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Now, new research suggests that giving this population a high-dose flu vaccine -- one with four times the usual amount of immune-spurring antigens -- can greatly cut their risk of hospitalization from the flu.
The shot, called Fluzone, seemed to help even the oldest old, the Brown University team said.
"In our study, a quarter of the sample was over 90. So we asked if the high-dose vaccine also would work better than regular-dose vaccine in the population we consider least able to respond," explained study lead researcher Dr. Stefan Gravenstein. "This paper says, yes, it can."
The study was published July 21 in the journal Lancet Respiratory Medicine. It was funded by the vaccine's maker, Sanofi-Pasteur.
One expert in caring for very ill people said that influenza poses special dangers for nursing home residents.
"Patients who are already suffering from other chronic diseases are helped with a better quality of life because they are not moved out of their comfortable environment to a hospital," noted Dr. Theodore Strange.
"This [new vaccine] is a huge in terms of cost of care and in quality of life for these patients," said Strange, who is associate director of medicine at Staten Island University Hospital in New York City.
In the new study, the Brown team analyzed Medicare claims data from more than 38,000 residents of 823 nursing homes in 38 states during the 2013-2014 flu season.
A high-dose flu vaccine was given to residents of more than 400 of the homes, while residents in the other homes received the standard dose.
The result: Overall hospitalization rates were 3.4 percent for residents who received the high-dose vaccine and 3.8 percent for those who received the standard dose.
The risk of hospitalization for respiratory illness, in particular, was nearly 13 percent lower in the high-dose group. That group also had a much lower rate of hospitalization for any reason, respiratory or otherwise, Gravenstein's group said.
"Respiratory illness as the primary reason for hospitalization accounted for only about a third of the reduction in hospitalization that we measured," noted Gravenstein, who believes the shot may help ward off hospitalization for causes beyond lung troubles.
Breaking it down another way, the study found that for every 69 residents who received the high-dose vaccine vs. the standard-dose vaccine, one more person avoided hospitalization during the flu season.
However, the overall death rate was not affected by which flu vaccine the participants received.
One prior study found that a high-dose flu vaccine can benefit older adults, but it focused on relatively healthy people. "It still needed to be established that it would help even the frailest folks, like those who reside in nursing homes," Gravenstein noted.
For his part, Strange called the study "well-designed," and after reviewing the findings he concluded that "even though the cost of the high-dose vaccine is significantly more, the benefit of keeping patients out of the hospital far outweighs its cost."
Dr. Alan Mensch helps direct medical affairs at Northwell Health's Plainview and Syosset Hospitals in New York. He agreed that until now, "little [has been] known about the efficacy of the flu vaccine in the frail elderly, such as those that reside in long-term health care facilities."
Mensch, a pulmonologist, also believes that death rates weren't affected because "the study was done during the 2013-2014 flu season, during which a relatively mild strain of flu predominated."
According to Mensch, it makes sense that frailer individuals might benefit from a tougher flu shot.
"What we can learn from this study is that in medicine, as in life, one size does not fit all," he said. "Medicine must strive to tailor therapies to individuals with different biology, gender and ages. This study is a step in the right direction."
-- Robert Preidt
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