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Flu Vaccination Does Not Prevent Death in Elderly?

Many people think getting a flu vaccination will protect them from getting the flu and, by extension, reduce the number of deaths attributed to an influenza outbreak.  New research, however, reveals the flu vaccination does not prevent death in elderly patients to the degree widely believed.  With meticulous evaluation strategies upon which to base their conclusion, a team of researchers in Alberta, Canada, suggests the flu vaccine’s benefits have been exaggerated over time and that “good” patients may sway the outcome of studies of the vaccine.

Dean T. Eurich, PhD, says the healthy-user effect may play a more significant role in studies conducted to examine the benefits of flu vaccinations on the elderly than previously thought.  In the past 20 years, the rate of vaccination in the United States’ elderly population has gone from only 15% to 65% but there has not been a comparative decline in the number of hospitalizations or of deaths attributed to influenza in this segment of the population.  Eurich, an assistant professor and clinical epidemiologist at the University of Alberta’s School of Public Health, says the individuals themselves getting vaccinated, or the healthy-user benefit, may be the reason for only about 10% of all deaths in the winter being attributed to the flu, even though the suggestion that flu vaccinations reduce death from influenza by 50%.

To test his theory, Eurich reviewed the case histories of 704 patients, all 65 or older, who were hospitalized for community-acquired pneumonia during the “off,” or non-flu, season of the year.  About half the patient’s had been vaccinated against the flu while the other half had not.

About 12% of all patients under review died, from all reasons, with eight days of hospitalization being the median length of hospital stay.  Upon first examination, the research indicated a reduced rate of death, by about 50%, for the patients who were vaccinated.  Once other factors, including but not limited to gender, smoking, severity of disease, immunization against pneumonia, and socioeconomic status, were evaluated, the research team reports an adjusted, and statistically insignificant, 19% risk of death from influenza.

Additional analysis of 3,400 more patients did not alter the research team’s finding although further analysis did reveal the difficulty involved with capturing the healthy-user effect in the patients who had been vaccinated.  The healthy-user effect describes ‘good’ patients who stay informed, exercise regularly, don’t smoke and use alcohol only in moderation, watch their diets, take prescriptions as directed, and see their healthcare providers for routine health maintenance and screening appointments.  And they get vaccinated every year.

The influence of the healthy user on medical research comes with broad implications, according to the research team.  The team has issued these directives to people across the board involved with influenza vaccinations:

• Certain groups of people still need to be vaccinated every year but no one should consider a vaccination as the only precaution to take against becoming sick with the flu.  People suffering from chronic diseases, the elderly, and the people who take care of them still receive benefit from flu shots but a vaccination should not take the place of regular hand washing, avoiding sick children and hospitals during flu season, and seeing a doctor as soon as symptoms begin.  Prophylactic antiviral medications may be needed, too, to reduce the chance or length of hospitalization.
• Vaccine developers must stop inflating mortality rates and reporting false findings in their drug studies.  Such faulty reporting may have thwarted efforts to develop vaccines that are newer, better, and especially beneficial to the elderly population.
• Policy makers are urged to direct care where it will be most effective, such as with improved education on the value of hand washing and by vaccinating more children and healthcare personnel.

Eurich’s findings will be included in the first September issue of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

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