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Paper of the Day - Flu jab benefit 'greatly exaggerated'

The benefits of vaccinating older people against flu have been hugely exaggerated, say US epidemiologists in a controversial new review.

They say there is such a lack of evidence for a public health policy practiced by most high income countries that it may be time to revisit the idea of placebo controlled trials.

There has been no decline in US flu-related mortality since 1980 despite vaccine coverage in the over 65s soaring from 15% to 65%.

Although there is good evidence for efficacy of flu vac-cines in younger adults, there are very few trials which have included older people- especially the over 70s.

The reviewers from the US National Institutes of Health say the exaggeration of benefit is probably because not-so-frail older people are much more likely to be vaccinated than those who are infirm.

And flu vaccines are much less effective in more elderly people.

This is the second large review this year to cast doubt on flu vaccination.

The first was written by Dr Tom Jefferson - coordinator of the Cochrane Vaccines Field and formerly a GP in Aldershot, Hampshire.

Writing in The Lancet this week he says the way forward might be to carry out placebo controlled trials which he admits is "the ultimate taboo".

But he adds: ‘That is the only ethical and scientific way to have a definitive answer .. to whether or not current vaccines protect elderly people.'

Lancet Infectious Diseases 2007;7:658-666.

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