Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS) Howard K. Koh, MD, received his flu shot at the NFID news conference on influenza on Sept. 27.
Public health officials and medical experts practiced what they preach by getting vaccinated against influenza during a National Foundation for Infectious Diseases (NFID) news conference held Sept. 27, 2012. Urging the public to follow suit, experts cautioned that influenza is unpredictable and that last year’s mild season is not necessarily an indication of what can be expected in 2012-2013 and, even during mild seasons, flu takes a serious toll.
Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS) Howard K. Koh, MD, announced the latest influenza vaccination coverage rates among children and adults, which reinforced the need for ongoing, collaborative efforts to improve influenza immunization.
“I urge everyone to join me and get a flu vaccine this year,” says Koh, who was the first to receive his flu vaccine during the news conference, held at the National Press Club in Washington, D.C. He was joined by leaders from the American Medical Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Pharmacists Association, AARP, National Medical Association, Centers for Disease Control and Prevention (CDC) and NFID, in partnership with the National Influenza Vaccine Summit, and called on everyone 6 months of age and older to follow CDC’s universal recommendation by getting vaccinated against influenza each year.
According to the CDC data, which was published in the Sept. 27, 2012 issue of CDC’s Morbidity and Mortality Weekly Report, influenza vaccination rates remained steady with an estimated 128 million people, or about 42 percent of the U.S. population receiving the influenza vaccine during the 2011-2012 season. However, rates varied widely between age groups and among states.
"The last several years have demonstrated that once again, influenza is predictably unpredictable," says Koh. "In 2009-2010 we experienced a pandemic with thousands of hospitalizations and deaths. Then this past season we have experienced our lowest and shortest peak for influenza-like illness since surveillance for this began. However, as we witnessed last year, even mild seasons can lead to suffering and death. So today we want to send the message that although last flu season was mild, people cannot become complacent this year. When it comes to the flu, we can't look to the past to predict the future. Don't take the risk and get your vacciantion. Each year in the U.S., an average of 5 percent to 20 percent of the population may be infected with influenza, leading to 200,000 hospitalizations and includes an average of 20,000 kids under the age of 5. The flu is not a stomach bug, it has the potential to be much more serious and can sometimes lead to death. On the other hand, people may be infected with flu and have no symptoms at all or may have mild respiratory symptoms so everyone should be cautious and even healthy people can get the flu and it can be serious for everyone."
More than 85 million doses of influenza vaccine have been distributed as of Sept. 14, 2012. Manufacturers project that about 135 million doses of influenza vaccine will be available this season in doctors’ offices, public health clinics, pharmacies, retail stores, and other venues.
“In this election year, there are many important national health issues that are up for debate, but this is one that’s easy to agree on,” says William Schaffner, MD, immediate past-president of NFID and chair of the Department of Preventive Medicine at Vanderbilt University School of Medicine, who led the news conference. “We should all be voting ‘yes’ for influenza and pneumococcal prevention. It is every individual’s responsibility to put prevention to good use and make vaccination part of their routine healthcare.”
Schaffner reminded attendees of the news conference of the importance of everyday preventive steps to ward off infection: "It's up to every individual to take advantage of opportunities to protect themselves, their families and their communities so let's put prevention to good use -- remember to engage in proper hand hygiene, proper sneeze and cough etiquette, and the prompt use of antivirals -- all of them are important to preventing influenza."
2011-2012 Influenza Vaccination Coverage Shows Steady Progress, Highlights Gaps
Steady gains have been made, particularly since influenza vaccine recommendations were expanded to include all healthy adults just two years ago. However, the CDC report indicates that coverage remains lower than the public health goals of 80 percent for people between the ages of 6 months and 65 years and 90 percent for people older than 65 years.
Vaccination rates among children age 6 months to 17 years remained steady at 52 percent, with the greatest increase among children age 6 to 23 months (approximately 75 percent were vaccinated in 2011-2012, an increase of slightly more than 6 percentage points higher than the previous year). Coverage for children decreased with age; vaccination among adolescents age 13 to 17 years remains low at 34 percent. Adults age 65 years and older – the group with the longest standing recommendation to receive the influenza vaccine – had the highest coverage rates among all adults (approximately 65 percent), but showed a continued decline over the past few years (from approximately 74 percent in 2008-2009). While pediatric vaccination coverage among race/ethnic groups was comparable, similar to the previous season, disparities still remain in the adult populations.
"For 2011-2012, despite the low levels of flu illness, the overall population, flu vaccination coverage was about 42 percent -- that's for Americans 6 months and older, and that number is similar to the figure we had before -- 43 percent," says Koh. "So we have sustained coverage for those two years but we need to keep the momentum going and increase coverage for this year and beyond. For kids, just 52 percent were vaccinated last season and that compares to 51 percent the year before. We know vaccination coverage decreases for children as they get older. Last year nearly 75 percent of children aged 6 to 23 months received vaccination as compared to just 34 percent of adolescents 13-17. Flu vaccination is especially important for young children because they are at high risk of complications. Parents must be aware that vaccination is important protection for their children. We are very pleased that for kids this past flu season for the second consecutive year there were no racial or ethnic disparities in coverage and we want that trend to continue in the future. For adults there is much room for improvement. Last year about 39 percent of adults 18 and older were vaccinated compared to some 41 percent the year before. We emphasize that vaccination is critically important for people with medical conditions that put them at a high risk such as asthma, heart disease and diabetes. Coverage among these high-risk adults aged 18 to 64 was only 45 percent, last season it was 47 percent. Some good news is that 47 percent of pregnant women were vaccinated and that means we are sustaining preogress we saw in 2009."
In addition to data on vaccination rates by age and race, Koh also released information about influenza immunization among pregnant women and healthcare personnel. Vaccination coverage among pregnant women remained consistent (47 percent), but still significantly higher than rates prior to the 2008-2009 influenza season which were regularly lower than 30 percent. The American College of Obstetricians and Gynecologists (ACOG) also recommends the influenza vaccine for pregnant women.
“Influenza is five times more likely to cause severe illness in pregnant women than women who are not pregnant,” says Laura Riley, MD, director of Obstetrics and Gynecology Infectious Disease, Massachusetts General Hospital, representing ACOG. The flu vaccine is safe and offers protection for the mother. Research shows it can decrease the baby’s risk of getting the flu for up to six months after birth.”
Among healthcare personnel, influenza vaccination rates increased slightly from the previous season (approximately 64 percent in 2010-2011 to 67 percent in 2011-2012), with highest rates among physicians (approximately 86 percent). By work setting, hospitals were associated with the highest vaccination coverage for healthcare professionals; coverage was lowest among healthcare professionals – other than physicians and nurses – working in long-term care facilities.
"Among healthcare personnel, vaccination coverage was 67 percent last year, similar to the 64 percent from the year before," says Koh. "We stress the consierable difference by occupation and by setting. Last year, for physicians working in a hospital, some 87 percent reported they were vaccinated but in comparison, in long-term care settings, healthcare personnel other than physicians or nurses had coverage rates of only 50 percent and this is worrisome because these professionals typically care for people at higher risk for complications in these LTC settings. We have studies that demonstrate that vaccination of healthcare personnel in LTC can decrease patient mortality."
Healthcare Community Plays a Critical Role in Motivating the Public
Research has consistently shown that a recommendation from a healthcare professional will greatly help to improve vaccination rates among all populations. "It is critical for physicians to protect themselves from the flu and to also encourage their patients to get vaccinated,” says Litjen Tan, MS, PhD, director of medicine and public health at the American Medical Association. “For example, pregnant women whose physician recommended the flu vaccine were five times more likely to get vaccinated, so we want to get the message out to all physicians that they can encourage patients to get vaccinated."
Location of vaccination has also changed slightly over the last few years. With an increasing number of venues offering vaccines, more people are opting to get vaccinated outside of traditional medical settings. All 50 states, D.C., and Puerto Rico now allow pharmacists to administer influenza vaccine, according to pharmacist Mitchel Rothholz, chief strategy officer for the American Pharmacists Association, and more than 20 million doses were administered by pharmacists last year.
“Pharmacists have been offering flu vaccines for nearly two decades, but the 2009 pandemic prompted greater collaboration throughout the immunization neighborhood, resulting in sustained public health gains. Pharmacists and pharmacies are playing a greater role within the immunization neighborhood in making vaccines and vaccine information more accessible to all community residents.”
2012-2013 Influenza Outlook
The seasonal influenza vaccine protects against the three viral strains most likely to cause the flu in the upcoming year. This year’s seasonal influenza vaccine has one strain in common with last year's vaccine, A/California/7/2009 (H1N1)-like virus, plus two new viral strains, A/Victoria/361/2011 (H3N2)-like virus and B/Wisconsin/1/2010-like virus. Four influenza vaccine options are available to meet the needs of various populations: a nasal spray; the traditional intramuscular injected vaccine; a high-dose injection for people age 65 years and older; and an intradermal vaccine that features a smaller needle.
While vaccination is the first line of defense against influenza, at the news conference, CDC outlined its three-step approach to fighting influenza. Vaccination is the first and most important step, coupled with everyday preventive actions such as good hand and cough hygiene. For those who do get infected, appropriate use of influenza antiviral drugs can help reduce the risk of serious complications from the infection. CDC recommends either oseltamivir or zanamivir for treatment and prevention of influenza.
Schaffner advised that the influenza season is also an opportune time for older adults to ask their doctors about pneumococcal disease and the status of their vaccination needs. Both vaccines can be administered at the same time. Pneumococcal infection is a common complication of influenza, although it can occur any time of year. Pneumococcal disease can be severe, leading to pneumonia, meningitis, and other serious infections. People age 65 years and older are recommended to receive the pneumococcal vaccine once. It is also recommended for adults 18 and older with certain health conditions, such as heart, lung and liver problems, diabetes, and asthma or those who smoke. Unfortunately, about 73 million U.S. adults who are recommended to receive the pneumococcal vaccine have not received it.
Leading by Example
At the news conference, NFID issued an influenza prevention commitment statement calling on healthcare professionals, business, and community leaders to “lead by example,” by making influenza prevention a health priority. More than 30 companies and organizations have already signed on to show their support. Additional information is available at: nfid.org/leadingbyexample.
Ask Koh, "Why get vaccinated? Simply put, it's the best protection that we have, and in fact, you see from studies that vaccination in 2010-2011 prevented almost 5 million flu cases, 2 million medical visits and an estimated 40,000 hospitalizations. We recommend hand hygiene and cough etiquette but these are not a substitute for getting an annual flu shot. Over the past five decades, hundreds of millions of Americans have safely received seasonal influenza vaccine, and when side effects do occur, they are usually mild. Of course we emphasize that flu vaccines do not give you the flu. We know that a flu vaccine is needed every year because the flu virus is constantly changing, so our message is, everyone 6 months of age and older should be vaccinated."
The National Foundation for Infectious Diseases (NFID) is a non-profit, tax-exempt (501c3) organization founded in 1973 dedicated to educating the public and healthcare professionals about the causes, treatment, and prevention of infectious diseases.
The news conference was sponsored by NFID in partnership with the National Influenza Vaccine Summit and is supported, in part, by the Centers for Disease Control and Prevention, MedStar Health Visiting Nurses Association, and through unrestricted educational grants to NFID from Genentech, Health Industry Distributors Association, MedImmune, Merck and Co., Inc., Pfizer Inc, and Sanofi Pasteur.