Janet E. McElhaney, MD, FRCPC, FACP, Geriatrician, Center for Immunotherapy of Cancer and Infectious Diseases and UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT, USA.

Influenza is a serious illness and is probably the single cause of excess mortality during the winter months in the portion of the population that is aged 65 and over. In spite of its limited efficacy in older adults, influenza vaccination is a cost-saving medical intervention that can help to prevent pneumonias, exacerbations of heart failure, and, surprisingly, heart attacks and strokes. As hospitalization rates for acute respiratory illnesses continue to rise in spite of widespread vaccination programs, antiviral drugs need to be incorporated into prophylaxis and early treatment strategies for influenza. Particularly in the institutional setting, seasonal prophylaxis or influenza outbreak control that involves the staff is essential.

Key words: influenza, antiviral drugs, vaccination, prophylaxis, drug resistance.

Caroline Penn, MD, CCFP, Travel Medicine & Vaccination Centre, Vancouver, BC.
Rusung Tan, MD, PhD, FRCPC, Travel Medicine & Vaccination Centre; Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC.

Cruise ships are a popular way for seniors to travel to all parts of the world. Although cruises are generally safe, day and overnight excursions to tropical countries can expose travellers to diseases such as malaria, yellow fever and dengue fever and to pathogens that cause diarrhea. Family physicians should ensure that those patients considering a cruise are medically stable and receive up-to-date travel medicine advice. With proper preparation and precautions against infectious and vector-borne illness, risks can be minimized and older people can benefit from the stimulation of travel.
Key words: cruise ships, older traveller, travel medicine, vaccinations, yellow fever, dengue, malaria.

Katherine Sheehan
University of St. Andrews,
St Andrews, Scotland.

Michael Gordon, MD, MSc, FRCPC
Vice President of Medical Services,
Baycrest Centre for Geriatric Care,
Professor of Medicine,
University of Toronto,
Toronto, ON.

The infection control troops are preparing for battle, waiting for the declaration of war. Once again, it's nearly time for our annual fight against the influenza virus. This potential killer affects hundreds of thousands of Canadians each year, leading to the hospitalization of 75,000 and resulting in 6,700 deaths. Of those who die, 90% are over the age of 65 and about half are residents of long-term care facilities. Elderly residents are particularly vulnerable because of their advanced age, underlying illness, close quarters with other residents and extensive contact with many caregivers.

D'Arcy L. Little, MD, CCFP
Director of Medical Education
York Community Services, Toronto, ON

Introduction
Influenza, an acute respiratory illness, causes more adults to seek medical attention than any other respiratory infection. In Canada, influenza is a seasonal disease, causing annual epidemics that affect 10-20 percent of the population and result in approximately 4,000 deaths, 70,000 hospitalizations, and 1.5 million days of lost work.¹ The elderly (people aged 65 years and older), and those with chronic cardiopulmonary disorders, diabetes and other metabolic diseases, have an increased risk of developing influenza complications. Hospitalization rates among elderly patients increase markedly during major influenza epidemics, and 90% of the deaths attributed to influenza and pneumonia are observed in this population.²

Vaccination remains the most reliable means of preventing an influenza infection and the resultant morbidity and mortality. Despite the significance of influenza, efforts to vaccinate the elderly remain suboptimal. A large study conducted in the Netherlands revealed that healthy elderly people avoid influenza vaccination because they fear the side effects, and because they believe that their general health is good and that the benefits of vaccination are, therefore, minimal.

Leora Horn, BSc, MSc

Over three hundred thousand Canadians currently suffer from Alzheimer's disease (AD) and the related dementias. AD is a degenerative disorder associated with a progressive decline in cognitive function. There is significant neuronal loss and impairment of metabolic activity in the cerebral cortex, hippocampus and subcortical structures affecting memory, language and emotion. At present, there are limited drugs used to treat the symptoms associated with the disease but there is no cure. In a recent Nature publication, Schenk et al., reported results that take the treatment of AD in a new direction by raising the possibility of vaccination as prevention against disease development. In two separate sets of experiments scientists were able to prevent the occurrence or reduce the presence of Alzheimer-like pathology in genetically engineered mice immunized with one of the proteins that may be responsible for disease evolution.¹

According to the Alz-heimer's Association of Canada, AD is the fourth leading cause of death in adults. The prevalence of AD increases exponentially with age. AD affects 1 in 100 Canadians between the ages of 65 and 74, 1 in 14 Canadians between the ages of 75 and 84 and 1 in 4 Canadians over 85. Symptoms of AD range from forgetfulness to disorientation to people, time and place resulting in an inability to function without assistance.