Is routine influenza immunization indicated for people over 65 years of age? An affirmative view.

Influenza is usually a minor, self-limiting illness, but for the elderly, especially the elderly who have chronic illnesses, it may be a severe or fatal disease. During influenza epidemics this disease may not always be recognized clinically as influenza but may appear as an acute decompensation in a patient with a known chronic illness. The influenza vaccine is not perfect, but it has been shown to be effective in the elderly. Reactions to the vaccine are usually minor and administration costs are low. Experience with influenza vaccine since the early 1940s has led to an improved, more pure vaccine formulation, has developed worldwide systems of tracking the dominant circulating viral strains, and has refined recommendations for vaccine usage based on clinical studies of its efficacy and cost effectiveness. Physicians should be aware of the present limitations of the existing studies and the imperfections of the vaccines, but in the elderly population, a proven intervention that will offer a substantial degree of protection during the influenza season should not be withheld. Most of the existing evidence suggests that the vaccine is effective and that physicians should be more stringent in their influenza immunization practices with the elderly. The elderly who are at high risk should be of high priority for receiving influenza vaccine, and the vaccine should also be recommended to healthy individuals aged 65 years and older because of its proven efficacy for reducing attack rates when appropriate viral strains are used.