According to recently released survey data, the overall U.S. population is aging and there are more adults 65 years of age and older than ever before. In Florida, where approximately 24 percent of the population is aged 65 or older, influenza is of particular concern because along with the very youngest, adults over the age of 65 are known to be the most affected by this illness. What’s important to realize is that even though our patients may present with little or no symptoms of influenza, we – as physicians – need to be aware that infection with the influenza virus can actually exacerbate other underlying conditions that can lead to hospitalization or complications related to other co-morbidities. Underlying medical conditions, such as diabetes, lung, heart and neurological diseases can be exacerbated by concomitant infection with Influenza viruses. Pneumonia, bronchitis, sinus and ear infections and worsened angina, coronary artery disease and congestive heart failure, are examples of flu-related complications. Furthermore, there is newer data that implicates influenza infection with increases in homebound states, declines in ability to perform daily living activities, and lessened exercise capacity and activity, generally, the consequences of which further predispose the frail elderly in particular to rapid decline in health and quality of life.
Among those 65 and older, influenza and its related complications account for more than 60 percent of the estimated 226,000 flu-related hospitalizations and 90 percent of the 3,000 to 49,000 flu-related deaths in the United States each year.
As health care providers, we must ensure that we are offering the best care possible for our patients. For those adults 65 and older, we know that the Immune systems function declines with age, leaving older adults more vulnerable to a multitude of illnesses, not the least of which is influenza and its potentially deadly complications.
Health care providers might not be aware that there is now an influenza vaccine option targeting this age group that specifically addresses this age-related decline of the immune system. The FDA approved a higher dose influenza vaccine, which contains four times the amount of antigen as the standard dose influenza vaccine. It is believed that the four fold increase in antigens in the vaccine may stimulate the body to generate more antibodies against influenza following vaccination. Laboratory study demonstrated this to be the case and efficacy studies are underway to evaluate real world performance. Other technological innovations are currently underway through the use of adjuvants and the search for better vaccines. Nevertheless, to date, this is the only FDA approved influenza vaccine for use in this population now.
The high dose influenza vaccine is also among the influenza vaccines included in the U.S. Centers for Disease Control and Prevention’s Recommendations for Prevention and Control of Influenza. The higher dose vaccine is also covered by Medicare Part B. The high dose influenza vaccine has shown a higher risk for side effects at the injection-site (e.g., fever, soreness), but no greater risk of systemic reactogenicity than the standard dose.
If we have a vaccine aimed specifically at adults 65 and older to address their unique needs, shouldn’t we be taking advantage of it for our most vulnerable patients? I encourage my colleagues to review their patient population and consider the options available when it comes to influenza vaccine for adults 65 and older. I also encourage all health care providers to make influenza vaccination a priority for all their patients ages 6 months and older in line with CDC recommendations. Let’s make vaccinating the entire state of Florida against influenza a priority this year and every year!