Managed Care - October 2008 - (Page IS9) sider strategic guidelines for immunization. The Advisory Committee on Immunization Practice (ACIP) traditionally had called for annual immunization against influenza among adults aged 50 and older; residents of chronic care facilities; children and adults with chronic health conditions, such as chronic pulmonary disease, renal dysfunction, or immunosuppression from HIV; pregnant women; and children aged 6 months to 18 years who receive long-term aspirin therapy (ACIP 2006, Bridges 2003). However, due to high rates of influenzarelated medical care for children, along with their role in the spread of influenza to susceptible household contacts and the community, ACIP recently voted to expand immunization recommendations to include universal vaccination for all children aged 6 months through 18 years (Table). The committee also advised that inadequate vaccination for children younger than age 9 — i.e., only one dose in their first vaccination year — should be corrected by giving two doses 4 weeks apart in the subsequent year. Another key point was the recommendation to vaccinate household members and out-of-home care providers of all children who are at high risk, and of all healthy children younger than 5 years of age. Current vaccination statistics Vaccination is the most effective method for preventing influenza and reducing the burden of flu complications. Achieving national goals for TABLE immunization as established by the ACIP, Recommendations for influenza vaccination however, has been a challenge (ACIP 2006, Committee on Infectious Diseases 2008). As Advisory Committee on Immunization Practices shown in Figure 1 (page 10), immunization • Adults aged 50 or older, residents of chronic care facilities, chilguidelines have been well adopted by adults dren and adults with chronic conditions, pregnant women, and older than 65, who achieved an immunizachildren 6 months to 18 years who are on aspirin therapy should be immunized against influenza. tion rate of 65 to 70 percent in 2004. In addi• Immunization providers should begin efforts to offer influenza tion, the elderly with comorbid conditions vaccination to all children aged 6 months through 18 years in the reached a rate as high as 75 percent. Meeting 2008–2009 influenza season, if feasible. the goals for other populations, however, has • Annual vaccination for all children aged 6 months through 18 been less successful (Lu 2008). Influenza vacyears should begin in the 2009–2010 influenza season. cination coverage in 2004 was only 50.5 per• Children aged 6 months to 18 years who have not been vaccicent for adults aged 50 to 64, and 27.2 percent nated previously or who were vaccinated for the first time during for those aged 18 to 49. the previous season and received only one dose should receive The U.S. Centers for Disease Control and two doses of vaccine. Prevention’s (CDC) Healthy People 2010 ini• The first dose should be as soon as is feasible after vaccine betiative also has rather rigorous influenza vaccomes available, so that both doses can be administered before cination objectives (CDC 2005). With recomthe onset of influenza activity. mendations for 90 percent vaccination among noninstitutionalized adults older than age 65, Healthy People 2010 90 percent vaccination of institutionalized • 90 percent vaccination rate for noninstitutionalized persons adults, and 60 percent vaccination for other ≥65 years of age risk groups by the year 2010, a mid-course re• 90 percent vaccination rate for institutionalized adults view determined that these goals are not being • 60 percent vaccination for other risk groups met. Immunization rates for adults over age 65 Sources: ACIP 2006, ACIP 2008, CDC 2005 reached 69.3 percent, but none of the other age and risk categories had achieved rates above 50 percent at the time of the review. This is reflected in the rates for adults aged 50 to 64 with comorbidity (48.4 percent), adults aged 50 to 64 without comorbidities (32.2 percent), adults aged 18 to 49 with or without high-risk conditions (30.5 percent and 18.3 percent, respectively), and children aged 6 months to 23 months (20.6 percent fully vaccinated) (CDC 2007a, 2007b, 2007c). In addition, there are two demographic groups for whom suboptimal coverage has far-reaching implications. Vaccination among pregnant women in 2004 was only 14.4 percent (Figure 1, page 10), despite the fact that this population is more likely to develop serious medical complications and require hospitalization for flu symptoms than age-matched, nonpregnant peers (Lu 2008). Furthermore, vaccinating a pregnant woman has the potential to also protect the newborn infant via the transfer of maternal antibodies through the placenta to the developing fetus so that the child is born with a degree of protective immunity (Zaman 2008). Although concerns about the safety of immunization to both mother and child might play a role in the inadequate uptake in this population, there is no documented evidence of harm to the pregnant mother or fetus associated with influenza vaccine (Munoz 2005, Heinonen 1973). Similarly, although there has been a trend toward improved immunization rates among health care workers, maximum IMMUNIZATION STRATEGIES / MANAGED CARE 9
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