Don't duck the flu shot

Things are looking up this flu season. Memories still may be fresh about the recent experiences in which vaccine distribution was marred by shortages, delays and other hiccups, but public health officials this year -- for the second year in a row -- are predicting an ample supply.

In total, 132 million doses are expected for 2007-08. That amount is 30 million more than was produced last year. Good news, indeed -- but it brings its own challenge. Specifically, it is absolutely crucial that this wealth of vaccine be used to protect as many people as possible. And that endeavor promises to require focus on several levels.

One can start with flu vaccination rates within the world of medicine.

According to the Centers for Disease Control and Prevention, rates among physicians and other health care workers have hovered around 40% for the last decade -- a very low figure. These professionals are, after all, in the trenches every day, seeing patients who have the flu or who are at high risk of catching it and having complications.

The bottom-line concern is that unvaccinated health professionals are more likely to contract the flu and to transmit it to susceptible patients. Thus, the first message is clear: All health care professionals should get vaccinated -- especially those who have direct patient contact -- unless they have a medical contraindication to the vaccine.

The oft-cited explanations of why they opt out mirror those of the general population. The excuses stem from a lack of awareness by health care workers that they are among the groups that need to be immunized, a lack of access, high cost and even the misperception that influenza is not a serious illness. Vaccine uptake among this group also varies widely by level and years of training, age, occupation and facility type. But when the risks involved are considered -- that one out of every five Americans gets the flu annually; that more than 200,000 people are hospitalized each year from its complications, including 20,000 children; and that about 36,000 people die -- the importance of flu vaccination efforts becomes even more clear.

One of the national health objectives for 2010 is to achieve 60% vaccination coverage levels for health professionals. Research indicates that interventions in the workplace offer success. Rates have been shown to improve when health care facilities highlight the vaccine's value and safety and make the shots free and convenient.

To this end, the Joint Commission has adopted a standard for hospitals and long-term-care facilities to offer the vaccine to staff, to track rates and to advance programs to increase participation. This step is a very positive development. Another strategy is for facilities to obtain a signed declination from health professionals who decline influenza vaccination for reasons other than medical.

The American Medical Association has long encouraged physicians to set positive examples for patients by assuring that they are completely immunized. As a co-sponsor of the National Influenza Vaccine Summit, the AMA also works to communicate to physicians the latest information regarding vaccine supply and demand.

Such efforts are very important. CDC data indicate that demand for the regular yearly flu preventive remains down from levels before the vaccine shortage two years ago. Moreover, trends show that interest in the vaccine ebbs after Thanksgiving, even though the bug continues to circulate well into spring.

Therefore, public health officials are urging doctors to offer the vaccine in December, January and beyond. Adequate supplies of various influenza immunizations are available, and everyone who would benefit from a reduced risk of getting influenza or who might transmit the virus to others should be vaccinated.

This includes not only health care workers but also children between 6 months and 5 years old, pregnant women and people who are 50 and older. It includes anyone who is 6 months old or older with a chronic medical condition, a weakened immune system or any condition that can compromise breathing. It also encompasses household contacts and caregivers of anyone at high risk for complications, such as children younger than 6 months and people older than 65 or who are nursing home residents.

The time for the flu vaccine is beginning now. And physicians and health professionals are encouraged to roll up their sleeves, step to the front of the line and then offer this preventive to as many patients as possible.