Physicians Leading the Way in Flu Vaccinations

Miriam E. Tucker

September 26, 2013

Washington, DC — Influenza immunization rates have risen impressively among many US demographic groups with an "extraordinary" 92.3% of physicians setting the example by getting vaccinated, new data from the Centers for Disease Control and Prevention (CDC) demonstrate.

"I'm really excited to say that today I have some good news. Last season, more people were vaccinated against influenza in the United States than in previous seasons," Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, said in a press briefing here sponsored by the National Foundation for Infectious Diseases.

Some of the findings were published September 26 in the CDC's Morbidity and Mortality Weekly Report, and all the data are available at the CDC Web site.

Howard K. Koh, MD, assistant secretary for health, US Department of Health & Human Services, noted that the government is now promoting immunization with the launch of the Affordable Care Act, which mandates full coverage of all recommended vaccines in all healthcare plans, both governmental and private.

"We don't want cost to be a barrier to prevention," said Dr. Koh, who demonstrated his allegiance to the cause by receiving a flu vaccine in front of the audience.

"Good News" on Influenza Vaccination

Dr. Schuchat presented the new numbers. In the 2012-2013 season, 56.6% of children aged 6 months through 17 years received the influenza vaccine, up 5.1 percentage points from 2011-2012. Among adults, the 41.5% vaccinated in 2012-2013 represents a 2.7 percentage point increase from the previous year.

There was significant variation by state, with an overall 38 percentage point difference between the top and bottom states. Rhode Island scored the highest immunization rate among children, at 82%, whereas South Dakota topped the states for adults, at 53%.

"We have a lot of room for improvement in adult vaccination all around, including in influenza, but we did do better this past season than in previous years," Dr. Schuchat said.

Disparities by race persist among adults, with whites and Asians having influenza vaccination rates of about 10 percentage points higher than Hispanic and black adults. Those differences aren't seen in children, though. "Kids are doing better all around," she observed.

Data on pregnant women were derived from a general-population Internet survey of 1702 women who were pregnant at any point during October 2012 through January 2013. Overall, 50.5% were vaccinated last season. "I want to congratulate our obstetricians, nurse midwives, and family physicians, who really took the challenge…We've really changed the social norm in pregnancy care," Dr. Schuchat commented.

Indeed, clinicians played a major role for pregnant women in particular. Among women who reported that their healthcare provider had both recommended the vaccine and offered it in the office or clinic, 70.5% were vaccinated. When the clinician recommended the vaccine but didn't offer it on-site, 46.3% were vaccinated. But, when the provider neither recommended nor offered the vaccine, just 16.1% received the vaccine.

"Pregnant women really look to their caregivers for advice to protect themselves and their baby. And we know clinician recommendation is a key influencer," Dr. Schuchat said.

High Rates Among Physicians

Data for healthcare personnel were also obtained via Internet survey, this time recruited from Medscape's membership roster. Among physicians, an "extraordinary" 92.3% received the influenza vaccine in 2012-2013, up from 85.6% in 2011-2012 and 84.2% in 2010-2011.

Pharmacists came close, at 89.1%, followed by nurse practitioners/physician assistants, at 88.5%. However, the flu vaccination rate among nonclinical personnel, including administrative support staff, food service workers, and housekeeping, was just 64.8%. "That's better than the [overall] population, but we really want everyone working around patients to be vaccinated," Dr. Schuchat said.

Even worse, just 58.9% of long-term care facility staff members had been vaccinated. "We have not made progress in this population," where evidence for the value of vaccinating caregivers is strongest and the population the most vulnerable, she said, noting that vaccine cost and lack of on-site access might be subpar in these settings.

Available for the first time this year are injectable and intranasal quadrivalent vaccines, as well as egg-free and cell-culture-derived options. And, for the last couple of years, a high-dose vaccine has been available for the over-65 population. The CDC doesn't recommend one vaccine over another. "The most important thing is to get vaccinated," Dr. Schuchat remarked.

Vaccine companies expect to produce at least 135 million doses this season, and have already distributed 73 million doses, she added.

Another recent development, Dr. Koh said, was the National Vaccine Advisory Committee's recommendation for new national adult immunization standards, which call upon "all providers, not some, to bear responsibility to ensure that adults receive the immunizations they need."

There are now 10 vaccines recommended for adults, including influenza, zoster, and tetanus-diphtheria pertussis, he noted, adding that "flu vaccination represents an opportunity to assess needs for other vaccines as well."

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