Elderly influenza vaccination

Influenza. Although current influenza vaccine (subunit spHt vaccine) has been in use yearly for the elderly, it is not recommended for the general population or infants. Improvements to increase or prolong the immunogenicity, reduce the side-effects (due to egg production procedure), and provide mass protection are stiU being pursued. One approach is to use a five, attenuated vims though cold adaptation. A vaccine has been used in Russia and demonstrated to be safe and efficacious for infants (82). Clinical trials for a similar vaccine are being carried out in the United States (83). 

Vedhara, K. et al., Chronic stress in elderly carers of dementia patients and antibody response to influenza vaccination, Lancet, 353, 627, 1999. 

Influenza vaccination of elderly individuals is recommended worldwide and has been targeted toward the elderly and those at serious risk of complications. 

Ives, D., J. Lave, N. Traven, and L. KuUer. 1994. Impact of Medicare Reimbursement on Influenza Vaccination Rates in the Elderly. Preventive Medicine 23 134—141. 

Nexoe, J., J. Kragstrup, and T. Ronne. 1997. Impact of Postal Invitations and User Fee on Influenza Vaccination Rates among the Elderly A Randomized Controlled Trial in General Practice. Scandinavian Journal of Primary Health Care 15(2) 109-112. 

Ohmit, S. E., A. Furumotodawson, A. S. Monto, andN. Fasano. 1995. Influenza Vaccine Use among an Elderly Population in a Community Intervention. American Journal of Preventive Medicine 11 (4) 271-276. 

Vila-Corcoles A, Ochoa O, de Diego C, Valdivieso A, Herreros I, Bobe E et al. Effects of annual influenza vaccination on winter mortality in elderly people with chronic pulmonary disease. Int J Chn Pract 2008 62 10-7. 

Other vaccines available are those for influenza(flu), pneumonia (lifetime immunity), rabies, cholera, smallpox, typhus, typhoid, and Rocky Mountain spotted fever. Some vaccines can cause adverse effects especially to small children or the elderly. Flu vaccine has been implicated in the onset of a condition known as Guillain-Barre syndrome, a polyneuritis which can lead to anything from mild pain and weakness in the extremities to paralysis. These symptoms can last from a few weeks to a few months. 

At present, vaccines are available for several serious viral infections, including polio, smallpox, rabies, measles, mumps, rubella, hepatitis A and B, and influenza. In some situations, vaccination against certain viral infections is routine. For instance, schoolchildren must periodically show evidence of polio, measles, and other vaccinations according to state and local laws. In other cases, vaccines are administered prior to potential exposure to the virus or in high-risk groups. Influenza vaccinations, for example, are often administered to elderly and debilitated patients during seasonal influenza outbreaks.75,109... 

Qll Acute exacerbations of chronic bronchitis can be caused either by viral or bacterial infections. Production of thick, green sputum suggests Chandra has a bacterial infection. Common bacterial pathogens affecting the lung include Streptococcus pneumoniae and Haemophilus influenzae. It is recommended that COPD patients receive influenza vaccine each year pneumoccocal vaccine is also often recommended in chronic lung disease and may prevent recurrence of chest infection in the elderly. 

De Donato S, Granoff D, Minutello M, Lecchi G, Faccini M, Agnello M, Senatore F, Verweij P, Fritzell B, Podda A. Safety and immunogenicity of MF59-adjuvanted influenza vaccine in the elderly. Vaccine 1999 17(23-24) 3094-101. 

Gomohn IH, Chapron DJ, Luhan PA. Lack of effect of influenza vaccine on theophylUne levels and warfarin anticoagulation in the elderly. J Am Geriatr Soc 1985 33(4) 269-72. 

Sankilampi U, Honkanen PO, Pyhala R, Leinonen M. Associations of prevaccination antibody levels with adverse reactions to pneumococcal and influenza vaccines administered simultaneously in the elderly. Vaccine 1997 15(10) 1133-7. 

The severity of the disease, not only in terms of its morbidity and mortality and the probability of permanent injury to its survivors, but also in the likelihood of infection must be sufficient to warrant the development and routine deployment of a vaccine and its subsequent use. Thus, whilst influenza vaccines are constantly reviewed and stocks maintained, the control of influenza epidemics through vaccination is not recommended. Rather, those groups of individuals, such as the elderly, who are at special risk from the infection are protected. 

Response to influenza vaccine generally is measnred in terms of antibody response and, more important, efficacy. The elderly and individuals with chronic diseases are less likely to develop antibody levels that are considered protective and may remain snsceptible to influenza infection. However, vaccination confers protection from secondary complications and reduces the risk of hospitalization or pneumonia by 50% to 60% and death by 80%. Influenza vaccine is cost-effective in nursing home populations, in the elderly who live in the community, and in healthy working adults. " ... 

Dorrefl L, Hassan 1, Marshall S, et al. Chnical and serological responses to an inactivated influenza vaccine in adults with HIV infection, diabetes, obstructive airways disease, elderly adults and healthy volunteers. Int J STD AIDS 1997 8 776-779. 

Nichol KL, Nordin J, Mullooly J, et al. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med 2003 348 1322-1332. 

It has been reported to stimulate humoral and cellular immune responses in combination with several subunit antigens. It has also been proven safe, and does not cause any major adverse reactions. In clinical trials it has already been used with influenza, HSV or HIV antigens, and has been marketed as part of an enhanced influenza vaccine for the elderly. MF59 does not form a depot at the injection site, but targets macrophages and dendritic cells at the site of injection and in lymph nodes. 

L., and Bindels, J., Effect of a complete nutritional supplement on antibody response to influenza vaccine in elderly people, J. Gerontol, 57, M563, 2002. 

Poll D, Chiarugi L, Capanni M, Antonucci E, Abbate R, Gensini GF, Prisco D. Need of more frequent international normalized ratio monitoring in elderly patients on longterm anticoagulant therapy after influenza vaccination. Blood CoagFibrinol (2002) 13, 297-300. 

A very thoroughly investigated interaction, the weight of evidence being that no adverse interaction normally occurs with any type of influenza vaccine in children, adults or the elderly. Even so, bearing in mind the occasional and unexplained reports of an interaction it would seem pmdent to monitor the effects of concurrent use (for nausea headaches, palpitations), although problems are very unlikely to arise now that purer vaccines are available (see Mechanism ). Note that any rise in theophylline levels is likely to be transient. 

Drug-drug interactions Coadministration of tramadol with vitamin K antagonists increases INR [81 ]. Findings were confirmed by a case-control trial assessing patients on tramadol who were placed on a vitamin K antagonist [82 ]. Patients on rifampicin experienced decreased oral bioavailability of lOO-mg tramadol and decreased durabon of acHon of intravenous 50-mg tramadol [83 -]. A case series of two elderly women on 100-mg oral tramadol demonstrated acute onset of hallucinations after administration of influenza vaccine [84 ]. 

Kulkarni PS, Manjunath K, Agarkhedkar S. Safety and immunogenicity of an adjuvanted whole virion, inactivated A (HlNl) 2009 influenza vaccine in young and elderly adults, and children. Vaccine 2012 31(l) 20-2. 

DiazGranados CA, Dunning AJ, Jordanov E, Landolfi V, Denis M, Talbot HK. High-dose bivalent influenza vaccine compared to standard dose vaccine in elderly adults safety, immunogenicity and relative efficacy during the 2009-2010 season. Vaccine 2013 31(6) 861-6. 

Maducado JD, Bhagya-Rao B, Davogustto G, McKelvy BJ. Acute disseminated encephalomyelitis following seasonal influenza vaccination in an elderly patient. Clin Vaccine hmnunol 2013 20(9) 1485-6. 

Influenza vaccination of persons 65 years of age and older can save money and improve health (98,99). Influenza vaccination has been shown to be cost saving for healthy working adults (96) and can reduce direct costs and be cost saving in high-risk elderly populations in managed care settings (91,100). 

Gross PA, Weksler ME, Quinnan GV Jr, Douglas RG Jr, Gaerlan PE, Denning CR. Immunization of elderly people with two doses of influenza vaccine. J Clin Microbiol 1987 25 1763-1765. 

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