When asked to name the most challenging month of the year, retail executives will likely point to the time period between “Black Friday” and Christmas Eve. During this time, there are dramatic increases in the number of customers and inventory management is critical. When asked that same question, pediatricians would highlight the days between Labor Day and Halloween for some of the same reasons. This is the time for these practitioners to “fall back” into flu vaccination mode.
The American Academy of Pediatrics (AAP) has issued its 2018 - 2019 guidelines for influenza vaccinations and it will be up to pediatric practices to do everything in their power to reach out to every child in their patient database. Based on what many contagious disease experts called “the flu epidemic of 2017 - 2018,” there will likely be much more interest in getting flu shots this year.
A Deadly Year for Flu
According to numerous news reports, including this one from NBC News, flu is a major killer. “The Center for Disease Control and Prevention (CDC) estimates that between 140,000 and 700,000 people get sick enough from flu every year in the U.S. to require hospital care. Plus, the annual flu epidemic kills anywhere from 12,000 to 56,000 people a year, depending on how bad the flu season is.” Last year was a particularly bad year.
The CDC noted that “flu activity stayed high in all 50 states, or nearly all, for weeks on end — an unusual pattern. A record 180 children died during the 2017- 2018 flu season and approximately 80 percent of these deaths occurred in children who had not received a flu vaccination this past season.”
The Controversy on FluMist Continues
According to a report from the Center for Infectious Disease and Policy, the AAP issued revised flu vaccination recommendations for the upcoming season, which say that children ages 6 months and older should get the flu shot and that the live, attenuated nasal spray vaccine - FluMist - should be used only as a last resort.
The AAP's recommendation regarding FluMist is slightly different than that of the CDC, which has no preferential recommendation between injectable vaccines and the inhaled formulation. First licensed in 2003, FluMist offered a needle-free, option for children in a formulation that's easier to use in school-based flu vaccination campaigns. However, in 2015 the CDC's Advisory Committee on Immunization Practices (ACIP) removed its recommendation for the vaccine, based on disappointing performance against the 2009 H1N1 strain.
After intense study, ACIP voted to include the vaccine in its recommended line-up for the 2018-19 flu season. The decision was reached after flu experts reviewed findings from AstraZeneca (the vaccine's maker) that suggested improved performance based on shedding and antibody response in children ages 2 to 4 years old following the company's switch to a different 2009 H1N1 type, from A/Bolivia to A/Slovenia.
In its recommendations, the AAP said its Committee on Infectious Diseases and ACIP have reviewed and carefully considered all influenza vaccine data available and new information on FluMist's updated formulation for the 2018-19 flu season. Given that FluMist protection against 2009 H1N1 was inferior during past flu seasons, however, the committee said it's effectiveness is unknown for the upcoming season.
It added that both AAP and the CDC support the use of FluMist for the upcoming flu season, with the goal of optimizing vaccine coverage and optimal protection for all ages. The AAP recommends inactivated trivalent (three-strain) or quadrivalent (four-strain) flu shots for all children, reserving FluMist for children who would otherwise not receive a flu vaccine, such as in cases of vaccine refusal, and for whom the vaccine is indicated—healthy children age 2 and older.
Are Egg-Free Vaccines More Effective?
According to news reports, the University of Pittsburgh Medical Center is taking a different approach to flu vaccinations this year. It will only be buying the two egg-free vaccines on the market: Flucelvax and FluBlok. The hospital will be using these vaccines for all patients - 4 years and older - and all of its 85,00 employees. It made this decision because there is some evidence these two formulations may work better than the older vaccines grown in eggs, said Dr. Richard Zimmerman, who advises the UPMC Influenza Committee.
“The egg-free vaccines appear to have perhaps a 10 percent higher effectiveness over the traditional egg-based vaccines, Zimmerman said in an interview. “Given the recent information about the egg-free vaccine, I plan for my family to get the egg-free this year.”
Don’t Go Trick- or-Treating Without a Flu Shot
For many years, pediatric immunization experts have known that the ideal time for children to receive flu shots is before October 31st. This is based on the fact that flu season gets into high gear during the winter months. This year, a savvy marketing approach is being offered by the AAP and it can help pediatric practices to focus on this date.
Since Halloween is a very popular holiday for young children (and, of course, for the parents who must accompany them on the “candy trail”), this date is being used to emphasize the “deadline” for childhood flu vaccination. Getting this message - Don’t Go Trick-or-Treating Without a Flu Shot - to parents via email campaigns, text messaging, in-clinic signage with a Halloween theme and other marketing tactics can help remind parents and kids about the importance of getting the shot before October 31st.
A Pediatric Electronic Health Records (EHR) Platform Can Help Manage This Outreach
While it is recommended that every child receive an annual flu shot, some children are at a greater risk from complications from this disease. A pediatric-focused EHR such as that of PCC can help a practitioner track those patients with chronic medical conditions such as asthma and diabetes or those who are immunocompromised and at a higher risk for flu complications.
The PCC platform can also help a busy practitioner deal with the sheer volume of children who need flu shots. The platform can be used to help the practice efficiently generate lists of kids who are overdue for their vaccinations. It can also be used to remind the doctor of the need for flu shots during well-visits. During a busy period such as flu shot season, an effective patient outreach can dramatically increase the number of children who are immunized against this serious disease.
Every doctor has an appreciation of the old adage: Prevention is the best cure. This is especially true with children and influenza. In addition to being critical to the health of young patients, using the PCC EHR as an outreach or marketing tool, more children - both existing and new patients - can be served. In addition to being good medicine, this is good business for the pediatric practice.