Outbreak highlights low flu vaccination rates

Even if history records the 2009-H1N1 influenza epidemic as mild, its appearance highlights the need to improve seasonal-flu vaccination rates among the elderly and the healthcare workers who take care of them, said speakers during a influenza symposium.

Vaccination rates among people aged 65 years and older have remained stagnant since the late 1990s, at about two thirds of that population, despite Medicare coverage of the influenza vaccine. For 2007-2008, 71.2 percent of people aged 65 years or older were vaccinated. The National Center for Health Statistics Healthy People 2010 has target of 90 percent for flu vaccinations.

The study of 393 ambulatory patients aged 65 years and older at three rural clinics in Mississippi found that 9.5 percent of the patients had never received an influenza vaccine and 4 percent had not had one for more than 10 years. Nearly all of the study participants reported their health as fair or good.

The reasons cited most frequently for not receiving a flu shot during the past year were the belief that there was no need (45 percent), having had a reaction to a previous injection (22 percent), or thinking that immunization caused the flu (15 percent).

None of the patients cited concerns about cost or undisclosed vaccine ingredients, although the latter concern has been recorded among low-income urban residents.

The overall immunization rate in the study was 73.5 percent, but the number was significantly higher among patients who received postcard reminders and whose nurse practitioner had received and shared a fact sheet on influenza than among patients who were not exposed to either intervention.

Giving reminders and information is a simple, very cost-effective strategy. Health care provider recommendations go a long way toward improving vaccination behaviors. In one study, a provider’s recommendation was one of the strongest independent predictors of whether a patient at high risk would be vaccinated.

Symposium moderator took aim at the other side of the equation, stressing the need for all healthcare workers and volunteers with patient contact to be vaccinated each fall and during a community outbreak. Increased vaccination rates reduce lost work days and errors made by workers filling in for absent colleagues.

Currently, fewer than half of all healthcare workers are vaccinated. In 2007-2008, 41.8 percent of healthcare workers were vaccinated, well below the Healthy People 2010 goal of 605 for this group.

Healthcare workers may come to work with influenza because they are asymptomatic, disregard symptoms because of a misdirected work ethic, or unaware that they pose a danger to their patients. This last point may be surprising.