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High-Dose Flu Vaccine Decreases Hospital Stays

Elderly who receive the higher dose are less likely to need inpatient care

Elderly nursing-home residents who receive the high-dose flu vaccine are less likely to wind up in the hospital than those who receive the usual dose, a new study shows.

Steven Gravenstein, MD, and colleagues from the University Hospitals Case Medical Center in Cleveland studied vaccination data covering September through November 2013 from more than 53,000 participants in 833 nursing homes. The nursing homes were randomized to use either high-dose or low-dose vaccine as standard of care during the flu season; the study used a two-by-two factorial design, with the nursing homes stratified by whether they offered standard-dose vaccination to staff or usual care.

Top-line results were presented at the IDWeek meeting being held in San Diego by the Infectious Diseases Society of America, the HIV Medicine Association, the Society for Healthcare Epidemiology of America, and the Pediatric Infectious Diseases Society.

As noted  by MedPage today, research has already shown that the high-dose vaccine improves immunity and prevents lab-confirmed flu, but Gravenstein and colleagues were trying to see what effect that had on important outcomes such as mortality and death. People getting the high-dose vaccine were significantly less likely to need inpatient care than those who got the standard-dose drug.

Residents had an average age of 83, about 70% were female, and three-quarters were white, the investigators found. The study had complete follow-up on about 80% of participants, and the reasons for incomplete data did not differ between the high-dose and low-dose groups. Overall, there were 5,239 hospital admissions in the high-dose arm and 5,517 in the low-dose arm, 19.7% and 20.9% of the cohort, respectively. Multivariable logistic regression yielded an odds ratio for any hospital admission of 0.93 (95% confidence interval, 0.088–0.098, significantly in favor of the high-dose arm (P = 0.019), Gravenstein reported. For mortality, the dose had no significant effect, he added. The presence or absence of free staff vaccination appeared to have no effect on either outcome, but Gravenstein told MedPage Today that he and colleagues are still studying that data.

Gravenstein cautioned that using all-cause hospital admission as an outcome might mask the effect of vaccine dose on admission for influenza, adding that the investigators are waiting for Medicare claims data that will help pin down that aspect of the study.

Source: MedPage Today; October 12, 2015.

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