US Surgeon General and Assistant Secretary for Health David Satcher, MD, PhD and leading infectious disease experts urged physicians to take greater responsibility for making sure adult patients get vaccinated against pneumococcal disease and influenza. This call to action was issued at a press conference convened by the National Foundation for Infectious Diseases (NFID) and the National Coalition for Adult Immunization (NCAI). The conference, held in Washington, DC on October 7,1999, helped to highlight National Adult Immunization Awareness Week, which was celebrated October 10-16 this year.

"We protect our children through immunization, and we must also make sure that this important step is taken for our nation's elderly population," said Dr. Satcher. Currently, only 65 percent of people age 65 and older receive annual flu shots, and the rate is even lower for the pneumococcal vaccine at only 45.5 percent.

"In an average year, 20,000 Americans die from influenza. Thousands of deaths and hospitalizations and millions of cases of flu could be avoided if more people got a flu shot each year," said Dr. Satcher. He continued, "Flu is a serious threat, especially for older people and those with chronic illness. There is an effective flu vaccine, but not enough people are getting it. The best way to prevent flu and its consequences is to get vaccinated before the influenza season hits." The consequences of influenza--which include pneumonia and death--are especially pronounced in high-risk groups: people age 65 and older and those with other medical conditions, such as asthma, diabetes or chronic heart disease.

According to the CDC, it is estimated that during most influenza seasons, approximately 10 to 20 percent of the population is infected with influenza, although rates of infection vary among different age groups and from one season to another. Up to one percent of those infected will require hospitalization and among those, as many as eight percent die.

Pneumococcal disease, which claims as many as 40,000 lives each year in the US, accounts for more deaths than any other vaccine-preventable disease. Yet, many doctors and other health care providers still neglect to offer pneumococcal vaccine to older Americans as a routine part of office visits and hospital admissions. The vaccine can be given at the same time as the flu shot, is generally given once in a lifetime and it is fully reimbursable through Medicare Part B.

"One simple shot has the power to prevent needless suffering and death for thousands of older Americans, save countless healthcare dollars and improve quality of life for everyone," said Dr. Satcher.

While influenza vaccination rates are improving, a national survey of Medicare beneficiaries found that nearly twenty percent of the unvaccinated Medicare recipients did not know they needed the influenza vaccine, according to Walter A. Orenstein, MD, director of the National Immunization Program, Centers for Disease Control and Prevention (CDC). Dr. Orenstein advised, "We need to remain vigilant in promoting flu shots among those 65 and older. Physicians can play a major role in this effort, but older Americans and those at high risk for complications of influenza should be encouraged to ask their physicians about the vaccine during an office visit."

In the last flu season, widespread influenza activity was reported from the third week of January through the second week of April. In the last week of January, the excess death attributable to influenza and pneumonia exceeded the epidemic threshold, it remained at epidemic proportions for the next 11 weeks. Last year marked the fourth consecutive year that the death rate due to pneumonia and influenza was elevated for several weeks running.

"Although the 1998-1999 death rates have not yet been finalized, preliminary estimates suggest that the final death toll with be well above the average of 20,000," said Keiji Fukuda, MD, MPH, epidemiology section chief of the CDC's Influenza Branch.

Gregory Poland, MD, chairman of NCAI and head of vaccine research at Mayo Clinic in Rochester, Minnesota, emphasized the disparity between adult and childhood immunization and called for making adult immunization an integral part of national public health systems, similar to what has been done for childhood immunization. He called this disparity an "outrage to older adults and to the public health system."

"When you realize that approximately 40,000 adults die each year in the United States from pneumococcal disease, compared to the approximately 300 to 500 childhood deaths for vaccine- preventable diseases, you know something is terribly wrong," said Dr. Poland. "It is time to end what amounts to an epidemic of indifference and make adult immunization as high a priority as childhood vaccination."

Dr. Poland urged physicians, hospitals and long-term care facilities to mandate the offer of vaccinations or institute standing orders throughout the system to help ensure older adults and other at risk patients are protected against pneumococcal disease.

Kristin L. Nichol, MD, MPH, chief of medicine at the VA Medical Center in Minneapolis and professor of medicine at the University of Minnesota, emphasized that vaccination not only improves health but also saves medical costs and lost wages in healthy working adults. Citing a definitive study published in the Journal of the American Medical Association, Dr. Nichol said of pneumococcal vaccination, "In any given year, vaccinating as many as 23 million elderly people who may have not been vaccinated would have saved 78,000 years of healthy life and save $194 million."

She continued, "The per person cost of vaccination is more than offset by savings in hospital treatment of pneumococcal bacteremia. There are 50,000 cases of bacteremia each year in the US, with a 15-20 percent death rate among adults and double that (30-40 percent) among elderly patients."

According to Dr. Nichol, influenza can take a major toll in young, otherwise health adults. She cited a report on 846 working adults, half of whom were given a flu shot. Compared with the unvaccinated workers, those who received the vaccine missed 43 percent fewer days of work during the flu season because of a respiratory ailment. "Flu shots keep working adults healthy," Dr. Nichol said. "They also offer tremendous economic benefits to individuals, families, and society at large."

A full transcript of the press conference, including the agenda, vaccination data, speaker biographies and streaming video are available via the NFID web site.

The press conference was supported, in part, by unrestricted educational grants from Aviron, King/Monarch Pharmaceuticals, Medeva Pharmaceuticals, Merck Vaccine Division, Pasteur Mérieux Connaught, and Wyeth Lederle Vaccines.