Experts Urge Expanding Influenza Vaccination Season to Increase Immunization Rates

BETHESDA, Md. -- Healthcare professionals should increase influenza immunization rates by implementing key, practice-proven interventions and offering vaccine at every opportunity throughout the entire influenza season, conclude leading influenza experts in a July 2008 supplement to the American Journal of Medicine. The experts assert that the medical community is not taking advantage of routine office visits to immunize all recommended individuals against a disease that causes more than 200,000 hospitalizations and more than 36,000 deaths in the United States every year. This year, more people are recommended for influenza vaccination than ever before -- nearly 250 million Americans.

Although the supplement contributors each emphasize different aspects of influenza immunization, all underscore the need for vaccine to be offered by healthcare providers from October through January and beyond. The recommendation supports guidelines from the Centers for Disease Control and Prevention (CDC) and is aimed at reducing influenza-related illness and death, particularly among high-risk populations such as children, the elderly and those with chronic conditions.

"What we are really talking about is a paradigm shift," said William Schaffner, MD, chair of the Department of Preventive Medicine at Vanderbilt University School of Medicine, president-elect of the National Foundation for Infectious Diseases and guest editor of the journal supplement. "As the number of people who need to get vaccinated has been expanded by public health officials, so has the time-frame for vaccination. Vaccines given later in the year or even into the New Year are still beneficial in helping people avoid this serious illness."

Earlier this year, the CDC expanded its recommendations for annual influenza immunization to include all children 6 months through 18 years of age. The new recommendation is to take effect as soon as feasible, but no later than the 2009-10 influenza season. The change will add about 30 million children to the total number of people for whom CDC recommends annual influenza vaccination.

Schaffner added, "It is abundantly clear that we cannot vaccinate everyone in a two- to three-month vaccination window. Since influenza usually peaks around February in the U.S., vaccination given in December and later continues to be medically relevant."

In the supplement, Schaffner and Walter A. Orenstein, MD, associate director of Emory Vaccine Center at Emory University in Atlanta, report there is no shortage of influenza vaccine today and predict no shortages in the future because more vaccine manufacturers have entered the market. The CDC estimates projected capacity for 2008-09 to be 143 to 146 million doses. Authors say the overriding issue now is to increase consumer demand for influenza vaccine.

In another paper, Gregory A. Poland, MD, Mayo Vaccine Research Group, Mary Lowell Leary Professor of Medicine, Mayo Clinic, and David R. Johnson, MD, MPH, director, Scientific and Medical Affairs, sanofi pasteur Inc., report that healthcare providers are "missing important opportunities" to vaccinate people during office visits.

Based on insurance claims filed by 240,000 physicians from 2004 to 2007, the researchers found that 25 million people at high risk for complications from influenza visited doctors an average of 2.2 times each year between November and February, the usual peak of influenza season, but did not get vaccinated. The researchers urge stepped-up efforts by healthcare providers to take advantage of ongoing access to patients and vaccinate them starting when they make visits during the early fall when vaccine becomes available, and continuing throughout the influenza season.

Patricia K. Stinchfield, RN, MS, CPNP, director of infectious disease, immunology, rheumatology and infection control at Children's Hospitals and Clinics of Minnesota urges healthcare providers to communicate a simple message, "All children need an influenza vaccine." Among other steps to overcome barriers to vaccination, she recommends establishing weekend, evening or parallel track daytime "influenza only" vaccination clinics; issuing standing orders that allow nurses and other health care providers to vaccinate without direct doctor supervision; and increased reminder and recall efforts. These steps can apply both to pediatric and adult populations.

A survey reported in the supplement indicates that consumer cost is not a major barrier to adult immunization. In telephone interviews with 2,002 consumers, more than 80 percent of those who were behind on one of three immunizations (tetanus, influenza and pneumococcal) said cost was not a factor. Rather, many had the mistaken belief that healthy people do not need vaccines, according to findings by Johnson and colleagues Kristin L. Nichol, MD, MPH, of the VA Medical Center and University of Minnesota and Kim Lipczynski, PhD, of Adelphi Research by Design of Philadelphia. The survey was commissioned by sanofi pasteur Inc.

Many of the authors also stressed that the low influenza immunization rate in healthcare providers is a serious problem. The CDC recommends annual influenza vaccination for all healthcare providers, but rates hover around 40 percent in most years. Schaffner calls on his colleagues to "view annual influenza vaccination as a professional responsibility." He goes on to say that by getting vaccinated, healthcare providers can be positive role models, reduce the likelihood of getting sick themselves and, most importantly, avoid doing harm by infecting patients in their care.

Source: National Foundation for Infectious Diseases and the American Journal of Medicine