Vaccines for preventing seasonal influenza and its complications in people aged 65 or older

Updated
Authors: 
Demicheli V, Jefferson T, Di Pietrantonj C, Ferroni E, Thorning S, Thomas RE, Rivetti A

Review aim

The aim of this Cochrane Review, first published in 2006, was to summarise research that looks at the effects of immunising the elderly (those aged 65 years or older) with influenza vaccine during influenza seasons. We used information from randomised trials comparing influenza vaccine with dummy vaccine or with nothing. The influenza vaccines were prepared by treating influenza viruses with a chemical that kills the virus (inactivated virus), and the vaccination was given by injection through the skin. We were interested in showing the effects of vaccines on reducing the number of elderly with confirmed influenza, the number who had influenza-like symptoms such as headache, high temperature, cough, and muscle pain (influenza-like illness, of ILI), and harms from vaccination. We looked for evidence of the impact of influenza or ILI such as hospital admission, complications, and death. We will update this review in the future only when new trials or vaccines become available.

Observational data from 67 studies included in previous versions of the review have been retained for historical reasons but have not been updated because of their lack of influence on the review conclusions.

What was studied in this review?

Over 200 viruses cause ILI, producing the same symptoms (fever, headache, aches, pains, cough, and runny nose). Without laboratory tests, doctors cannot distinguish between viruses, as they last for days and rarely lead to serious illness. At best, vaccines are only effective against influenza A and B, which represent about 5% of all circulating viruses. Inactivated vaccine is prepared by treating influenza viruses with a specific chemical agent that 'kills' the virus. Final preparations may contain either the complete viruses (whole-virion vaccine) or the active part of them (split or subunit vaccines). These vaccines are typically administered by injection through the skin. The virus strains contained in the vaccine are usually those that are expected to circulate in the following epidemic seasons (two type A and one or two B strains), which are recommended by the World Health Organization (seasonal vaccine). Pandemic vaccine contains only the virus strain that is responsible for the pandemic (e.g. the type A H1N1 for the 2009 to 2010 pandemic).

Key messages

Inactivated vaccines can reduce the proportion of elderly who have influenza and ILI. Data on deaths were sparse, and we found no data on hospitalisations due to complications. However, variation in the results of studies means we cannot be certain about how big a difference these vaccines will make across different seasons.

Main results

We found eight randomised controlled trials (over 5000 people), of which four assessed harms. The studies were conducted in community and residential care settings in Europe and the USA between 1965 and 2000.

Older adults receiving the influenza vaccine may experience less influenza over a single season, from 6% to 2.4%, meaning that 30 people would need to be vaccinated with inactivated influenza vaccines to avoid one case of influenza. Older adults also probably experience less ILI, from 6% to 3.5%, meaning that 42 people would need to be vaccinated to prevent one case of ILI. The amount of information on pneumonia and mortality was limited. Data were insufficient to be certain about the effect of vaccines on mortality. No cases of pneumonia occurred in one study that reported this outcome, and no data on hospitalisations were reported. We do not have enough information to assess harms relating to fever and nausea in this population.

The impact of influenza vaccines in older people is modest, irrespective of setting, outcome, population, and study design.

How up to date is this review?

The evidence is current to 31 December 2016.

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