CDC Telebriefing Transcript

Despite the Availability of Vaccine, Rates of Flu and Pneumococcal Shots for Older Americans Remain Low

November 14, 2002

CDC MODERATOR: Yes. Thank you for joining us this afternoon. My name is Curtis Allen. I'm in the press office at the National Immunization Program.

Today's topic is influenza and pneumococcal vaccination levels among persons age 65 and older in the United States.

Mr. Jim Singleton will be our spokesperson today. He is an adult immunization expert in the National Immunization Program. He will make a brief statement and then we will open it up for questions. Following the teleconference, if you would like to ask further questions, you can contact the press office at 404-639-3286. A full transcript will be on the Web site later this afternoon.

Mr. Singleton's last name is spelled S-i-n-g-l-e-t-o-n, and with that, I will turn it over to Mr. Singleton. Thank you.

MR. SINGLETON: Thank you, Curtis, and welcome, everyone.

Influenza and pneumococcal disease together kill more Americans per year than all other diseases for which vaccines are available. Annual influenza epidemics kill an average of 20,000 Americans, and these are mostly persons 65 or older.

Pneumococcal disease, which can occur at any time of the year, kills about three thousand elderly Americans each year. Many of these deaths are preventable and our national health objectives for the year 2010 call for at least 90 percent of persons 65 or older to receive an annual influenza vaccination and a lifetime dose of pneumococcal vaccine.

To check our progress towards these objectives in each state, and for our nation as a whole, we analyzed data from the 2001 Behavioral Risk Factor Surveillance System.

This is a telephone survey of community-dwelling civilian adults conducted in each state, the District of Columbia and three U.S. territories.

One of our key findings was that less than 80 percent of persons 65 or older in all states reported flu vaccination during the past 12 months, or ever receiving pneumococcal vaccination.

Nationally, we found that influenza vaccination is reaching only two-thirds of older Americans who could benefit from it.

After dramatic increases in vaccine coverage during the past decade, we saw indications of a plateau by 1999, and then a slight drop in coverage from 1999 to 2001, and the coverage dropped from 66.9 percent in 1999 to 64.9 percent in 2001.

This recent drop in coverage is probably the result of the delays in distribution of influenza vaccine in 2000.

Pneumococcal vaccine coverage is even worse. Only 60 percent nationally, in 2001. And this is despite the fact that just one dose of pneumococcal vaccine is needed, in contrast to the need for an annual flu shot.

However, the increase in pneumococcal vaccination rates was about six percentage points above the 1999 rate of 54 percent. So there has been some good progress in that area.

We also found that the racial and ethnic disparities in vaccination of older Americans has continued. Coverage for both vaccines was lower among blacks and Hispanics compared to non-Hispanic whites.

For example, for influenza vaccination, coverage was 67 percent in whites but only 48 percent for blacks, and only 55 percent for Hispanics.

These findings are significant because they suggest we must expand our efforts to improve vaccination rates if we hope to reach our national health objectives of 90 percent coverage for these two vaccines in elderly Americans by the year 2010, and one of the ways CDC is trying to improve coverage is by continuing to promote flu vaccine throughout the flu season.

The optimal time to get a flu shot is during October and November. However flu vaccination should continue into December and later because many persons remain unvaccinated by the end of November, and the seasonal flu activity in the U.S. doesn't typically reach peak levels until late December through early March.

Influenza vaccine is particularly recommended for elderly persons and others at high risk of influenza-related complications, and is also recommended for household contacts of these high-risk persons, and for health care workers, and flu vaccine should also be given to others who want to decrease their risk of influenza infection.

Now this year, the record number of 93 million influenza vaccine doses are projected to be available and the distribution is on time this year. Several million doses remain available for purchase.

Continued efforts to vaccinate during December and throughout the influenza season can increase coverage and provide the benefits of available supplies of flu shots to as many people as possible.

Another way CDC is trying to improve vaccination coverage is to encourage health care providers to adopt proven strategies such as standing orders for vaccination, patient reminder recall systems, provider reminders, provider assessment and feedback techniques, and offering vaccinations to hospitalized patients before discharge.

To assist providers in these efforts, CDC recently published the first ever adult immunization schedule which is approved by the Advisory Committee on Immunization Practices, and this schedule is also accepted by the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.

The schedule provides a convenient up-to-date tool for providers for assessing the vaccine needs of their patients during office visits and giving appropriate vaccines to these patients.

And we're also further investigating reasons why vaccine coverage is high in some states and low in others, and we hope that lessons learned from this investigation may be used to improve coverage in states with low coverage.

Finally, to investigate strategies for eliminating the racial and ethnic disparities in vaccinations, CDC is implementing the Racial and Ethnic Adult Disparities Immunization Initiative, or READII. This is a two-year demonstration project that will be conducted in Chicago, Milwaukee, a rural area of Mississippi, Rochester, New York, and San Antonio.

Local and state health departments in these areas will work with community partners, health care providers, CDC, other federal agencies, and try to identify and implement effective ways to improve flu and pneumococcal vaccination rates among elderly blacks and Hispanics.

In conclusion, we need to reach millions more people 65 and older, who are still not receiving the benefits of influenza and pneumococcal vaccines. To do this, health care providers should offer pneumococcal vaccine throughout the year at every opportunity and should continue to offer influenza vaccine during December and throughout the flu season, even after flu activity has been documented in the community.

And finally, particular effort is needed to improve vaccination of elderly blacks and hispanics.

CDC MODERATOR: Okay. That concludes our statement. John, we could open it up for questions.

AT&T MODERATOR: Certainly. And once again, ladies and gentlemen, if you do have a question, please press the 1 at this time.

And we do have a question from the line of [inaudible] Marcus with Health Scout. Please go ahead.

QUESTION: Hi. I was hoping you could talk a little bit about what the flu season has been like so far, and what you expect it to be like, and whether you have strains.

MR. SINGLETON: We can never predict the timing and severity of a given flu season, going into it this early. The current activity could be characterized as low, and there's nothing unusual that's been noted. There have been some influenza isolates identified, and what has been tested has been consistent with the vaccine strains. So we don't have any indication of any problems so far. This is not unusual for this time of year to have relatively low activity.

QUESTION: Am I still on?

CDC MODERATOR: Yes.

QUESTION: I saw on the website, that as of November 2nd, Louisiana had some regional activity. Can you--what does regional activity mean, as opposed to sporadic or widespread?

MR. SINGLETON: There's a specific definition for that. This is really reported by the state epidemiologist. But it's showing that they're having some cases of flu or outbreaks of flu in large cities in the area.

QUESTION: Thank you.

CDC MODERATOR: Next question.

AT&T MODERATOR: And that's from the line of Bob Lamondola [ph] with the Sun Sentinel. Please go ahead.

QUESTION: Yes, hi. Thanks for taking the question. I'm just wondering if you can tell how do you intend to try to spread the word, or you know, increase the numbers in the minority communities?

MR. SINGLETON: Well, in our Ready Project, which is mentioned earlier, we're leaving it up to the local, state health departments to come up with specific strategies that might work in their area. But in general, sort of--you can try to use media, different media channels, some that are culturally appropriate to reach the people, so there's a general awareness in the community. You can try to expand the access to flu vaccine to people.

One of the things we think is most important is working with the health care providers because the majority of older people, whether they're a minority or not, have access to health care; their vaccines are covered by Medicare. And you know, report a lot of visits to the doctor, so we also are stressing working with the health care providers in the area to both do a better job at vaccinating people, and helping them try to overcome potential resistance to vaccine they may get from their patients.

QUESTION: Do you think the problem is mostly lack of access, or is it just that people are not interested, or they don't know where to go?

MR. SINGLETON: We think that there's multiple reasons. We do lower coverage rates in African-Americans, for example, with lower levels of education, and in general, those who don't access health care, have lower vaccine coverage. But when we control for these type of factors, we still see a significant disparity in both African-American and hispanic elderly. We think there's other--that contributes partly, but there's other factors involved, may have to do with the level and quality of health care available in the communities that people access, or the interaction between the provider and the patient. Maybe they're more likely to refuse, but maybe doctors aren't as likely to offer the vaccine or they're less efficient at convincing people to take the vaccine.

QUESTION: Thank you.

CDC MODERATOR: Next.

AT&T MODERATOR: And a question from the line of Marian Folcule [ph] with CNN. Please go ahead.

QUESTION: Just one quick question about the pneumococcal vaccine. Do you think that doctors need to make people aware of the need for this, and what does that vaccine all cover, because to be honest, I never had one of those either and never knew that I should get one.

MR. SINGLETON: Well, the pneumococcal vaccine is specifically recommended for people 65 and over, and then younger people with specific medical conditions such as diabetes, heart disease, lung disease, which incidentally does not include asthma, which is an indication for flue vaccine, and immuno-compromised people, people with kidney disease. And those are similar to the indications for flu vaccine. So not everybody is recommended to get a flu vaccine. You know, a healthy 34-year-old would not be recommended to get that vaccine.

But what it does is protect against one of the most common forms of bacterial pneumonia, which we do think doctors should offer this vaccine to all their patients that are eligible. We have an adult immunization schedule that we think is a convenient tool for physicians to use so they can have it in their office and remind them who should be getting that particular vaccine. And we would like doctors to screen people for the various vaccines they may be eligible for whenever they have an opportunity with the patient in the office.

QUESTION: And where is that? Does the CDC website have that adult schedule on the website?

MR. SINGLETON: Yes, it is.

QUESTION: Okay, great. Thank you.

CDC MODERATOR: The way to access that is cdc.gov/nip, as in National Immunization Program. That is the easiest way to get to the adult schedule.

QUESTION: Thank you.

CDC MODERATOR: next question.

AT&T MODERATOR: And ladies and gentlemen, just a quick reminder, if you do have a question, please press the 1.

And, Mr. Allen--we do have a question from Ed Marcus with Health Scout. Please go ahead.

QUESTION: Sorry to beat the buzzer there. I just was hoping you could reiterate the guidelines for pneumococcal vaccine. Who are the recommended groups?

MR. SINGLETON: It would be all persons, age 65 and over, and persons under age 65 with certain chronic conditions such as diabetes, heart disease, lung disease such as chronic bronchitis and emphysema, but not asthma, persons with immuno compromise, either from say cancer treatment or HIV infection, people with kidney disease, and people with sickle cell disease also, particularly relevant for the African-American community.

QUESTION: And why--do all of those predispose them to respiratory infections or is there something--is there a common thread?

MR. SINGLETON: Predisposes them to having a severe case of pneumococcal infection which would lead to invasion of the bloodstream of the bacterium, which can be life threatening.

QUESTION: Okay, thank you.

CDC MODERATOR: Next question.

AT&T MODERATOR: Mr. Allen, no further questions in queue.

CDC MODERATOR: Have anything else to add, Jim?

MR. SINGLETON: I just want to remind everyone it's not too late to get vaccinated. We want to promote the message of continuing flu vaccination throughout December and even after flu activity is documented in the community, and particular efforts to reach the vaccination of black and hispanic elderly, and offer pneumococcal vaccine at every opportunity.

CDC MODERATOR: Again, thank you for joining us this afternoon. The transcript of this teleconference will be on the website later this afternoon at www.cdc.gov/media. If you have additional questions, please call the media relations line at 404-639-3286. And if there are no other questions, thank you for joining.

AT&T MODERATOR: And ladies and gentlemen, that does conclude your conference for today. Thank you for you participation and you may now disconnect.

[End of telebriefing.]

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