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By Michael Fuoco, Pittsburgh Post-Gazette (TNS)

PITTSBURGH — Giving frail, older residents of long-term care facilities a high-dose flu vaccine produces a significantly better immune response than a regular flu shot, a University of Pittsburgh School of Medicine study has found.

Published in the Journal of Infectious Diseases and funded by Fluzone High-Dose vaccine-maker Sanofi Pasteur, the study marks the first time the efficacy of the high-dose vaccine already on the market was evaluated for long-term care residents.

That population, the most vulnerable to flu-related death, has historically shown only moderate benefits from the standard flu vaccine. Among the elderly population, clinical efficacy of the standard vaccine is reduced by 17 to 60 percent.

The U.S. Food and Drug Administration licensed Fluzone High-Dose in December 2009 as a vaccine specifically designed for people 65 years of age and older. It contains four times the antigen of regular shots that prompts the immune system to make antibodies against the flu.

But health care providers wondered whether it would work for the frail and elderly and whether it was worth the cost — twice that of a regular flu vaccine but likewise covered by Medicare — even if it had some benefit, said David A. Nace, the study’s lead author.

The findings answer those questions in the affirmative, said Nace, director of long-term care and flu programs in Pitt’s Division of Geriatric Medicine and chief medical officer for UPMC Senior Communities.

“What this (study) shows is that for this very vulnerable population it makes complete sense that if you’re going to do anything, go all out and go high dose. If it were my parents, I’d want them to have this (high-dose vaccine).”

The Pitt study involved 187 people with an average age of 86.7 years living in 15 community-based, long-term care sites in Western Pennsylvania. It found that those who received the high-dose vaccine had a higher immune response than the standard vaccine for all the flu strains in the 2011-12 and 2012-13 flu seasons except for one strain. There were no serious adverse reactions to the vaccine, Nace noted.

He emphasized that the high-dose vaccine is not a guarantee against contracting the flu and recommended a “bundled approach” in long-term care facilities: vaccination of health care workers, asking those with flu-like illness not to visit residents, practicing proper cough etiquette and hand hygiene, and frequent sanitation of commonly used areas and equipment.

Nace said UPMC has adopted the high-dose vaccine as standard care for elderly patients in its nursing homes, hospitals and outpatient facilities as have other health-care providers nationally.

Reba Roberts, 99, a resident of UPMC’s at Cumberland Crossing Manor in McCandless, received the high-dose vaccine. She is a retired nurse and a strong advocate for getting a flu shot ever since she contracted the flu more than 40 years ago.

“After that, I got a flu shot every year and haven’t had it since,” said Roberts, who formerly worked at West Penn Hospital.

“People are foolish if they don’t get a flu shot. It doesn’t hurt. You might as well get it so you don’t get sick.”

Photo: v1ctor Casale via Flickr

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Jeff Danziger lives in New York City. He is represented by CWS Syndicate and the Washington Post Writers Group. He is the recipient of the Herblock Prize and the Thomas Nast (Landau) Prize. He served in the US Army in Vietnam and was awarded the Bronze Star and the Air Medal. He has published eleven books of cartoons and one novel. Visit him at DanzigerCartoons.

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