’Tis the season for flu — so who gets the first shot?
A delay in production of flu vaccine this year means pharmacists need to prioritize who gets the shots earliest and who can wait. Identifying at-risk patients to the medical team will help provide protection for a large number of patients.
Heading the list of at-risk patients are the elderly, pregnant women, and chronically ill children. The need for 75 million doses is anticipated for the 2000-2001 flu season, with an estimated 18 million doses planned for distribution during December. While the optimal time to give the vaccine is October through mid-November, administration of the vaccine should continue well into December to people at high risk for influenza complications.
That's a big change from last year. According to the Centers for Disease Control (CDC; Atlanta), 77 million doses of flu vaccine were distributed, with 3 million doses returned to suppliers.
Vaccination of patients older than 65 substantially reduces morbidity and mortality associated with influenza. According to CDC data, for each million elderly people vaccinated, approximately 900 deaths and 1,300 hospitalizations are prevented during the average flu season. The average flu season brings with it approximately 20,000 deaths and 110,000 pneumonia and influenza hospitalizations resulting from influenza infection. A high percentage of each of these figures occurs in patients older than 65.
Because of the health impact of delayed flu vaccine availability, the CDC and the Advisory Committee on Immunization Practices (ACIP) have updated recommendations for this year's flu season.
The CDC and ACIP also advise that when the vaccine is available, efforts to vaccinate be focused on those at high risk for influenza and on health care workers who care for these people. Because vaccine supply is expected to increase substantially in December, high-risk people and health care workers should plan to be vaccinated into December and later. Efforts to vaccinate those who are not at high risk but are between the ages of 50 and 64, should begin in December and continue as long as vaccine is available. Mass vaccination efforts have already been under way. Many patients seeking vaccine have found that obtaining it at their local pharmacy is not only more feasible (based on availability), but is also less expensive than receiving the vaccine at their physicians’ offices.
Use opportunity for pneumonia protection
ACIP recommends pneumococcal vaccines for many of the same patients who are at high risk for influenza complications. Annual flu vaccination provides an opportunity to administer pneumococcal vaccine to these patients, but it is not a substitute for the flu vaccine. With this year’s delay in availability of flu vaccine, many adults who do not receive the flu vaccine may be especially susceptible to secondary bacterial pneumonia, which is a major complication of influenza and can be life-threatening. Pneumococcal vaccine can provide protection against secondary bacterial pneumonia.
Updated ACIP info for the 2000-2001 influenza season
People at high risk for complications from influenza are:
• people older than 65;
• residents of nursing homes and other chronic-care facilities that house people of any age who have chronic medical conditions;
• children and adults who have chronic disorders of the pulmonary or cardiovascular systems, including asthma;
• children and adults who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunosuppression (e.g., caused by medications or human immunodeficiency virus);
• people ages 6 months to 18 years who are receiving long-term aspirin therapy and therefore might be at risk for developing Reye syndrome after influenza;
• women who will be in the second or third trimester of pregnancy during the influenza season.
(Source: MMWR Oct. 6, 2000; 49(39):888-92, available from www.cdc.gov.)
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