Flu shots plentiful, doctors urged to get as well as give

Experts predict this year's vaccine formulation will be more protective than last season's.

By Kevin B. O’Reilly , Susan J. Landers — Posted Oct. 13, 2008

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It's flu season. Again.

The good news is this year's vaccine is in ample supply. But with it, comes a challenge. Physicians should not only seek to immunize as many patients as possible, but also their staff members -- and themselves.

A survey released in September indicated that a critical step toward this goal is a conversation. Specifically, although physicians wield a great deal of persuasive clout in getting patients to receive the flu vaccine, they don't use that power frequently enough.

The National Foundation for Infectious Diseases found that 70% of a representative sample of 2,029 adults said they would likely get vaccinated if their physician or other health care professional recommended it. The vast majority also said they would likely continue to receive the vaccine in subsequent years.

"Patients need to hear from us the importance of the flu vaccine," said AMA Secretary Ardis D. Hoven, MD, an infectious diseases specialist in Lexington, Ky.

However, that conversation does not happen often enough, she said. A survey found nearly four in 10 respondents never discussed flu vaccination with their health care practitioners. Half of the patients who did have the conversation said they initiated it.

Dr. Hoven spoke at a September briefing sponsored by the NFID, the American Medical Association, the Centers for Disease Control and Prevention, and a number of other medical and public health organizations.

Perhaps the even greater responsibility for health professionals is to walk the walk -- in other words, to get the shot. CDC Director Julie Gerberding, MD, MPH, expressed disappointment during the briefing that more than half of health care professionals fail to do so. "As a doctor I think it is unconscionable for health care workers not to receive the vaccine."

In the 2006-07 flu season, only 42% of health care professionals were vaccinated -- a number that has remained stable for a decade.

Changing for the better

In a move to boost that figure, more than 1,300 hospitals have signed on to the "flu vaccination challenge." The initiative was launched in September by Joint Commission Resources, a nonprofit publishing affiliate of the Joint Commission. It will recognize hospitals that top the 42% national rate of health professional vaccinations.

The CDC first recommended in 1981 that all doctors, nurses and other health professionals get the flu shot annually. Back then, only about one in 10 was immunized, and the guideline led to substantial improvement.

Still, randomized controlled trials have shown that unvaccinated health professionals can spread the disease in long-term-care settings and nursing homes, with a 44% drop in death rates when all workers are immunized. CDC data also show a correlation between hospital staff immunization rates and hospital outbreaks. About a quarter of health care workers contract influenza each year and nearly half of them are asymptomatic.

Overall, the CDC says one in five Americans gets the flu every year. Of these cases, 200,000 are hospitalized and about 36,000 die.

"It is both an ethical and professional responsibility for every health care worker to be vaccinated against influenza every year," said William Schaffner, MD, a consultant to Joint Commission Resources' flu vaccination challenge and chair of the Dept. of Preventive Medicine at Vanderbilt University School of Medicine in Nashville, Tenn. He also is NFID president-elect.

Hospitals that surpass the 42% rate will be listed on a Web site (link).

The goal, according to JCR, is for at least 2,000 hospitals to register for the challenge.

Protective value

Health officials are confident this year's reformulated vaccine will provide more protection from circulating viruses than did last season's version. That formulation failed to protect against the influenza B strain and was only partially effective against the influenza A viral strains, said Daniel B. Jernigan, MD, MPH, CDC deputy director in the influenza division.

For 2008-09, all three strains are new -- an unusual event -- and all three appear to be on target to offer protection. No recent findings suggest the presence of emerging viruses that differ from those the vaccine was designed to combat, said Dr. Jernigan.

This year's expanded CDC flu recommendations call for immunizing children and teens ages 6 months through 18 years and any adults who want to reduce the risk for becoming ill with influenza or of transmitting it to others. All in all, these categories encompass about 84% of the population. People older than 50 and those at high risk for influenza complications are particularly urged to get vaccinated, as are their household contacts.

"It might be easier to say who isn't eligible," said Dr. Gerberding. "That would be children under 6 months of age and completely healthy adults who have no contact with someone who isn't."

But even with the preventive's ever-broadening target list, many people are still being missed. For example, children 6 months to 2 years old receiving a flu shot for the first time require two doses administered a month apart. Only 21% were fully vaccinated last year, said Dr. Gerberding. Also last year, 86 children died from the flu.

Among people older than 65, 72% were vaccinated during the 2007-08 season. "Although that's pretty good, it should be 100%," she added.

The abundance of vaccine, however, is cause for optimism. "I have a smile on my face this year because we are looking at a wonderful supply of flu vaccine," said Dr. Gerberding. The season's expected 143 million to 146 million doses began being shipped to physicians' offices in August.

The word is: "start vaccinating yesterday," said Dr. Schaffner, who was the briefing moderator.

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Talking about flu shots

A survey of a representative sample of 2,029 adults by the National Foundation for Infectious Diseases found that nearly four in 10 people report never discussing influenza vaccination with their health care professional. Among the findings:

38% said they have never discussed influenza vaccine with their health care professionals.

29% said they had discussed immunization but had initiated the conversation themselves.

29% said a physician had initiated the conversation

5% said they didn't know or refused to answer.

Note: Figures do not add to 100% because of rounding.

Source: "National Consumer Survey: Doctors and Patients Not Talking Enough About Influenza Vaccination," National Foundation for Infectious Diseases, Sept. 24 in pdf(link)

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Hoping to expand the vaccine's reach

There's plenty of room for improvement in 2008-09 flu vaccination, public health officials say, especially based on these tallies from the 2006-07 season.

Fully vaccinated
Health care professionals 42.0%
By age only
6-23 months 21.3%
2-4 years 37.9%
50-64 36.0%
65 and older 65.6%
For those with high-risk conditions
5-17 33.0%
18-49 25.5%
50-64 46.1%
Those without high-risk conditions
5-17 17.5%
18-49 15.3%
50-64 31.8%
Household contacts of people at high risk
5-17 26.0%
18-49 17.0%

Sources: Morbidity and Mortality Weekly Report, Aug. 8 and Sept. 26

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External links

"Talk Flu to Me," an influenza public service campaign by the National Foundation for Infectious Diseases (link)

"Prevent Influenza Now," resources for health professionals and patients from the National Influenza Vaccine Summit (link)

Joint Commission Resources' Flu Vaccination Challenge (link)

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