"As influenza vaccine first becomes available through November, vaccination programs should focus on persons at greatest risk for complications associated with influenza, including those 65 and over and those with chronic illnesses, and on health care workers who have contact with these individuals," said Dr. Fukuda.

Vaccination among high-risk groups should continue into December andlater as long as influenza vaccine is available. Those at high risk for complications from influenza are:

-- Persons aged 65 and older

-- Residents of nursing homes and other facilities housing persons with chronic illness

-- Children and adults with chronic pulmonary and cardiovascular disorders, including asthma

-- Children and adults who have required regular medical follow-up because of chronic metabolic diseases, including diabetes, renal dysfunction, hemoglobinopathies or immunosuppression

-- Persons aged six months to 18 years who are receiving long-term aspirin therapy

-- Pregnant women in the second or third trimester of pregnancy during the influenza season

The CDC also recommends that mass vaccination campaigns be postponed until later in the season and held as vaccine becomes available. The purpose for delaying these campaigns is to minimize the number of campaigns that are cancelled from lack of vaccine. Special efforts should be made in December and later to immunize persons 50-64 years of age who are not at high risk and are not household contacts of high-risk persons.

During the past 18 influenza seasons, activity peaked during January through March in 14 of the seasons. It takes approximately two weeks after vaccination to develop antibodies against the influenza to provide protection.

"Even with the supply delays, it's most likely that most people who want to protect themselves will be able to get vaccine before flu activity peaks," said Fukuda.

Pneumococcal Vaccine

CDC also recommends many of these same high-risk groups be vaccinated against pneumococcal disease. "Assuring pneumococcal vaccination of high-risk persons early in the season will provide substantial protection against the potentially deadly disease," said Kristin Nichol, M.D., M.P.H., chief of medicine service at VA Medical Center in Minneapolis, Minnesota.

Pneumococcal vaccine can be administered at any time of the year, but in adults it is given most often at the same time as the influenza vaccine in early to mid-fall. ACIP's new recommendations stress that pneumococcal vaccine be administered even if influenza vaccine is not yet available. The ACIP recommendations also call on providers to emphasize that pneumococcal vaccination is not a substitute for influenza vaccination and that patients need to return for influenza vaccine when it is available in their communities.

Pneumococcal vaccine is generally given once in a lifetime to those who are vaccinated at age 65 and older. Any individual who cannot recall being vaccinated against pneumococcal disease can be safely revaccinated. Adults who are vaccinated before age 65 or who have certain other chronic conditions may need to be revaccinated after five years.

"Medicare beneficiaries are in the high-risk group who need priority vaccination," said Jeffrey Kang, M.D., M.P.H., director of the office of clinical standards and quality, HCFA. "They must not be discouraged by reports of vaccine delays and should get their vaccinations now. But they also should remember, it's better to get their shots late than not to get them at all."

Influenza and pneumococcal vaccinations are reimbursable by Medicare Part B.

Disparity in Vaccination Rates Continues

Along with urging the elderly and chronically ill to get vaccinated early, the medical groups called attention to disparities in vaccination rates-two out of three minority adults aged 65 and older have not been vaccinated against pneumococcal disease.

"The risk for contracting pneumococcal disease and influenza among African Americans and Hispanics older than 65 years of age, and especially those who have chronic medical conditions, is an ever-present threat," said Bonnie Word, M.D., representing the NMA. "African Americans, in particular, appear to be at increased risk for acquiring pneumococcal disease, and the reasons for this are not fully understood.  An additional factor that compounds this situation for both African Americans and Hispanics includes lower levels of vaccination when compared to other populations."

Also at the press conference, the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) announced an initiative encouraging general internists to improve adult vaccination rates, including influenza and pneumococcal disease. According to Sandra Adamson Fryhofer, M.D., F.A.C.P., president of ACP-ASIM, the three-year initiative will be comprised of physician education primarily for the organization's 115,000 members, including distribution of practice management tools to help internists incorporate immunization into office systems.

Founded in 1973, NFID is a non-profit organization dedicated to public and professional educational programs about, and in support of, research into causes, treatment and prevention of infectious diseases. 

NCAI is a network of more than 100 organizations dedicated to promoting adult immunization primarily through educational and motivational activities. The coalition was formed in 1988 to make the most efficient use of public and private resources to achieve national goals in adult immunization.

This press conference is supported, in part, by unrestricted educational grants to the National Foundation for Infectious Diseases and the National Coalition for Adult Immunization by Aventis Pasteur, Aviron, Health Care Financing Administration, Merck Vaccine Division and Wyeth Lederle Vaccines and Pediatrics.

SOURCE: National Foundation for Infectious Diseases, National Coalition for Adult Immunization