Nearly Half of U.S. Population Make Annual Flu Vaccination Routine

Tom Frieden, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), led by example and encouraged all to get an annual flu shot.

With influenza season approaching, health experts at a news conference held at the National Press Club by the National Foundation for Infectious Diseases (NFID) reinforced the need for everyone six months of age and older to get vaccinated with updated 2015-2016 vaccine. Influenza vaccination coverage estimates have steadily increased, particularly over the past five years, and are highest in young children and older adults, who are among those most vulnerable to severe complications from the flu. The coverage estimates, announced by Tom Frieden, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), also include new reports on vaccination coverage among healthcare personnel and pregnant women and were published in this week's issue of CDC's Morbidity and Mortality Weekly Report and on CDC's FluVaxView website.

Each season, flu causes millions of illnesses, hundreds of thousands of hospitalizations and thousands or sometimes tens of thousands of deaths. A flu vaccine is currently the best defense available against getting the flu. "Vaccination is the single most important step people can take to protect themselves from influenza," says Frieden.  "Flu can be serious and it kills tens of thousands of Americans each year.  Vaccination is easier and more convenient than ever, so get yourself and your family protected."

Panelists who joined Frieden in the call for everyone age 6 months and older to get vaccinated annually against flu included William Schaffner, MD, medical director of NFID and professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine; Kathleen Neuzil, MD, MPH, professor of medicine and director, Center for Vaccine Development at the University of Maryland School of Medicine; and Wendy Sue Swanson, MD, MBE, pediatrician, blogger (Seattle Mama Doc) and executive director of Digital Health at Seattle Children's Hospital.

Overall, CDC estimates that 47 percent of the U.S. population age 6 months and older was vaccinated during the 2014-2015 season, similar to the 2013-2014 season and up from an estimated 41 percent five years ago. Coverage remains highest among children age 6 months through 23 months at 75 percent, the only age group that met the public health vaccination coverage goal of 70 percent. Children age 2 years through 4 years followed at 68 percent. Although vaccination coverage decreases in older children, vaccination among children age 5 years through 12 years is still above the national average, at 62 percent. In contrast to younger children, the estimated vaccination rate for adults age 18 years through 49 years has yet to top 40 percent.  Similar to young children, coverage rates for adults age 65 years and older also remained high at an estimated 67 percent.

Coverage for pregnant women, who also are at high risk for serious influenza-related complications, remained steady as well during the 2014-2015 season, with 50 percent reporting getting vaccinated before or during their pregnancy.

Doctors, nurses and other healthcare personnel have higher vaccination rates. Overall, 77 percent of healthcare personnel (including medical and nonmedical staff) reported getting a flu vaccine and rates climb to 90 percent in hospital settings. However, opportunities for improvement remain because low coverage rates persist among long-term care facility staff (64 percent). Low rates in these settings are of great concern since it puts some of the nation's most vulnerable patients at greater risk of getting the flu. Healthcare personnel in long-term care settings also were least likely to report that their employer required vaccination or made it available onsite.

Flu Prevention Begins with Vaccination
The rate of flu-related hospitalizations among people age 65 years and older last season was the highest ever recorded since this type of record-keeping began a decade ago. Flu also hit children hard with 145 lab-confirmed influenza-associated pediatric deaths reported, a number that is known to be an underestimate of the true number of these deaths. All four medical experts reminded the public about the importance of annual flu vaccination to protect everyone, including those who are young and healthy, from severe outcomes.

As Schaffner noted, "Last season reinforced that every flu season is a unique experience. While we track flu viruses around the world all year long to help prepare the best vaccines possible, the viruses are tricky and can change. Occasionally, flu viruses will change substantially after they are included in the vaccine. This can result in lower than usual vaccine effectiveness, which is what happened last season. But this season's vaccine has been updated and vaccination is always our first and best defense in fighting flu and protecting public health."

CDC recommends a three-step approach to fighting flu, with vaccination being the first step. In addition to vaccination, CDC urges people to take everyday preventive actions such as avoiding close contact with sick people, covering coughs and sneezes, and frequent handwashing using soap and water or alcohol-based hand rubs when soap and water are not immediately available.

Influenza antiviral drugs can be a second line of defense for treatment of some who get sick with flu. CDC recommends these prescription drugs for people who are very sick with flu or who are at high risk for serious flu complications, like young children, pregnant women, people with certain chronic health conditions and people age 65 years and older. Many observational studies have found that in addition to lessening the duration and severity of symptoms, antiviral drugs can prevent flu complications. For example, a recent study in Clinical Infectious Diseases found that early treatment of flu-hospitalized people age 65 years and older with flu antiviral medications cut the duration of their hospital stay and reduced their risk of needing extended care after discharge. Because it is important to start antiviral medication quickly, high-risk patients should contact a healthcare professional at the first signs of influenza symptoms, which include sudden onset of fever, aches, chills and tiredness.

Physicians may prescribe antiviral medication based on a patient's symptoms, their existing health status and whether influenza is circulating in the community. Advances in diagnostic testing have also enabled accurate and   rapid in-office results.

Everyone Age 65 Years and Older as well as Younger Adults with Certain Health Risks Need Pneumococcal Vaccination
Experts recommend pneumococcal vaccination for everyone age 65 years and older and for adults with certain chronic health conditions, such as diabetes, heart disease and lung disorders, as well for people who smoke. Pneumococcal disease causes a range of serious illnesses and often is a common and deadly complication of influenza.

There are two types of pneumococcal vaccine recommended for use in adults. The vaccine(s) each adult needs and when to get them varies based on age and health risk factors. Earlier this month, CDC updated its pneumococcal vaccine recommendations for healthy adults age 65 years and older, calling for a minimum interval of one year between the two types of pneumococcal vaccines, replacing the previously recommended six- to 12-month interval. This change was made to allow the recommended interval between these vaccinations to match, regardless of which vaccine is administered first.

Schaffner urged all adults in high-risk groups to talk to their healthcare professional and to get pneumococcal vaccines as recommended. "Either pneumococcal vaccine can be given at the same time as the influenza vaccine, and both are covered by Medicare, meaning now is a great time to get protected against both flu and pneumonia." Dr. Schaffner also noted that the Affordable Care Act calls for all insurers to cover these types of preventive vaccines.

Clinician Recommendations are Critical
The expert panel today stressed the critical role of healthcare professionals in patient vaccination decisions. Strong, personal recommendations and an offer of vaccination from healthcare professionals to their patients greatly improve vaccination coverage. For example, vaccination coverage is substantially higher (68 percent) among pregnant women who reported receiving a provider recommendation and offer of vaccination compared to women who received only a recommendation and no offer (34 percent) and those who received no offer or recommendation (9 percent).

"I know as a pediatrician and mom the importance of leading by example.  There is no question that it is essential doctors, nurses and all healthcare workers get vaccinated for flu themselves, engage patients in conversations about vaccines, and make a strong recommendation," said Swanson. In addition to her pediatric practice duties, Swanson regularly communicates through her blog (Seattle Mama Doc) and other social media channels (@SeattleMamaDoc) to stay connected with patients, parents, the public and professional colleagues.

Vaccine Virus Selection, Supply and Options
Two influenza virus strains have been changed in this season's flu vaccines based on the viruses experts expect to be circulating during the upcoming season. The 2015-2016 vaccines have different influenza A (H3N2) and influenza B (Yamagata lineage) components compared to last season's vaccines. Manufacturers' projections indicate that more than 170 million influenza vaccine doses will be available this season in doctors' offices, hospitals, pharmacies, clinics, retail stores, workplaces and other venues.

Among the vaccine options are the traditional flu shot, a nasal spray vaccine, an intradermal vaccine given with a much smaller needle, a high-dose vaccine for people age 65 years and older and a recombinant (egg-free) vaccine. One type of inactivated vaccine can be given either by a needle or by jet injector. All vaccines protect against the same three or four influenza viruses.

"In addition to preventing hospitalizations, getting vaccinated and avoiding influenza also means avoiding extra medical costs, and not missing work or school," said Neuzil. "People frequently ask if it will be a bad influenza season.  While influenza is unpredictable, we do know that every year, people get sick, and some are hospitalized and some die from influenza. So your best odds are to get the flu vaccine annually to keep yourself and others protected."

The National Foundation for Infectious Diseases (NFID) is a non-profit, tax-exempt 501(c)(3) organization founded in 1973 dedicated to educating the public and healthcare professionals about the causes, treatment and prevention of infectious diseases across the lifespan.

In addition to CDC, NFID was joined at the news conference by experts from leading public health and medical organizations including AARP, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American  Nurses Association,  American Pharmacists Association, Families Fighting Flu, and National Minority Quality Health Forum, among others.

This news conference is sponsored by NFID and is supported, in part, by the Centers for Disease Control and Prevention, MedStar Visiting Nurse Association  and through unrestricted educational grants from Alere, Inc., AstraZeneca, BD Medical, bioCSL, Genentech, GlaxoSmithKline, GOJO Industries, Merck & Co., Inc., Novartis Vaccines and Diagnostics Inc., Pfizer Inc. and Sanofi Pasteur Inc. NFID policies prohibit funders from controlling program content.

Source: National Foundation for Infectious Diseases