| The history
of influenza and the critical need and
recommendation for this vaccine may not
be fully appreciated by the public –
as well as many health professionals.
Each year, an estimated 5 to 20 percent
of all Americans--15 to 59 million people--contract
influenza.
Complications of influenza include bacterial
pneumonia, dehydration, and worsening
of chronic conditions, such as asthma,
diabetes, and congestive heart failure.
Epidemics of influenza typically occur
during the winter months in temperate
regions and have been responsible for
an average of approximately 36,000 deaths/year
in the United States during 1990-1999.
Influenza viruses also can cause pandemics,
during which rates of illness and death
from influenza-related complications can
increase worldwide. The influenza pandemic
of 1918-1919 killed more people than World
War I, at somewhere between 20 and 40
million people, making it the most devastating
epidemic recorded in world history. Influenza
viruses cause disease among all age groups.
Rates of infection are highest among children,
but rates of serious illness and death
are highest among persons aged greater
than 65 years and persons of any age who
have medical conditions that place them
at increased risk for complications from
influenza.
The annual direct medical costs of influenza
are estimated at up to $4.6 billion. Total
direct and indirect costs (such as lost
work or school days) of a severe flu epidemic
are at least $12 billion. Influenza vaccine
is cost effective. Cost of treatment for
influenza-like illnesses including office
visits, tests, procedures and medications
was estimated to be $145 per case. But
the cost of delivering the influenza vaccine
was estimated to be just $16.70 per person
vaccinated, including direct and indirect
medical costs as well as costs associated
with potential side effects.
Influenza vaccination is the primary
method for preventing influenza and its
severe complications. In a report from
the Advisory Committee on Immunization
Practices (ACIP) the primary target groups
recommended for annual vaccination are
1) persons at increased risk for influenza-related
complications (e.g., those aged greater
than or equal to 65 years and persons
of any age with certain chronic medical
conditions); 2) persons aged 50 to 64
years because this group has an elevated
prevalence of certain chronic medical
conditions; and 3) persons who live with
or care for persons at high risk (e.g.,
healthcare workers and household contacts
who have frequent contact with persons
at high risk and who can transmit influenza
to those persons at high risk).
One third of all Americans age 50 to
64 have one or more medical conditions
that make them at increased risk for serious
flu complications. Prevalence of influenza
vaccinations varies substantially by race.
Among adults 50-64, non-Hispanic whites
were 8.1 percent more likely than non-Hispanic
blacks and 8.2 percent more likely than
Hispanics to have been vaccinated. For
adults 65 and older, non-Hispanic whites
were 18.4 percent more likely than non-Hispanic
blacks and 13.2 percent more likely than
Hispanics to have received an influenza
vaccination.
Vaccination is associated with reductions
in influenza-related respiratory illness
and physician visits among all age groups,
hospitalization and death among persons
at high risk, otitis media among children,
and work absenteeism among adults. Influenza
vaccines can prevent up to 60 percent
of hospitalizations and 80 percent of
deaths from influenza-related complications
among the elderly.
Although influenza vaccination levels
increased substantially during the 1990s,
further improvements in vaccine coverage
levels are needed, chiefly among persons
aged less than 65 years who are at increased
risk for inlfuenza-related complications
among all racial and ethnic groups, among
blacks and Hispanics aged greater than
or equal to 65 years, among children aged
6 to 23 months, and among healthcare workers.
ACIP recommends using strategies to improve
vaccination levels, including using reminder/recall
systems and standing orders programs.
For adult immunization clinical practice
guideline see:
Adults:
http://www.cdc.gov/nip/recs/adult-schedule.htm
Also: http://www.cdc.gov/mmwr/preview/mmwrhtml/00025228.htm
Influenza:
http://www.cdc.gov/mmwr/preview/mmwrhtml/00023141.htm
However, this measure has been simplified
compared to the practice guideline, and
made congruent to the HEDIS measure, by
eliminating the 19-49 year old group for
which there are additional risk-specific
inclusion criteria. All adults 50+ should
be receiving influenza vaccine.
For more information on the measure specific
to 50-64 year old adults see:
http://www.ncqa.org/Docs/SOHCQ_2005.pdf
(page 42)
http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?doc_id=468
http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?doc_id=7789
This measure is also in the Health Disparities
Collaborative, Prevention Pilot, Measure
#11 http://healthdisparities.net/hdc/html/collaboratives.topics.prevention.asp
This is an important measure of well
adult care systems including consumer
health education, professional education,
outreach, reminder and recall systems,
and use of standing orders. |
