PROPHYLAXIS OF INFLUENZA IN THE ELDERY. IS THERE ANY ALTERNATIVE?
Journal Title: Annals of Mechnikov Institute - Year 2017, Vol 0, Issue 4
Abstract
The benefits of influenza vaccination in the elderly individuals are the subject of serious discussion. Evidence-based medicine can not boast of a large number of randomized clinical trials of the anti-influenza vaccine effectiveness in the elderly due to ethical issues. Over the past 20 years, the only large randomized clinical trial was to investigate an inactivated anti-influenza vaccine in adults aged ≥60 years, which was performed during one season and limited to healthy subjects. This trial demonstrated a 58% reduction in the risk of serologically verified uncomplicated influenza infection in the patients aged 60-69, but no conclusive findings were made for the individuals aged ≥70 years, because the capacity of this study was insufficient to investigate the vaccination efficiency in this age group. Moreover, an evidence of efficacy in healthy subjects aged 60-69 can not be related to the elderly at the age of 70, since elderly age and concomitant diseases are associated with an increased risk of complications and the immune system weakening. With respect to the lack of an evidence, based on randomized clinical trials, we use the results of observational, usually retrospective cohort trials that may be biased. We analyzed the results of randomized multicenter vaccine trials including Fluzone High-Dose Vaccine, meta-analysis data, and concluded that evidence for protection in adults aged 65 years or older is lacking. As an alternative, the results of clinical trials and a meta-analysis of the effectiveness of vitamin D3 for the prevention of influenza / influenza-like illnesses are considered. The extraskeletal effects of vitamin D are analyzed. The interest in vitamin D extraskeletal effects has rapidly grown over the last thirty years due to the identification of Vitamin D receptors (VDRs) in different systems, organs, and cell types. The effects of 1.25 (OH) 2D3 on regulation of both inherent and adaptive immune systems are string and their evaluation has been just started. VDR was detected in activated CD4+ and CD8 + T cells, B cells, neutrophils, monocytes, macrophages, and dendritic cells. The results of the meta-analysis twenty five randomized controlled trials (11,321 participants aged from 0 to 95 years) published by Adrian R. Martineau et al. were presented. The meta-analysis has found that adding vitamin D reduced the risk of acute respiratory infections among all the participants (0.88 corrected odds ratio, 95% 0.81-0.96 confidence interval, P for heterogeneity <0.001). Vitamin D did not affect a part of participants who experience at least one serious adverse event (corrected odds ratio of 0.98, 0.80-1.20, P=0.83). It was finally concluded that the vitamin D supplement was safe and generally protected against acute respiratory infections. A conclusion was drawn on the need for a large clinical trial comparing the efficacy and safety of a flu vaccine and vitamin D3.
Authors and Affiliations
O. I. , Grishyna, O. Babinets, G. R. Kalchenko
Keywords
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- EP ID EP613219
- DOI 10.5281/zenodo.1133761
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