Flu message for physicians: Get the shot, lead by example

With flu season fast approaching, health officials are reminding physicians of the importance of the influenza vaccine -- for patients and for health professionals.

Based on Centers for Disease Control and Prevention guidance, the flu shot is recommended for an estimated 174 million Americans -- including those who are elderly, very young or immunocompromised, and those who work in the health care delivery system. Still, many people go without, leading to illness, complications and an average of 36,000 U.S. deaths each year. Additionally, in the last two decades, flu-related hospitalizations have increased from 114,000 to more than 200,000 annually.

"That's unacceptable," said AMA Trustee Herman I. Abromowitz, MD. He spoke at a Washington, D.C., briefing held last month by the National Foundation for Infectious Diseases and the National Coalition for Adult Immunization.

Their message: Flu can be deadly but also can be prevented.

"The influenza virus ... must be taken seriously by the health care community, as well as the American public, every fall and every winter," said William Schaffner, MD, NFID board member and chair of the department of preventive medicine at Vanderbilt University School of Medicine in Nashville, Tenn.

Physicians and other health workers, however, appear still to fall short when it comes to leading by example.

"Only 36% of health care professionals are being vaccinated for the flu," said Dr. Abromowitz. "As physicians, we must practice what we preach. When front-line health care professionals do not follow vaccination recommendations, the risks are great to ourselves, our families and our patients."

Physicians should also take every opportunity to discuss the shots with patients, said Dr. Abromowitz. "Studies have shown that many patients decide to receive the flu vaccine only when their physician recommends it."

Changes this year

New for the 2004-2005 influenza season are specific recommendations for children ages 6 months to 23 months.

Last year's outbreak came early and hit its youngest victims with particular force, causing 152 flu-related deaths among children younger than 18 in 40 states, according to data collected by the CDC. And, though nearly half had underlying medical conditions, 40% of these mortalities were among previously healthy kids.

In addition, the Sept. 24 Morbidity and Mortality Weekly Report estimated that during the 2002-2003 flu season -- the first time the CDC encouraged vaccination for healthy children -- the vast majority went without adequate protection. Only 4.4% of those ages 6 months to 23 months were fully vaccinated against influenza. Additionally, only 7.4% received at least one vaccine dose.

"This season, CDC not only encourages flu shots for young children, we recommend them," said CDC Director Julie Gerberding, MD, MPH, in a statement.

Healthy children younger than age 2 have a high risk of being hospitalized with serious influenza complications. Thus, vaccination is also recommended for family members and close contacts of this age group. Health officials emphasized the need for those who interact with children younger than 6 months to get the shot because these infants cannot be vaccinated.

"These are the most vulnerable kids," said Carol J. Baker, MD, a professor of pediatrics at Baylor College of Medicine in Houston and the American Academy of Pediatrics' liaison to the CDC's Advisory Committee on Immunization Practices.

Meanwhile, a sufficient amount of vaccine will be available to meet overall demand during the season's critical months, according to Keiji Fukunda, MD, MPH, chief of the epidemiology unit for the CDC's influenza branch.

The CDC anticipates 100 million doses to be distributed in the United States -- 13 million more than last year. Currently, two of the three manufacturers, MedImmune Inc. and Aventis Pasteur, expect to complete distribution by late October. The third, Chiron Corp., which had production difficulties in late summer, expects to have 42 million to 44 million doses distributed at that time, with remaining supplies delivered in mid-November for a total of 46 million to 48 million doses.

This year's vaccine has been formulated to protect against A/Fujian/411/2002 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like and B/Shanghai/361/2002-like strains.

Because strains mutate constantly, it is not unusual for the circulating virus strains to not exactly match those contained in the vaccine, as was the case last season. However, according to Dr. Fukunda, two new studies showed last year's vaccine still offered 50% protection against influenza. In other seasons, the flu shot has reached protection levels between 70% and 90%.

Health officials also reminded physicians and the general public that pneumococcal vaccination with polysaccharide vaccine is appropriate at any time of the year. It can be administered at the same time as the flu shot.

Each year there are an estimated 175,000 hospitalized cases of pneumococcal pneumonia.

And, in terms of invasive pneumococcal disease, of the nearly 40,000 annual U.S. cases and more than 5,100 related deaths, more than half occur among adults who are recommended to receive vaccination.

The death and illness toll extracted by pneumococcal illness is "not a failure of the vaccine but a failure to vaccinate," said Gregory Poland, MD, director of the Mayo Vaccine Research Group.