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Last updated on 05 Sep 2008

Vaccinating younger population minimizes life-years lost to influenza
05 September 2008

NEW YORK (Reuters Health) - Shifting the current vaccination strategy to target younger populations would reduce the number of years of life lost (YLL) to influenza, according to a report in the August 1st issue of The Journal of Infectious Diseases.

Vaccination allocation policy has been the subject of debate in light of several issues, among them the criticism by bioethicists of the inherent axiom that any life lost has the same value, regardless of the age of the deceased, the authors explain.

Dr. Mark A. Miller from the National Institutes of Health, Bethesda, Maryland, and colleagues sought to provide an alternative quantitative tool to help guide pandemic vaccine priority setting and achieve the greatest possible population impact, by preventing the loss of as many years of life as possible.

For a 1918-like pandemic scenario, in which most YLL occur for the younger age groups, the optimal vaccination group comprises people younger than 45 years, according to the models employed.

For a 1957-like epidemic, in which YLL were similar for older and middle age groups, it is unclear whether vaccinating the middle-age group would be better than vaccinating seniors, leading the investigators to conclude "that these age groups would be equally good choices."

For a mild 1968-like influenza epidemic, the researchers note, vaccinating people 45 to 64 years old represents the optimal strategy for minimizing YLL.

"Our estimation is not an endorsement of any particular policy but highlights how the choice of health outcome metrics such as YLL can influence the prioritization of age groups to vaccinate in pandemic settings," the authors explain. "It also shows that the vaccine priority scheme for seasonal influenza is not optimized to mitigate the impact of pandemic influenza."

"These results suggest the need for pandemic plans to have an element of flexibility that allows the prioritization of age groups for immunization at the start of a pandemic to be modified as age-specific epidemiological data on the novel virus become available in real time," the researchers conclude.

"Equally important, the question of who should be vaccinated first needs to be debated and reasoned through now, before the onset of a public health emergency, while we have the time to reflect on which decision-making metric is the most appropriate," they add.

J Infect Dis 2008;198:305-311.