Shot of security
Getting vaccinated does not make the elderly bullet-proof against influenza, as many people believe, according to a paper co-authored by a Group Health researcher in Seattle.
But don’t use that as an excuse to avoid a poke in the arm. Just because the benefits of flu shots in seniors have been exaggerated doesn’t mean older people should stop getting the annual shot, says Dr. Lisa Jackson, a researcher for the Group Health Center for Health Studies.
“It is the only thing we have to prevent influenza,” Jackson says. “We should keep using that exactly the same way we are now.”
Oft-repeated statistics say flu shots reduce the risk of wintertime death in the elderly by half. Public policy has been based on that number, in an effort to get everyone older than 65 vaccinated. And yet, only about five percent of all deaths among the elderly in winter are blamed on flu.
Plus, if those mortality statistics have been inflated, they can keep researchers from doing further study on the topic, Jackson says. Would it be ethical to enroll someone in a randomized, controlled trial and give them a placebo when their risk of death without vaccine would be so significantly elevated?
Jackson says, “The magnitude of the effect did not seem plausible to us … The current strategy is that all seniors should get the flu vaccine. The question is, is that working? … We need to not base our policy on evidence that might not be as robust as we thought.”
The research review appears in this month’s edition of The Lancet, in a paper titled “Mortality benefits of influenza vaccination in elderly people: an ongoing controversy.”
Jackson, along with researchers from George Washington University and the National Institute of Allergy and Infectious Diseases, examined studies at Group Health that found that unvaccinated seniors did, in fact, have much higher rates of death during winter than their vaccinated peers.
Further review showed that seniors who didn’t get flu shots still had higher death rates the rest of the year.
“Seniors who decide to get vaccinated were at lower risk of death during all time periods,” Jackson says. “On average, it seems to be healthier seniors getting the vaccine.”
But Dr. Jeff White, a family practice doctor at Group Health-Lidgerwood in Spokane, says, at least anecdotally, he gets notices every year from nursing homes about their flu shot clinics. So, he knows many of the frailest elderly are getting vaccinated.
But, White says, “A flu shot is probably not any more important than eating healthy and staying active and staying out of small rooms with disease-ridden populations.”
That’s why he urges his older patients in particular to “figure out how you’re going to stay active when the weather gets bad.”
Giving the lungs a workout can help keep infection from settling in.
Jackson and the other researchers hope their paper will spur other scientists to look more closely at the benefits of flu vaccine in older adults.
It’s believed that flu shots become less effective in seniors because antibody response decreases with age. But no one knows how significant that decline is, or whether an increased dose of vaccine might counteract it, she says.
“The older you are the less well your immune system seems to function,” Jackson says.
Maybe scientists need to come up with vaccines more well-suited to the immune reactions of the elderly, Jackson and her colleagues write. Or maybe the push should be on vaccinating those in close contact with seniors.
Whatever the case, there needs to be a better understanding of the effect of flu shots on elderly populations, Jackson says.
“It’s important to know what’s actually happening,” she says.