Asthma patients have low flu-vaccination rate

Jun 24, 2008 (CIDRAP News) – Only about 36% of people suffering from asthma received an influenza shot in the 2005-06 flu season, despite their increased risk for flu complications, according to the Centers for Disease Control and Prevention (CDC).

In the first estimate of national flu vaccination coverage in asthma patients, the CDC found that vaccination rates were well below national public health targets for all age-groups, according to an article in the Jun 20 issue of Morbidity and Mortality Weekly Report (MMWR).

The CDC has recommended flu shots for asthma patients ever since 1964, given their risk for complications, the report notes. It says about 22.9 million Americans, including 6.8 million children and 16.1 million adults, were reported to have asthma in 2006.

The agency used the National Health Interview Survey (NHIS), an ongoing, in-person interview survey of US civilians, to gather data on flu immunization in people with asthma. The 2005-06 flu season marked the first time the NHIS was able to yield an estimate of coverage in people with asthma when there was no shortage of flu vaccine.

Of 15,295 participants (aged 2 years and older) in the NHIS, 1,248 had asthma and answered questions about vaccinations. Of these 1,248, 36.2% had received a shot during the flu season, as compared with 23.9% for those with no asthma.

For the asthma patients, immunization was most common in the older groups: 48.6% for those aged 50 to 64 and 75.7% for those 65 and older. The coverage for asthma patients of all ages fell well short of the government's "Healthy People 2010" goals for flu immunization: 60% for people aged 18 to 64 with high-risk conditions and 90% for everyone aged 65 and up.

Vaccination coverage varied significantly with healthcare affiliation and insurance coverage. Those who had a "usual place for healthcare" had a coverage rate of 38.7%, versus only 10.4% for those without a regular provider. Similarly, vaccination coverage was 39.9% for those with health insurance, versus 14.5% for those without insurance. Coverage also varied according to income level, but did not differ significantly by race, ethnicity, or history of an asthma exacerbation within the preceding year.

Although coverage was higher for asthma patients who had had more healthcare visits in the preceding year, even those with 10 or more visits had only a 50.8% vaccination rate.

The findings "emphasize the need for measures to uniformly increase influenza vaccination rates among persons with asthma," the CDC says. The agency recommends such interventions as automated reminders, standing orders, multi-component educational programs, reduction of travel distance or out-of-pocket vaccine costs, and provider performance feedback.

One limitation of the survey is that it did not cover whether children being vaccinated for the first time received a second dose, as recommended by the CDC.

CDC. Influenza vaccination coverage among persons with asthma—United States, 2005-06 influenza season. MMWR 2008 Jun 20;57(24):653-6 [Full text]

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