Last year ushered in a swirl of notoriety regarding influenza vaccine.
The 2003-2004 flu season arrived early and hit hard. For many
individuals, thanks in part to tremendous media hype and a delay in the
availability of vaccine supplies, flu shots were a highly-sought after
commodity.
Despite the high visibility of last year’s flu season, and ample media
attention about the importance and safety of flu vaccines, a
significant number of Tennesseans either chose not to receive flu
vaccine or may have encountered a barrier to access. Researchers with
the Tennessee Department of Health and Vanderbilt University Medical
Center’s
Department of Preventive Medicine conducted a survey of Tennessee
citizens finding significant disparities in the rates of influenza
vaccination.
With all the media attention and preventive health awareness focused on
influenza, investigators wanted to know why individuals would choose
not to be vaccinated, or if they wanted to receive flu vaccine, what
barriers stood in their way.
In a study just published in the journal Clinical Infectious Diseases,
over 4,000 Tennesseans were surveyed after last year’s flu season as to
whether they received a flu vaccination. If the respondent was not
vaccinated he or she was asked why. The study offers insight into
access to care, and the public’s ongoing perceptions of flu vaccine,
that will allow infectious diseases practitioners to guide future
immunization policies.
The study’s principal investigator Timothy F. Jones, M.D., initiated
the survey because he believes that understanding the public’s
perception of influenza vaccination, and variables that influence or
impede the public’s decision to get immunized is critical if
immunization rates are to be improved.
"Unfortunately, despite recent vigorous efforts to get the word out to
educate medical providers and the public, in four of the last five flu
seasons there have been unfortunate situations that might have
presented barriers to immunization such as delays and shortages of
vaccine," said Jones deputy state epidemiologist for Communicable and
Environmental Disease Services at the Tennessee Department of Health
and assistant clinical professor of Preventive Medicine at VUMC.
"With our close relationship between the (State) Department of Health
and Vanderbilt we were ideally poised to perform this fairly large
survey quickly and efficiently. It is quite remarkable that we managed
to complete the entire survey, from conception and analysis to
dissemination of the results, in less than a year. This is particularly
important given the huge problems with shortages this year. The events
of this year are nothing we could have predicted, but I think these
data contribute substantially to understanding many of the complex
issues that are being raised this winter during this time of flu
vaccine shortage."
Slightly more than one-half of the total number of study respondents
indicated they were vaccinated last year either at a private medical
clinic, their workplace, a health department or pharmacy.
Three-fourths of survey respondents indicated having a health risk
factor for which the Centers for Disease Control and Prevention
recommends vaccination. In spite of this, 41 percent of respondents in
high-risk categories indicated they chose not to be vaccinated. The
survey also found that more than 40 percent of respondents over age 50,
more than half of the surveyed health care workers, and 70 percent of
pregnant women surveyed were not immunized for influenza.
"We continue to face two problems: doctors still have not informed all
their high-risk patients that they need influenza vaccine, and many
patients remain concerned about the myth that they can get flu from the
flu vaccine," said William Schaffner, M.D., professor and chairman of
the Department of Preventive Medicine and a co-author of the study.
The survey also found blacks, rural residents, and the state’s
lower-income residents were significantly less likely to be vaccinated
than others. Six percent of the survey’s respondents who eventually
receive flu vaccine reported difficulty obtaining a shot. Only eight
percent of respondents reported requesting vaccine but not being able to
receive it, primarily due to vaccine unavailability.
About one-fourth of the total number of those responding to the survey
indicated they declined the vaccine when it was offered to them.
Reasons offered by those respondents include thinking the vaccination
was unnecessary, or that receiving it would make them ill.
Jones, Schaffner and the study’s other authors Amanda Ingram, MPH,
epidemiologist with the State Department of Health, and Allen S. Craig,
M.D., state epidemiologist for Communicable and Environmental Disease
Services at the Tennessee Department of Health and assistant clinical
professor of Preventive Medicine at VUMC, conclude there are still
significant barriers contributing to the varying rates of influenza
vaccination. Inadequate vaccine supply is only one component of the
problem. Other persisting problems are myths about the safety, or
possible side-effects associated with influenza vaccines.
"I think the study highlights the fact that there remain important
groups that still have far lower rates of influenza immunization than
they should, and unfortunately that includes health care providers. If
for no other reason, health care providers need to be immunized to
protect their patients," Jones said.
Media contact: John Howser 615-322-4747
john.howser@vanderbilt.edu