September 2000 • Volume 6 • Number 9
Immunization update: PPV and influenza
When it comes to adult immunizations, the pneumococcal polysaccharide vaccine gets no respect. And while patients generally know to seek out an annual flu shot, they may not find it so easy this year as distributors deal with a vaccine shortage.
Counsel patients about once-in-a-lifetime PPV
The AAFP Commission on Clinical Policies and Research has conducted an in-depth literature review followed by focus groups with physicians and patients to identify reasons for the low PPV immunization rates. Barbara Yawn, M.D., of Rochester, Minn., a commission member, says the AAFP hopes to help family physicians overcome those barriers to protect patients against bacterial pneumonia.
The Academy recommends that FPs discuss the immunization with all patients who are aged 65 years and older and with high-risk patients. Yet only 54 percent of adults 65 and older had received the immunization by 1997, the most recent year with available statistics. So why aren't people getting the vaccine?
AAFP influenza immunization prioritization policy
The AAFP Board recently approved a new policy recommending prioritization of the influenza immunization in the event of a shortage. The policy:
The American Academy of Family Physicians recommends that those individuals at highest risk for influenza should be given priority to receive the influenza vaccine. These include individuals who have medical conditions that put them at increased risk, including chronic cardiopulmonary disorders and metabolic diseases including diabetes mellitus, hemoglobin-opathies, immunosuppression and renal dysfunction; those who are residents of chronic care facilities; and health care providers, followed by other individuals aged 65 years and older, then by individuals aged 50 years and older.
"The primary barrier for everybody seems to be awareness," said Yawn. "There's just not a sense that this is a big deal." In fact, pneumococcal infections are the most common cause of bacterial pneumonia requiring hospitalization in the United States and result in about 40,000 deaths annually (twice the number caused by influenza).
In addition to a general lack of awareness about the PPV, people also think they're safe as long as they get an annual flu shot, Yawn said. "I think they may have the misperception that you get the flu first, and then you get pneumonia."
Another barrier is patients' sense that they're not at risk for pneumonia. Patients who are institutionalized; have chronic cardiac or pulmonary disease, diabetes or anatomic asplenia; or live in areas with an increased risk of pneumococcal disease should definitely receive the vaccine, Yawn said. "But there are some pretty clear indications that otherwise healthy people over 65 should get it, too."
Patients cite cost as another impediment, but Medicare covers the PPV for patients 65 and older, and insurance plans may cover it for younger patients if it's deemed appropriate.
Yawn said every adult patient's chart should include an immunization page, which can be quickly reviewed to ensure that the once-in-a-lifetime PPV has been administered. (Some patients require a booster.)
The new "Periodic Health Examinations: Summary of AAFP Policy Recommendations and Age Charts" includes recommendations for the PPV, as well as tools such as flow charts. They're free; just call the AAFP order department at (800) 944-0000 and request item #R962, or check them out at http://www.aafp.org/exam on the Academy's Web site.
"Just like with children, you can't always count on elderly people coming in for a well visit or a preventive care visit," Yawn said. "You have to take advantage of other opportunities. If they come in for something that is not life-threatening and you deal with their concerns, they'll talk to you about other things that need to be done."
Yawn said the AAFP is studying ways to help FPs incorporate the PPV into their care of older patients. She encouraged physicians to share their success stories by sending a letter to Bellinda Schoof, AAFP scientific affairs manager, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672.
Flu vaccine in short supply
Anticipating a shortfall of this year's influenza vaccine, the CDC's Advisory Committee on Immunization Practices has issued recommendations regarding flu immunization efforts.
The recommendations are published as a "notice to readers" in the CDC's July 14 Morbidity and Mortality Weekly Report. Read it at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4927a4.htm online.
"For the 2000-01 influenza season in the United States, lower than anticipated production yields for this year's influenza A(H3N2) vaccine component and other manufacturing problems are expected to lead to a substantial delay in the distribution of influenza vaccine and possibly substantially fewer total doses of vaccine for distribution than last year," the article says.
Noting that many vaccine providers are planning their fall vaccination activities, the ACIP offers the following recommendations:
- Delay implementation of organized influenza vaccination campaigns until early or mid-November.
- Continue routine vaccination of people who are at high risk for complications from influenza and their close contacts.
- Develop a provider-specific contingency plan for an influenza shortage in order to maximize vaccination of high-risk patients and health care workers with available vaccine.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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