"Flu Shots For The Elderly Are Ineffective". That′s the headline of an Oct. 23, 2008 release from the Orthomolecular Medicine News Service (1). The article picks up on a Sep. 2, 2008 report in the NY Times which claimed that "Doubts Grow Over Flu Vaccine in Elderly" (2).

"A growing number of immunologists and epidemiologists say the vaccine probably does not work very well for people over 70, the group that accounts for three-fourth of all flu deaths." (2)

The evidence for and against the flu shot′s effectiveness

Flu shots are effective if you believe the results of dozens of observational studies carried out over the last forty years or so. These studies seemed to show that flu shots cut the risk of dying in winter from any cause by almost 50% and reduced the need for hospitalization by nearly 30%. It should be pointed out that unambiguous evidence is hard to come by in this field, since doctors rarely confirm influenza with lab tests.

The only randomized placebo-controlled trial to date, a study published by a Dutch group in 1994, found that the vaccine prevented the flu in about 57% of patients in their sixties. For patients past seventy the rate dropped to just 23% — a far cry from 50%, but still better than nothing.

A 2005 article, on the other hand, painted quite a different picture. That paper pointed out that, even though the percentage of elderly getting an annual flu shot more than tripled from 1980 to 2001, there was no corresponding drop in the death rate. The authors concluded that the flu probably causes just 5 - 10% of all winter deaths in the elderly.

Now a new 2008 Lancet article questions the interpretation of earlier findings. These authors suggest that the very decision to get vaccinated simply sets healthy seniors apart from the sick and frail. They theorize that healthier and health-conscious patients are more likely to take the initiative to get a flu shot. Seniors who may have trouble taking care of themselves, and who might have led a less than healthy lifestyle, might simply not get to a doctor′s office for the shot. In other words, lower influenza rates in the vaccinated may have little to do with the vaccine′s effectiveness; seniors who bother to get vaccinated may simply be healthier to begin with.

Needless to say, this view isn′t universally shared by the health care community. Proponents of immunization maintain that any reduction in the number of influenza cases has to be welcome, even if there is no sound evidence that this reduction is due to the flu shot. Doubters, on the other hand, simply see this attitude as a triumph of marketing over science.

Why would flu shots be ineffective?

First, there are some 200 to 300 different influenza virus strains, but the vaccine usually contains antigens of only a few. Preparing vaccines for the coming flu season is an annual guessing game. More often than not the vaccine doesn′t contain antigens of the most virulent strains.

Secondly, our immune system weakens with age; older adults do not respond as well as younger people to vaccines. For example, elderly patients may need as much as four times the amount of antigen for the same immune response as people under forty.

Thirdly, flu shots and other vaccines have harmful side effects. The Vaccine Adverse Effect Reporting System (VAERS) of the U.S. Food & Drug Administration (FDA) receives around 11,000 serious adverse reaction reports per year. Serious reactions are defined as death, life-threatening illness, hospitalization, or disability resulting from a vaccine. The FDA admits that in all probability only about 10% of adverse reactions are reported. The U.S. National Vaccine Information Center puts that ratio at only 3%.

In addition, the elderly take more medications than younger people. Combined with an already weakened immune system and potential vaccine side effects, the risk of adverse reactions can only grow with age.

What can you do to protect yourself?

Whether or not you decide to get the flu shot, you should do everything you can to strengthen your immune system. As the article from the Orthomolecular Medicine News Service puts it:

"Is there an available alternative? Yes, there may be: give the elderly more nutrients, rather than more needles. Older people often have inadequate diets. With ageing and illness, their bodies′ need for vital nutrients goes up, yet frequently their intake actually goes down." (1)

and

"Over-reliance on vaccinating the elderly ignores their fundamental problems of poor diet and vitamin/mineral deficiencies. These are underlying reasons for a susceptible immune system. Supplemental nutrition is the "other" immune system booster. It is time to use it." (1)

The authors point out that high doses of vitamin C have been shown to reduce the frequency and severity of influenza. Vitamin D and the minerals selenium and zinc have also been found effective. I would add that a number of soluble fibers are known to strengthen the immune system as well.

The nutritional approach shouldn′t just be seen as a replacement for immunization. Even an effective vaccine still requires a functioning immune system. A vaccine presents the patient′s immune system with a weakened or dead virus. The immune system responds to that viral preparation in exactly the same way as it does to the real thing. By trial and error, the adaptive immune response develops antibodies and memory B cells against the viral strains it encounters; this process may take several days.

The difference between the live virus and the vaccine — and the idea behind vaccination — is that during that delay the real virus multiplies furiously and may overwhelm the patient, whereas the weakened or dead strain cannot. If the vaccination worked, the patient′s immune system is fully prepared to react immediately when it encounters the live virus.

So, do everything you can to strengthen your immune system, whether you decide to get a flu shot or not!

Sources

1. Flu Shots For The Elderly Are Ineffective. Orthomolecular Medicine News Service, Oct. 23, 2008, and references therein.
2. Doubts Grow Over Flu Vaccine in Elderly. Goodman B. NY Times Sep. 2, 2008.