Officials urge high-risk groups to get flu shots soon

Sep 14, 2005 (CIDRAP News) – National health officials made a major pitch today for healthcare workers and people most at risk for influenza and its complications to get flu shots within the next few weeks.

"There are going to be more opportunities than ever to get vaccinated, so go out and get your flu shot," said Mark B. McClellan, head of the federal Center for Medicare and Medicaid Services, in appealing particularly to Medicare recipients.

"Just do it," echoed William Schaffner, MD, of the National Foundation for Infectious Diseases, speaking at a news teleconference in Washington, DC.

The Centers for Disease Control and Prevention (CDC) is recommending that flu shots be reserved for high-risk groups—including people living in shelters because of Hurricane Katrina—until Oct. 24.

"That [date] gives us a good, solid month to vaccinate those who need it most," CDC Director Julie Gerberding, MD, MPH, said at the news conference. "We can avoid some of the problems we had last year because of the uncertainty about when the supply would be available for whom and where."

The CDC's priority groups for vaccination include 6- to 23-month-old children, people older than 64, nursing home residents, children and adults with chronic medical conditions, pregnant women, healthcare workers, and household contacts and caregivers of infants younger than 6 months.

In making their appeal, officials expressed confidence about this year's flu vaccine supply. Last year the supply shrank dramatically when Chiron Corp. had to cancel delivery of 48 million doses because of contamination at its factory in Liverpool, England.

"The vaccine supply this year is expected to be very good, with over 90 million doses coming online in the weeks ahead," said Schaffner, who is chairman of preventive medicine at the Vanderbilt University School of Medicine in Nashville.

Gerberding said the CDC expects 60 million doses from Sanofi Pasteur, 8 million doses from GlaxoSmithKline, and 3 million doses from MedImmune, which makes the intranasal vaccine FluMist. "That's a minimum of 71 million doses. Anywhere between 71 million and 90 million doses is what we're planning for right now."

The CDC recently estimated that Chiron would produce 18 million to 26 million doses for the US market this year. Today Gerberding said Chiron is on track to supply vaccine, but she declined to estimate how much. "We have no reason to be concerned about that, but we're making no firm statements until we know more," she said.

Officials specifically recommended early flu shots for hurricane evacuees living in crowded shelters. "We know those are places where respiratory diseases can easily spread," said Gerberding.

She said the government would provide vaccine for evacuees through the Vaccines for Children program, which provides free flu vaccine for vulnerable children such as Medicaid recipients and those in uninsured families. "By definition the evacuees are being declared uninsured at the moment and therefore eligible for Vaccines for Children vaccine," she explained.

Officials were especially emphatic in urging flu immunization for healthcare workers, fewer than 40% of whom typically get vaccinated.

"Every single doctor and nurse in America needs to make getting vaccinated a priority," said Ardis D. Hoven, MD, a board member of the American Medical Association. She added that one study showed the vaccine was 88% effective in preventing flu in healthcare workers.

"It's at best embarrassing and at worst tragic that less than 50% of healthcare workers get vaccinated annually," commented Gerberding.

Hoven said employers should make flu immunization free and as convenient as possible for health workers. The latter typically take care of their patients before they take care of themselves, and this can result in repeatedly postponing flu vaccination, she said.

Schaffner suggested that some healthcare workers don't understand they are in a priority group for immunization. "We need to do a better job of letting them know that the reason healthcare workers should be vaccinated is so that if they get influenza, they don't transmit it to patients," he said. "What they fail to realize is that after they get infected and before they get sick, for 24 or even 48 hours, they can be transmitting the flu virus to their patients."

Henry Bernstein, DO, of the American Academy of Pediatrics decried the "dismal" flu immunization rate of 38% for 2- to 17-year-old children with chronic conditions like asthma and diabetes. The rate for 6- to 23-month-old children last year was better at 48%, but it still needs improvement, he said.

Bernstein urged parents to schedule flu shots for children in high-risk groups "immediately," and also called on their household contacts to be immunized.

Schaffner cited "the stunning fact that children 6 to 23 months old, if they get influenza, have the same high rate of hospitalization as adults 65 years and older."

McClellan reminded listeners that Medicare this year more than doubled the reimbursement rate for flu shots, from an average of $8 to more than $18. In addition, the government is now requiring nursing homes to vaccinate residents unless they refuse or have medical contraindications, he noted.

Officials also urged vaccination against pneumococcal disease for young children and high-risk adults. Pneumococcal bacteria cause a variety of infections, including ear and sinus infections, pneumonia, meningitis, and bloodstream infections, said Cynthia G. Whitney, MD, MPH, of the CDC's National Center for Infectious Diseases.

"Pneumococcal disease is second only to influenza as a leading cause of death due to vaccine-preventable diseases," Whitney said. "Severe pneumococcal infection is a common complication of influenza."

Adults advised to get a pneumococcal shot include those older than 64, those living in nursing homes or in crowded conditions, those with weak immunity, and those who have diabetes or heart or lung disease, she said. Only 64% of elderly people report having had the shot, she said.

Medicare covers pneumococcal vaccine, and people can receive that shot and a flu shot at the same time, Whitney said.

Officials also commented that antiviral drug treatment may be a way to prevent flu for people who can't receive a flu shot, such as those who are allergic to eggs.

In response to a question, Gerberding said the policy of reserving flu shots for high-risk groups until Oct 24 is strictly voluntary. "We don't regulate the distribution of vaccine, and ultimately it's the physician's decision about when to vaccinate," she said.

See also:

Sep 1 CIDRAP News article "CDC: save flu vaccine for high-risk groups till Oct 24"

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