PETER MCCULLOUGH, MD | 12 Nov 2023
Southern Hemisphere Data Disappointing for High Risk Groups
As an adult medicine physician, every year I am personally confronted with the decision on annual influenza vaccination. As a former student, intern, resident, attending physician and professor of medicine working in large medical centers, I took 40 flu-shots over the years in keeping with medical staff requirements. For this entire time, I have never taken an influenza test for viral infections. What am I or anyone getting out of annual influenza vaccination?
Fowlkes et al, published interim data from REVELAC–i Network and the results of influenza vaccination March through July, 2023, from the Southern Hemisphere are disappointing. Systematic monitoring of influenza and COVID-19 vaccine effectiveness (VE), is conducted through the Pan American Health Organization’s Network for the Evaluation of Vaccine Effectiveness in Latin America and the Caribbean–influenza (la Red para la Evaluación de Vacunas en Latino América y–i])† el Caribe—influenza [REVELAC-i]. The overall rate of influenza vaccination among patients hospitalized for severe respiratory illnesses was 23.9%. Of those hospitalizations, 32.4% tested positive for influenza. No deaths were reported.
Because patients were not randomized, adjustment is required to calculate theoretical vaccine efficacy. As you can see, the vaccine efficacy for older adults, the high-risk group of concern, was a paltry 37.6% with the lower bound of the confidence interval at 13.1%. To recommend a vaccine clinically, I demand at least 50% vaccine efficacy, and since the point estimate is a statistical blur, I conservatively look at the lower bound of the confidence interval. None of the high risk groups met this clinical acceptance criteria to recommend influenza vaccination this year. Thus, influenza vaccination will not be recommended in my practice for this influenza season.
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