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 care workers who take care of them, said speakers during an 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, said geriatric nurse practitioner., during the annual meeting of the American Society of Geriatrics. For 2007-2008, 71.2% of people aged 65 years or older were vaccinated. The National Center for Health Statistics Healthy People 2010 has a target of 90 percent for flu vaccinations.

Study of 393 ambulatory patients aged 65 years and older at three rural clinics in Mississippi found that 9.5% of the patients had never received an influenza vaccine and 4% 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%), having had a reaction to a previous injection (22%), or thinking that immunization caused the flu (15%), said a nursing professor at the University of South Alabama in Mobile. 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%, 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,” observed. “ I received reminders from my gynecologist when it’s time for me to get a mammogram, postcard reminders from my dentist for my annual check-up, and reminders from my veterinarian for my dog to be immunized, but I’ve never received a reminder from any primary care provider telling me it’s time to have an annual immunization, particularly influenza.”

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 health care workers and volunteers with patient contact to be vaccinated each fall and during a community outbreak. Increased vaccination rates reduce lost work days errors made by workers filling in for absent colleagues.

Currently, fewer than half of all health care workers are vaccinated, said, medical director of Tockwotton Home, Providence R.I., and clinical director of Quality Partners of Rhode Island. In 2007-2008, 41.8% of health care workers were vaccinated, well below the Healthy People 2010 goal of 60% for this group.

Health care workers may come to work with influenza because they are asymptomatic, disregard symptoms because of a misdirected work ethic, or be unaware that they pose a danger to their patients.

This last point may be surprising, but he recalled a recent conversation with a nurse whose son was feverish after returning from Mexico. She wasn’t sure it was necessary for him to see a doctor.

“We believe that often in nursing homes where we have outbreaks that the original vector is a health care worker.”