Pinpointing Geriatric Best Practice for Influenza

December 21, 2015

Largest-ever study in nursing homes finds that high-dose flu vaccine reduces hospitalization risk for vulnerable populations

Center for Geriatric Medicine – January 2016

Stefan Gravenstein, MD, MPH, CMD, AGSF, FACP

Associate Director for Research, Center for Geriatric Medicine, UH Case Medical Center
Professor of Medicine, Case Western Reserve University School of Medicine.

The Center for Geriatric Medicine and Palliative Care at University Hospitals Case Medical Center is a nationally recognized exemplar of hospital, community and home geriatric and palliative care. Keeping with the Center’s mission to identify and provide the most effective and highest-quality care for an aging or ailing population, Director Stefan Gravenstein, MD, MPH, leads the nation’s largest study of the effectiveness of high-dose versus low-dose flu vaccines in nursing home populations.

The team found that athough both high- and low-dose influenza vaccines are considered equivalent in the standard of care, the high-dose vaccination, which contains four times more of a standard flu shot’s active ingredient, significantly further reduced (by 1.2 percent) the risk of hospitalization for the nursing home population during the influenza season in the high-dose group. The study involved more than 50,000 participants 65 years old and older (some 14,000 were over the age of 90) from 823 nursing homes in 38 states. The residents were given influenza shots to help protect them from influenza during the period of November 2013 to March 2014.

"Flu in a nursing home population is a major cause of hospitalizations," says Dr. Gravenstein. "In addition to pneumonia, flu can contribute to heart attacks, heart failure, and strokes, especially in an older nursing home population where it can easily spread among residents. In our study, for every 83 individuals receiving the high-dose vaccine, one person was prevented from being hospitalized."

The nursing homes in the study were randomly assigned to one of two groups as a care standard for influenza prevention, with either the regular dose of the influenza vaccine or the high-dose vaccine as the care standard for their residents age 65 and older.

"If given to all approximately 1.5 million nursing home residents, a 1 percent drop in hospitalizations would translate to thousands fewer being hospitalized, which should thereby reduce the cost of care for the flu and its complications in this population." Dr. Gravenstein concludes.

These initial findings were presented as part of a late-breaking research presentation at the Infectious Diseases Society of America meeting in September, 2015, and additional data analyses are forthcoming for eventual publication. The study was funded by Sanofi Pasteur, and the national study team includes researchers from Ottowa Hospital Research Institute, Brown University, the Veterans Administration Medical Center in Providence, Rhode Island, and Insight Therapeutics, LLC.

To contact Dr. Gravenstein directly, email

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