Older adults who get a flu shot have only half the risk of dying from flu as people who don't get vaccinated. They also are 27% less likely to be hospitalized because of flu. Those are among the conclusions of a large study published October 4 in the New England Journal of Medicine. The study looked at more than 10 years of data. It included more than 700,000 people. All were over age 65. HealthDay News reported on the study.

By Robert H. Shmerling, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

When older adults get influenza, it's more likely to lead to serious health problems and even death than when flu strikes younger adults. That's why current guidelines advise flu shots for all adults over age 50.

Yet the effectiveness of flu vaccine for the elderly has been uncertain. One recent study suggested that effectiveness has been overestimated. This study was in the medical journal Lancet. Apparently, winter hospital stays and deaths in this age group have actually increased despite rising rates of vaccination. One possible reason is that the flu vaccine isn't doing its job well.

That's why a new study in the New England Journal of Medicine is so helpful and important. It provides some of the best evidence to date confirming the benefits of flu shots for older people. Strengths of this study include its large size. It included more than 700,000 people. The data stretch across 10 flu seasons in multiple places.

Study subjects were at least 65 years old. The average was 74. Everyone lived in the community. This means they did not live in a nursing home or other institution.

Compared with those who did not get the flu shots, people who did get vaccinated were:

• 27% less likely to be admitted to the hospital for flu symptoms or pneumonia
• 48% less likely to die

Vaccination was effective even among the oldest group (age 90 and older).

These findings may be even better than they seem. Those who got the flu shot were, on average, sicker than those who did not get it. Elderly people with multiple medical problems have a higher risk of further problems and death caused by flu than those who are healthy.

The results of this study are encouraging. They also support current guidelines on flu shots. The guidelines say that older adults -- particularly those with multiple medical problems -- should get a flu shot every year.

What Changes Can I Make Now?

The message from this new study is clear: Older adults should be vaccinated for the flu. Some people may have reasons to turn it down, however. These include an allergy to eggs or a prior severe reaction to vaccination.

The vast majority of people vaccinated for flu get good protection without major side effects. Even when the vaccine fails to prevent infection, people who get it tend to have less severe disease and fewer complications.

Flu vaccination is a good idea for anyone who wants to reduce the chance of getting flu and spreading it to others. In addition to older adults, influenza vaccination is specifically recommended for:

• Children from ages 6 months to 5 years
• Women who are pregnant or may become pregnant during flu season
• Children and adults with medical illnesses such as asthma, heart disease, kidney failure or diabetes
• Children and adults who have reduced immune function, such as those who are infected with HIV or take drugs that suppress the immune system
• Nursing home residents
• Anyone who is in regular contact with those in high-risk groups, including health care professionals

Your doctor should offer you a flu shot (especially if you are in one of these high-risk groups). But don't wait for the offer! Contact your doctor to arrange vaccination. In many places, the flu shot also is offered at drug stores, town halls and other public sites.

Once you decide to get the flu shot, don't delay. It's best to be protected throughout the flu season, which begins in October or November.

Don't let unfounded rumors or past shortages discourage you from getting vaccinated. A common myth is that you can get the flu from the vaccine. That's not true. And it appears that there will be plenty of vaccine for the coming flu season.

For healthy people between the ages of 2 and 49, there is another option for vaccination. FluMist is sprayed into the nose. It seems about as effective as the injection. However, those at highest risk should stick with the standard vaccine. There's less evidence that the inhaled vaccine is effective for them.

Besides getting vaccinated, you can take other steps to decrease your chances of getting the flu:

• Wash your hands often. Flu can be spread through direct contact, so good hand hygiene can reduce your risk of getting it.
• Take antiviral medicines. Several antiviral drugs are approved to reduce flu risk if taken just before a predicted outbreak. These medicines are amantadine (Symmetrel), oseltamivir (Tamiflu), rimantadine (Flumadine) and zanamivir (Relenza). The use of these medicines has been limited. The reasons include side effects, cost, resistant strains and the difficulty of knowing when to take them.

What Can I Expect Looking to the Future?

Ongoing research of standard treatments will ensure that current guidelines make sense. You can expect to hear more updates regarding the risks and benefits of flu shots. You'll also hear more about the safety and effectiveness of the inhaled vaccine. Perhaps new vaccines will be developed. Hopefully, we will hear only more good news.