Flu Vaccine – Who gives the shot?

According to CIDRAP, the recent National Influenza Vaccine Summit led to some heated discussion over where patients receive their flu vaccine – public health clinics, personal physician, or alternative vaccination sites such as grocery stores, workplaces, pharmacies. Some physicians argue that alternative sites leads to fragmentation of health care and steers patients away from their “medical home”

One of the basic problems is who gets vaccine early and who has vaccine left when flu peaks late in the season. Primary care physicians argue that the alternative sites get vaccine first and their patients are tempted to go elsewhere for vaccination. In 15 of the past 25 flu seasons in the U.S. flu peaked in February or March and it is hard to locate providers with vaccine late in the season.

The summit was attended by many participants in the vaccination process such as manufacturers, clinicians, and public health. Hopefully this type of discussion can lead to innovative methods to improve vaccination rates.

Flu Shots for Children

The CDC Advisory Committee on Immunization Practices made a broad new recommendation that all school age children receive influenza vaccine. This would increase vaccination coverage from the current recommendation of 6 months to 59 months and children with chronic medical conditions to cover all children from 6 months to 18 years. Another 30 million children would be included in this recommendation.

It is thought that children have a significant burden of disease and carry their illness to their household contacts to include parents and grandparents.

Last year the influenza associated pediatric mortality was 68. Influenza associated pediatric hospitalizations are also significant. In addition childhood influenza means lost school days and parent work days.

It will be interesting to see how this new recommendation changes the influenza statistics when fully implemented.

Universal Flu Vaccine

Last week Acambis announced positive results in their clinical trial of a new influenza vaccine that targets a conserved region of the influenza A virus. A successful vaccine such as this could end the need for yearly reformulation of the influenza vaccine and could be a vaccine for the next influenza pandemic.

Influenza remains a serious public health threat and currently vaccines must be changed yearly to follow virus mutations. As pointed out in Effect Measure, the recently released CDC 2005 Causes of Death show that influenza and pneumonia are serious causes of mortality in the U.S.
“Note that the first contagious disease to make an appearance on the list is influenza and pneumonia, at number eight. In fact it is the only contagious disease on the list of the top fifteen causes of death.”

A universal influenza vaccine has tremendous public health implications. It is good to see influenza vaccine research moving forward again even if it takes the threat of a pandemic to do so.

Why Flu Spreads in the Winter?

Influenza has remained a mystery in many respects but scientists have finally solved part of the question of why the disease spreads primarily in the winter. It seems that the virus is more stable and stays in the air longer when the air is cold and dry. Flu season in the northern hemisphere is usually from Nov. to March and in the southern hemisphere is usually from May until Sept. Some hypothesis about why this occurs have been:

• In the winter people are indoors spreading infection, however people are crowded together all year round.
• In the winter children are in schools spreading infection, however we don’t usually see flu in Sept., Oct., or May
• There is a decreased immune response in the winter.

The research done at the Department of Microbiology at Mt Sinai School of Medicine does more than just hypothesize. Their research using guinea pigs directly tests the effects of temperature and relative humidity on the transmission of influenza. It is great to finally see some research aimed at understanding the basics of this common infection which is responsible for 36,000 deaths and about 226,000 hospitalizations in the U.S. every year.

Flu Vaccine Works for Older Adults

Now that I am close to becoming a Medicare recipient , I am aware that I will be using a lot more healthcare resources than I did as a healthy young American. Even if I continue in good health, I will still be a great burden to the system. For that reason, I want to know if the resources I am using is money well spent. I was excited to learn that my yearly flu vaccine is worth the investment. A recent article in the New England Journal of Medicine “Effectiveness of Influenza Vaccine in the Community-Dwelling Elderly” studies show that vaccination reduces the risk of hospitalization for pneumonia and influenza by 27% and reduces the risk of death from any cause by 48% http://content.nejm.org/cgi/reprint/357/14/1373.pdf

Influenza vaccine does not usually produce the same immune response in an elderly person as in a young adult so I want data to confirm my belief in the effectiveness of my annual influenza vaccination. This study covered 18 cohorts of elderly people in the community for 10 flu seasons. Influenza vaccine has been a covered benefit under Medicare since 1993 however only about 2/3 of the elderly in the community are vaccinated. I hope this article serves to improve that statistic.
I would like the next study to be “Does blogging reduce the risk of Alzheimer’s Disease in the elderly?”