Insufficient evidence for the benefits of influenza vaccines in the elderly

Clinical question: 
How effective are vaccines in preventing influenza, influenza-like illness, hospital admissions, complications and mortality in the elderly (65 years or older)?
Bottom line: 
There was insufficient evidence for the efficacy or effectiveness of influenza vaccines for elderly people, irrespective of setting, outcome, population and study design. Trivalent inactivated vaccines were the most commonly used influenza vaccines. The public health safety profile of the vaccines appeared to be acceptable. Until such time as the role of vaccines for preventing influenza in the elderly is clarified, more comprehensive and effective strategies for the control of acute respiratory infections should be implemented. These should rely on several preventive interventions that take into account the multi-agent nature of influenzalike illness and its context (such as personal hygiene, provision of electricity and adequate food, water and sanitation).
Caveat: 
The results were mostly based on non-experimental (observational) studies, which were at greater risk of bias, as not many good quality trials were available (only one randomised controlled trial). Studies done in residents of care homes often indicate the inevitably improvised nature of efforts to study the effect of vaccination during an epidemic. The resident population is usually more homogeneous than that in the community: older, with similar viral exposure and risk levels.
Context: 
Influenza vaccination of elderly individuals is recommended worldwide, as people aged 65 and older are at a higher risk of complications, hospitalisations and deaths from influenza. In the year 2000, 40 out of 51 high-income or middle-income countries recommended vaccination for all persons aged 60 or 65 or older.¹ 1. van Essen GA. Vaccine 2003;21:1780–5.
Review CD#: 
CD004876
PEARLS No: 
281
Date: 
September, 2010
Authored by: 
Brian R McAvoy