Extending flu shot season not simple

Many physicians endorse the concept of continuing to offer immunizations into the new year, but making it a reality is challenging.

By Victoria Stagg Elliott — Posted Jan. 14, 2008

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Brian Bachelder, MD, a family physician in Mt. Gilead, Ohio, supports public health and medical society efforts to extend the influenza vaccination season. But after he used up his supply of vaccine by early December 2007, patients who still needed or wanted it were referred to the local health department.

It's not that he had the problems of previous years, such as never receiving supplies or receiving them late. He got his 250 doses of flu vaccine early and used them. Although the system has more to offer, he's unwilling to take the financial risk.

"We considered ordering more, but we didn't want to get stuck with it," Dr. Bachelder said.

His sentiment is one example of implementation challenges faced by influenza vaccine advocates trying to capitalize on this year's plentiful supplies and promote vaccinating long beyond Thanksgiving, when patient demand traditionally lags. The hope is that extending the season will make it more possible for the growing number of people recommended to receive the vaccine to actually do so.

"The pilgrims didn't say stop vaccinating at Thanksgiving," said William Schaffner, MD, chair of the Dept. of Preventive Medicine at Vanderbilt University School of Medicine in Nashville, Tenn., and vice president of the National Foundation for Infectious Diseases.

"Influenza most often peaks in February," he said. "We really do have more time to vaccinate and get people protected, and we need to give the system more time to reach out to more people."

The Centers for Disease Control and Prevention designated the week after Thanksgiving 2007 as National Influenza Vaccination Week.

State health departments followed suit with various efforts to pass on the message that December and January were not too late to give and receive immunizations.

"It's never too late until you have had the flu," said William Hacker, MD, commissioner of the Kentucky Dept. for Public Health.

The AMA also sent a letter to physicians through state medical societies encouraging them to keep vaccinating long beyond Thanksgiving and publicizing increases in Medicare payment for the service.

This year's ample supply is encouraging creative approaches to stirring up interest. For instance, the Washington State Dept. of Health partnered with the state's lottery, using its resources to promote flu shots. And airport-based urgent care clinics set up kiosks after security checkpoints to take advantage of the often long wait times on the concourse.

"It's a good way for busy people to make time in their schedules to get a flu shot," said John Zautcke, MD, medical director of the University of Illinois Medical Center clinic at Chicago's O'Hare International Airport.

Still some learning curves

The reality, though, is that late-season vaccinations are not always economically or logistically possible. Flu vaccine is, for the most part, nonreturnable. Some physicians and public health departments are able to order it as needed and are doing so to keep supplies rolling in as patients ask for it. For others, once the initial doses are used up, new ones will not be ordered. Patients will be referred elsewhere.

"The vaccine distribution infrastructure does not encourage the full use of influenza vaccine and is not fully supportive of the nation's goal of getting as many eligible people immunized as possible," said Eddy Bresnitz, MD, deputy commissioner for the New Jersey Dept. of Health and Senior Services.

Unease also is simmering about the possibility that a wider time window may backfire and lead fewer people to consider the vaccination so urgently necessary.

"I wouldn't want to see the season stretched so much that people forget about the whole thing, and [getting it] tomorrow becomes never," said Keith Davis, MD, a family physician in Shoshone, Idaho. He is also president-elect of the Idaho Academy of Family Physicians, but was speaking on his own behalf.

While there are such worries, significant hope has emerged that the years of unstable, unpredictable supplies may be over because five companies currently manufacture the vaccine. This situation means that a loss or delay from one outlet may not be as disruptive as it has been in the past.

Anecdotal evidence also suggests that demand may be increasing, in part because of expanded CDC recommendations but also because the drama of so many rocky seasons put flu vaccine in the media spotlight.

"I see more demand this year because of the publicity and the fact that patients don't have to be jumping through so many hoops and calling around to get it," said Brian Mehlhaus, MD, a family physician with Iowa Health Physicians in Boone. He is also president of the Iowa Academy of Family Physicians, but was speaking on his own behalf.

The National Influenza Vaccine Summit, organized by the AMA and CDC, is scheduled to hold its next meeting in May in Chicago.

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