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Analysis

Delayed Flu Shots Are More Effective, But Riskier Too

By John Commins  
   March 14, 2019

Waiting until closer to the start of flu season offers greater immunity. However, there are risks with delay, especially if the flu comes early, or patients skip their flu shot. 

Thousands of flu cases and hundreds of deaths could be avoided if older adults get their flu shots in October instead of August, new research suggests.

"There's controversy in the public health community over whether influenza vaccination should happen as soon as the vaccine becomes available in August, or if it's better to wait until later in the fall,” said study lead author Kenneth J. Smith, MD, professor of medicine and clinical and translational science at the University of Pittsburgh School of Medicine.

"What we've found is that it's a balancing act, but if a clinician believes a patient will return for vaccination in the fall, then our analysis shows that it is best if they advise that patient to wait," Smith said.

Smith pointed to a previous study which showed that flu vaccines are less potent as the flu season progresses and peaks in mid-winter.

Waiting until closer to the start of flu season ensures greater immunity.

However, if flu season arrives early or if delayed vaccination prompts more than one in 20 people who would otherwise be vaccinated to skip their flu shot, then the gains are negated, according to the Pitt study, published in the American Journal of Preventive Medicine

Pitt researchers ran computer models to compare a "compressed" vaccination period that begins in October to the status quo, which typically begins in August, for people aged 65 or older.

The researchers focused on older adults because waning vaccine effectiveness is more of a threat to the elderly whose immune systems don't typically mount as strong of a defense to infections as younger people.

Older adults also have higher early vaccination rates than younger adults.

Using data from the 2013-2014 and 2014-2015 flu seasons, the researchers forecast the number of cases, hospitalizations and deaths for compressed and status quo vaccination scenarios if the flu season had peaked in December, February or April – early, normal or late, respectively. "Peak" refers to the period when the greatest number of people are sick that season.

In the projections for the normal and late flu seasons, compressed vaccination saved as many as 258 lives and prevented up to 22,062 cases of flu, compared to status quo vaccination timing.

But if flu season peaked early, as it does in about one of every four seasons, the model projected that dozens to hundreds of older adults would die because they wouldn't have been vaccinated in time.

In addition, the team found that if more than 5.5% of older adults who defer vaccination ultimately don't get the flu shot, then compressed vaccination will be a failure and will prevent fewer influenza cases than status quo vaccination.

Smith says these findings can help clinicians determine when to offer their patients flu immunizations – if the patients have multiple appointments each year and will be in the office in the fall or if they are in a senior community where flu immunization is offered through a scheduled clinic, then waiting is likely advisable.

However, if a patient comes in only for an annual check-up and is unlikely to seek out the flu vaccine in the fall, or if offering vaccinations during a compressed window will put overwhelming strain on the clinic, then getting vaccinated when convenient – even if that's in August – is best.

"In all scenarios, simply getting vaccinated is the best way to avoid the flu," said Smith. "If the choice is between getting the influenza immunization early or not getting it at all, getting it early is definitely better."

“If a clinician believes a patient will return for vaccination in the fall, then our analysis shows that it is best if they advise that patient to wait.”

John Commins is a senior editor at HealthLeaders.


KEY TAKEAWAYS

'Compressed' vaccination saved as many as 258 lives and prevented up to 22,062 cases of flu, compared to status quo vaccination timing.

However, if flu season peaked early, dozens to hundreds of older adults would die because they wouldn't have been vaccinated in time.

In addition, more than 5.5% of older adults who defer vaccination ultimately don't get the flu shot.


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