The CDC has published practice guidelines for giving inoculations for the H1N1 (swine) flu. Because there is not enough vaccine to immediately inoculate everyone, priority is being given to the following categories of younger people (and health care workers). From the CDC “Vaccination Recommendations:”
- Pregnant women…
- Household contacts and caregivers for children younger than 6 months…
- Healthcare and emergency medical services personnel…
- All people from 6 months through 24 years of age
- Children from 6 months through 18 years of age because we have seen many cases of novel H1N1 influenza in children and they are in close contact with each other in school and day care settings, which increases the likelihood of disease spread, and
- Young adults 19 through 24 years of age because we have seen many cases of novel H1N1 influenza in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population; and,
- Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.
Then, healthy younger people are next in line who are not otherwise included among the prioritized groups:
Once the demand for vaccine for the prioritized groups has been met at the local level, programs and providers should also begin vaccinating everyone from the ages of 25 through 64 years.
What about people 65 and older? They are at the end of the line. But wait: Before we scream, “Age discrimination!” the CDC has an apparently cogent reason for putting older people last:
Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older.
Okay, maybe that’s understandable. But what I don’t get is not including people age 65 and older who have compromised immune systems and higher risk of medical complications if they contract diseases such as flu along with the younger cohort with these issues who do receive priority. I mean it isn’t as if older people are immune to the thing, and if they do and have existing health issues that cause serious complications, it could kill them just as dead as a younger person with such problems.
Don’t get me wrong: I am not accusing the CDC of Ezekiel Emanualism, but could someone please explain to me why a healthy younger person receives priority for a swine flu vaccine over an unhealthy older person?
September 1st, 2009 | 7:01 am
Dear Mr Smith,
In this case, I think the reason is, as you state, “Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups.” For the usual, annual epidemic flu, the usual recommendation is to prioritize those who are over 50 years of age. If older people in general appear to have more resistance to the pandemic strain, it makes sense to move those people with less resistance to the head of the line.
This is after all a public health measure, and not an exercise in individualized medical care for individual patients . . . taking the recommendations into consideration, an individual physician can make individualized decisions for individual patient situations . . .
September 1st, 2009 | 8:40 am
You said: “Don’t get me wrong: I am not accusing the CDC of Ezekiel Emanualism, but could someone please explain to me why a healthy younger person receives priority for a swine flu vaccine over an unhealthy older person?”
You ask an important question. In response I would refer you to Betsy McCaughey’s column in the Wall Street Journal on August 27, 2009 says this regarding Health Care Rationing and Ezekiel Emanual recent thoughts.
It is most likely mere coincidence that the CDC policy puts into practice Dr. Emanuel’s ideas. McCaughey says this:
“Dr. Emanuel concedes that his plan appears to discriminate against older people, but he explains: “Unlike allocation by sex or race, allocation by age is not invidious discrimination. . . . Treating 65 year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.” (thelancet.com, Jan. 31, 2009).
Also note the CDC policy not to vaccinate those under six months. Another strange “mere coincidence?”
“The youngest are also put at the back of the line: “Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. . . . As the legal philosopher Ronald Dworkin argues, ‘It is terrible when an infant dies, but worse, most people think, when a three-year-old dies and worse still when an adolescent does,’ this argument is supported by empirical surveys.” (thelancet.com, Jan. 31, 2009).”
September 1st, 2009 | 2:38 pm
“Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups.”
This certainly can be a factor when rationing a limited supply of vaccine but I think that the risk of morbid or fatal complication is certainly more important. For instance if 25 to 40 year old get the infection more commonly than 65 and older patients but 50% of older individuals die versus 1% of younger individuals then there could be a more compelling reason to vaccinate the elderly and sick.
What we need is mortality and morbidity of the current infections within the various age groups and taking into account pre-existing illness.
September 1st, 2009 | 7:27 pm
actually, although most influenza is worse in the elderly, this strain of flu was around here before in the 1960′s, so a lot of us have some immunity to it.
We had an outbreak a month ago in our province of the Philippines…the young staff were very sick, as was my visiting grandson. But my husband and I only were mildly ill with the flu.
So it might not be “Rationing” against the elderly as much as protecting those most at risk, ie the young and the “young old” who didn’t have it fifty years ago.
And remember: If your immune system is bad, the vaccines don’t work as well either.
September 2nd, 2009 | 4:51 am
What Tioedong said is true. It seems that a similar strain was responsible for a pandemic around 1960, so most people living back then would have been exposed to it and are in fact immune. I haven’t read the evidence for this myself but I have been told this is so by a Professor of infectious medicine.
He also said that H1N1 is ridiculously hyped. The mortality for H1N1 is in fact considerably lower than usual for influenza epidemics; I suspect it is because the eldest, who are usually the most vulnerable, do not get hit.
September 3rd, 2009 | 12:05 am
Being a stay-at-home pregnant lady, who is mildly fanatical about disinfecting grocery store cart handles (about the only publicly touched thing I touch) I’ve got to say I’m more worried about getting sick from the *vaccine* than from other people. (My husband works with a very limited group of folks, and generally isn’t even *HOME* for most of the week, so my infection vector consists of…um… one couple, who are over the age of 65.-.- )
September 3rd, 2009 | 12:55 am
Foxfier! Congratulations. I suggest the name Wesley if it’s a boy, or Wesleyina if its a girl! Nobody ever takes me up on that, alas.
September 3rd, 2009 | 5:52 pm
Tioedong,
I understand that that is the case. BUT even if the illness is less severe in the elderly, I would be interested in mortality data. It still may be the case that more of the elderly (in absolute numbers) will have morbid and mortal complication from the infection. The elderly have such a higher prevelance of coexisting illness that even mild infection might have terrible consequence.
For instance a 70 year old man with chronic obstructive lung disease might have a higher likelihood of dying of mild infection than a healthy 40 year old with no comorbid illness.
It would be nice if the CDC was more specific at the website. They say they are basing the rationing on mortality data but then the recommendations only mention the incident data.
September 16th, 2009 | 6:25 pm
I am a professional Health care worker who is retired and over 65. Firstly, as people age, and especially those with chronic diseases have compromised immune systems. Many persons 65 and over have a chronic health problem regardless of whether or not a diagnosis has been established.
Secondly, the first community of persons to develope influenza, regardless of the type ciculating in the community, are those persons who are nursing home residents. Most of these persons are over 65 years of age. All of these people have chronic health problems.
Thirdly, the rate of nosocomial infections are rampant in hospitals. These infections occur in persons who are ill with compromised immune systems. This may include persons of all ages, and especially those who are very young, and also those who are over 64.
Fourthly, Based on my experience of taking care of patients for many years, most of the persons who became ill with various types of infections including influenza’s have been the very young, and the elderly people with chronic diseases.
Fifthly, I cannot make comments on whether or not the the vaccine is being rationed for a certain age group, however all I can say is this, I believe the there are many persons 65 and over who might feel that they are being left out, and the only criteria that is evident is age related, and the fact that the CDC claims that elderly persons get less ill.
I do know that as most persons age they are more prone to chronic diseases because their of compromised immunity.
September 16th, 2009 | 6:43 pm
These comments are based on my professional experience.
September 17th, 2009 | 11:00 pm
I agree with most of what Joe has to say about this.
The CDC publishes monthly something called “The Morbidity Report” for various illnesses. It will be interesting to see over the following months how this pans-out for the elderly. I have my doubts about these “current studies…” since the administration has already targeted the elderly for many of the cut-backs in the proposed Health Care Bill.
The morbidity report can be downloaded from their web site.
September 24th, 2009 | 2:37 pm
i am a 76 year old heathy woman. i wish they wouldnt lie about giving us swine vaccine just tell the truth i dont mind saving a younger person but i hate LIES
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