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Another Nod for the Flu Vaccine

A large, long-term study supports benefits in adults 65 years or older.

With the arrival of flu season come the usual exhortations to vaccinate and be vaccinated. In this case, that advice takes the form of a giant retrospective review of hospitalization and death rates among vaccinated and nonvaccinated older adults (age, 65) who were members of 18 U.S. HMO cohorts who were followed during 10 recent flu seasons.

Prevalence of most chronic medical conditions, including diabetes, heart disease, and pulmonary disease, was higher among 415,249 vaccinated adults than among 298,623 nonvaccinated adults. Older age and presence of at least one chronic condition were the strongest predictors of hospitalization and death in these cohorts. However, the rate of hospitalization for pneumonia or influenza, averaged across 10 winters, was 27% lower in vaccine recipients, and the death rate was 48% lower. A relatively smaller effect on hospitalizations was seen during two seasons when the vaccine poorly matched the circulating virus. Hospitalization rates were also calculated for two summers, and they were similar in the two groups, suggesting that a healthy-vaccinee bias was not driving these results.

Comment: Other studies have yielded similar findings, but few have been so large or so long. An editorialist concludes that these data support the current policy of vaccinating older adults but also clearly demonstrate that the inactivated influenza vaccine is by itself a relatively mediocre tool for controlling flu in this population. Until more immunogenic vaccines are developed, routine vaccination of younger people could limit transmission and play an important role in control.

— Abigail Zuger, MD

Published in Journal Watch General Medicine October 16, 2007

Citation(s):

Nichol KL et al. Effectiveness of influenza vaccine in the community-dwelling elderly. N Engl J Med 2007 Oct 4; 357:1373.

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Treanor JD. Influenza —The goal of control. N Engl J Med 2007 Oct 4; 357:1439.

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• Medline abstract (Free)