Effectiveness of influenza vaccine in aging and older adults: comprehensive analysis of the evidence

Foremost amongst the diseases preventable by vaccination is influenza. Worldwide, influenza virus infection is associated with serious adverse events leading to hospitalization, debilitating complications, and death in elderly individuals. Immunization is considered to be the cornerstone for preventing these adverse health outcomes, and vaccination programs are timed to optimize protection during the annual influenza season. Trivalent inactivated influenza virus vaccines are believed to be both effective and cost-saving; however, in spite of widespread influenza vaccination programs, rates of hospitalization for acute respiratory illness and cardiovascular diseases have been increasing in this population during recent annual influenza seasons. From meta-analyses summarizing estimates of influenza vaccine effectiveness from available observational clinical studies, this review aims to examine how effective current influenza vaccine strategies are in the aging and older adult population and to analyze which are the most important biases that interfere with measurements of influenza vaccine effectiveness. Furthermore, consideration is given to strategies that should be adopted in order to optimize influenza vaccine effectiveness in the face of immune exhaustion.

[1]  S. Roth,et al.  Pooled safety analysis of diclofenac sodium topical solution 1.5% (w/w) in the treatment of osteoarthritis in patients aged 75 years or older , 2012, Clinical interventions in aging.

[2]  P. Lang,et al.  Immunosenescence and herd immunity: with an ever-increasing aging population do we need to rethink vaccine schedules? , 2012, Expert review of vaccines.

[3]  A. Monto,et al.  Influenza hemagglutination-inhibition antibody titer as a correlate of vaccine-induced protection. , 2011, The Journal of infectious diseases.

[4]  E. Vermeire,et al.  A systematic review of the evidence on the effectiveness and risks of inactivated influenza vaccines in different target groups. , 2011, Vaccine.

[5]  Mark M. Davis,et al.  Limited efficacy of inactivated influenza vaccine in elderly individuals is associated with decreased production of vaccine-specific antibodies. , 2011, The Journal of clinical investigation.

[6]  D. Skowronski,et al.  Influenza Vaccine Effectiveness in the Elderly Based on Administrative Databases: Change in Immunization Habit as a Marker for Bias , 2011, PloS one.

[7]  C. Siegrist,et al.  Vaccine effectiveness in older individuals: What has been learned from the influenza-vaccine experience , 2011, Ageing Research Reviews.

[8]  P. Lang.  Inactivated Influenza Vaccines: Pre-Vaccination Haemagglutinin-Antibody Titres Influence the Vaccine Response but Not Necessarily the Vaccine Effectiveness , 2011, Drugs & aging.

[9]  J. Michel,et al.  Immunosenescence: Implications for vaccination programmes in adults. , 2011, Maturitas.

[10]  F. Ansaldi,et al.  Inactivated Influenza Vaccines , 2011, Drugs & aging.

[11]  M. Ebell,et al.  A Systematic Review of Clinical Decision Rules for the Diagnosis of Influenza , 2011, The Annals of Family Medicine.

[12]  T. Jefferson,et al.  Influenza vaccination for healthcare workers who work with the elderly: systematic review. , 2010, Vaccine.

[13]  A. Monto.  Seasonal influenza and vaccination coverage. , 2010, Vaccine.

[14]  P. Lang,et al.  Influenza vaccine effectiveness in aged individuals: The role played by cell-mediated immunity , 2010 .

[15]  Danny Sama,et al.  Factors Associated with Increased Healthcare Worker Influenza Vaccination Rates: Results from a National Survey of University Hospitals and Medical Centers , 2010, Infection Control & Hospital Epidemiology.

[16]  N. Andrews,et al.  Incidence of 2009 pandemic influenza A H1N1 infection in England: a cross-sectional serological study , 2010, The Lancet.

[17]  A. Falsey,et al.  The Diagnosis of Viral Respiratory Disease in Older Adults , 2010, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[18]  H. Stiver,et al.  Influenza vaccines provide diminished protection but are cost‐saving in older adults , 2010, Journal of internal medicine.

[19]  K. Nichol.  Challenges in evaluating influenza vaccine effectiveness and the mortality benefits controversy. , 2009, Vaccine.

[20]  G. Air,et al.  Antibody quantity versus quality after influenza vaccination. , 2009, Vaccine.

[21]  Mark A. Miller,et al.  Influenza vaccination and mortality benefits: new insights, new opportunities. , 2009, Vaccine.

[22]  C. Bridges,et al.  Estimating influenza-associated deaths in the United States. , 2009, American journal of public health.

[23]  F. Carrat,et al.  Effect of Influenza Vaccination of Nursing Home Staff on Mortality of Residents: A Cluster‐Randomized Trial , 2009, Journal of the American Geriatrics Society.

[24]  A. Monto,et al.  Influenza control in the 21st century: Optimizing protection of older adults. , 2009, Vaccine.

[25]  Bruce Fireman,et al.  Influenza Vaccination and Mortality: Differentiating Vaccine Effects From Bias , 2009, American journal of epidemiology.

[26]  J. Nelson,et al.  New strategies are needed to improve the accuracy of influenza vaccine effectiveness estimates among seniors. , 2009, Journal of clinical epidemiology.

[27]  S. Sambhara,et al.  Immunosenescence and Influenza Vaccine Efficacy , 2009, Current topics in microbiology and immunology.

[28]  M. Schwenkglenks,et al.  Vaccination coverage rates in eleven European countries during two consecutive influenza seasons. , 2009, The Journal of infection.

[29]  G. Pawelec,et al.  Immunosenescence and vaccine failure in the elderly , 2009, Aging clinical and experimental research.

[30]  S. Pallesen,et al.  The Effectiveness of Cognitive and Behavioural Treatment of Chronic Pain in the Elderly: A Quantitative Review , 2009, Journal of Clinical Psychology in Medical Settings.

[31]  C. Siegrist,et al.  B-cell responses to vaccination at the extremes of age , 2009, Nature Reviews Immunology.

[32]  M. Loeb,et al.  Immunosenescence and vaccination in nursing home residents. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[33]  J. Baeyens,et al.  Flu vaccination policy in old adults: need for harmonization of national public health recommendations throughout Europe. , 2009, Vaccine.

[34]  James E. Crowe,et al.  Neutralizing antibodies derived from the B cells of 1918 influenza pandemic survivors , 2008, Nature.

[35]  L. Jackson.  Benefits of examining influenza vaccine associations outside of influenza season. , 2008, American journal of respiratory and critical care medicine.

[36]  Harry B. Greenberg,et al.  Influence of Prior Influenza Vaccination on Antibody and B-Cell Responses , 2008, PloS one.

[37]  J. Nelson,et al.  Influenza vaccination and risk of community-acquired pneumonia in immunocompetent elderly people: a population-based, nested case-control study , 2008, The Lancet.

[38]  D. Skowronski,et al.  Rapid decline of influenza vaccine-induced antibody in the elderly: is it real, or is it relevant? , 2008, The Journal of infectious diseases.

[39]  K. Nichol,et al.  Effectiveness of influenza vaccine in the community-dwelling elderly. , 2007, The New England journal of medicine.

[40]  Cecile Viboud,et al.  Mortality benefits of influenza vaccination in elderly people: an ongoing controversy. , 2007, The Lancet. Infectious diseases.

[41]  E. Salsench,et al.  Effect of influenza vaccine status on winter mortality in Spanish community-dwelling elderly people during 2002-2005 influenza periods. , 2007, Vaccine.

[42]  C. Bridges,et al.  The annual impact of seasonal influenza in the US: measuring disease burden and costs. , 2007, Vaccine.

[43]  Anne M Johnson,et al.  Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial , 2006, BMJ : British Medical Journal.

[44]  A. Flahault,et al.  Real-time monitoring of the influenza vaccine field effectiveness. , 2006, Vaccine.

[45]  K. Nichol,et al.  Influenza vaccination: policy versus evidence , 2006, BMJ : British Medical Journal.

[46]  T. Jefferson,et al.  Influenza vaccination for healthcare workers who work with the elderly. , 2006, The Cochrane database of systematic reviews.

[47]  A. Coffield,et al.  Influenza vaccination health impact and cost effectiveness among adults aged 50 to 64 and 65 and older. , 2006, American journal of preventive medicine.

[48]  A. Hoes,et al.  Benefits of influenza vaccine in US elderly--appreciating issues of confounding bias and precision. , 2006, International journal of epidemiology.

[49]  B. Psaty,et al.  Functional status is a confounder of the association of influenza vaccine and risk of all cause mortality in seniors. , 2006, International journal of epidemiology.

[50]  J. Nelson,et al.  Evidence of bias in estimates of influenza vaccine effectiveness in seniors. , 2006, International journal of epidemiology.

[51]  Cécile Viboud,et al.  Antibody response to influenza vaccination in the elderly: a quantitative review. , 2006, Vaccine.

[52]  V Demicheli,et al.  Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review , 2005, The Lancet.

[53]  J. McElhaney,et al.  The unmet need in the elderly: designing new influenza vaccines for older adults. , 2005, Vaccine.

[54]  D. Grobbee,et al.  Clinical effectiveness of influenza vaccination in persons younger than 65 years with high-risk medical conditions: the PRISMA study. , 2005, Archives of internal medicine.

[55]  D. Fleming,et al.  Influenza and its relationship to circulatory disorders , 2004, Epidemiology and Infection.

[56]  H. Greenberg,et al.  Immunization Against Viral Respiratory Disease: A Review , 2004, The Pediatric infectious disease journal.

[57]  Mark A. Miller,et al.  Influenza and the winter increase in mortality in the United States, 1959-1999. , 2004, American journal of epidemiology.

[58]  B. Stricker,et al.  Influenza vaccination in community-dwelling elderly: impact on mortality and influenza-associated morbidity. , 2003, Archives of internal medicine.

[59]  John Mullooly,et al.  Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. , 2003, The New England journal of medicine.

[60]  A. Hoes,et al.  Confounding by indication in non-experimental evaluation of vaccine effectiveness: the example of prevention of influenza complications , 2002, Journal of epidemiology and community health.

[61]  Trang Vu,et al.  A meta-analysis of effectiveness of influenza vaccine in persons aged 65 years and over living in the community. , 2002, Vaccine.

[62]  K. Nichol,et al.  Influenza vaccine effectiveness in preventing hospitalizations and deaths in persons 65 years or older in Minnesota, New York, and Oregon: data from 3 health plans. , 2001, The Journal of infectious diseases.

[63]  Karen McAulay,et al.  Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial , 2000, The Lancet.

[64]  C. Cox,et al.  A study of the impact of influenza on the functional status of frail older people. , 1998, Archives of internal medicine.

[65]  D. Stott,et al.  Influenza Vaccination of Health Care Workers in Long-Term-Care Hospitals Reduces the Mortality of Elderly Patients , 1997, The Journal of infectious diseases.

[66]  H. Sacks,et al.  The Efficacy of Influenza Vaccine in Elderly Persons , 1995, Annals of Internal Medicine.

[67]  M. Hornbrook,et al.  Influenza Vaccination Programs for Elderly Persons: Cost-Effectiveness in a Health Maintenance Organization , 1994, Annals of Internal Medicine.

[68]  D. Kaiser,et al.  Clinical effectiveness of influenza vaccination in Manitoba. , 1993, JAMA.

[69]  W. Beyer,et al.  Antibody induction by influenza vaccines in the elderly: a review of the literature. , 1989, Vaccine.

[70]  J. S. Stevenson.  In older adults , 1980 .

[71]  THE WORLD HEALTH ORGANIZATION , 1954 .

[72]  Nicholas S. Kelley,et al.  Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. , 2012, The Lancet. Infectious diseases.

[73]  Conjugate Meningococcal.  Statement on Seasonal Influenza Vaccine for 2011-2012: An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI)†. , 2011, Canada communicable disease report = Releve des maladies transmissibles au Canada.

[74]  T. Jefferson,et al.  Vaccines for preventing influenza in the elderly. , 2010, The Cochrane database of systematic reviews.

[75]  R. Harpaz,et al.  Recommendations of the Advisory Committee on Immunization Practices (ACIP) , 2008 .

[76]  Thomas R. Riley,et al.  A Randomized Double-blind Placebo-controlled Trial , 2004 .

[77]  B. Grubeck‐Loebenstein,et al.  The aging of the immune system. , 2002, Advances in immunology.

[78]  C. Bridges,et al.  Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). , 2000, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[79]  G. Dinant,et al.  The efficacy of influenza vaccination in elderly individuals. A randomized double-blind placebo-controlled trial. , 1994, JAMA.

[80]  J. Phair,et al.  Ageing and infection. , 1988, Ciba Foundation symposium.