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CDC Tells Health Care Providers to Get Their Flu Vaccinations

Kate Traynor

A public health campaign that was unveiled yesterday to protect more Americans from the flu and its complications included a plea for health care professionals to get their annual influenza vaccination.

"Health care workers may not be at risk for severe complications, but they can pass the flu virus on to somebody else under their care," said Julie Gerberding, director of the Centers for Disease Control and Prevention (CDC). "So this year, we're putting a special emphasis on immunization of health care personnel and others" involved in the care of those who are vulnerable to influenza-related complications, she said.

Gerberding was one of several speakers at a press conference in Washington, D.C., sponsored by the National Foundation for Infectious Diseases and the National Coalition for Adult Immunization.

In past years, American Medical Association President Donald Palmisano told the audience, the bulk of health care professionals have not received an annual influenza shot.

"Only 38 percent of health care professionals are getting vaccinated for the flu," Palmisano said. "That's an alarmingly low number, especially when you consider the CDC recommendations that all health care professionals receive the influenza vaccine."

National Foundation for Infectious Diseases Chairman William Schaffner praised pharmacists and other "nontraditional providers" of immunization services who have sought and received authorization from state licensing boards to administer influenza and pneumococcal immunizations. Many patients, Schaffner said during yesterday's press conference, "are now seeking out these immunizations" in supermarkets and other sites outside of the physician's office.

Palmisano said that, in addition to protecting patients, the vaccination of health care workers "cuts down on frustrating problems such as sick days away from work." He emphasized that flu-related absenteeism among unvaccinated hospital workers could be catastrophic if it coincided with another public health threat in the community, such as the appearance of severe acute respiratory syndrome.

Gerberding said that complacency about the risks of influenza is a problem in this country.

"People fail to appreciate how important and how serious influenza really is," she said. Gerberding emphasized that influenza-related disease is responsible for more than 36,000 deaths and 114,000 hospitalizations on average each year in the United States.

Kristin Nichol, chief of medicine at the Minneapolis VA Medical Center, described influenza as "the single leading cause of death from any vaccine-preventable disease" in the United States. Because influenza is associated with an increased risk of death from all causes, Nichol said that getting an annual influenza vaccination would produce "a large and virtually immediate effect on death rates."

Although the past two flu seasons have been mild, Nancy Cox, chief of CDC's Influenza Branch, warned that influenza A (H3N2), a viral strain that is associated with increased illness and death, may be the predominant strain this season.

According to CDC, current rates of influenza vaccine coverage fall below national benchmarks that call for 90 percent of noninstitutionalized seniors and 60 percent of adults age 18–64 years who are at high risk for influenza-related complications to receive the vaccination each year by 2010.

"Among people age 65 and older, only about two in three end up vaccinated," Gerberding said. "In some populations, in particular African Americans and Hispanics...we've achieved even lower immunization rates. And in some cases, the rate is dropping."

CDC's new outreach program includes what Gerberding called a free, "comprehensive toolkit" available at the agency's Web site. The toolkit includes posters and informational flyers for health care providers and patients. Some materials are available in both English and Spanish.

A recent change in federal reimbursement rates could help boost influenza vaccination rates among seniors and others covered by Medicare Part B. For the 2003–2004 flu season, the Centers for Medicare & Medicaid Services (CMS) increased the administration fee (PDF) for influenza vaccination—along with vaccination for pneumococcal pneumonia and hepatitis B—to $7.72, a near doubling of last season's rate. Payment for the flu vaccine was likewise increased to $9.95 per dose, and pneumococcal vaccine was raised to $18.62 per dose.

"We recognize the vital importance of making sure that there are no barriers to [vaccinating] Medicare beneficiaries," said William Rogers, a medical officer for CMS. "There's no financial reason that every Medicare beneficiary shouldn't take advantage of this benefit...and get vaccinated."

Rogers said later that CMS will not reimburse health care providers for the administration of FluMist, MedImmune Inc.'s recently approved intrasasal flu vaccine.

"FluMist was approved for healthy people five to 49 years old, and these people would not be Medicare beneficiaries," Rogers explained.

According to CDC, health care providers who may come into contact with immunocompromised people should receive the traditional inactivated influenza vaccine instead of FluMist, which contains live attenuated virus.

Palmisano encouraged employers in the health care industry to take steps to increase influenza vaccination rates among employees, such as providing the vaccine at no cost and scheduling work-site vaccination clinics for employees.

"If we want vaccination rates to go up, health care employers must embrace these ideas to convey the importance of the vaccine to their employees," he said.