For Patients With Asthma, Flu Vaccine Coverage Falls Short

When it comes to immunizing people with asthma against influenza, there's plenty of room for improvement. That's according to an article in the June 20 issue of Morbidity and Mortality Weekly Report, or MMWR, that assessed specific aspects of influenza vaccination coverage during the 2005-2006 influenza season.

The article, "Influenza Vaccination Coverage Among Persons with Asthma -- United States, 2005-06 Influenza Season," reported that only 36.2 percent of people with asthma received an influenza vaccine during the 2005-2006 flu season. That percentage is well below the Healthy People 2010 influenza vaccination target of 60 percent coverage of adults ages 18-64 with high-risk conditions.

The CDC's Advisory Committee on Immunization Practices, or ACIP, recommends influenza immunizations for all people with asthma, regardless of severity, because they are at higher risk for severe flu-related complications. In these patients, the ACIP recommendations note, trivalent inactivated influenza vaccine should be used.

The MMWR report used data from the 2006 National Health Interview Survey to examine national influenza vaccination rates in people ages 2 years and older who had asthma. The nationally representative survey is conducted annually through in-person household interviews.

"The results of this study indicate that influenza vaccination coverage of all persons with asthma can be improved by increasing access to health care and using opportunities for vaccination during health care visits," the report stated.

Individuals without a usual place for health care, said the report, were less likely to be immunized against influenza. Almost 90 percent of those without a regular place for health care were unvaccinated, compared with about 61 percent of those who had such a place. The more health care visits a person made, the greater the chance of receiving an influenza vaccine. Almost 18 percent of individuals with asthma who reported making one health care visit were immunized against influenza, while nearly three times as many, or almost 51 percent, received the vaccine if they made 10 or more such visits.

"There's clear and unequivocal evidence that patients with a medical home reap a benefit in terms of having higher vaccine coverage," said Jonathan Temte, M.D., Ph.D., of Madison, Wis., a family physician and ACIP member. "When patients have a medical home and have ongoing periodic care for chronic disease, such as asthma, we know the compliance with various guidelines, including immunizations, goes up."

In general, immunization rates also are higher in clinics and practices with vaccine registries and procedures for reminding patients in particular risk categories to schedule an appointment for a particular vaccination, Temte said.

Reminding all patients with asthma about their risk factors for flu-related complications may help bring these coverage statistics up, said FP Doug Campos-Outcalt, M.D., of Phoenix, AAFP liaison to the ACIP.

"Many people with asthma have relatively mild disease, and they and their physicians might not appreciate they are at risk for complications from influenza," Campos-Outcalt said.

The MMWR report found that neither race and ethnicity nor severity of asthma (indicated by the number of emergency department visits or exacerbations) had a significant impact on patients' likelihood of receiving the influenza vaccine. Vaccination coverage was higher among patients who had health insurance and those whose families earned more than 4.5 times the federal poverty level. Age also had a significant impact on coverage rates; older patients with asthma (those ages 50-64 and those 65 and older) had the highest influenza vaccination rates.

In addition to using reminders, standing orders and educational programs, the report's authors also recommended offering influenza vaccines through January and February of the influenza season to reduce missed opportunities to immunize patients with asthma.

Although it's important to provide influenza vaccines to patients with asthma, they're only one target group that health care professionals are missing, according to Temte. Children, pregnant women and family members of those who are at high risk all fall short of immunization goals, he said.

Finally, physicians and other health care personnel should take a peek at the vaccinations listed in their own medical charts, Temte recommended. "We are still at an atrociously low level for health care providers," he noted.