Monday, December 11, 2017

What's new with flu?

- Jennifer Middleton, MD, MPH

We're starting to see our first few cases of influenza where I practice, and the Centers for Disease Control and Prevention (CDC) confirms that the 2017-18 influenza season is off and running in the United States. The predominant activity thus far has been influenza A(H3N2), which is included in all formulations of the influenza vaccine available in the US. Less than 40% of eligible children and adults in the US have received this year's vaccine, but it's not too late to increase our practices' vaccination rates. Here are some simple tips and tools to help do so from the primary care literature.

The Annals of Family Medicine's latest issue includes a randomized controlled trial using text messages to encourage influenza vaccination that had modest success in an Australian multi-center trial. The researchers chose to focus on high-risk populations within these 10 practices including the elderly, young children, pregnant women, individuals with co-morbid health conditions, and certain ethnic minorities. An average of 29 patients (or parents) received text messages for every patient who was vaccinated, costing the practices $3.48 per additional vaccinated patient (at $0.12/text message). That "number needed to text" (my wording) may seem unimpressive, but the cost and time investment that resulted in those vaccinations was modest. The greatest increase in vaccination rates was in children under the age of 5.

An article from Family Practice Management reviews five simple steps to improving vaccination rates: find a champion, use standing orders, optimize your documentation, provide regular reminders to providers, and give ongoing feedback. The authors describe a template for their vaccination standing order, tips for documenting vaccines received elsewhere and vaccine refusals, the use of electronic health record (EHR) and visual reminder systems, and tracking vaccination numbers with simple office metrics. They review the evidence base behind each of these five steps and provide specifics regarding how to implement each one.

A recent AFP Practice Guideline reviews the CDC's Advisory Committee on Immunization Practices' (ACIP) recommendations for the current season. It includes descriptions of the currently available vaccination products and also provides guidance regarding vaccinating persons with a history of Guillain-Barre syndrome (only in individuals at high risk of complications from influenza) or egg allergy (closely monitor persons with a history of anaphylactic egg allergy immediately after vaccination).

The AFP By Topic on Influenza provides many more resources, including patient information handouts and tips for conversing with vaccine-adverse individuals. The CDC's weekly FluView report is another useful tool that I recently added to my AFP Favorites page.

What strategies has your practice used to encourage influenza vaccination?