Search

The rates of morbidity and mortality due to influenza and pneumococcal diseases are high among persons with underlying medical conditions; thus, influenza and pneumococcal polysaccharide vaccines are recommended for those [...]

This review of the recommendations for routine vaccines includes those used on the Recommended Childhood Immunization Schedule and the Recommended Adult Immunization Schedule. The rationale is provided for recent changes, [...]

The safety and efficacy of current vaccines are reviewed for high-risk populations, such as those with underlying medical conditions or occupational or lifestyle circumstances. The morbidity and mortality from vaccine-preventable [...]

Introductory article Effects of a large-scale intervention with influenza and 23-valent pneumococcal vaccines in adults aged 65 years or older: a prospective study B Christenson P Lundbergh J Hedlund A [...]

Background: Influenza and pneumococcal vaccination rates remain too low. This survey assessed generalist and subspecialist physicians' knowledge, attitudes, and practices regarding influenza and pneumococcal vaccinations for high-risk patients. Methods: A self-administered questionnaire was mailed to 6000 physicians randomly selected from a national database. Results: After 3 mailings, 1874 physicians (32%) of the 5858 eligible responded. Although most physicians thought that it was very important for their high-risk patients be current on influenza and pneumococcal vaccinations, only 86% and 75% of generalists and subspecialists, respectively, very strongly recommended influenza vaccinations to their elderly patients and only 81% and 64%, respectively, very strongly recommended pneumococcal vaccinations to their elderly patients (P Conclusions: Nontrivial proportions of generalist and subspecialist physicians fail to strongly recommend influenza and pneumococcal vaccinations to their elderly and high-risk patients. Other effective strategies for promoting vaccine delivery are also used relatively infrequently. These findings suggest areas for improvement if vaccination rates are to reach national goals. Arch Intern Med. 2001;161:2702-2708

Attempts by managed care organizations to increase the rate of influenza and pneumococcal immunizations among older hospital patients may be difficult. Faxed requests to the 106 attending physicians of 153 hospital patients to immunize before discharge resulted in a total of four immunizations. Policy directives to the hospital rather than the physician may be more promising.

Influenza and pneumococcal infections are important causes of hospitalization and death among individuals who are elderly or who have chronic illnesses. Influenza and pneumococcal vaccines may prevent these infections and their complications, but most high-risk patients have not received them. Doubts about their effectiveness, fears of side effects, and the lack of programs to promote their use contribute to the underuse of these vaccines. Although adequate controlled trials in high-risk patients are lacking, there is observational evidence that they are moderately effective, reducing serious complications of influenza and pneumococcal infections by about one-half. They are cost-effective compared with other preventive interventions and may be cost saving. Their safety has been demonstrated in numerous studies. Health care providers should promote influenza and pneumococcal vaccination. Strategies that have been shown to be successful in increasing the use of these vaccines include provider education and feedback, flagging charts of vaccination candidates, mailed reminders to patients without fall appointments, standing orders for nurses to administer the vaccines, walk-in vaccination clinics, and vaccination of hospitalized patients at discharge.

Pneumococcal and influenza vaccination trends, conditioned by seasons are examined.

* OBJECTIVE Immunization rates for influenza and pneumococcal vaccines among the elderly (especially minority elderly) are below desired levels. We sought to answer 4 questions: (1) What factors explain most [...]

Background: More than 2 million Native Americans (ie, Native Americans and Native Alaskans) live in the United States; 60% reside in cities. This population, especially its elders, is especially susceptible to respiratory diseases: yet, adherence to guidelines for influenza and pneunococcal immunizations is unknown. Objectives: To evaluate how frequently older and high-risk adults received vaccinations for influenza and pneumoncoccal infection and to identify patient characteristics associated with adherence to published recommendations. Methods: Retrospective medical record review of 550 Native American elders seen in an urban primary care practice defined using a culturally appropriate age threshold ([is greater than or equal to] 50 years) and standard criteria ([is greater than or equal to] 65 years). Univariate analyses examined demographic and clinical information by vaccination status. Logistic regressions identified factors associated with adherence to immunization guidelines. Results: Among patients aged 50 years and older with any indication according to published recommendations, rates were low for influenza (31%) and pneumococcal (21%) immunizations. Likewise, few subjects at least 65 years of age had been immunized appropriately against influenza (38%) or pneumococcus (32%). Younger age and alcohol use were significantly associated with less frequent immunization; Medicare insurance, depression, and more health problems and taking more medications predicted significantly higher immunization rates. Aged 65 years or older and having cardiovascular disease or diabetes mellitus were specific indications significantly correlated with receipt of influenza and pneumococcal vaccine. Conclusions: Regardless of age or risk, inadequate vaccination rates were observed in elderly Native Americans. Our findings suggest the need to identify obstacles to immunization and to conduct prospective and elderly intervention studies in Native American populations. Arch Intern Med. 2000;160:1443-1448

RATIONALE FOR IMMUNIZATION -- The rationale for the use of influenza and pneumococcal vaccine in patients with diabetes is reviewed in the American Diabetes Association technical review 'Use of Influenza [...]

PURPOSE: Influenza and pneumococcal vaccines are underused. Systems approaches that incorporate administrative and organizational strategies are more successful than education of providers for improving vaccination rates. Little has been published on the long-term success and durability of such efforts. METHODS: We performed a 10-year time-series study to examine the durability and success of an ongoing, multifaceted, institution-wide influenza and pneumococcal vaccination program. The program was first implemented at the Minneapolis Department of Veterans Affairs (VA) Medical Center in 1987-88 following the demonstration that a clinic-based standing order policy was much more successful than provider education for improving vaccine delivery. The program ensures that vaccine is offered to all high-risk patients followed up at the medical center, promotes convenient access for patients, and facilitates efficient administration of vaccine. Specific elements include an annual mailing to patients, standing orders for nurses, walk-in clinics, and the use of standardized, preprinted documentation forms. Initially the program targeted high-risk outpatients for influenza vaccination. It was extended to include inpatients in 1989-90. Pneumococcal vaccinations were added to the program in 1994-95. Vaccination rates are estimated each year from surveys mailed to randomly selected patients, and vaccine utilization is monitored through pharmacy logs. RESULTS: The survey response rates have exceeded 75% each year. Influenza vaccination rates for all high-risk patients followed up at the medical center have increased from 58% following the 1987-88 vaccination season to 84% in 1996-97 (P [is less than] 0.001). Pneumococcal vaccination rates have also increased from 34% in 1994-95 to 63% in 1996-97 (P [is less than] 0.001). Vaccination rates are similar for inpatients and outpatients, but rates for high-risk patients [is less than] 65 years of age remain lower than for the elderly: 69% versus 89% for influenza, 1996-97 (P [is less than] 0.001); 52% versus 66% for pneumococcal, 1996-97 (P = 0.05). For elderly patients followed up at the medical center, influenza (89% versus 67%, P [is less than] 0.0001) and pneumococcal (66% versus 43%, P [is less than] 0.0001) vaccination rates significantly exceeded those for the state of Minnesota in 1996-97. The annual number of influenza vaccine doses dispensed has increased from 10,000 in 1987-88 to more than 22,000 in 1996-97; and more than 13,000 doses of pneumococcal vaccine have been administered from 1994-95 through 1996-97. CONCLUSION: This simple, multifaceted program that incorporates administrative and organizational strategies to enhance influenza and pneumococcal vaccination rates has been highly durable and successful over a 10-year peroid. Similar strategies if implemented in other settings may enhance vaccination rates for the millions of high-risk patients who have yet to be immunized. Am J Med. 1998;105:385-392. [C] 1998 by Excerpta Medica, Inc.

NEW ORLEANS -- Rates of pneumococcal and influenza vaccination were extremely low among diabetic patients seen at three clinics serving a large diabetic population, P.L. Yang reported at the southern [...]

Nurses and other appropriate healthcare personnel can now provide influenza and pneumococcal vaccinations to Medicare and Medicaid patients without a physician's order, thanks to a new federal rule that went [...]