Image: Flu shots
David Mcnew  /  Getty Images file
Emily Moore administers a flu shot to Juanita Dunn, 86, while Antonio Prieto awaits his turn as free flu shots are offered to people over 50 by the Los Angeles County Department of Health Services last fall.
By Robert Bazell Chief science and health correspondent
NBC News
updated 10/10/2006 9:25:46 AM ET 2006-10-10T13:25:46

Two winters ago my mother-in-law Betty almost died of the flu. A health-conscious woman, she always gets her annual flu shot. So what happened? 

The answer reveals a serious weakness in the U.S. immunization policy. Flu shots don’t protect older people as much as you might think.

Every year at this time as flu shots become available we hear the statistics.  According to the federal Centers for Disease Control and Prevention, the regular seasonal influenza, not the dreaded pandemic strain, kills about 36,000 Americans annually, a terrible toll — almost as many as die from auto accidents.

Ninety percent of those are 65 and older, and many — but by no means all — have underlying medical conditions that weaken the lungs or heart. In my mother-in-law’s case, life-long asthma sparked a nearly fatal reaction to the flu. Today, Betty is back again as an extraordinarily vital woman, an active member of her family and community with an energy level exceeding many people decades younger than her (for reasons of her vanity I won’t reveal her exact age). But for a few terrifying weeks we almost lost her.

Since flu vaccine became available in 1945, government efforts have allocated it primarily to those 65 and over, and those with other medical problems. But recent studies reveal Betty’s case is hardly unique. As people age, their immune systems wane and respond less to all sorts of vaccinations. Studies show that flu shots prevent sickness in people 65 or older only 30 to 70 percent of the time, though infections may be milder in those who have had the shot. The huge variation from study to study results in part because “people over 65” make up a very diverse group and because in different years the vaccine is more closely matched to the virus that is circulating in the community

Even more significant, a study out last year from Lone Simonsen, Ph.D., and his team at the National Institute of Allergy and Infectious Disease concluded that the shots had no impact on the death rate from flu complications in people over 65 from 1980 when 20 million people got shots to recent years when around 80 million did. So flu shots appear to be failing to achieve their major objective of lowering the death rate.

One possible solution is to give older people higher doses. A recent study showed that seniors can safely receive five times the normal dose of flu vaccine and achieve a level of immunity comparable to younger patients. 

Increasing numbers of experts are embracing a much bolder idea — vaccinate everyone in the country every year. Not long ago this might have been considered a public health pipe dream. But all the publicity about bird flu and the threat of a pandemic have focused attention on flu vaccination, making the public more receptive to seasonal flu shots and drug companies more interested in the profits they can generate.

Universal immunization would eliminate a lot of misery and lost work and school days while keeping the virus from spreading to sick or older people (family members, friends or strangers) who might die from it.

And the immunization need not be 100 percent. In medicine, there is a  concept is called "herd immunity" — that is, if enough members of a group of animals (including humans) are immunized against a disease, the entire group is more likely to escape infection.

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This year the government recommends shots for adults 50 and over (down from 65 in previous years), children 6 months to 5 years (up from 2 years old last year) and other groups including those with chronic health conditions, pregnant women, health care workers and household contacts of the above.  These recommendations already encompass 218 million out of the 300 million Americans. But of course not everyone who should get the shot does.

There is not nearly enough vaccine to immunize nearly everyone just yet. Federal health officials were thrilled to announce last week that the country will have 115 million doses this year from five separate suppliers — enough, they hope, to avoid the shortages that cropped up two years ago when just two manufacturers turned out 61 million doses after a plant was forced to close for safety violations.

But the recommendations for using the record number of doses available this year indicate a slow movement toward universal vaccination.

The next logical target for annual flu vaccination should be school-age kids. Young children can get very ill (and, in some rare cases, even die suddenly) from flu. Older kids seldom get so sick, but runny-nosed encounters in classrooms and playgrounds make up the major reservoir that spreads the virus to the entire community. An experiment in Japan proved that immunizing school-age children could cut deaths in the elderly by many thousands. A similar trial is now underway in Knoxville, Tenn.

Convincing more people to get shots would also nudge manufacturers to make more vaccine, which would help build up the manufacturing capacity so the country can respond as quickly as possible if there is a major threat from deadly bird flu or any other pandemic strain.  But more important, universal vaccination might be the best way to slash flu’s enormous death toll among older Americans.

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