If you’ve been reading headlines this fall you are likely confused about flu shots. Several weeks ago you were told: “Proof Lacking for Flu Vaccine,” or “Flu Vaccine Mortality Benefits For Elderly Vastly Overstated.”
One week later headlines proclaimed: “Flu Shots for Elderly Are Effective,” and “Flu Shots Halve Risk of Death, Cut Illness in Elderly.”
So which is it? These contradictory reports can’t both be right. The trouble is that there is not enough data to know for sure. Experts have been arguing about this issue for decades.
Last year an article in the British Medical Journal (Oct. 28, 2006) suggested that flu vaccination for healthy people under 65 “did not affect hospital stay, time off work, or death from influenza and its complications.”
Public health officials worry a lot more about older people, of course. That’s because they are especially vulnerable to death from influenza or its complications. Scientists have found that older people do not mount as strong an immune response to the vaccination as younger people.
A recent pair of studies has created consternation because of conflicting conclusions. An analysis in The Lancet Infectious Diseases (Oct. 2007) concludeed that vaccinating frail elderly people has not been shown to protect them from influenza death. Even though a majority (65 percent) of senior citizens now get a flu shot each year compared to 15 percent in 1980, mortality rates from flu and pneumonia have not dropped.
This bleak outlook was challenged the following week in the New England Journal of Medicine (Oct 4, 2007). Researchers pulled together 10 years of data from health maintenance organizations. They found that older people who were vaccinated were 27 percent less likely to need hospitalization for influenza or pneumonia. The death rate was halved, according to this analysis.
The problem with both studies is that they depend on observational data instead of placebo-controlled trials. The gold standard for scientific evidence is from experiments where one group gets an active shot and the other receives an inactive saline injection. Such studies are expensive and many public health officials worry that they would be ethically questionable. Depriving elderly patients of a flu shot is considered immoral.
Without such data, however, experts have to sort through statistical tea leaves trying to determine how well flu shots work. We may never know how effective flu immunization really is for the elderly.
There are some other options that may help this flu season, though. These include antiviral flu drugs such as Flumadine or Tamiflu that can be taken to speed recovery.
Vitamin D is also important for a strong immune system. It increases production of a natural infection-fighting chemical that can help ward off illnesses caused by bacteria, fungi and viruses, including influenza. Levels of vitamin D frequently drop in the winter when people don’t go out in the sun. Many elderly people don’t get outside even in the summer and are deficient in vitamin D year round.
That may be why grandmothers used to insist on dosing the family with cod liver oil. It is rich in vitamin D. People who don’t like the flavor might want to take a supplement instead.
