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Flu shot does not reduce risk of death (in elderly)
American Thoracic Society ^ | Aug 29, 2008 | Unknown

Posted on 08/29/2008 4:02:48 AM PDT by decimon

The widely-held perception that the influenza vaccination reduces overall mortality risk in the elderly does not withstand careful scrutiny, according to researchers in Alberta. The vaccine does confer protection against specific strains of influenza, but its overall benefit appears to have been exaggerated by a number of observational studies that found a very large reduction in all-cause mortality among elderly patients who had been vaccinated.

The results will appear in the first issue for September of the American Journal of Respiratory and Critical Care Medicine, a publication of the American Thoracic Society.

The study included more than 700 matched elderly subjects, half of whom had taken the vaccine and half of whom had not. After controlling for a wealth of variables that were largely not considered or simply not available in previous studies that reported the mortality benefit, the researchers concluded that any such benefit "if present at all, was very small and statistically non-significant and may simply be a healthy-user artifact that they were unable to identify."

"While such a reduction in all-cause mortality would have been impressive, these mortality benefits are likely implausible. Previous studies were likely measuring a benefit not directly attributable to the vaccine itself, but something specific to the individuals who were vaccinated—a healthy-user benefit or frailty bias," said Dean T. Eurich,Ph.D. clinical epidemiologist and assistant professor at the School of Public Health at the University of Alberta. "Over the last two decades in the United Sates, even while vaccination rates among the elderly have increased from 15 to 65 percent, there has been no commensurate decrease in hospital admissions or all-cause mortality. Further, only about 10 percent of winter-time deaths in the United States are attributable to influenza, thus to suggest that the vaccine can reduce 50 percent of deaths from all causes is implausible in our opinion."

Dr. Eurich and colleagues hypothesized that if the healthy-user effect was responsible for the mortality benefit associated with influenza vaccination seen in observational studies, there should also be a significant mortality benefit present during the "off-season".

To determine whether the observed mortality benefits were actually an effect of the flu vaccine, therefore, they analyzed clinical data from records of all six hospitals in the Capital Health region in Alberta. In total, they analyzed data from 704 patients 65 years of age and older who were admitted to the hospital for community-acquired pneumonia during non-flu season, half of whom had been vaccinated, and half of whom had not. Each vaccinated patient was matched to a non-vaccinated patient with similar demographics, medical conditions, functional status, smoking status and current prescription medications.

In examining in-hospital mortality, they found that 12 percent of the patients died overall, with a median length of stay of approximately eight days. While analysis with a model similar to that employed by past observational studies indeed showed that patients who were vaccinated were about half as likely to die as unvaccinated patients, a finding consistent with other studies, they found a striking difference after adjusting for detailed clinical information, such as the need for an advanced directive, pneumococcal immunizations, socioeconomic status, as well as sex, smoking, functional status and severity of disease. Controlling for those variables reduced the relative risk of death to a statistically non-significant 19 percent.

Further analyses that included more than 3,400 patients from the same cohort did not significantly alter the relative risk. The researchers concluded that there was a difficult to capture healthy-user effect among vaccinated patients.

"The healthy-user effect is seen in what doctors often refer to as their 'good' patients— patients who are well-informed about their health, who exercise regularly, do not smoke or have quit, drink only in moderation, watch what they eat, come in regularly for health maintenance visits and disease screenings, take their medications exactly as prescribed— and quite religiously get vaccinated each year so as to stay healthy. Such attributes are almost impossible to capture in large scale studies using administrative databases," said principal investigator Sumit Majumdar, M.D., M.P.H., associate professor in the Faculty of Medicine & Dentistry at the University of Alberta.

The finding has broad implications:

* For patients: People with chronic diseases such as chronic respiratory diseases such as chronic obstructive pulmonary disease, immuno-compromised patients, healthcare workers, family members or friends who take care of elderly patients and others with greater exposure or susceptibility to the influenza virus should still be vaccinated. "But you also need to take care of yourself. Everyone can reduce their risk by taking simple precautions," says Dr. Majumdar. "Wash your hands, avoid sick kids and hospitals during flu season, consider antiviral agents for prophylaxis and tell your doctor as soon as you feel unwell because there is still a chance to decrease symptoms and prevent hospitalization if you get sick— because flu vaccine is not as effective as people have been thinking it is."

* For vaccine developers: Previously reported mortality reductions are clearly inflated and erroneous–this may have stifled efforts at developing newer and better vaccines especially for use in the elderly.

* For policy makers: Efforts directed at "improving quality of care" are better directed at where the evidence is, such as hand-washing, vaccinating children and vaccinating healthcare workers.

Finally, Dr. Majumder said, the findings are a reminder to researchers that "the healthy-user effect is everywhere you don't want it to be."


TOPICS: Health/Medicine; Science
KEYWORDS: health
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Finally, Dr. Majumder said, the findings are a reminder to researchers that "the healthy-user effect is everywhere you don't want it to be."
1 posted on 08/29/2008 4:02:49 AM PDT by decimon
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To: decimon
... because they are elderly. Flu or no flu; shot or no shot, dying is pretty inevitable for the elderly.
2 posted on 08/29/2008 4:06:30 AM PDT by Gerasimov (www.totels.com/insideout)
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To: Gerasimov

True, but not all come to a rapid end for some jihadi microbes.


3 posted on 08/29/2008 4:12:38 AM PDT by decimon
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To: Gerasimov

Dying is pretty inevitable for the young, as well. In fact, despite advances in medical technology, the risk of death for all humans remains at 100%.


4 posted on 08/29/2008 4:24:39 AM PDT by dsmtoday
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To: decimon

This is what I’ve been saying for years. Flu shots are not the end all be all.

Every year I’ve gotten one, I’ve been sick, dead sick, with no change in lifestyle.

I don’t get them for me, I don’t get them for my kids nor does my hubby get them and we do just fine,

It’s the flu for heaven’s sake, I had it once a year as a child, Bad cough or throwing up, so what? Ya get over it.

However I must add, we are all healthy with nothing chronic.


5 posted on 08/29/2008 4:24:48 AM PDT by netmilsmom (The Party of Darkness prefers to have the lights out. - Go Fierce 50!!!)
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To: netmilsmom

The chance of death for the elderly is 100%. Accept it and move on.


6 posted on 08/29/2008 4:28:17 AM PDT by JusPasenThru (THE WORLD ENDS!!! Conservatives, Republicans hardest hit.)
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To: netmilsmom

I can’t say the flu shot has ever been beneficial for me. However, last year I got the pneumonia vaccine after I got the flu shot, and this morning is the first stuffy nose I have had. (And I always have had sinus problems in the spring!)


7 posted on 08/29/2008 4:28:45 AM PDT by mathluv
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To: netmilsmom
However I must add, we are all healthy with nothing chronic

I have a chronic illness (MS) but I don't get the flu vaccine. Everytime I've gotten one I've had an exacerbation. Granted if I get the flu, I'll probably have an exacerbation, but I have rarely had the flu in the years I haven't taken one, and the years I take it, I guarantee myself a flare up because of the after effects of the vaccine.

I took the pneumonia vaccine last year at my GP's request...sure enough flare up of my MS. I'm steering clear of vaccines.

8 posted on 08/29/2008 4:30:59 AM PDT by Dawn531
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To: mathluv

See, I have no chronic problems.
And see no reason to get any of these shots.


9 posted on 08/29/2008 4:32:04 AM PDT by netmilsmom (The Party of Darkness prefers to have the lights out. - Go Fierce 50!!!)
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To: decimon

I rarely get the flu, and I’ve never had a shot. I do wash my hands a lot, though.


10 posted on 08/29/2008 4:32:25 AM PDT by trisham (Zen is not easy. It takes effort to attain nothingness. And then what do you have? Bupkis.)
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To: Dawn531

Really!?!

See that says something to me. You are being given something to boost your immunity, yet isn’t MS an Auto-immunine disease?

One would think that anyone with auto-immune problems should not get one of these.


11 posted on 08/29/2008 4:34:16 AM PDT by netmilsmom (The Party of Darkness prefers to have the lights out. - Go Fierce 50!!!)
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To: netmilsmom

I went years without getting any of the shots. Now that I am older, I follow the advice of my doctor. I do have some chronic problems.


12 posted on 08/29/2008 4:36:52 AM PDT by mathluv
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To: trisham

They Lady!

My poor daughter was always sick. She was out of Kindergarten 37 days with everything from Norwalk virus to pink eye. And when she got sick, so did her little sister who would end up with UTIs so they wanted to do surgery on her.

What happens, I start to homeschool and suddenly, they are very rarely sick. They can even go around other sick kids and not get sick.

I think they built up natural immunities.


13 posted on 08/29/2008 4:37:24 AM PDT by netmilsmom (The Party of Darkness prefers to have the lights out. - Go Fierce 50!!!)
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To: dsmtoday
I certainly cannot argue with your skills as an actuary!
14 posted on 08/29/2008 4:38:36 AM PDT by Gerasimov (www.totels.com/insideout)
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To: netmilsmom
I can't get flu shots because when I do I get that strain of flu only much, much worse.

I went 26 years between bouts of flu and I last had a mild case of it back in 1992 or '93.

When my late father was in the Army he had to have special orders cut for him not to get flu shots cause he would get the flu when he did. He didn't get a flu shot he didn't get the flu and I'm the same way.

15 posted on 08/29/2008 4:38:51 AM PDT by proudofthesouth (Homosexuality IS a choice! There isn't any biological reason for it. They CHOOSE to be that way!)
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To: netmilsmom
I believe it. Another very good reason to home-school!
16 posted on 08/29/2008 4:40:05 AM PDT by trisham (Zen is not easy. It takes effort to attain nothingness. And then what do you have? Bupkis.)
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To: netmilsmom

Actually anything that boosts the immune response, messes with MS.

We take interferons (some of us) to modulate our immune systems so they don’t attack our nerves (myelin.)

A cold, a bladder infection, anything that hypes up your immune response will cause a rise in symptoms. They warn against taking immune boosters such as echinacea for the same reason. Our immune systems are not suppressed or lacking.

Normally I don’t catch many viruses, or colds. The whole family can pass it around, but I’ll stay healthy...one advantage to having an immune system on hyper drive, LOL.

In severe exacerbations they give steroids to suppress the immune response..I, personally, rather wait out the flares as steroids and I don’t get along too well.


17 posted on 08/29/2008 4:43:33 AM PDT by Dawn531
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To: netmilsmom

Add Vit D and lots of Vit C.


18 posted on 08/29/2008 4:45:13 AM PDT by Conservativegreatgrandma
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To: decimon

The flu shot doesn’t lessen the chances of death if a senior citizen is struck by a car.


19 posted on 08/29/2008 4:55:19 AM PDT by IbJensen (Ali Bama isn't going to make it!)
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To: trisham
I rarely get the flu, and I’ve never had a shot. I do wash my hands a lot, though.

I rarely get sick if I don't let myself dry out (mucous membranes). I prefer to keep the house cool in the winter.

20 posted on 08/29/2008 5:04:09 AM PDT by decimon
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