Have Idiopathic Pulmonary Fibrosis? Experts Recommend High-Dose Flu Vaccine this Winter

Getting a cold or flu is bad enough for most “healthy” people, but if you have a progressive, incurable lung disease, such as idiopathic pulmonary fibrosis (IPF), cystic fibrosis, COPD, or an immune disease, it can be fatal. If you or someone you know has a condition that impairs lung function and/or the immune system, there’s a preventive measure you may want to consider.

According to a new study, scientists at the University of Pittsburgh School of Medicine believe expanding the high-dose influenza vaccine recommendation to include middle-aged adults with chronic health conditions (such as IPF) may make economic sense and save lives.

Each year, between 12,000 and 56,000 people die annually in the U.S. from the flu, and up to 35.6 million people are infected. The U.S. Centers for Disease Control and Prevention tallies the expense to an estimated $10.4 billion a year in direct medical expenses and an additional $16.3 billion in lost earnings annually.

The new study, published online and scheduled for an upcoming issue of Vaccine, calls for clinical trials of the high-dose and new recombinant (egg-free) trivalent (three-component) influenza vaccines in 50- to 64-year-old adults with chronic illnesses, such as heart or lung disease, diabetes or cancer. The trials would aim to determine if a high-dose vaccine does provide better protection than the currently recommended standard-dose quadrivalent (four-component) vaccine.

But there’s one problem: The high-dose vaccine costs almost twice as much as the standard version. Anyone with IPF would say it’s worth it and the researchers agree. Now they just have to prove it.

The growing proportion of middle-aged adults with chronic health conditions coupled with the modest effectiveness of the standard-dose influenza vaccine prompted us to explore whether existing vaccines already recommended for the elderly also could protect younger people,” said lead author Jonathan Raviotta, M.P.H., C.P.H., senior research specialist with The Pittsburgh Vaccination Research Group (PittVax) in Pitt’s School of Medicine. “Sure enough, expanding the recommendation does seem like a good policy — in silico (computer simulation). Before making such a recommendation, real-world clinical trials are needed.”

The high-dose influenza vaccine is recommended for adults over age 65 because their immune response to the standard-dose vaccine diminishes with increasing age. However, at almost double the price, it is more expensive than the standard vaccine. To test the value of conducting large clinical trials of the vaccine in 50- to 64-year-olds with chronic conditions, Raviotta and his colleagues used the Influenza Decision Analysis model, which was developed by PittVax, to explore the cost-effectiveness of alternate influenza vaccination scenarios.

Because the circulating influenza strains can shift from season to season, annual vaccine effectiveness can vary widely. Also, the effectiveness of both the standard-dose and high-dose vaccines among middle-aged patients with different levels of chronic medical conditions is unknown.

“PittVax will continue to test new vaccination scenarios to help guide flu immunization recommendations,” said senior author Richard K. Zimmerman, M.D., M.P.H., professor in Pitt School of Medicine’s Department of Family Medicine and Pitt Graduate School of Public Health’s Department of Behavioral and Community Health Sciences. “These analyses are essential to choosing the best immunization policies that save lives from influenza, which kills thousands annually.

For the latest information on flu strains and vaccine options, check out the Centers for Disease Control (CDC) key flu facts webpage.

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