EGEDE RESPONDS

Sengupta and colleagues raise interesting issues about strategies for influenza prevention and the role of complementary and alternative prevention measures practiced by elderly African Americans. In our article, we emphasized the importance of “creative strategies that target younger adults and minority patients and that address culturespecific erroneous beliefs toward vaccination.” The results of the pilot study undertaken by Sengupta et al. highlight some of these beliefs. There is certainly no harm in encouraging infection prevention strategies such as handwashing, use of disinfectants, and avoidance of crowded environments and contact with sick persons. However, health care providers need to be cautious about endorsing alternative treatments for influenza, such as cod liver oil, vitamins, and a host of other therapies that have no proven efficacy against the influenza virus.

In a recent article that discussed strategies for management of influenza in the elderly population, Gravenstein and Davidson emphasized that “vaccination remains the single most important tool for preventing morbidity and mortality among elderly individuals.”1 It is possible that additional studies may lend support for the use of alternative therapies such as taking Oscillococcinum, echinacea, or ginseng for influenza, but at present there is insufficient evidence to recommend their use as first-line therapies.1,2 In addition, one study showed that individuals aged 65 years or older, who used provider-based complementary and alternative medicine were less likely than nonusers to receive the influenza vaccine (odds ratio = 0.2; 95% confidence interval = 0.1, 0.6).3 Although additional studies are needed to confirm this finding, it draws attention to the potential for complementary and alternative medicine use to have negative effects on influenza vaccination rates in the elderly.

The points raised by Sengupta et al. are noteworthy and well taken. A variety of strategies at national, point-of-care, and community levels are needed to increase vaccination coverage among elderly African Americans. Illness prevention practices should be encouraged as long as they do not detract from ongoing efforts to increase vaccination coverage in minority patients.