The clinical diagnosis of influenza

The impact of targeting all elderly persons in England and Wales for yearly influenza vaccination: excess mortality due to pneumonia or influenza and time trend study

OBJECTIVE

To investigate the impact on mortality due to pneumonia or influenza of the change from risk-based to age group-based targeting of the elderly for yearly influenza vaccination in England and Wales.

DESIGN

Excess mortality estimated using time series of deaths registered to pneumonia or influenza, accounting for seasonality, trend and artefacts. Non-excess mortality plotted as proxy for long-term trend in mortality.

SETTING

England and Wales.

PARTICIPANTS

Persons aged 65-74 and 75+ years whose deaths were registered to underlying pneumonia or influenza between 1975/1976 and 2004/2005.

OUTCOME MEASURES

Multiplicative effect on average excess pneumonia and influenza deaths each winter in the 4-6 winters since age group-based targeting of vaccination was introduced (in persons aged 75+ years from 1998/1999; in persons aged 65+ years from 2000/2001), estimated using multivariable regression adjusted for temperature, antigenic drift and vaccine mismatch, and stratified by dominant circulating influenza subtype. Trend in baseline weekly pneumonia and influenza death rates.

RESULTS

There is a suggestion of lower average excess mortality in the six winters after age group-based targeting began compared to before, but the CI for the 65-74 years age group includes no difference. Trend in baseline pneumonia and influenza mortality shows an apparent downward turning point around 2000 for the 65-74 years age group and from the mid-1990s in the 75+ years age group.

CONCLUSIONS

There is weakly supportive evidence that the marked increases in vaccine coverage accompanying the switch from risk-based to age group-based targeting of the elderly for yearly influenza vaccination in England and Wales were associated with lower levels of pneumonia and influenza mortality in older people in the first 6 years after age group-based targeting began. The possible impact of these policy changes is observed as weak evidence for lower average excess mortality as well as a turning point in baseline mortality coincident with the changes.

Influenza outbreak in a well-vaccinated nursing home population in Belgium

Elderly people in nursing home communities are vulnerable to contagious infections, including the influenza virus. Systematic anti-influenza vaccination is an important preventive measure; however, vaccination does not provide absolute protection. We report an outbreak of influenza A infection in a well-vaccinated nursing home population. Several factors can facilitate the occurrence of this type of outbreak. This report mainly addresses the discrepancy between the circulating viral strain and strains present in the recommended vaccine.

The impact of influenza on the health and health care utilisation of elderly people

Despite intensive research, influenza viruses still present one of the major causes of respiratory disease throughout the world. The elderly population and those individuals considered "at risk" due to presenting co-morbidity are especially vulnerable to influenza infection; this is evident from increased rates of morbidity and mortality in these populations during winter epidemic periods. Successful vaccination campaigns have targeted these groups over the last few years, providing protection to an increasing number of susceptible individuals. However, during periods of influenza virus activity there are still seasonal pressures put on both primary and secondary health care services. In the event of a serious influenza epidemic or pandemic, these burdens could jeopardise health care provision to at risk populations. In this report we discuss current issues surrounding the impact of influenza on the health care utilisation of elderly people.