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

It is true that persons aged over 65 years have greater morbidity and mortality from influenza. This increased morbidity and mortality, however, is mostly the result of a higher prevalence of other chronic diseases in the elderly. There is no evidence that vaccination, even in epidemic years when the antigenic match of the influenza strain and the vaccine is good, benefits the 60 percent of the noninstitutionalized population over the age of 65 years who do not have other high-risk diseases. In fact, the grade II-3 evidence cited by the US Preventive Services Task Force actually supports not immunizing this population group. Even among high-risk patients, the benefit from influenza vaccination is highly variable and difficult to demonstrate. In some years there will be little influenza, and little benefit will accrue; in other years the vaccine-influenza antigenic match will not be good, and little benefit will be obtained. In a few years (two of the 12 years during which Barker's studies were done), a reduction in morbidity can be demonstrated for high-risk elderly persons. Even then, vaccine efficacy is only about 33 percent. Patients are telling physicians that they do not feel influenza vaccination is worthwhile. Less than 25 percent of high-risk persons are vaccinated annually. Many of those vaccinated do so because they falsely believe influenza vaccination will prevent the common cold. In accordance with the ACIP recommendation, high-risk patients with concomitant chronic disease (priority 1) should be immunized, because at least some benefit can be demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)