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Public
May Be Complacent About Immunization As Influenza Season Nears
Older Americans Also Urged to Receive
Pneumococcal Vaccine
Sept. 24, 2003 -- Leading medical and public
health officials yesterday called for renewed vigilance against an old
killer -- influenza -- which continues to kill an average of
approximately 36,000 Americans and results in the hospitalization of
more than 114,000 Americans per year. At a press conference
yesterday, held in
the nation's capital by the National Foundation for Infectious
Diseases (NFID) and National Coalition for Adult Immunization (NCAI),
Dr. Julie Gerberding, director of the Centers for Disease Control
and Prevention (CDC), and other experts underscored the severity of
influenza and urged Americans to get immunized.
"It is simply unacceptable
that such a large number of people continue to die and suffer as a
result of influenza," said Dr. Gerberding. "Getting an influenza
vaccination every year is the best protection against influenza. We
encourage Americans, particularly those 50 and older and people of
any age with chronic conditions of the heart or lungs, diabetes or
kidney disease, to get their influenza vaccination in October or
November."
Health officials also urged at-risk people to be immunized
against pneumococcal disease -- a shot recommended for people age 65
or older and for younger people with chronic medical conditions.
Pneumococcal vaccination with the polysaccharide vaccine is
appropriate at any time of the year, and can be administered at the
same time as the influenza vaccine.
Mild Flu Seasons Might Contribute to Public Complacency
Public health officials said the mild flu seasons during the past
two years might result in public complacency.
"Even relatively mild flu seasons cause thousands of
vaccine-preventable deaths," said Dr. Gerberding. "The severity of
influenza outbreaks cannot be predicted. We must assume that every
season will be severe. Influenza immunization just makes sound
medical sense."
Estimates of Flu-Related Deaths Revised Upward/Vaccination
Coverage Falls
Short of Healthy People 2010 Goals
Influenza claims far more lives in the United States than
previously thought -- an annual average of 36,000 deaths per year
from 1990 through 1999, according to a study published in the
Journal of the American Medical Association (JAMA).(1) By using a
new, more accurate method to analyze flu data, the study showed a
marked increase in mortality related to influenza over the 20-year
study period, mostly among seniors.
For the 2000-01 season, the estimated vaccination coverage among
adults aged 18-64 years with high-risk conditions was 29 percent,
substantially lower than the Healthy People 2000 and 2010 objective
of 60 percent. Among persons aged 50 to 64 and as well as those
under age 50 with chronic medical conditions, only 41 percent and 21
percent, respectively, were vaccinated against influenza.
Oldest and Youngest at Special Risk
"One reason for the rise in mortality may be the aging of the
U.S. population -- a group that has been steadily growing,"
suggested Nancy Cox, PhD, a co-investigator of the JAMA study and
chief of the CDC's Influenza Branch.
Annual influenza vaccination is recommended for all persons age
50 or older and those with certain chronic medical conditions.
At the other end of the age spectrum, children are receiving new
attention for influenza immunization. The American Academy of
Pediatrics, CDC and others now encourage healthy children 6 to 23
months old to be vaccinated as they are at a heightened risk of
hospitalization from flu-related complications.
New fears have also emerged from recent surveillance data, which
shows older healthy children may be in danger of complications from
influenza. A study of the last flu season in the state of Michigan
documented 10 cases of serious influenza-related illness and four
influenza-related deaths among those under age 21. None of the
victims had known risk factors, Dr. Cox said.
New Study Shows Flu Vaccine Reduces Hospitalizations and Death
Among
Seniors
According to a study reported in the New England Journal of
Medicine,(2) influenza vaccine reduces the risk of hospitalization
for cardiac disease and stroke for people aged 65 or older.
The study found immunization reduces seniors' risk of being
hospitalized for heart disease by 19 percent and stroke by 16 to 23
percent. It also showed a flu shot reduces the risk of death from
all causes by nearly 50 percent.
"These data have important public health implications and support
stepped- up efforts to promote vaccination in our expanding older
age groups," concluded Kristin L. Nichol, MD, MPH, MBA, the study's
lead investigator.
Dr. Nichol also reminded Americans that annual flu vaccination
appointments are a convenient, critical time for at-risk people be
immunized against pneumococcal disease -- a shot recommended for
people age 65 or older and for younger people with chronic medical
conditions. Pneumococcal disease is responsible for approximately
175,000 hospitalizations.
Low Health Care Worker Influenza Vaccination Rates Endanger
Patients
The low rate of health care professionals vaccinated was
addressed by American Medical Association (AMA) President Donald
Palmisano, MD, JD, who underscored the need for health care workers
to be immunized to protect themselves -- and patients -- against
influenza.
Studies show only 38 percent of all health care professionals --
who have the potential for passing influenza to vulnerable patients
-- get the vaccine each year. Physicians and nurses are among those
health care professionals not seeking vaccination, increasing the
likelihood of transmitting the disease.
"Health care professionals are on the front line with at-risk
patients in hospitals, nursing homes and medical offices," said Dr.
Palmisano. "All health care professionals are urged to get a flu
shot to prevent disease transmission to at-risk patients."
Dr. Palmisano noted that vaccination would help head off
flu-induced medical and nursing staff shortages and called for
improved strategies to increase influenza vaccination among health
care workers.
Additionally, Dr. Palmisano urged physicians to purchase both the
influenza and pneumococcal vaccines in order to have adequate
supplies, and praised CMS for raising the reimbursement rates.
Disparities Persist Among Minority Groups
Influenza and pneumococcal immunization rates among Hispanics and
African-Americans continue to lag behind those of whites across age
and risk groups.
According to the CDC, only 52 percent of African American and 46
percent of Hispanic adults aged 65 years of age or older are
routinely immunized against influenza compared to 70 percent of
whites. Disparities for pneumococcal vaccination are even wider with
30 percent of Hispanics and 31 percent of African Americans
receiving the vaccine compared to 57 percent of whites.
Plentiful Vaccine Supply; Suspension of Tiered Vaccination
Schedule
There should be sufficient supplies of influenza vaccine
available during the coming influenza season to allow all persons
wishing to avoid influenza, regardless of age or health status, to
be vaccinated as soon as vaccine becomes available.
CDC estimates that vaccine manufactures will produce
approximately 85.5 million doses of influenza vaccine during the
2003 influenza season. This projection represents 9.5 million fewer
doses than were produced last year. However, influenza vaccine
production is expected to exceed the estimated 79 million doses that
were actually sold to providers in 2002.
New Nasal Vaccine Alternative for Healthy Persons
Officials today also noted that healthy persons now have a new
alternative influenza vaccine to consider-a nasal spray also known
as "live-attenuated influenza vaccine" or "LAIV." The nasal vaccine
is approved for use in healthy persons aged 5-49 years to prevent
influenza A and B. Influenza causes approximately 38 million missed
school days and 70 million workdays lost by adults who are sick or
tending to the sick.
While LAIV can be used in healthy people aged 5-49 years, the
injectable inactivated influenza vaccine can be used for anyone,
healthy or high-risk, 6 months of age or older.
Medicare Part B/Medicaid Covers Vaccination
William Rogers, medical officer in the Office of the
Administrator, Centers for Medicare and Medicaid Services, stressed
the importance of older Americans getting annual flu shots. People
age 65 and older are more likely to get influenza and more likely to
develop complications of the disease, Dr. Rogers said. Medicare Part
B and Medicaid cover influenza and pneumococcal vaccines.
Dr. Rogers noted that for the 2003-2004 season Medicare has
increased the amount of payments for both influenza and pneumococcal
vaccines and the fee for administering the shots. The administration
fee for both shots for this season is $7.72, a 94 percent increase
over last year. Medicare payment for influenza vaccine has risen
from $8.02 in 2002 to $9.95 this year. Effective Oct. 1, 2003, the
payment for pneumococcal vaccine rises to $18.62, compared to $13.10
last year.
NFID and NCAI
Founded in 1973, NFID is a non-profit organization dedicated to
public and professional educational programs about, and in support
of, research into causes, treatment, and prevention of infectious
diseases.
NCAI is a network of more than 140 organizations dedicated to
promoting adult immunization primarily through educational and
motivational activities. The coalition was formed in 1988 to make
the most efficient use of public and private resources to achieve
national goals in adult immunization.
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