in Italy also found no decrease in deaths from flu among the elderly, despite an increase in vaccines by 60 percent in that population.

Researchers say those results raise questions about whether the flu vaccine helps prevent death in older people.

"You just shouldn't look at the data and thinks this works," said Jackson, who for several years has been studying how well the flu vaccine prevents death after infection in the elderly.

The flu accounts for an average of 5 percent of deaths in the elderly, or about one out of every 1,000 deaths, between December and March each year, according to the article. People at least 80 years old are 11 times more likely to die from the flu than those 65 to 69. During the 1990 and 2001 flu seasons, an average of 76 percent of all influenza-related deaths occurred among people age 70 years or older, and 55 percent were among people 80 years or older.

Despite the findings, Jackson said people age 65 and older should receive flu vaccines each year. Her message is the need for more research studies comparing new and potentially more effective vaccines for elderly people. She said that because there are few harmful side effects to the flu vaccine, administering it annually is better than doing nothing.

"The complicated part of the article is it doesn't tell you what the truth actually is," Jackson said.

"It's still a difficult question to answer. Seniors are a very diverse population, and it's hard to take general results and apply then to a single person," she said.

Dr. Jeff Duchin, chief of communicable diseases at Public Health -- Seattle & King County, said the article is meant for researchers, and the public should still adhere to vaccine guidelines and realize that the flu kills tens of thousands of people each year.

Duchin said the goal is to have long-term protection that doesn't require a yearly vaccine, which now is developed based on which strain of the disease is predicted to circulate each season. Until then, people shouldn't change their practices.

"It's not perfect, and we're all in agreement that better flu vaccines are needed. This is an ongoing controversy," he said. "The message is, flu kills, the vaccine works, get vaccinated."

WHO SHOULD GET INFLUENZA VACCINE?

People who should receive flu vaccine include those at risk of complications if they get influenza and adults and children who live, work or may come in contact with people at high risk. These groups include:

All children ages 6 to 59 months.

Women who will be pregnant during flu season.

People ages 2 to 64 with chronic medical conditions such as heart disease, lung disease, asthma, kidney disease or diabetes.

Residents of nursing homes and other facilities that house people who have chronic medical conditions.

People who are 65 and older, with or without chronic medical conditions.

Source: Public Health -- Seattle & King County

NASAL VACCINE

Last week, the Food and Drug Administration approved use of the nasal influenza vaccine LAIV (FluMist) for healthy children ages 2 to 4 without a history of recurrent wheezing. It was already approved for healthy people ages 5 to 49 who are not pregnant.

Source: Centers for Disease Control and Prevention