Nation's Top Health Experts Urge Influenza and Pneumococcal Vaccination as Influenza Season Approaches

WASHINGTON, D.C. -- The Centers for Disease Control and Prevention (CDC) Director Julie L. Gerberding, MD, joined the nation's leading infectious disease experts to warn the public about the severity of influenza and pneumococcal disease and called for renewed efforts to increase vaccination rates among those considered at risk of complications from these vaccine-preventable diseases.

The urgent immunization message was issued by experts from the American Academy of Pediatrics (AAP), American Medical Association (AMA), Centers for Medicare & Medicaid Services (CMS) and CDC.  Officials from these groups joined a press conference held by the National Foundation for Infectious Diseases (NFID) in partnership with the National Influenza Vaccine Summit (NIVS) at the National Press Club in Washington, D.C.

"Everyone would benefit from an annual influenza vaccination, but for many people, influenza vaccination is critical," said Julie L. Gerberding, MD, MPH, director of the CDC.  "This year, to help ensure that people at highest risk for serious complications are vaccinated, we're making them a priority for the next six weeks.  From now until Oct. 24, we're asking those who provide influenza vaccine to give the first available doses to people in our priority groups and to healthcare providers who have contact with patients or people in the priority groups.  Getting an influenza vaccine is the best way to protect yourself and your patients against this disease."

People who are at high priority for influenza vaccination are: anyone age 65 years and older; people with chronic health conditions, such as heart disease, diabetes, asthma, chronic bronchitis or HIV; and children age 6 to 23 months old.  In addition, health care professionals and household contacts or out-of-home caregivers of children less than 6 months of age should be vaccinated to prevent giving influenza to vulnerable patients and children who are at high risk of complications.(1)

Gerberding also stated while there is heightened concern surrounding avian influenza outbreaks in Europe and Asia, regular influenza seasons pose an immediate danger that result, on average, in about 36,000 deaths and more than 200,000 hospitalizations in this country each year.(2,3)

Overall immunization rates among high-risk groups have not increased in recent years, prompting health experts to call for concerted efforts to ensure those at greatest risk for hospitalization and death receive influenza vaccine this season.

For the past several years, immunization rates among those age 65 years and older have been below 68 percent -- far short of the Healthy People 2010 goal of 90 percent.  Only one-third of children with underlying medical conditions (e.g., asthma, diabetes) are immunized against influenza annually -- the lowest vaccination rate for any recommended childhood vaccine in the U.S.  Moreover, the 34.2 percent immunization rate among adults (18-64 years of age) with medical conditions is substantially lower than the 2010 Healthy People Goal of 60 percent for this group.  Coverage rates among healthcare workers were no higher than 40 percent, further underscoring a call to action for vaccination this season.(2)

Health officials also urged vaccination against pneumococcal disease for Americans 65 years of age and older and those of any age with certain underlying medical condition.  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.  Of the nearly 40,000 cases and more than 4,000 deaths from invasive pneumococcal disease each year in the U.S., more than half occur among adults who are recommended to receive vaccination.(4)

CMS Administrator Mark McClellan, MD, PhD, stressed the importance of annual influenza vaccination for Americans 65 years of age and older. Medicare Part B and Medicaid cover both influenza and pneumococcal vaccines.

McClellan announced that Medicare has increased the amount of the payments for influenza and pneumococcal vaccines as well as the administration fee. Medicare will pay $24.57 per dose for the pneumococcal vaccine this year, up from $23.28 in 2004.  Payment for the influenza vaccine also increases to $12.06, compared to $10.10 last season.  The administration fee for both vaccinations has risen more than 100 percent this year from $8.21 in 2004 to $18.57 in 2005.

In another development, McClellan provided an update on a new rule requiring nursing homes in the U.S. to vaccinate all their patients against influenza and pneumococcal disease to be eligible for Medicare and Medicaid programming benefits. "Many at-risk people are not getting the vaccines they need," said McClellan.  "If approved, this proposed rule will go a long way toward ensuring the vaccination of approximately 2 million nursing home residents in 18,000 nursing homes each year."

Despite long-standing recommendations to vaccinate all children with underlying medical conditions, such as asthma and diabetes, vaccination rates among these children have consistently remained low.  Nearly 70 percent of children with asthma do not receive an influenza vaccine in a given year making this the lowest immunization rate for any recommended childhood vaccine.(2)  According to the CDC, an estimated nine million U.S. children younger than 18 years have been diagnosed with asthma at some point in their lives.(5)

"Immunization rates are alarmingly low among children with asthma and other chronic medical conditions, putting them at greater risk for serious influenza infection and its complications," said Henry H. Bernstein, DO, a member of the Committee on Infectious Diseases of the AAP.  "Parents and providers need to make every effort in getting high-risk older children and all children 6 through 23 months of age vaccinated every year."

Last season, new vaccination recommendations for all children 6 through 23 months resulted in a higher than expected 48 percent coverage rate for a new recommendation, yet it was far below the Healthy People 2010 goal of 90 percent for routinely recommended childhood vaccines.(6)  Studies show that children less than 2 years of age who get influenza are hospitalized at rates similar to those seen in adults age 65 years and older.(7,8)  In 2003, more than 150 influenza-related deaths among children younger than 18 years of age were reported to the CDC.(2)

Bernstein further underscored the need for vaccination of every household member and out-of-home caregiver who comes into direct contact with children who have chronic medical conditions and children younger than 24 months, to prevent the spread of the influenza virus.  In particular, vaccination is urged for parents, older brothers and sisters, grandparents, babysitters and others in contact with children 6 to 23 months and older children with medical conditions, such as asthma or diabetes.

Physicians, nurses and other health care professionals play an important role in preventing influenza from spreading by getting vaccinated.  "The AMA encourages physicians to lead by example and get vaccinated against influenza," said AMA Trustee Ardis D. Hoven, MD. "Only about 40 percent of healthcare professionals receive the flu

vaccine, we need to raise that number to protect our patients -- particularly

those at risk of serious complications from influenza," said Hoven. "Hospitals and nursing homes are high-risk areas for acquiring influenza.  We encourage healthcare facilities to develop flu vaccination programs that measure and maximize vaccination rates for healthcare professionals."

Studies show that vaccination of healthcare professionals leads to fewer deaths among nursing home patients, and also helps to increase vaccination rates among patients who seek a healthcare professional's advice. "For many patients, the advice of their physician remains the tipping point toward healthy behaviors," said Hoven. "Let's follow the advice we give our patients and prevent influenza outbreaks by getting vaccinated."

"Low pneumococcal coverage rates leave too many Americans vulnerable to

invasive disease," said Cynthia G. Whitney, MD, MPH, acting chief of the Respiratory Diseases Branch of the CDC.  "Americans may not realize the risk pneumococcal disease poses to patients 65 years and older."

Whitney warned that with just 57 percent of those 65 and older being vaccinated, the death rate could increase.  The Healthy People 2010 goal for pneumococcal vaccination coverage of those age 65 and older is 90 percent.(9)

Although anyone can contract pneumococcal disease, some groups are at particularly high risk for the disease or its complications, including persons age 65 years and older, those with chronic illness or weakened immune systems and residents of chronic or long-term care facilities.(10)

The CDC has instituted prioritization of inactivated (injectable) influenza vaccine as a temporary measure to ensure that those persons who are at highest risk of complications from influenza have access to vaccine.  Until Oct. 24, 2005, CDC recommends the following priority groups receive the inactivated influenza vaccine: all adults aged 65 years and older; residents of long-term care facilities; adults and children with underlying medical conditions, such as asthma and diabetes; children ages 6 through 23 months; pregnant women; health care workers who provide direct patient care; and household contacts and out-of-home caregivers of children less than 6 months of age.(1)

Beginning Oct. 24, 2005, all persons will be eligible for vaccination with the inactivated influenza vaccine, which can be administered to healthy and high-risk persons aged six months and older.(1)

These prioritized recommendations do not pertain to the nasally administered vaccine, live attenuated influenza vaccine (LAIV), which can be administered at any time for vaccination of non-pregnant healthy persons aged 5-49 years, including most health care personnel and persons in close contact with high-risk groups.  In addition, antiviral medications are useful for early treatment of influenza, as a supplement to influenza vaccination for disease prevention and control.  Antiviral medication can also be used for

prevention of influenza among patients one year old and younger, specifically those at highest risk of influenza who cannot get vaccinated.(1)

References:

1.  Centers for Disease Control and Prevention. Update: Influenza Vaccine Supply and Recommendations for Prioritization for During the 2005-06 Influenza Season. MMWR 2005;54:850.

2.  Centers for Disease Control and Prevention. Prevention and control of influenza: Recommendation of the Advisory Committee on Immunization Practices (ACIP). MMWR 2005;54(No.RR-8):1-40.

3.  Thompson WW, Shay D, Weintraub E, et al. Influenza-associated hospitalizations in the United States. JAMA 2001;292:1333-1340.

4.  Centers for Disease Control and Prevention. 2005 Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Streptococcus pneumoniae, 2004 - Provisional. Available via the Internet: http://www.cdc.gov/ncidod/dbmd/abcs/survreports/spneu04prelim.htm.

5.  Bloom B, Cohen RA, Vickerie JL, Wondimu EA. Summary health statistics

for U.S. children: National Health Interview Survey, 2001. National Center for Health Statistics. Vital Health Stat 10(216). 2003:3.

6.  Centers for Disease Control and Prevention. Estimated influenza vaccination coverage among adults and children - United States, September 1, 2004 - January 31, 2005. MMWR 2005;54:304-307.

7.  Neuzil KM, Wright PF, Griffin MR. Burden of influenza illness in children with asthma and other chronic medical conditions. J Pediatr 2000; 137:856-64.

8.  Neuzil KM, Mellen BG, Wright PF, Mitchel EF Jr, Griffin MR. The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. N Engl J Med 2000;342:225-31.

9.  Centers for Disease Control and Prevention. 2004 National Health Interview Survey.  Available via the Internet: v/nchs/data/nhis/earlyrelease/200506_05.pdf

10. Centers for Disease Control and Prevention. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997;46(No. RR-8):10-14.

Source: National Foundation for Infectious Diseases