Influenza B vaccine lineage selection--an optimized trivalent vaccine.

Epidemics of seasonal influenza viruses cause considerable morbidity and mortality each year. Various types and subtypes of influenza circulate in humans and evolve continuously such that individuals at risk of serious complications need to be vaccinated annually to keep protection up to date with circulating viruses. The influenza vaccine in most parts of the world is a trivalent vaccine, including an antigenically representative virus of recently circulating influenza A/H3N2, A/H1N1, and influenza B viruses. However, since the 1970s influenza B has split into two antigenically distinct lineages, only one of which is represented in the annual trivalent vaccine at any time. We describe a lineage selection strategy that optimizes protection against influenza B using the standard trivalent vaccine as a potentially cost effective alternative to quadrivalent vaccines.

The confounded effects of age and exposure history in response to influenza vaccination.

Numerous studies have explored whether the antibody response to influenza vaccination in elderly adults is as strong as it is in young adults. Results vary, but tend to indicate lower post-vaccination titers (antibody levels) in the elderly, supporting the concept of immunosenescence-the weakening of the immunological response related to age. Because the elderly in such studies typically have been vaccinated against influenza before enrollment, a confounding of effects occurs between age, and previous exposures, as a potential extrinsic reason for immunosenescence. We conducted a four-year study of serial annual immunizations with inactivated trivalent influenza vaccines in 136 young adults (16 to 39 years) and 122 elderly adults (62 to 92 years). Compared to data sets of previously published studies, which were designed to investigate the effect of age, this detailed longitudinal study with multiple vaccinations allowed us to also study the effect of prior vaccination history on the response to a vaccine. In response to the first vaccination, young adults produced higher post-vaccination titers, accounting for pre-vaccination titers, than elderly adults. However, upon subsequent vaccinations the difference in response to vaccination between the young and elderly age groups declined rapidly. Although age is an important factor when modeling the outcome of the first vaccination, this term lost its relevance with successive vaccinations. In fact, when we examined the data with the assumption that the elderly group had received (on average) as few as two vaccinations prior to our study, the difference due to age disappeared. Our analyses therefore show that the initial difference between the two age groups in their response to vaccination may not be uniquely explained by immunosenescence due to ageing of the immune system, but could equally be the result of the different pre-study vaccination and infection histories in the elderly.

[Health expenditure in the context of social expenditure. A generational analysis of tendencies in Spain in the context of demographic aging. 2008 SESPAS Report]. / El gasto sanitario en el contexto del gasto social. Un análisis generacional de las tendencias en España en un contexto de envejecimiento demográfico. Informe SESPAS 2008.

The tendency for public welfare spending to be increasingly aimed at the elderly has been identified in several developed countries. While population aging is a common trend, it is not obvious why the shift in spending exceeds the trend in aging, or why per capita spending on the elderly is increasing. In the first part of the present article, we show that this trend is occurring in Spain, identify the losers from this development, discuss the policies that underlie it, and propose adjustments based on Musgrave's fixed proportions rule for fair intergenerational distribution. These policies aim to manage population aging, labor market participation of youth and women, as well as public policies that combine 'work-fare' strategies with the more traditional 'welfare' strategies. In the second part of this paper, we explore the contribution of public health expenditure to overall public social expenditure, and analyze the effect of increasing health on distributional fairness. This analysis is guided by our perception that social policy, including health policy, should be more horizontal, i.e. it should take into account the sum total of a mixed basket of resources aimed at any recipient group, to avoid the skewed allocation of resources that arises from compounding various independent distributions of resources. Coordination of the various channels of social expenditure should ensure precisely targeted recipients and cross-departmental sources. The normative fairness criterion to be used should be precisely specified. In Spain (1980-2000) the oldest segment of the population has gained the most, appropriating an increased share of resources. This increase goes beyond the amount that could be explained by population aging throughout the period. The 'losers' are individuals with different fragility conditions. On average the youngest working group has suffered the highest relative loss.

El gasto sanitario en el contexto del gasto social. Un análisis generacional de las tendencias en España en un contexto de envejecimiento demográfico. Informe SESPAS 2008 / Health expenditure in the context of social expenditure. A generational analysis of tendencies in Spain in the context of demographic aging. 2008 SESPAS Report

La tendencia del gasto social a distribuirse hacia las edades más avanzadas se ha advertido en varios países desarrollados. Mientras el envejecimiento de la población es una tendencia común, no es obvio por qué el cambio en los gastos excede a la propia evolución del envejecimiento, o por qué el gasto aumenta en términos por cápita. En la primera parte del artículo mostramos que hay indicios claros de esta tendencia en España, identificamos a los colectivos perjudicados, abordamos las políticas que afectan a esta tendencia, y proponemos ajustes basados en la regla de proporciones fija de Musgrave para una distribución intergeneracional más justa. Son las políticas relacionadas con el envejecimiento poblacional, con la inserción laboral de jóvenes y mujeres, y las estrategias del work-fare, junto con las más tradicionales del welfare. En la segunda parte insertamos el gasto sanitario público en el conjunto del gasto social. Adoptamos la perspectiva de que las políticas sanitaria y social deberían ser más horizontales, menos dependientes del formato de financiación, y coordinadas con visión intersectorial en su destino e interdepartamental en su origen. El criterio normativo de equidad pretendido debe ser explícito y preciso. Las políticas deben asegurar coherencia entre los distintos tipos de prestaciones públicas, y determinar la cuantía de componentes de bienestar adicionales a los derivados de la renta personal, para compensar su desigualdad mediante prestaciones públicas monetarias o en especie. En España (1980-2000), el grupo de edad más avanzada ha sido el que ha obtenido unas mayores ganancias, «acaparando » una mayor proporción de recursos, que han aumentado más allá de lo que podría explicarse solamente por el envejecimiento de la población. Los «perdedores» son individuos en diversas condiciones de fragilidad y, en términos medios, la generación de trabajadores más joven es la categoría de edad que ha sufrido las mayores pérdidas relativas

The tendency for public welfare spending to be increasingly aimed at the elderly has been identified in several developed countries. While population aging is a common trend, it is not obvious why the shift in spending exceeds the trend in aging, or why per capita spending on the elderly is increasing. In the first part of the present article, we show that this trend is occurring in Spain, identify the losers from this development, discuss the policies that underlie it, and propose adjustments based on Musgrave¿s fixed proportions rule for fair intergenerational distribution. These policies aim to manage population aging, labor market participation of youth and women, as well as public policies that combine `work-fare¿ strategies with the more traditional `welfare¿ strategies. In the second part of this paper, we explore the contribution of public health expenditure to overall public social expenditure, and analyze the effect of increasing health on distributional fairness. This analysis is guided by our perception that social policy, including health policy, should be more horizontal, i.e. it should take into account the sum total of a mixed basket of resources aimed at any recipient group, to avoid the skewed allocation of resources that arises from compounding various independent distributions of resources. Coordination of the various channels of social expenditure should ensure precisely targeted recipients and cross-departmental sources. The normative fairness criterion to be used should be precisely specified. In Spain (1980-2000) the oldest segment of the population has gained the most, appropriating an increased share of resources. This increase goes beyond the amount that could be explained by population aging throughout the period. The ¿losers¿ are individuals with different fragility conditions. On average the youngest working group has suffered the highest relative loss (AU)

El gasto sanitario en el contexto del gasto social. Un análisis generacional de las tendencias en España en un contexto de envejecimiento demográfico. Informe SESPAS 2008 / Health expenditure in the context of social expenditure. A generational analysis of tendencies in Spain in the context of demographic aging. 2008 SESPAS Report

La tendencia del gasto social a distribuirse hacia las edadesmás avanzadas se ha advertido en varios países desarrollados.Mientras el envejecimiento de la población es unatendencia común, no es obvio por qué el cambio en los gastosexcede a la propia evolución del envejecimiento, o por quéel gasto aumenta en términos por cápita.En la primera parte del artículo mostramos que hay indicios clarosde esta tendencia en España, identificamos a los colectivosperjudicados, abordamos las políticas que afectan a esta tendencia,y proponemos ajustes basados en la regla de proporciones fijade Musgrave para una distribución intergeneracional más justa.Son las políticas relacionadas con el envejecimiento poblacional,con la inserción laboral de jóvenes y mujeres, y las estrategiasdel work-fare, junto con las más tradicionales del welfare.En la segunda parte insertamos el gasto sanitario público enel conjunto del gasto social. Adoptamos la perspectiva de quelas políticas sanitaria y social deberían ser más horizontales, menosdependientes del formato de financiación, y coordinadas con visiónintersectorial en su destino e interdepartamental en su origen.El criterio normativo de equidad pretendido debe ser explícitoy preciso. Las políticas deben asegurar coherencia entre los distintostipos de prestaciones públicas, y determinar la cuantía decomponentes de bienestar adicionales a los derivados de la rentapersonal, para compensar su desigualdad mediante prestacionespúblicas monetarias o en especie(AU)

En España (1980-2000), el grupo de edad más avanzada hasido el que ha obtenido unas mayores ganancias, ®acaparando» una mayor proporción de recursos, que han aumentadomás allá de lo que podría explicarse solamente por el envejecimientode la población. Los ®perdedores» son individuos endiversas condiciones de fragilidad y, en términos medios, la generaciónde trabajadores más joven es la categoría de edadque ha sufrido las mayores pérdidas relativas(AU)

The tendency for public welfare spending to be increasinglyaimed at the elderly has been identified in several developedcountries. While population aging is a common trend, it is notobvious why the shift in spending exceeds the trend in aging,or why per capita spending on the elderly is increasing.In the first part of the present article, we show that this trendis occurring in Spain, identify the losers from this development,discuss the policies that underlie it, and propose adjustmentsbased on Musgrave’s fixed proportions rule for fair intergenerationaldistribution. These policies aim to manage populationaging, labor market participation of youth and women,as well as public policies that combine ‘work-fare’ strategieswith the more traditional ‘welfare’ strategies.In the second part of this paper, we explore the contributionof public health expenditure to overall public social expenditure,and analyze the effect of increasing health on distributionalfairness. This analysis is guided by our perception thatsocial policy, including health policy, should be more horizontal,i.e. it should take into account the sum total of a mixed basketof resources aimed at any recipient group, to avoid the skewedallocation of resources that arises from compoundingvarious independent distributions of resources. Coordinationof the various channels of social expenditure should ensureprecisely targeted recipients and cross-departmental sources.The normative fairness criterion to be used should be preciselyspecified.In Spain (1980-2000) the oldest segment of the populationhas gained the most, appropriating an increased share of resources.This increase goes beyond the amount that could beexplained by population aging throughout the period. The ’losers’are individuals with different fragility conditions. On averagethe youngest working group has suffered the highest relativeloss(AU)