A new study based on more
than three decades of data suggests that giving flu
shots to the elderly has not saved any lives.
Led by National Institutes
of Health researchers, the study challenges standard
government dogma and is bound to confuse senior citizens.
During last fall's flu vaccine shortage, thousands of
older Americans, heeding the government's public health
message, stood in long lines to get their shots.
"There is a sense that
we're all going to die if we don't get the flu shot,"
said the study's lead author, Lone Simonsen, a senior
epidemiologist at the National Institute of Allergy
and Infectious Diseases in Bethesda, Md. "Maybe that's
a little much."
The study should influence
the nation's flu prevention strategy, Simonsen said,
perhaps by expanding vaccination to schoolchildren,
the biggest spreaders of the virus.
However, the U.S. Centers
for Disease Control and Prevention in Atlanta plans
no change in its advice on who should get flu shots,
saying the NIH research isn't enough to shift gears.
"We think the best way
to help the elderly is to vaccinate them," said CDC
epidemiologist William Thompson. "These results don't
contribute to changing vaccine policy."
The CDC currently recommends
flu shots for people age 50 and over, nursing home residents,
children 6-23 months, pregnant women, people with chronic
health problems and certain health care and day care
workers. When vaccine was scarce a few months ago, healthy
adults under 65 were urged to forgo the shot.
Although the study, published
Monday in the Archives of Internal Medicine, looks at
data from the whole U.S. elderly population over time,
it doesn't directly compare vaccinated vs. unvaccinated
elderly, Thompson said. Previous studies that made that
comparison found the vaccine decreased the rate of all
winter deaths.
It's also unlikely that
a single study would trigger a change in policy, said
CDC spokesman Glen Nowak.
But the former head of
the nation's vaccine strategy, Dr. Walter Orenstein,
said Simonsen's work "should make us think twice about
our current strategy and (about) potentially enhancing
it." Orenstein is former director of the CDC's National
Immunization Program and now leads a program for vaccine
policy development at Emory University.
A shift to vaccinating
schoolchildren, the age group most likely to spread
the flu virus, is advocated by colleagues of Orenstein's
at Emory in a separate report to be published Tuesday
in the American Journal of Epidemiology.
The NIH and Emory papers,
one a highly technical statistical analysis of death
data and the other a commentary based on field studies
and mathematical modeling, come during a season that
focused the nation's attention on vaccine supplies.
As a vaccine shortage
loomed last fall, the CDC urged shots only for the highest-risk
groups. Most of the 36,000 people who die each year
of flu-related causes are elderly and the nation's strategy
has focused on getting shots to them, as well as other
high-risk groups.
Last week the CDC reported
that about 59 percent of older Americans got shots in
2004, down from 65 percent in 2003. Based on her research,
Simonsen doesn't expect to see a corresponding increase
in flu-related deaths this year, something that "can
be seen as good news."
The flu vaccine is less
effective in the elderly than in younger people. It
works, but not very well, said Ira Longini, a biostatistics
professor at Emory University's Rollins School of Public
Health and a proponent of vaccinating schoolchildren.
While it's smart for
senior citizens to get their yearly flu shots because
it can decrease their risk of getting sick, he said,
a smarter government strategy would emphasize shots
for children, ages 5 to 18. His statistical models show
that strategy could save more elderly Americans from
hospital visits and death.
"If we really want to
make a difference and control influenza, we simply have
to change the policy. We have to vaccinate large numbers
of children," Longini said.
He and his colleague
Dr. Elizabeth Halloran write that if 70 percent of schoolchildren
were vaccinated, the elderly would be protected without
flu shots. The strategy would require 42 million doses
of flu vaccine. Even during this season's shortage,
there were 57 million doses available, their report
says.
Yearly flu shots have
been recommended for people 65 and older since the 1960s
and for those 50 and older since 2000. Vaccination rates
have risen among seniors from 20 percent before 1980
to 65 percent in 2001, according to the NIH study.
Simonsen and her team
of researchers could find no corresponding decrease
in death rates. Their analysis took into account the
fact that people are living longer and that more virulent
strains of flu dominated the 1990s.
The CDC's Thompson said
Simonsen didn't take into account the effect of a gradual
lengthening of the average flu season over the decades.
But Simonsen said that no matter what model she used
to define a flu season, she came to the same result.
Older Americans should
keep their risk in perspective, said Dr. Lisa Schwartz
and Dr. Steven Woloshin, senior researchers at the VA
Outcomes Group, a small group of researchers trying
to promote the straightforward presentation of medical
information.
For the average senior
citizen, the annual risk of dying from the flu is low:
about 1 in 1,000. They said senior citizens still should
try to get flu shots, but shouldn't panic if vaccine
isn't available.
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On the Web:
Archives of Internal
Medicine: http://archinte.ama-assn.org/
Centers for Disease Control
and Prevention: http://www.cdc.gov/
