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Senior Citizen Health & Medicine
Studies Show Only Modest Benefits of Flu Shots Among
Older Adults
By Becky Ham,
Science Writer
Health Behavior News Service
July 18, 2006 - Although national and international
health organizations urge anyone over age 65 to get yearly flu shots,
the vaccinations are only modestly effective in preventing flu and its
complications among older adults, according to a new review of recent
studies.
Similarly, there is a little evidence that
vaccinating healthcare workers protects their elderly patients from flu
complications, another study found.
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The reviews appear in the current issue of The
Cochrane Library, a publication of The Cochrane Collaboration, an
international organization that evaluates medical research. Systematic
reviews draw evidence-based conclusions about medical practice after
considering both the content and quality of existing medical trials on a
topic.
In their review of 71 studies, Dr. Daniela Rivetti
of the public health department of Asti, Italy ,and colleagues found
that flu shots prevented 45 percent of flu-like illnesses, hospital
admissions and flu-related deaths among nursing home and long-term care
patients. Flu vaccinations prevented only 25 percent of these outcomes
in older adults still living in the community.
The findings would seem to fly in the face of
recommendations by the Centers for Disease Control and Prevention and
others who have made regular flu vaccinations among older adults a
centerpiece of good public health.
The current recommendations are based in part on
tallies of deaths from all causes, in which people who have been
vaccinated are among those least likely to die in a given year. However,
those who are most likely to get vaccinated are also those most likely
to have higher incomes and better health care.
This may mean that the apparent benefits of
vaccination could just be a reflection of better health among those who
get the shots, Rivetti and colleagues suggest.
Research that focuses on vaccinations effects on
all causes of death rather than just flu illnesses are likely to lead
to unrealistic estimates of the effects of the vaccines, Rivetti and
colleagues say.
However, studies that compare the effects of flu
vaccinations against placebo are no longer possible on ethical
grounds, because of current flu vaccine recommendations, they add.
The review does suggest vaccinating the elderly in
institutions such as nursing homes may be effective, preventing about 45
percent of pneumonia cases, hospital admissions and flu-related deaths,
the Cochrane reviewers say.
W. Paul Glezen, an infectious disease researcher at
Baylor College of Medicine, says the Cochrane review and other recent
flu studies clearly show that better vaccines are needed to protect
elderly patients who are particularly vulnerable to complications of
influenza.
The CDC and others also recommend flu shots for
health workers who care for older adults, although less than 40 percent
of these workers were vaccinated in 2003.
A second Cochrane review by Dr. Roger Thomas of the
University of Calgary in Alberta, Canada, and colleagues found some
evidence that vaccinating the staff of long-term nursing homes can
reduce pneumonia deaths, but not proven cases of flu or lower
respiratory tract infections among the elderly.
On the whole, there is no credible evidence that
vaccinating health workers affects flu complications in their elderly
patients, Thomas and colleagues conclude.
There is evidence that vaccinating the elderly
works and vaccinating those under 60 works, but not yet really good
proof that vaccinating health care workers provides a synergistic
benefit for the elderly in institutions, Thomas said.
Greater efforts to vaccinate another high-risk
group schoolchildren could help protect vulnerable older people,
according to Glezen Many studies have shown that school children have
the highest rates of infection with influenza each year and that they
are the major spreaders of influenza in the community and introducers
into the household, he said.
The Rivetti review was supported by the public
health department of Asti and Alessandria, Italy. Tom Jefferson, a
co-author of both reviews, has received money for consulting, research
and speaking from GlaxoSmithKline Ltd., Roche Ltd., Chiron Ltd. and
Sanofi-Synthelabo Ltd.
Note: The Cochrane Collaboration is an
international nonprofit, independent organization that produces and
disseminates systematic reviews of health care interventions and
promotes the search for evidence in the form of clinical trials and
other studies of interventions. Visit http://www.cochrane.org for more
information.
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