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Influenza Vaccination Coverage Among People With High-Risk Conditions in the U.S.

      Introduction

      During annual influenza epidemics, rates of serious illness and death are higher among those who have medical conditions, such as pulmonary disease, diabetes, or heart disease, which place them at increased risk of influenza complications. Annual influenza vaccination was recommended for people with high-risk conditions as early as 1960.

      Methods

      Data from the 2012–2013 Behavioral Risk Factor Surveillance System were analyzed in 2014 to estimate national and state-specific influenza vaccination coverage among people aged 18–64 years with high-risk conditions. Prevalence ratios adjusted for demographic and access-to-care characteristics were calculated using logistic regression and predictive marginal models.

      Results

      Unadjusted influenza vaccination coverage was 45.4% among adults aged 18–64 years with at least one high-risk condition, compared with 32.9% among those with no high-risk conditions (p<0.05). Among adults aged 18–64 years with multiple conditions (at least two high-risk conditions), vaccination coverage was 53.2%. Coverage was 43.9% for those with pulmonary diseases, 52.7% for those with diabetes, 48.1% for those with heart disease, and 45.0% for those with cancer. Individuals with high-risk conditions were more likely to receive an influenza vaccine than those with no high-risk conditions, even after controlling for demographic and access-to-care characteristics.

      Conclusions

      Despite ongoing influenza vaccination recommendations for adults with high-risk conditions, coverage was below the Healthy People 2020 target; only about half were vaccinated. Primary care providers and subspecialists should ensure routine assessment of vaccination status every fall and winter and recommend vaccination to people with high-risk conditions.
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      References

        • Anderson G.
        Chronic conditions: making the case for ongoing care. Robert Wood Johnson Foundation, Princeton, NJ2010
        • Grohskopf L.A.
        • Olsen S.J.
        • Sokolow L.Z.
        • et al.
        Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP) - United States, 2014-15 influenza season.
        MMWR Morb Mortal Wkly Rep. 2014; 63: 691-697
        • Barker W.H.
        • Mullooly J.P.
        Impact of epidemic type a influenza in a defined adult population.
        Am J Epidemiol. 1980; 112: 798-813
        • Barker W.H.
        Excess pneumonia and influenza associated hospitalization during influenza epidemics in the United States, 1970-78.
        Am J Public Health. 1986; 76: 761-765https://doi.org/10.2105/AJPH.76.7.761
        • Glezen W.P.
        Serious morbidity and mortality associated with influenza epidemics.
        Epidemiol Rev. 1982; 4: 25-44
        • Burney L.E.
        Influenza immunization.
        Public Health Rep. 1960; 75: 944https://doi.org/10.2307/4590965
        • Fiore A.E.
        • Shay D.K.
        • Broder K.
        • et al.
        Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009.
        MMWR Recomm Rep. 2009; 58: 1-52
        • CDC.
        Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010.
        Morb Mortal Wkly Rep. 2010; 59: 1-62
      1. CDC. Flu Vaccination coverage, United States, 2012-13 influenza season. 2013; http://www.cdc.gov/flu/fluvaxview/coverage-1213estimates.htm.

      2. U.S. DHHS. Healthy People 2020: immunization and infectious diseases. http://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases.

      3. CDC. Overview: BRFSS 2012. http://www.cdc.gov/brfss/annual_data/annual_2012.html.

        • Parekh A.K.
        • Goodman R.A.
        • Gordon C.
        • Koh H.K.
        • HHS Interagency Workgroup on Multiple Chronic Conditions.
        Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life.
        Public Health Rep. 2011; 126: 460-471
        • Lu P.J.
        • Gonzalez-Feliciano A.
        • Ding H.
        • et al.
        Influenza A (H1N1) 2009 monovalent and seasonal influenza vaccination among adults 25 to 64 years of age with high-risk conditions--United States, 2010.
        Am J Infect Control. 2013; 41: 702-709https://doi.org/10.1016/j.ajic.2012.10.027
        • Bridges C.B.
        • Winquist A.G.
        • Fukuda K.
        • et al.
        Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Recomm Rep. 2000; 49 (quiz CE1-7): 1-38
        • Singleton J.A.
        • Wortley P.
        • Lu P.J.
        Influenza vaccination of persons with cardiovascular disease in the United States.
        Tex Heart Inst J. 2004; 31: 22-27
        • Davis M.M.
        • Wortley P.M.
        • Ndiaye S.M.
        • Woods M.G.
        • Clark S.J.
        National availability of influenza vaccine among medical subspecialty practices.
        Am J Prev Med. 2004; 26: 307-310https://doi.org/10.1016/j.amepre.2003.12.016
        • Nichol K.L.
        • Zimmerman R.
        Generalist and subspecialist physicians’ knowledge, attitudes, and practices regarding influenza and pneumococcal vaccinations for elderly and other high-risk patients: a nationwide survey.
        Arch Intern Med. 2001; 161: 2702-2708https://doi.org/10.1001/archinte.161.22.2702
        • National Vaccine Advisory Committee
        Recommendations from the National Vaccine Advisory Committee: standards for adult immunization practice.
        Public Health Rep. 2014; 129: 115-123
        • CDC.
        Interim results: state-specific seasonal influenza vaccination coverage - United States, August 2009-January 2010.
        MMWR Morb Mortal Wkly Rep. 2010; 59: 477-484
        • Mac Donald R.
        • Baken L.
        • Nelson A.
        • Nichol K.L.
        Validation of self-report of influenza and pneumococcal vaccination status in elderly outpatients.
        Am J Prev Med. 1999; 16: 173-177https://doi.org/10.1016/S0749-3797(98)00159-7
        • Zimmerman R.K.
        • Raymund M.
        • Janosky J.E.
        • Nowalk M.P.
        • Fine M.J.
        Sensitivity and specificity of patient self-report of influenza and pneumococcal polysaccharide vaccinations among elderly outpatients in diverse patient care strata.
        Vaccine. 2003; 21: 1486-1491https://doi.org/10.1016/S0264-410X(02)00700-4
        • Mangtani P.
        • Shah A.
        • Roberts J.A.
        Validation of influenza and pneumococcal vaccine status in adults based on self-report.
        Epidemiol Infect. 2007; 135: 139-143https://doi.org/10.1017/S0950268806006479
        • Gilca R.
        • De Serres G.
        • Boulianne N.
        • et al.
        Risk factors for hospitalization and severe outcomes of 2009 pandemic H1N1 influenza in Quebec, Canada.
        Influenza Other Respir Viruses. 2011; 5: 247-255https://doi.org/10.1111/j.1750-2659.2011.00204.x
        • Warren-Gash C.
        • Smeeth L.
        • Hayward A.C.
        Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic review.
        Lancet Infect Dis. 2009; 9: 601-610https://doi.org/10.1016/S1473-3099(09)70233-6
      4. Guide to Community Preventive Services. http://www.thecommunityguide.org/index.html