National Advisory Committee Recommends Changes to Flu Shot Program

    September 2005 - To avoid some of the confusion and missed opportunities that accompanied vaccination efforts during last year's flu season, shots should be offered this year throughout the community and at every medical visit, according to new recommendations by the federal vaccine advisory committee.

    Health care providers who dispense the vaccine should also be better compensated for their purchases to offset the financial risk involved in buying up quantities of a vaccine that may or may not be used each season, the committee suggests. Their recommendations are published in the latest issue of the American Journal of Preventive Medicine.

    More Americans are vaccinated for flu every year than for any other disease, says the committee's influenza working group head Charles Helms, M.D., of the University of Iowa Hospital and Clinics, but there are still numerous opportunities for flu prevention.

    "Every contact with the health care system should be used as an opportunity to vaccinate," Helms says.

    After the 2004-2005 flu season, the Department of Health and Human Services asked the advisory committee to convene a special working group to find ways to improve the vaccination effort. The group came up with several recommendations to boost flu prevention:

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    • In the past few years, flu vaccines have been offered in nontraditional settings such as workplaces, churches and shopping malls, an approach that should be expanded, the working group says.
    • Health care providers should be better compensated by insurance plans for flu vaccination costs, the group concludes. One recent study suggests that physicians may lose between $3.36 and $32.76 per flu shot, compared to average Medicare immunization reimbursements.
    • The United States needs to develop a coordinated effort, similar to the federal Vaccines for Children program, to vaccinate poor and uninsured adults, the group says.
    • The group strongly recommends that health care workers get a yearly flu vaccine. Despite years of research showing that vaccinated workers take fewer sick days and can help lower death rates in their patients, only 38 percent of health care workers were vaccinated in 2001.

    Researchers and policymakers should also take a closer look at the potential benefits of expanding vaccination efforts to include school-age and younger children. In 2002, the American Academy of Pediatrics and other groups began encouraging flu vaccinations for children ages 6 to 23 months.

    The Academy's recommendation "is based on the fact that young children, less than 2 years old, have rates of complications and hospitalization similar to those of adults older than 65," explains Jos L. Muoz, M.D., chief of pediatric infectious diseases at Maria Fareri Children's Hospital, and professor of pediatrics, microbiology and immunology at New York Medical College.

    "Children who are allergic to eggs or who have a fever should not receive the vaccine," Muoz says. "Otherwise, the vaccine is remarkably safe and effective and reduces the burden of influenza disease in infants."

    In a second study in the journal, Mary Patricia Nowalk and colleagues at the University of Pittsburgh Schools of Medicine and Public Health examined flu vaccinations among young children at inner-city clinics. The researchers found that a doctor's recommendation to vaccinate was the most important deciding factor for whether children got immunized against flu.

    "A clear message that the doctor recommends influenza vaccination for a child is an important factor for ensuring vaccination, and may foster the idea that vaccination is smart,'" Nowalk and colleagues say.

    New methods of delivering the vaccine, such as nasal mists or skin patches will be essential, "given that traditional vaccination delivery using needle and syringe may be unwieldy and unpopular in school-aged population," Helms observes.

    None of the recommendations directly addresses the problem of vaccine shortages, or how to make sure that the season's vaccine correctly matches the season's particular flu variety, Helms acknowledges.

    However, the recommendations "would have a major and positive impact on vaccine supply, uptake and investments in new vaccines and technologies," he says.

    The Nowalk study was supported by the Centers for Disease Control and Prevention, the Association of Teachers of Preventive Medicine and the EXPORT Health Project at the Center for Minority Health, University of Pittsburgh Graduate School of Public Health.

    • Helms CM, et al. Strengthening the nation's influenza vaccination system: a National Vaccine Advisory Committee Assessment. Am J Prev Med 29(3), 2005.
    • Nowalk MP, et al. Parental perspectives on influenza immunization of children aged 6 to 23 months. Am J Prev Med 29(3), 2005.

    Source: American Journal of Preventive Medicine

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