Healthcare Infection Prevention: Special focus: Vaccines
Flu news: More money, nasal delivery this season
Forget shots; play misty for me
Increased reimbursement, a new nasal delivery system, and the lingering shadow of severe acute respiratory syndrome (SARS) should combine to make for a memorable 2003-2004 flu vaccination season. Public health officials are expected to recommend flu shots with a little more urgency then normal because of the possible resurgence of SARS.
In addition, many health care providers may not be aware that there is a 94% average increase in payment rate for influenza and pneumococcal vaccine administration this year. Providers also are entitled to separate payments for the cost of the vaccines. The national average fee paid by Medicare for administering the flu vaccine went up to $7.72 on March 1, 2003, compared to a national average of $3.98 for the previous year.
Actual amounts vary geographically. However, during the National Vaccine Summit held earlier this year in Chicago, it became clear that relatively few physicians and other providers were aware of the new, higher payment rate for vaccine ad-ministration. The Centers for Disease Control and Prevention (CDC) has begun an educational campaign to rectify the situation.
"The additional incentive of an increased payment rate for vaccine administration is an important development that will help physicians make influenza vaccination a priority," says Walter Orenstein, MD, director of the national immunization program at CDC.
In another development, the Food and Drug Administration (FDA) recently approved FluMist, the first nasally administered flu vaccine to be marketed in the United States. It also is the first live virus influenza vaccine approved in the United States. The new nasal vaccine is manufactured by MedImmune Vaccines Inc. of Gaithersburg, MD. It will be marketed by MedImmune and Wyeth Inc. in Philadelphia. The nasal vaccine is approved to prevent influenza illness due to influenza A and B viruses in healthy children and adolescents, ages 5-17, and healthy adults, ages 18-49. Children ages 5 to 8 need two doses at least six weeks apart in their first year of influenza vaccination with FluMist, and individuals 9 to 49 need one dose.
The new vaccine provides another option for protection against influenza and potentially will increase the availability of the injected killed virus vaccine for those people at highest risk, according to the FDA. "Having enough supplies of flu vaccine available has sometimes been a challenge because there are few manufacturers; the vaccine needs to be changed every year; and certain strains of the virus grow slowly during the vaccine development process," says Mark McClellan, MD, PhD, FDA commissioner. "In addition, for those people who are eligible for the new vaccine and are reluctant to get a shot, such as healthy children over the age of 5, the availability of FluMist will be especially welcome."
The vaccine is formulated to contain each of the three influenza virus strains recommended by the U.S. Public Health Service for the 2003-2004 influ-enza season: two strains of influenza A, which causes the most severe and widespread outbreaks, and one strain of B, which usually causes a more mild illness. However, unlike these circulating virus strains, the strains of live virus in the vaccine are modified so they do not grow well at body temperature but replicate enough to induce protective immunity. In clinical trials, FluMist was evaluated in 20,228 individuals, including more than 10,000 healthy children 5 to 17. The efficacy of the vaccine in preventing influenza was approximately 87% among children in the trial. As with other live virus vaccines, the nasal vaccine should not be given for any reason to those with immune suppression, including immune deficiency diseases, such as AIDS or cancer, and people who are being treated with drugs that cause immunosuppression.
Increased reimbursement, a new nasal delivery system, and the lingering shadow of severe acute respiratory syndrome (SARS) should combine to make for a memorable 2003-2004 flu vaccination season.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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