Ways to improve influenza immunization rates

With the 2012-13 influenza season underway, I want to remind my colleagues that while influenza vaccination has been around for 60 years, the times are changing, and physicians need to change too. We now have newer vaccine options targeting specific populations that were not available just a decade ago.

Alas, many providers have not taken advantage of these options that 1) potentially offer better protection for patients aged 65+ and 2) might improve immunization rates among younger, healthy adults – a group the CDC began recommending for an annual vaccination in 2010.

According to the U.S. Census, there are more adults 65 years of age and older than ever before and physicians are painfully aware that this group is hardest hit by influenza and its complications. Also, remember that even if only mild influenza symptoms present, that the virus can exacerbate other underlying conditions – such as diabetes, lung and heart disease – that can lead to hospitalization. More than 60 percent of the estimated 226,000 flu-related hospitalizations and 90 percent of the 3,000 to 49,000 flu-related deaths in the U.S. annually occur in seniors.

The age-related decline of the immune system inspired the question – do we need a  stronger flu shot for this population?  The FDA answered when it licensed a high dose influenza vaccine two years ago that contains four times the amount of antigen as a standard dose and has been shown to generate a more robust immune response, a strong indicator of possible protection. (Efficacy studies are underway.)  Designed for seniors, the high dose vaccine is included in the CDC’s Recommendations for Prevention and Control of Influenza and is covered by Medicare Part B.

So, the question remains, do we – as physicians – use this new option or stick with the same old, same old?  In my humble opinion, it doesn’t make sense to wait for additional data several years down the road when this FDA-approved vaccine is at hand and could better help stave off hospitalizations and potentially save lives among seniors right now.

Beyond high dose influenza vaccine, there are also delivery options to consider.  In the past few years, new devices, including a nasal spray vaccine and an intradermal vaccine with an ultra-fine needle, came to market.  The intradermal vaccine for adults 18 through 64 years of age features an ultra-fine micro-needle that is 90 percent shorter than the typical needle used for intramuscular injection. I suggest that this needle innovation may be an attractive option to adults who previously deferred immunization.

Finally, physicians are constantly under pressure to incorporate new systems (e.g., electronic health records) and the latest medicines into our practice.  But we can improve our efforts to increase influenza immunization rates and, thereby reduce, influenza-related hospitalizations and deaths. Further, offering the latest medical breakthroughs reflects favorably on the reputation of a health practice, which may attract a more diverse and robust patient population.

This flu season, I encourage my colleagues to offer influenza vaccine options to increase influenza vaccination amongst all patients.

William Schaffner is a professor and chairman of the Department of Preventive Medicine and professor of medicine in the Division of Infectious Diseases at Vanderbilt University School of Medicine.

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