Adverse reactions to influenza vaccine alone or with pneumococcal vaccine in the elderly.

Abstract

To the Editor: Influenza and pneumococcal infections are important public health problems in many countries, including Italy, and are major causes of morbidity and mortality in the elderly. Vaccination reduces significantly the need for hospital treatment and prevents deaths due to invasive viral or pneumococcal infections.1 Thus, the Immunization Practices Advisory Committee recommends that influenza and pneumococcal vaccines be administered to people aged 65 and older.2, 3 Nonetheless, the prescribing of influenza vaccination in Italy is only about 50% and of pneumococcal vaccination, 5%, partly because of doubts about the efficacy of vaccination and the fear of side effects. Simultaneous injection of the two vaccines could raise the rate of pneumococcal vaccination at least to the same level as influenza; an educational campaign might improve the prescribing of these vaccines to the elderly. We evaluated the efficacy of an educational program involving medical personnel and the subjects enrolled, and examined the acceptance and frequency of local and systemic reactions after simultaneous vaccination against influenza and pneumococcal infection. At the Geriatric Unit of the Ospedale Maggiore, between October and November 2002, 320 subjects aged 65 or older (113 men; 207 women; mean age=76.8, range 63–98) were enrolled to receive influenza (Inflexal V, Istituto Sieroterapico Berna S.r.l.) or influenza and pneumococcal (Pneumo23, Aventis Pasteur MSD S.p.a.) vaccines. Before vaccination, trained medical staff thoroughly informed each subject about the rationale for the therapy and its potential side effects. We injected influenza vaccine into the deltoid muscle of the right arm alone or pneumococcal vaccine simultaneously into the left arm, according to an alternate-day schedule. All subjects were given a symptom diary and asked to record any local (pain, rash, ecchymosis) or systemic (fever, headache, weakness, muscle pain, nausea) adverse reactions occurring on the day of vaccination and in the 7 days afterward. The diary was to be returned within 2 weeks. One hundred sixty subjects received influenza vaccine alone (52 men; 108 women; mean age=76.5, range 63–94), and 150 were given influenza plus pneumococcal vaccine (56 men; 94 women; mean age=77.1, range 63–98). More than half of the subjects vaccinated (180/310, 58%) returned the diary, 89 having received the single vaccination and 91 the double vaccination. The medical staff telephoned the remaining 130 subjects for a phone interview; 116 had forgotten to return the diary, 14 had misplaced it. None of these 130 subjects reported significant side effects. Thirty of 160 subjects (33%) who received the influenza vaccine alone and 24 of 150 (24%) who received the double vaccination reported minor adverse reactions. The incidence of local reactions was 27% and 20% and of systemic reactions was 16% and 13% in the influenza and influenza-pneumococcal groups, respectively. There were no serious side effects after vaccination even in subjects taking oral anticoagulants. These findings lead us to conclude that the simultaneous administration of the two vaccines to an elderly population is safe. Detailed information on the vaccination, provided by trained personnel, is a major factor in making the vaccination acceptable to the elderly.