No excuses not to get the flu vaccine this year

Washington -- Influenza vaccine should be plentiful for the upcoming season -- at an expected 132 million doses, it would be the most ever -- but the challenge to use it all remains.

Not that there aren't plenty of people who need the vaccine and haven't been getting it.

New data released by the Centers for Disease Control and Prevention reveal alarmingly low immunization rates for children and adults. Equally concerning are data showing that, for the past decade, just 40% of physicians and other health care workers have been vaccinated.

CDC Director Julie Gerberding, MD, MPH, called this statistic "the saddest piece of information we have." She said the vaccine protects not only the recipients but also their families and their patients. "In this era where everyone is concerned about patient safety and quality of care, it is unconscionable that a health care worker would not get this vaccine." She and others spoke at a Sept. 19 briefing marking the start of this year's flu season.

Jeanne Santoli, MD, MPH, deputy director of the CDC's Immunization Services Division, said health care providers' low coverage rate reveals an important coverage gap. "This data is important because it not only impacts how well it protects health care workers but how well we protect the high-risk patients that these providers see and care for every day."

Reasons put forward in past years for this low immunization rate include lack of awareness by health care workers that they are among the groups needing to be vaccinated, lack of access to vaccine, cost and the misperception that influenza is not a serious disease. But, as AMA Trustee Ardis Hoven, MD, pointed out, research shows that health care facilities can greatly improve employees' vaccination rates by highlighting the value and safety of the vaccine and making it free and convenient.

On the positive side, enough vaccine should be at hand this season to fill this and other coverage gaps, said representatives from medical associations, including the AMA, and federal health agencies. They recommended that immunizations begin as soon as the vaccine arrives and continue into the new year. Often, they noted, the disease doesn't peak until February.

Although some may consider the flu to be an inconvenience and a missed week of work, it's much more than that for the youngest, oldest and sickest, Dr. Gerberding said. The flu's annual toll continues to be 36,000 deaths and more than 200,000 hospitalizations. Influenza can be particularly severe for those with such conditions as diabetes and heart disease.

The vaccine "truly does have a benefit," she said. "People's lives are saved, and illnesses are reduced."

This reality reiterates the importance of physicians' setting a positive example and also urging their patients to follow suit. "Studies show that a health care worker's recommendation is one of the strongest factors influencing patients to get vaccinated," Dr. Hoven said.

The AMA will launch a campaign during this year's National Immunization Week -- Nov. 26 to Dec. 2 -- directing physicians in state and specialty societies to "Advise and Immunize." The AMA, through its sponsorship of the National Vaccine Summit, also provides information online (link).

Boosting low rates is the goal

The hope is that immunization rates will improve for everyone, but particularly for those identified as being most in need, including young children and older adults. For the 2005-06 season, only one in five children 6 months to 23 months old was fully vaccinated and only one in 10 who needed two doses received them both. It is recommended that youngsters who have never been vaccinated for the flu receive two doses initially.

And now physicians have another option for their 2- to 5-year-old patients since the Food and Drug Administration approved on Sept. 19 the use of the nasal influenza vaccine for children in this age group. Previously the vaccine was approved for children 5 and older and adults to age 49.

The nasal vaccine, however, should not be administered to anyone with asthma or to children younger than 5 with recurrent wheezing, according to the FDA.

The need for better coverage is evident even among the group with the highest coverage rates, adults 65 and older. Although 69% were immunized in the 2005-06 season, the Healthy People 2010 campaign set a 90% goal for this high-risk population.

Pointing to an added enticement, Centers for Medicare & Medicaid Services acting administrator Kerry Weems noted that the flu vaccine is free for Medicare recipients. Also available at no cost is the pneumococcal vaccine.

"Only about 65% of people 65 years old and older have been vaccinated against pneumococcal disease," said Robert Hopkins Jr., MD, who serves on the American College of Physicians' Adult Immunization Advisory Board. Yet influenza and pneumonia combined represent the nation's eighth leading cause of death, he said.

Medicare reimbursement for the flu shot will increase by nearly 5% this season to $13.22 for the common version and $17.37 for the preservative-free version, according to CMS' Weems. The reimbursement rate for each dose of pneumonia vaccine will increase by 10% to $29.73. The program's national average administration fee for the vaccines was $19.33 for 2007. The 2008 numbers weren't yet available in mid-September.