- Aug 24, 2001
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The common-sense notion that vaccinating the elderly is the best way to save the elderly also deserves scrutiny, according to a study this week in the journal PLoS Medicine. Infants and the elderly don't spread the flu as much as, say, a schoolchild or business traveler. Might you decrease both illness and death, including among the old, by vaccinating other age groups first?
As it happens, that is what doctors did in Tecumseh, Mich., in 1968. They vaccinated school-age kids, whose lower natural immunity and many contacts (not to mention a tendency to sneeze all over the place) makes them high transmitters of infectious disease. That tactic slowed the spread of disease and cut the death rate from flu to below that in a matching community.
Last year, scientists showed in a model that if you vaccinate about 60% of U.S. schoolchildren, flu deaths among the elderly would fall to 6,600 from the typical 34,000. "It's not necessarily true that the best way to protect someone is to vaccinate that person," says Ira Longini of the Fred Hutchinson Cancer Research Center, Seattle. "In the case of the elderly, flu vaccine doesn't protect them very well, so breaking the chain of transmission provides greater protection."
In the PLoS study, mathematician Lauren Ancel Meyers of the University of Texas, Austin, and colleagues analyzed patterns of flu transmission under different assumptions about how likely a carrier is to infect other people. Using data on household size, age distribution and other factors, they compared a strategy that targets infants and the elderly with one targeting those most likely to catch flu: school-age kids.
For moderately contagious strains, says Prof. Meyers, the optimal strategy is to vaccinate the kids. "This severs the transmission chain," she says, thereby indirectly protecting the old. For very contagious strains, it is better to vaccinate those most likely to die if they catch flu, such as the elderly. "Highly contagious strains can find their way around this buffer of immunized schoolkids," she explains.
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