Commentary: Options for flu vaccine for those 65 and older should be made clear

Commentary: Options for flu vaccine for those 65 and older should be made clear

If you are older than 65, you should know that some flu vaccines are better than others for you. A high-dose vaccine (Fluzone) was developed by Sanofi-Pasteur. In a clinical trial published in the New England Journal of Medicine, researchers demonstrated that the Fluzone was 22-45 percent more effective at preventing flu than regular vaccine in patients 65 years of age or older.

Another study examined all respiratory illness occurring during flu season among older vaccine recipients. This study demonstrated a 13 percent advantage for Fluzone. There are two other new high-dose vaccines but they do not have strong data behind them.

In discussing this situation with friends and with residents at two local long-term care facilities, I was surprised to find that no one knew that there was a high-dose vaccine and no one knew that there might be an advantage in taking the high-dose vaccine compared to any other vaccine.

I also called the Connecticut Department of Health and learned that they have no specific policy on which vaccine long-term care facilities in the state should offer. They said that they just go by what the U.S. Centers for Disease Control recommends.

Why didn’t you know about the high-dose vaccine and what does the Centers for Disease Control say?

The center and the Advisory Committee for Immunization Practices don’t specify a “preference” for high-dose vaccines for older folks. A “preference” in their lingo means that other vaccines are not recommended for that population. This would therefore require providers like doctors, pharmacies, hospitals and others to specifically provide the high-dose vaccine for older folks. The advisory committee “recommends” high-dose vaccine for those older than 65, but this does not mean the same thing as a “preference” for provider.

The advisory committee states that older folks should get vaccinated and they then list all available vaccines as choices. To add to the problem, the high-dose vaccine is two to three times more costly than the regular vaccine. While providers are reimbursed by Medicare and other insurers for the high-dose vaccine, their procurement costs are higher and this may be dissuasive.

When I set out to find high-dose vaccine for myself and my family back in early November, I called three CVS pharmacies in our area. One had the vaccine early on but had already run out by the beginning of November. A second had never ordered the high-dose vaccine. The third had it available. My personal physician also offered high-dose vaccine for all his patients age 65 years and older.

I spoke with Dr. Lisa A. Grohskopf who is the Centers for Disease Control’s liaison with the Advisory Committee for Immunization Practices. She explained that there are 13 different influenza vaccines available this season of which two are licensed for use in persons aged 65 years of age and older. The advisory committee will not provide a specific “preference” for high-dose vaccine because (1) there might be differences across different flu seasons (only two seasons were studied); (2) it was not compared to other high-dose vaccine; and (3) it is not clear that the manufacturer would have been able to provide it to a larger population. (I did not speak to Sanofi-Pasteur about this.)

This reasoning is specious. There was a large randomized trial showing consistent improvements in efficacy across several different analysis populations in two different flu seasons for Fluzone. If the objection is that it should have been compared to other high-dose vaccines — that seems unreasonable. Those other manufacturers should be encouraged to come up with the same kind of data that Sanofi-Pasteur provided for Fluzone in order to get a preference for use in older individuals.

The end result of the Advisory Committee for Immunization Practices’s dithering is that no one understands that there is a better vaccine available for older individuals and therefore, that those who need it don’t get it.

Shlaes, of Stonington, is a retired infectious disease physician and microbiologist. He was featured in The Sun’s Easy Chair feature on Oct. 25, 2015.


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