Flu Shots: The more you get, the worse they work?/ CIDRAP

Study:  Getting flu shots 2 years in a row may lower protection

Robert Roos  News Editor

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Mar 1, 2013 (CIDRAP News) – Experts are puzzled by a new study in which influenza vaccination seemed to provide little or no protection against flu in the 2010-11 season—and in which the only participants who seemed to benefit from the vaccine were those who hadn't been vaccinated the season before.

The investigators recruited 328 households in Michigan before the flu season started and followed them through the season. Overall, they found that the infection risk was nearly the same in vaccinated and unvaccinated participants, indicating no significant vaccine-induced protection, according to their report in Clinical Infectious Diseases. That contrasted sharply with several other observational studies that found the vaccine to yield about 60% protection during the same season.

In trying to figure out why the effectiveness was so low, the researchers sifted their data in different ways, said Arnold S. Monto, MD, of the University of Michigan, senior author of the study. "We discovered that if you separated out those that had not been vaccinated the previous year, you got percentages close to what were seen in the major vaccine effectiveness studies," he told CIDRAP News.

"We were playing with this for a long time, and there was clear interaction of sequential vaccination and vaccine effectiveness, looking at it in a strictly statistical way," he added. "We felt it had to be separated out."

The vaccine was found to be 62% effective in those who hadn't been vaccinated the previous year. That was similar to findings in the other observational studies and also to the results of a recent, rigorous meta-analysis of randomized controlled trials. In contrast, those who had been vaccinated 2 years in a row (before both the 2009-10 and 2010-11 seasons) got no significant protection.

An additional finding was that the vaccine did not seem to protect participants who were exposed to flu in their own household, though the numbers in that arm of the study were small.

Researchers from the US Centers for Disease Control and Prevention and the University of Hong Kong collaborated with University of Michigan researchers on the study, with Suzanne E. Ohmit, DrPH, of Michigan as the lead author.

The findings come amid a growing number of studies that raise questions about flu vaccine effectiveness (VE). They include, among others, last week's CDC report that this year's vaccine has worked poorly in elderly people and three recent European studies showing that vaccine-induced immunity in the 2011-12 season waned after 3 to 4 months. Other studies have cast doubt on the long-standing belief that a close match between the vaccine virus strains and circulating strains improves VE.

In an editorial commentary accompanying the Michigan study, John Treanor, MD, and Peter Szilagyi, MD, both of the University of Rochester Medical Center, wrote, "As we are currently struggling through one of the most vigorous influenza seasons in recent memory, the apparent failure of influenza vaccine under optimal conditions seen in this study is indeed troubling."

And Edward Belongia, MD, a Wisconsin clinician-researcher and member of the CDC's Influenza Vaccine Effectiveness Network, said he was perplexed by the low overall VE in the study, given the approximate 60% protection levels found in studies by the network the same season. "I don't know what to make of it," he told CIDRAP News.

Other researchers have said that additional studies suggesting a negative effect of prior-year vaccination on flu VE will be emerging in coming months, but they declined to give any details...

Another flu expert, Michael T. Osteholm, PhD, MPH, said the findings further complicate the already difficult challenge of framing flu vaccination recommendations. Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, which publishes CIDRAP News, was the lead author of a lengthy 2012 report on the flu vaccine landscape and the need for better vaccines."We're at a major crossroads in integrating our current influenza vaccine science with our current flu vaccine recommendations," he said. "The issues of vaccine efficacy by age and by vaccine [formulation] as well as the concept of waning immunity in a given season, the lack of correlation between vaccine virus match with circulating viruses and protection, and the potential for repeated annual vaccination to lower one's protection, versus not being repeatedly vaccinated, are all immense challenges for us today."If we don't go back and revisit our current vaccine recommendations, I think we stand to lose a great deal of credibility with both the medical community and even the general public as to the trustworthiness of what public health concludes and promotes," he said. "This is exactly why we need game-changing influenza vaccines."