Sep 23, 2005 (CIDRAP News) – Researchers who reviewed 64 studies report that influenza vaccination is only modestly beneficial for elderly people overall, with nursing home residents benefiting more than people living on their own.”Our findings show that, according to reliable evidence, the effectiveness of trivalent inactivated influenza vaccines in elderly individuals is modest, irrespective of setting, outcome, population, and study design,” says the report by Tom Jefferson and four colleagues, of the Cochrane Vaccines Field, based in Alessandria, Italy. The study was published online yesterday by The Lancet.The researchers found that flu vaccines, when well matched to circulating flu strains, reduced the risk of hospitalization for flu or pneumonia by 45% for elderly (65 or older) nursing home residents. For people living at home, flu vaccines were 26% effective in preventing hospitalization for flu or pneumonia. However, vaccination didn’t significantly lower the risk of laboratory-confirmed influenza in either group.The team searched five databases for studies of the effectiveness of flu vaccine in preventing influenza, flu-like illnesses, and related hospital admissions, complications, and death. They found 64 studies from the past four decades, including five randomized trials, 49 cohort studies, and 10 case-control studies, that met their criteria.For elderly residents of nursing homes who received vaccines well matched to circulating flu strains, the vaccines yielded risk reductions of 23% for flu-like illness, 46% for pneumonia, 45% for hospitalization for flu or pneumonia, 42% for death from flu or pneumonia, and 60% for death from any cause. However, vaccination yielded no significant benefit when the match with circulating flu strains was poor or unknown.The benefits were smaller for elderly people living in the community, according to the authors’ analysis of 20 cohort studies. Vaccines didn’t significantly reduce the participants’ risk for flu, flu-like illness, or pneumonia. With well-matched vaccines, risk reductions were 26% for hospitalization for flu or pneumonia and 42% for all-cause mortality. Vaccines did not reduce the risk of hospitalization for heart disease or the risk of death from respiratory disease.However, vaccination looked somewhat more beneficial for community dwellers when the authors adjusted for confounding variables, including sex, age, smoking, and other illnesses. In that analysis, vaccines reduced the risk of all-cause mortality by 47% and lowered the risk of hospitalization by 24% for heart disease and 22% for respiratory diseases.The authors write that no firm conclusions could be drawn from the five randomized controlled trials they analyzed. However, in analyzing the two trials that had “adequate” randomization and blinding, they found that vaccines were 43% effective in preventing flu-like illness and 58% effective against flu in community-dwelling older peopleThe study’s main findings show somewhat smaller benefits than those cited by the Centers for Disease Control and Prevention (CDC). Information on the CDC Web site says that for older people in nursing homes, flu immunization can be 50% to 60% effective in preventing flu-related hospitalization or pneumonia and 80% effective in preventing flu-related death. Also, the CDC says that community dwelling older people who get flu shots can lower their risk of hospitalization for pneumonia or flu by 30% to 70%.In response to the new study, the CDC issued a statement today emphasizing that vaccination remains the best way to protect older people from flu and its complications. The agency acknowledged that flu vaccines are not 100% effective and that older people and those with chronic diseases may develop less immunity than healthy young adults.The CDC said the finding that flu vaccination is more effective for nursing-home residents than for community-dwelling older people “is unexpected and not consistent with other data, including information on immune response to vaccination.”The study authors write that on the basis of their findings, “We believe efforts should be concentrated on achieving high vaccination coverage in long-term care facilities coupled with a systematic assessment of the effect of such a policy. One possible way to improve this strategy might involve the vaccination of carers [caregivers] in an effort to reduce transmission.”The federal government took steps in that direction last month, announcing that nursing homes that serve Medicare recipients would be required to offer flu shots to residents. The government also wants to increase vaccination coverage for nursing home staff members, but there are no plans to require vaccination for them.The new report was published little more than a week after the CDC urged older people and others in high-risk groups to get their flu shots soon. The agency has recommended that flu shots be reserved for the high-risk groups until Oct 24.Jefferson T, Rivetti D, Rivetti A, et al. Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review. Lancet 2005;Sep 22 (early online pubication)See also:CDC information on efficacy and effectiveness of flu vaccinehttp://www.cdc.gov/flu/professionals/vaccination/efficacy.htm
“After the widest consultation with various sectors of the society, including local businesses, the hotel sector and trade unions, we decided to reopen the border,” Browne added. “That is not what I stand for. Nor, is it what the Government I lead stands for,” he added. Browne said that despite the enormous pressure on government revenues that have been badly hit by the effects of COVID-19 “we have carved out funds to buy these COVID-19 testing supplies. “No one is exempt from them now, nor will they be at any time in the future. That includes me, every Government Minister, the Governor-General – simply put, everyone who enters the country from abroad will be tested and quarantined or isolated as appropriate while this pandemic continues. We are learning from experience,” Browne added. “We are already bolstering our arrangements at the airport and other ports of entry, including the acquisition of 12,500 rapid test kits, 20,000 swabs and 2000 reagents which have been shipped and will arrive on the island shortly.” ST. JOHN’S, Antigua – The Antigua and Barbuda government says every person entering the country will need to be tested and will undergo mandatory quarantine, after the island recorded 39 cases of the coronavirus (COVID-19) from individuals who recently arrived in the country. Officials say all 39 had been placed in quarantine since their arrival in Antigua. The 39 cases now bring the total number of cases in Antigua and Barbuda to 65. “Our purpose is to isolate any who tests positive and to keep them away from our healthy domestic population. I know that there will be those who will seize this opportunity to attack the government, claiming that we should have kept our borders closed to all, including nationals who were trapped abroad. “My Government and the country as a whole, was faced with a choice of continuing to keep our borders shut and watch our country and its people decline into abject poverty and disaster, or open the borders, while putting protections firmly in place, that would give tourism a chance to revive and our people a better opportunity to live and prosper. “It is important that you know that none of these persons have been hospitalized. Presently, there is no one hospitalized in Antigua and Barbuda with COVID, and none of the new cases require hospitalization.” Browne said the detection and quarantining of these 39 new cases, “demonstrate the effectiveness of the procedures that have been established and are being scrupulously implemented at our ports of entry. He said the 39 new cases are persons, in which in excess of half are returning nationals – who entered Antigua by air over the last few days. Browne said that none of the 39 cases is a threat to the community at this time, and that, through the identification, tracing and quarantining process, the Ministry of Health is containing and treating affected persons. Antigua and Barbuda earlier this month reopened its borders after it had been shut down as part of the measures to deal with the spread of the virus that has killed three people and infected 65 others here. “Those, who make these claims, do so for selfish political reasons. They would prefer the economy to wither and die; they would prefer unemployment to rise and poverty to increase, just so that they can take advantage of people’s suffering for their own selfish political ends. “Everyone who enters Antigua and Barbuda, including returning nationals, to live within communities with relatives and friends, with no exception, will be tested and will be quarantined mandatorily,” Prime Minister Gaston Browne said, adding “we must continue to keep our country safe”. CMC
Kusal Perera top-scored with his ODI best score of 135 as Sri Lanka thrashed Ireland by 136 runs in the second one-day international at Malahide on Saturday to clinch the two-match series 2-0.After put in to bat, Sri Lanka posted 377/8, riding on the batting exploits from Perera and Seekkuge Prasanna (95). In reply, Ireland were bowled out for 241 with five overs to spare.For Ireland, Andy McBrine top-scored with a 79 while Sri Lanka pacer Suranga Lakmal finished with figures of 4 for 38.Sri Lanka recently lost a three-match Test series against England and will get involved in a five-match ODI series against England starting Tuesday at Trent Bridge.