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Value of Flu Vaccination in Preventing Elderly
Deaths is Questioned
Feb. 15, 2005 - Studies
which report that influenza vaccination reduces winter mortality risk
among the elderly by 50 percent may substantially overestimate the
vaccination benefit, according to the February 14 issue of The Archives
of Internal Medicine, one of the JAMA/Archives journals.
Accurate determination
of the impact of influenza on mortality is difficult because the
infection is often cleared before the onset of the secondary
complications that actually cause a person's death, according to the
article.
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Although influenza vaccination of the elderly in the U.S. has
increased from 15 to 20 percent before 1980 to 65 percent in 2001, the
authors could find no correlation between this increasing vaccination
coverage after 1980 and declining deaths rates in any age group.
Observational studies may introduce a systematic bias that leads to a
substantial over-estimate of the impact of influenza vaccination on
mortality, the authors suggest.
Lone Simonsen, Ph.D., of
the National Institute of Allergy and Infectious Diseases, and
colleagues, used statistical models that estimate the winter-seasonal
all-cause mortality above an estimated baseline to determine
influenza-related mortality indirectly. Their model incorporated
information on deaths among the elderly from pneumonia and influenza and
all other causes from 33 winter seasons from 1968-2001. "Our results,
based on national vital statistics, are simply not consistent with the
very large mortality benefits reported in observational studies," the
authors write. The authors suggest that this disconnect may be explained
by a disparity in who is likely to be vaccinated. "Very ill elderly
people, whose fragile health would make them highly likely to die over
the coming winter months, are less likely to be vaccinated during the
autumn vaccination period," they stated.
"Our results have
obvious implications for influenza vaccination policy. … The present
findings, and those of at least one other study, indicate that the
shortage [of influenza vaccine in the 2004-2005 season] will have little
impact [on mortality]…," the authors conclude. "Other cohort studies
suggest that the shortage will have a tremendous impact on mortality
among the elderly. Either way, this vast disconnect between conclusions
from different studies must be sorted out."
Editor's Note: This
study was funded by an Unmet Needs grant from the National Vaccine
Program Office, Washington, D.C.
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