Experts press for better H1N1 vaccine uptake in risk groups

Jan 12, 2010 (CIDRAP News) – Federal officials and representatives from some of the nation's biggest health advocacy groups today teamed up to push the importance of pandemic H1N1 vaccination for people who have chronic medical conditions such as asthma, diabetes, and cancer.

As part of National Influenza Vaccination Week, the experts spelled out the risks to these groups in a live Web seminar (webinar) hosted by the US Department of Health and Human Services (HHS). The urgency to vaccinate groups that are at high risk for flu complications comes at a time when the vaccine is plentiful and there is a lull in pandemic flu activity.

Adults under age 65 with underlying medical conditions have been among the priority groups to receive the vaccine. Recommendations state that people with chronic conditions should receive the inactivated injectable vaccine rather than the live attenuated nasal-spray version.

Nicole Lurie, MD, HHS assistant secretary for preparedness and response, told webinar participants that though vaccine uptake in children who have underlying conditions is growing, uptake for adults with chronic conditions is lagging. She also warned that the pandemic virus has caused more deaths in these adults than any other group.

She said one reason some adults with chronic conditions don't get vaccinated is that many have well-controlled disease, are living normal lives, and don't see themselves as having an increased risk for flu complications. She added that it's up to healthcare providers, healthcare groups, public health workers, and loved ones to help those with chronic medical conditions understand that immunization is in their best interest.

"Not only are people with chronic conditions at increased risk for complications, flu can make their chronic conditions worse," Lurie said, adding that, for example, diabetes can be difficult to control during an influenza infection.

Anthony Fiore, MD, a medical epidemiologist with the Centers for Disease Control and Prevention (CDC), said public health officials worry that pandemic flu vaccination rates in those with chronic conditions will end up mirroring the low rates in this group for the seasonal flu vaccine. He said the seasonal flu vaccination rate for this group of adults is about 40% and is even lower in younger adults.

For the pandemic vaccine, so far about 30% of high-risk children and 20% of adults with chronic conditions have been immunized, he said. "There's still a long way to go to capture all of those at risk," he added.

Otis Webb Brawley, MD, chief medical officer with the American Cancer Society, said about 16,000 cancer patients and survivors are hospitalized each year for seasonal flu, and about 9% of them die of the disease.

He said hospitalized patients are 10 times more likely to die from flu than the general population and pointed out that vaccination of patients and their contacts is the best way to prevent such flu deaths.

Christine Tobin, president of healthcare and education for the American Diabetes Association (ADA), told the group that the primary message for patients with diabetes is to get both the seasonal and pandemic vaccines, because having the flu can contribute to ketoacidosis and secondary infections such as pneumonia.

The ADA also advises people to get the pneumococcal vaccine, take practical steps such as hand washing to minimize exposure to the virus, and plan in advance for illnesses. For example, she said it's vital that patients with diabetes know whom to call if they get sick and have diabetes and over-the-counter medications on hand, plus enough soft food and liquids to last up to a week.

Patients who can't consume their usual diet should be encouraged to replace the calories with soft food or beverages, Tobin said, adding that body temperature and blood glucose levels should be monitored closely during flu infections.

Mary Partridge, chairwoman of the American Lung Association, said 35 million people in the United States live with chronic lung conditions. Though flu vaccination rates are generally good for patients with chronic obstructive pulmonary disease (COPD), rates for asthma patients remain low, averaging about 36% for adults and children. "This is an important concern for the Lung Association," she said.

About 15% of patients hospitalized with H1N1 infections have had COPD, and about a third had asthma, she said. Even more worrisome, about 28% percent of adults admitted to intensive care units (ICUs) for severe H1N1 infections have had asthma or COPD, Partridge said.

"Vaccination is an important first line of defense," she said.

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