Ah, another “cost effective” study that makes one go “Huh”: from PsyOrg:

Influenza vaccines: Poor evidence for effectiveness in elderlyFebruary 17, 2010Evidence for the safety and efficacy of influenza vaccines in the over 65s is poor, despite the fact that vaccination has been recommended for the prevention of influenza in older people for the past 40 years. These are the conclusions of a new Cochrane Systematic Review.

OK, guys, let’s have a reality check.M/P>

This was not a study, but a “Cochrane Systemic Review”.That means someone did the medical equivalent of googling all the studies on Influenza, and then mashing together all the details and finding the results.The beancounters are pushing similar studies to insist docs to ensure we practice “scientific” medicine, and with trends in cost control such things dould very well become mandates in the near future, never mind that most docs know that 80 percent of what we treat are uncomplicated illnesses or chronic diseases, and that a lot of a good doc’s time is spent practicing the “art” of medicine, giving a sympathetic ear to problems that often don’t get put down in the scientific medical record.

When it comes to influenza, the dirty little secret is that most influenza cases never get diagnosed by docs (they stay home in bed). Without a good double blind population study, which compares the same type of patient in both groups, you have to take the results with a grain of salt.And the article actually admits that only one “study” was a good study:

the researchers were only able to identify one recent RCT with “real” outcomes. In other words, this was the only RCT that used influenza cases as an outcome, as opposed to surrogate outcomes such as measurements of influenza antibodies in the blood. All the other studies included in the review were deemed of low quality and open to bias.

Let’s have a reality check.There are problems for any vaccine in high risk populations: and that includes the elderly, the chronically ill, those with cancer, the malnourished, or the very young.Sometimes the vaccine doesn’t work. The problem is a weakened immune system. If you get a shot, you might not make the expected level of antibodies, i.e. enough to protect you against the illness.

So, for example, when they revived the pneumonia vaccine, originally they gave it only to the elderly: But it didn’t work too well, so now they suggest you give the first dose at a younger age if you are a smoker or have risks of lung disease, so that when you are old and get a “booster” shot, it increases the immunity you already have.

Pneumococcal disease is common in babies, but the vaccine didn’t work for them, a “conjugated” vaccine is now given to the little ones. From Wikipedia:

A conjugate vaccine is created by covalently attaching a poor antigen to a carrier protein, thereby conferring the immunological attributes of the carrier on the attached antigen. This technique for the creation of an effective immunogen is most often applied to bacterial polysaccharides for the prevention of invasive bacterial disease.

Translation: think of putting a huge “DANGER” sign on a small object, so that those guarding can notice the dangerous object easier. And when the body’s immune system “sees” the big sign, it is able to make a better immune response the the object.For infant’s pneumococcal vaccine, they combine the worst strains of pneumococcus with an inactive version of tetanus toxoid to get a stronger immune response.Back to grandmom.Influenza vaccine doesn’t always work. Some folks just don’t get a decent immune response, and this is higher in “high risk” groups.To make things worse, as I noted above, the vaccine is only good for one influenza virus, and influenza tends to change it’s protein coat from year to year.  (It’s like telling the guard to shoot everyone in a blue coat, but some invaders wear red coats. )So how to best protect Grandmom?Ironically, it’s the old fashioned ways: wash your hands, don’t cough in someone’s face, don’t visit around or go to school/work when you are sick, and if there is an epidemic, close the schools, theatres, and discourage church going. Stop visiting to nursing homes and hospitals.  In Asia, they tend to wear masks during epidemics, and when Swine Flu hit our area, the security guards started screening for temperature before they’d let you into the local mall.

One of the lessons learned from the SARS epidemic is that the“old fashioned” methods of infectious disease control, including isolation, hygiene and quarrantine,  works.Indeed, if there is an epidemic of anything and not enough vaccine or medicine to go around, not giving vaccine to the elderly sounds like a heartless triage,If such an epidemic occurs, and medicine or vaccine is limited, one could argue that giving the shot to caregivers and her favorite grandkid would lower a grandmom’s risk of infectious disease almost as well as giving her the shot, and that traditional quarantine methods, just by keeping Grandmom away from sick folks, could be the best prevention

.——————————————-Nancy Reyes is a retired physician living in the rural Philippines. She blogs about medicine at HeyDoc Xanga Blog 

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