Influenza vaccine and older people: an evidence-based policy? (original) (raw)
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Archives of Internal Medicine, 2005
Background: Influenza vaccination has consistently been shown to prevent all-cause death and hospitalizations during influenza epidemics among seniors. However, such benefits have not yet been demonstrated among younger individuals with high-risk medical conditions. In the present study, we evaluated the effectiveness of influenza vaccine in persons recommended for vaccination of any age during an epidemic. Methods: We conducted a case-control study during the 1999-2000 influenza A epidemic nested in a cohort of 75227 primary care patients. End points were all-cause mortality and episodes of hospitalizations or general practitioner (GP) visits for influenza, pneumonia, other acute respiratory disease, acute otitis media, myocardial infarction, heart failure, and stroke. The effectiveness of vaccination was evaluated by means of logistic regression analysis with adjustments for age, sex, prior health care use, medication use, and comorbid conditions. Results: Among high-risk children and adolescents younger than 18 years (n=5933; 8% of the study population), 1 death, 3 hospitalizations for pneumonia, and 160 GP visits occurred. After adjustments, 43% (95% confidence interval [CI], 10%-64%) of visits were prevented. Among high-risk adults aged between 18 and 64 years (n=24928; 33% of the study population), 47 deaths, 23 hospitalizations, and 363 GP visits occurred. After adjustments, vaccination prevented 78% of deaths (95% CI, 39%-92%), 87% of hospitalizations (95% CI, 39%-97%), and 26% of GP visits (95% CI, 7%-47%). Among elderly persons (n = 44 366; 59% of the study population), 272 deaths and 166 hospitalizations occurred, and after adjustments the vaccine prevented these end points by 50% (95% CI, 23%-68%) and 48% (95% CI, 7%-71%), respectively. Conclusion: Persons with high-risk medical conditions of any age can substantially benefit from annual influenza vaccination during an epidemic.
Influenza vaccination: do the aged reap the benefit?
Postgraduate Medical Journal, 1995
An audit of 100 elderly in-patients with appropriate medical conditions revealed that 63% had not been vaccinated this winter. 74% would have accepted vaccination if offered. A general practitioner questionnaire found that 42% relied on elderly patients coming forward and requesting vaccination. Unfortunately, many elderly patients are still missing out on influenza vaccination.
Effectiveness of influenza vaccine in aging and older adults: comprehensive analysis of the evidence
Clinical Interventions in Aging, 2012
Foremost amongst the diseases preventable by vaccination is influenza. Worldwide, influenza virus infection is associated with serious adverse events leading to hospitalization, debilitating complications, and death in elderly individuals. Immunization is considered to be the cornerstone for preventing these adverse health outcomes, and vaccination programs are timed to optimize protection during the annual influenza season. Trivalent inactivated influenza virus vaccines are believed to be both effective and cost-saving; however, in spite of widespread influenza vaccination programs, rates of hospitalization for acute respiratory illness and cardiovascular diseases have been increasing in this population during recent annual influenza seasons. From meta-analyses summarizing estimates of influenza vaccine effectiveness from available observational clinical studies, this review aims to examine how effective current influenza vaccine strategies are in the aging and older adult population and to analyze which are the most important biases that interfere with measurements of influenza vaccine effectiveness. Furthermore, consideration is given to strategies that should be adopted in order to optimize influenza vaccine effectiveness in the face of immune exhaustion.
Cochrane re-arranged: Support for policies to vaccinate elderly people against influenza
Vaccine, 2013
The 2010 Cochrane review on efficacy, effectiveness and safety of influenza vaccination in the elderly by Jefferson et al. covering dozens of clinical studies over a period of four decades, confirmed vaccine safety, but found no convincing evidence for vaccine effectiveness (VE) against disease thus challenging the ongoing efforts to vaccinate the elderly.
Polskie Archiwum Medycyny Wewnetrznej-polish Archives of Internal Medicine, 2009
Human seasonal influenza is a large burden of morbidity and mortality for societies, affecting mainly elderly people and those with underlying chronic medical conditions. Annual vaccination of older adults and other risk groups is the most effective measure for reducing morbidity and mortality associated with infection. A 2008 survey showed 40-fold differences between the vaccination coverage in various European Union countries in individuals aged ≥65 years, ranging from less that 2% to more than 80% in the 2006-2007 season, with Poland belonging to the countries with low influenza vaccination coverage. Annual monitoring of the vaccination coverage is crucial for achieving and maintaining high uptake levels. The need to pay for the vaccine out of pocket is a strong factor discouraging vaccination, and there is evidence that reimbursing costs of influenza vaccination influences vaccination coverage. Although annual influenza immunization of healthcare workers is an important method of preventing the nosocomial transmission of influenza and decreasing the exposure of vulnerable patients, worldwide influenza vaccination rates among healthcare personnel are unacceptably low, rarely exceeding 40%. It is important to keep high vaccination coverage among elderly nursing-home residents. More research is needed to clearly establish the effect of dose sparing strategies of influenza vaccination, e.g., via intradermal immunization, on the immune response in elderly recipients. Finally, due to the emergence of the pandemic influenza A (H1N1) 2009 virus and the development of vaccines directed towards it, the upcoming influenza season 2009-2010 will pose a particular challenge to influenza vaccination programs, and will require careful planning.