Each year, the flu causes an average of about 36,000 excess deaths and over 200,000 hospitalizations in the US.1,2 Much of this morbidity and mortality is preventable, yet each year, a large proportion of those for whom the vaccine is recommended go unvaccinated (TABLE 1).
TABLE 1
High-risk groups who went unvaccinated with influenza vaccine (2005)
| POPULATION GROUP | PROPORTION UNVACCINATED |
|---|---|
| Household contacts of those at high risk | 83%–91% |
| Pregnant women | 84% |
| Patients, ages 50–64 years | 77% |
| Patients, ages 6–23 months | 67% |
| Those with high-risk medical conditions | 66%–82% |
| Health care workers | 64% |
| Patients, ages ≥65 years | 40% |
Improving rates among health care workers
The recommendations of the Centers for Disease Control and Prevention (CDC) for the 2007–2008 influenza season include a new recommendation that targets health care worker vaccination rates.3 Because of the low rate of vaccination of health care workers, and the potential impact of higher coverage on both worker and patient safety, the CDC now recommends that the level of vaccination coverage be used as one measure of a facility’s patient safety quality program. The CDC also recommends the implementation of policies to encourage acceptance of the vaccine, such as requiring those caregivers who refuse immunization to sign waivers.
Improving rates among patients
To improve vaccination levels among patients, the CDC recommends:
- using reminder/recall systems
- using standing order programs
- administering the vaccine before and during the influenza season to patients during routine health care visits.
For more on improving vaccination coverage, see “Tips to help improve vaccination rates”.
Offer the vaccine to anyone who wants it
While the groups for whom vaccine is recommended are the same as last year (TABLE 2), this year the CDC is emphasizing the importance of:
- offering the vaccine to anyone who wants to reduce their risk of contracting influenza or transmitting the virus to others.
- continuing to offer vaccine to those susceptible throughout the flu season.
A minor change from last year’s recommendations involves children who are 6 months through 8 years of age who receive only 1 dose of vaccine their first year of vaccination. The CDC now recommends that these children receive 2 doses the next year. If they receive only 1 dose 2 years in a row, the CDC recommends only a single dose annually thereafter.
TABLE 2
Who should receive the influenza vaccine?
| Anyone who wants to reduce their risk of contracting the flu or transmitting the virus to others People at high risk for complications from the flu, including:
|
The 2 vaccines: How they differ
The same 2 vaccine types are available this year as last: trivalent influenza vaccine (TIV) and live attenuated influenza vaccine (LAIV). The vaccines include the same viral strain antigens and either can be used annually unless contraindicated (TABLE 3).
The major differences between the 2 vaccine types are:
- LAIV is administered as an intranasal spray while TIV requires an intramuscular injection
- LAIV is approved only for healthy people who are 5 to 49 years of age, whereas TIV is approved for anyone over the age of 6 months
- The interval between 2 doses in children under 9 years of age is 4 weeks for TIV and 6 to 10 weeks for LAIV
- LAIV should not be administered to family members or close contacts of those who are immunosuppressed and require a protective environment, while TIV can be used in this situation
- LAIV, being a live virus vaccine, should be administered simultaneously with, or 4 weeks after, the administration of other live virus vaccines. TIV is not a live virus vaccine, and its timing in relation to other live virus vaccines is not an issue.
TABLE 3
Contraindications and precautions for influenza vaccines
| TIV trivalent influenza vaccine |
| ||
| LAIV live attenuated influenza vaccine |
| ||