Sensible Medicine This Fortnight in Medicine XX
Feb 25, 2026
Discussion of high-dose versus standard-dose influenza vaccines for older adults, focusing on hospitalization outcomes and low event rates. Debate over public health value, cost, and regulatory issues around mRNA flu comparators. Review of beta blocker use after myocardial infarction in patients with preserved ejection fraction, including a surprising signal suggesting harm in women and whether that finding is real.
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High-Dose Flu Vaccine Has Tiny Impact On Hospital Admissions
- High-dose influenza vaccine shows minimal effect on hard outcomes in older adults.
- In a 332,438-person Danish trial mean age 74, hospitalization for influenza or pneumonia was 0.68% vs 0.73% (high vs standard dose).
Regulators Accept Softer Endpoints Than Hospitalization
- Soft endpoints matter for regulators even when hard endpoints don't change.
- FDA used influenza-like illness as acceptable endpoint, which differs from hospitalization or death used in the Danish trial.
Clinic Case Shows Flu Can Cause Serious Organ Injury
- Adam Sifu shares a clinical experience illustrating flu severity in older adults.
- He described an 87-year-old patient with influenza A and AKI whose GFR dropped to about half despite outpatient management.