Flu Vaccine Only Mildly Effective in Elderly
By Amanda Gardner
HealthDay Reporter

WEDNESDAY, Sept. 21 (HealthDay News) -- The flu vaccine, a cornerstone
of public health policy, is only mildly effective in the population for
which it is supposedly most critical: the elderly.

According to a study appearing in the Sept. 22 online issue of The
Lancet, vaccines against influenza are only "modestly effective" in
people in long-term care facilities and even less effective for elderly
people still living in the community.

That research is twinned with another flu study, which found more bad
news: that resistance to drugs used to treat influenza has risen 12
percent in the past decade.

This finding, the authors stated, raises questions about the
government's policy of stockpiling such drugs.

Strong opinions to the vaccine study came from all sides of the issue.

"The vaccine doesn't work very well at all," said study author Dr. Tom
Jefferson, an epidemiologist with the Cochrane Vaccines Field in Rome.
"Vaccines are being used as an ideological weapon. What you see every
year as the flu is caused by 200 or 300 different agents with a vaccine
against two of them. That is simply nonsense."

Dr. Marc Siegel, author of False Alarm: The Truth About the Epidemic of
Fear, agreed. "We have set up a situation where a fear is created, and
then we try to create the treatment for this fear. The public gets the
idea that the flu is going to kill them and the vaccine will save them.
Neither is true," he said. "The flu vaccine has use in cutting down on
deaths from complications in the chronically ill and people at great
risk, but it's not a panacea."

The U.S. Centers for Disease Control and Prevention responded strongly
on the other side.

"We certainly do hope that people will not be sidetracked from this
important point. There are studies that show that the vaccine is
effective in preventing serious complications of the flu," said CDC
spokesman Tom Skinner. "This is not going to change the fact that we
each and every year recommend people in high-risk categories to get the
vaccine."

Health officials worldwide, including those at the CDC, push to get as
many elderly individuals as possible vaccinated against the flu each
year. According to the study, in 2000, 40 of 51 developed or rapidly
developing countries recommended vaccines for all individuals aged 60
and older. In 2003, 290 million doses of vaccine were distributed
worldwide.

Earlier this month, U.S. health officials starting urging all eligible
persons to get a flu shot, with priority given to the elderly and
certain other groups. And to avoid last year's flu vaccine shortage,
U.S. health officials have planned for a total of 97 million doses of
vaccine.

The current study provided no new data but, rather, looked at 64
existing studies which looked at the effectiveness of the flu vaccine
over 96 flu seasons.

For elderly people living in the community, inactivated influenza
vaccines prevented up to 30 percent of hospitalizations for pneumonia
but were not effective against the flu, flu-like illnesses or
pneumonia. "The vaccines didn't seem to prevent influenza," Jefferson
said.

For elderly people living in long-term care facilities, the picture was
slightly brighter, with vaccines preventing up to 42 percent of deaths
caused by influenza and pneumonia only.

"We have to concentrate our resources elsewhere or invest in better
vaccines," Jefferson stated.

The authors of the second study screened 7,000 influenza A isolates for
gene mutations known to confer drug resistance to the antivirals
amantadine and rimantadine.

Overall drug resistance increased from 0.4 percent in 1994-95 to 12.3
percent in 2003-04. Also, 61 percent of resistant viruses isolated
since 2003 were from people in Asia. Some Asian countries had drug
resistance frequencies exceeding 70 percent, possibly a reflection of
different prescribing practices.

Strikingly, more than 84 percent of all resistant viruses during the
10-year period under question were identified since the 2003 flu
season.

This highlights the importance of continuing to expand surveillance of
the emergence of resistance to these drugs, said Rick Bright, lead
author of the study and a research scientist with the CDC.

"This is a warning that overuse of antiviral drugs leads to
resistance," Siegel said. "The drugs should be specifically used for
influenza that is a problem in terms of duration and possible risk of
death, not for everybody."

The study authors voiced concern that rising rates of resistance will
render amantadine and rimantadine ineffective for treatment or
prevention in the event of an influenza pandemic. That, in turn, would
render government stockpiles useless.

"I question stockpiling these drugs. You're going to have to discard or
overuse them. It's sending a message to the public that these are
lifesaving drugs," Siegel said. "Antivirals should be considered in
high-risk cases," but in other cases they may only be of limited
effectiveness, he said.

"We have to differentiate between potential risk and something that
clearly is in the offing. Fear is a warning system that is supposed to
protect us against imminent danger such as a gorilla hanging over us,"
he added. "I want to know why more effort isn't put on getting our
vaccination method up-to-date instead of stockpiling millions of doses
of vaccine and sending a fear message. We need to see reality."

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