State-Specific Influenza Vaccination Coverage Among Adults — United States, 2006-07 Influenza Season

PJ Lu, PhD; GL Euler, DrPH; GT Mootrey, DO; F Ahmed, MD, PhD; KG Wooten, MA


Morbidity and Mortality Weekly Report. 2008;57(38):1033-1039. 

In This Article

Editorial Note

Compared with the previous season, influenza vaccination coverage significantly increased during the 2006-07 season among all adult groups for whom vaccination is recommended, but has not yet matched 2003-04 season coverage nor achieved the Healthy People 2010 target of 60% for persons aged 18-64 years with high-risk conditions and 90% for persons aged ≥65 years.

During the 2004-05 season, one influenza vaccine manufacturer was unable to supply any vaccine to the United States, which reduced the expected supply of trivalent inactivated influenza vaccine by nearly half. In response to the shortage, CDC recommended that healthy persons aged 50-64 years without high-risk conditions not be a priority group for influenza vaccination during that season. Compared with the 2003-04 season, influenza vaccination coverage levels declined by approximately half in this group, to 21.8%; however, coverage also declined among adults for whom vaccination continued to be recommended during the shortage season. During the 2005-06 season, the vaccine supply was adequate, but distribution of vaccine from one manufacturer was delayed, and vaccination coverage only partially rebounded. During the 2006-07 season, the vaccine supply was sufficient, distribution was not delayed, and vaccination coverage further increased to levels nearly equal to those achieved before the shortage. However, the coverage rebound for persons aged 50-64 years without high-risk conditions was weaker than for other groups. Targeted communications efforts might be appropriate for persons in this population group who might believe they are not recommended for vaccination (and their health-care providers).

The gap in vaccination coverage between whites and other racial/ethnic groups remained essentially the same for the 2005-06 and 2006-07 seasons, except for Asians, for whom the racial/ethnic gap was eliminated. Veterans Administration clinics also eliminated racial/ethnic disparities in influenza vaccination among older adults by using multimodal programs. These include standing orders, patient reminders, freestanding vaccination clinics, assessment of vaccination rates with feedback, and incentives to clinicians to improve influenza vaccination coverage.[5]

NHIS results for the two most recent influenza seasons indicate that approximately 84% of all influenza vaccinations were administered during September-November.[6] Health-care providers, health departments, and community vaccinators should offer influenza vaccine routinely as soon as it is available and throughout the entire influenza season.

CDC compared the results with estimates from the 2007 National Health Interview Survey (NHIS). NHIS is a national household survey conducted annually with a face-to-face interview method. Estimated influenza vaccination coverage from the 2007 NHIS was lower than that from BRFSS for all age groups examined (i.e., 25.5% among persons aged 18-49 years with high-risk conditions, 36.0% among persons aged 50-64 years, and 65.6% among persons aged ≥65 years).[1] The NHIS estimates, all lower than the BRFSS estimates in this report, might reflect the fact that BRFSS is limited to landline telephones. NHIS data indicate that persons with landline telephones have higher influenza vaccination rates than persons living in households without landline telephones.[1,7]

The findings in this report are subject to at least three other limitations. First, self-reported influenza vaccination status is subject to recall bias. Second, persons with certain high-risk conditions (e.g., emphysema, bronchitis, cancer, kidney diseases, and neurologic conditions that impair lung function) identified by ACIP were not ascertained by the survey. Finally, sample sizes for blacks and Hispanics were relatively small, which limited comparisons by age and racial/ethnic groups at state levels.

To further increase influenza vaccination coverage among all adults, health-care providers should recommend influenza vaccination in accordance with ACIP recommendations throughout the influenza season. Standing orders for vaccination should be implemented in various settings, and reminder and recall systems for patients and providers should be incorporated into medical practices and facilities that routinely provide vaccinations to adults.[8,9,10]


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