Are flu jabs pointless for the elderly?

Flu jabs do not cut emergency admissions in the elderly. Sanjay Tanday investigates.

What is the story?
Flu vaccinations fail to cut the number of elderly people being admitted to hospital with illnesses triggered by the virus, media reports have claimed.

The latest research found that even after adjustments for age, sex, chronic deprivation and smoking status, influenza vaccination still had no effect on reducing hospital admissions for acute respiratory illness.

The findings fuel growing doubts over the effectiveness of the £115 million annual flu vaccination campaign, say the papers.

Influenza vaccination is currently recommended for all elderly people aged 65 and over in the UK, as well as individuals in at-risk groups such as those suffering from respiratory problems like asthma and COPD.

However, the study researchers warn the findings do not negate the need for an influenza vaccine.

Instead, they suggest that relying on the influenza vaccines to control the annual pressure for winter beds in hospitals is unlikely to be a sufficiently effective yearly strategy.

What is the research?
The reports are based on a case-control study of elderly patients with acute respiratory illness during the winter of 2003/4.

The researchers, in collaboration with the Health Protection Agency (HPA), assessed the effect of routine influenza vaccine in preventing emergency respiratory admissions among a cohort of 3,970 patients taken from 79 general practices in central England.

Patients were included in the cohort if they were aged 65-89 and if they consulted their GP for an acute episode of respiratory disease between 1 October 2003 and 31 March 2004.

Patients admitted to hospital with acute respiratory disease were identified using GP records and hospital admission data.

GP records were also used to show that 74.5 per cent of the patients in the study had been vaccinated against influenza.

A control group of 639 individuals matched for age, sex and consultation date was also included in the study.

During the winter of 2003/4 there was a modest rise above baseline of influenza-like illness activity in England, consistent with normal seasonal activity.

Over the duration of the study, 500 people were hospitalised for acute respiratory problems.

Of those patients that were hospitalised, 61 per cent had received a flu jab.

After adjustment for age, sex COPD and other chronic medical conditions, the researchers concluded that the influenza vaccine had no effect on reducing hospital admissions for respiratory disease.

What do the researchers say?
Lead researcher Dr Rachel Jordan, from the department of public health and epidemiology at the University of Birmingham, said: 'The study does not contradict the government's policy of vaccinating high risk groups including the elderly.

'Indeed we support the current immunisation programme as the previously published evidence suggests that influenza vaccine is effective in reducing influenza-related complications in elderly patients in general.'

The study was looking at the causes of winter pressures on the NHS from the perspective of healthcare managers, she said.

'We know that influenza is one cause, but there are many other respiratory viruses which also precipitate admission.

'We cannot rely on the flu vaccination programme to affect admissions, especially in years where there are low circulating levels of virus.'

There is a need for additional measures such as the improved vaccination of healthcare workers against influenza, increased efforts to support smoking cessation and ensuring that patients with long-term conditions such as COPD receive appropriate and effective services to keep them out of hospital, she added.

A spokesman for the HPA said: 'The HPA endorses the DoH's influenza vaccine campaign because it provides protection against influenza infection in at-risk individuals.'

What do the experts say?
A spokesman from the DoH said: 'Our influenza policy is to protect those who are most at risk of death should they develop influenza.

'Experts advise that the majority of them benefit by at least having a less severe illness. UK policy is under review to take into consideration all available evidence.'

Informing patients

  • Influenza vaccination does not reduce the number of elderly patients admitted to hospital for respiratory disease.
  • Influenza vaccination alone will not ease the winter bed pressure in hospitals.
  • Study researchers stress that it is still important that patients receive a flu jab.

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