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GPs buried under trusts' workload dump

Flu vaccine does not cut admissions of elderly patients

By Lilian Anekwe

The reputation of the flu vaccination campaign has suffered a major blow, with a Health Protection Agency study concluding it has no impact on emergency admissions in the elderly.

Experts urged the Government to consider investing in alternative public health measures with much greater potential to reduce rates of hospital admissions for respiratory illness.

The research fuels growing doubts over the effectiveness of flu vaccination, following a recent review in The Lancet Infectious Diseases that claimed the supporting evidence had been ‘greatly exaggerated'.

The latest study, published online by Vaccine, analysed uptake data and hospital admission rates for 3,970 people aged between 65 and 89 registered with 79 general practices in England.

Even after adjustment for age, sex, chronic conditions, deprivation and smoking status, flu vaccination still had no effect on admissions for acute respiratory illness.

Vaccinated patients had a non-significant 20% increase in risk of admission.

The researchers said their results were consistent with earlier reviews, which found the ‘observed effects in the community-dwelling elderly are likely to be overestimated'.

They also warned: ‘Solely relying on the influenza vaccine to control the annual winter bed pressure in hospitals is unlikely to be a sufficiently effective yearly strategy.'

Dr Peymane Adab, an author on the HPA study and senior lecturer in public health at the University of Birmingham, told Pulse: ‘Flu vaccination is not the major driver of admissions, so putting all of our efforts into vaccination won't have a major impact on admissions.

‘We should look at other factors instead – like reducing COPD exacerbations, treating chest infections and promoting smoking cessation. These are possibly going to be things that are more effective.'

Dr Tom Jefferson, coordinator of the Cochrane Vaccines Field, urged the Department of Health to look again at the flu vaccination campaign.

‘This adds to the uncertainty, but I'm not sure people are taking any notice. What I want to see is the Government taking stock of this because this is a major health campaign every year that uses public money.'

Dr Douglas Fleming, member of the JCVI flu sub-group, admitted other respiratory viruses were more significant contributors to respiratory admissions than influenza, but added: ‘That's not to say flu vaccination has not been effective in contributing to greatly reduced illness during the past few years.'

lanekwe@cmpmedica.com

Relying solely on flu vaccine unlikely to be an effective strategy Relying solely on flu vaccine unlikely to be an effective strategy How doubts over efficacy of flu vaccine have escalated

November 2006
A meta-analysis of flu vaccines in the elderly found the effect on all-cause mortality varied from none to more than total flu mortality – findings described as ‘counter-intuitive and implausible'
Cochrane Database of Systematic Review, 2006

April 2007
Cochrane review finds very little evidence to support vaccinating healthy adults against flu, and some concern over adverse effects, including transient paralysis and Guillain-Barré syndrome.
Cochrane Database of Systematic Review, 2007

September 2007
Authors of a systematic review in The Lancet Infectious Diseases say the benefits of the vaccine have been ‘greatly exaggerated'
The Lancet Infectious Diseases 2007;7:658 66

October 2007
Case-control study concludes ‘influenza vaccine did not show a protective effect on emergency respiratory admissions'
Vaccine 2007, early online publication

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