High-risk middle-aged adults may benefit from high-dose flu vaccine used for elderly

By John Murphy, MDLinx
Published September 28, 2017

Key Takeaways

Giving high-dose or recombinant trivalent influenza vaccines to middle-aged high-risk patients would not only be cost effective, but also reduce illness and save lives, reported researchers in the journal Vaccine.

An increasing number of aging baby boomers have chronic conditions—including heart or lung disease, diabetes, and cancer—that place them at high risk for influenza complications, the researchers noted.

“The growing proportion of middle-aged adults with chronic health conditions, coupled with the modest effectiveness of the standard-dose influenza vaccine, prompted us to explore whether existing vaccines already recommended for the elderly also could protect younger people,” said lead author Jonathan Raviotta, MPH, CPH, senior research specialist with The Pittsburgh Vaccination Research Group (PittVax) at the University of Pittsburgh School of Medicine, in Pittsburgh, PA.

For this study, the researchers performed a cost-effectiveness analysis that investigated several immunization strategies among 50- to 64-year-olds with chronic illnesses. Researchers compared various combinations of high-dose trivalent inactivated influenza vaccine (HD-IIV3) or recombinant trivalent influenza vaccine (RIV) against standard-dose trivalent (SD-IIV3 only) or standard-dose quadrivalent inactivated influenza vaccines (SD-IIV4) in these patients.

Results of their analysis showed that “under the right conditions, administration of HD-IIV3 in high-risk patients 50 to 64 years old and SD-IIV4 to the remaining 50- to 64-year-olds can have a substantial public health impact,” the authors wrote. Although this HD-IIV3 + SD-IIV4 strategy in 50- to 64-year-olds would cost more than the current immunization strategy, it would avert 100,000 more influenza cases, 1,900 more hospitalizations, and 130 more deaths than the SD-IIV3 only strategy, the researchers estimated. 

“Sure enough, expanding the [current] recommendation does seem like a good policy—in silico. Before making such a recommendation, real world clinical trials are needed,” Raviotta said.

In the real world, the effectiveness of the vaccine depends on how well it matches circulating viruses in that season. Due to such mismatches, vaccines have not been consistently effective in the past few years, the researchers noted.

“PittVax will continue to test new vaccination scenarios to help guide flu immunization recommendations,” said senior author Richard K. Zimmerman, MD, MPH, Associate Professor of Behavioral and Community Health Sciences in the Graduate School of Public Health at Pitt’s School of Medicine. “These analyses are essential to choosing the best immunization policies that save lives from influenza, which kills thousands annually.”

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