The Evolving Landscape of Influenza Immunizations - Episode 11
The expert panel identifies patient populations who can benefit most from influenza vaccination.
Mitchel Rothholz, RPh, MBA: Studies have shown that some patients can benefit from the influenza vaccine. Who are those patients? How should pharmacists identify and communicate with those patients?
John Beckner, RPh: Most pharmacies have a significant number of patients with diabetes in their population, and certainly folks who have other chronic diseases, such as heart disease and asthma. Smokers could also benefit. Anyone can benefit from the seasonal flu vaccine, but certainly those populations could benefit and should protect themselves against serious disease.
Jeff Goad, PharmD, MPH: To John’s point, it also helps to customize the message rather than say that everyone 6 months and older should get the flu vaccine. Say, “You’re a smoker, which increases your risk of pneumococcal pneumonia. You have diabetes, which increases your risk of more severe disease. Or you have cardiopulmonary or endocrine,” all these different things. You can customize it, then it becomes a recommendation for them, not for everyone. Also, we can’t forget that pregnancy is still in there as well. Make sure our pregnant patients know that they should be vaccinated. That has been a constant struggle that ob-gyns [obstetrician-gynecologists] and pharmacists have faced.
Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: Mitch, that’s part of doing the gap analysis of the patient when they come in. You’ve done your job to get them to come into the pharmacy to pick up their medications through a medication synchronization program. Before they came in, you were doing a full review of their medications and looking at whether there’s a gap in their medications, and vaccines would be 1 of those gaps. Which vaccine are they eligible for, and why should they be getting that? That’s when you can have that conversation and say, “You’re a high-risk patient, and this is why this vaccine is important.” [That way] before they come in to pick up the medication or set up the service, they know in advance that they’re going to come in and do this and have that conversation with the pharmacist. If we do that over and over, I guarantee that we’ll increase the vaccination rates of patients.
John Beckner, RPh: To that point, I saw a recent number that said 9 of 10 people coming into a community pharmacy had some type of vaccine need. Mitch, correct me if I’m wrong. You may have told me that. I’m trying to emphasize the opportunity there.
Mitchel Rothholz, RPh, MBA: There are a lot of missed opportunities that are great opportunities for that discussion and impact. Have any of you utilized some of the recent publication work that was put out in terms of heart disease prevention or heart attack prevention and flu? Any insights from that work that you want to share with the audience on how you communicate that to your patients?
Jeff Goad, PharmD, MPH: There’s a positive bias toward literature. We like to find the studies that support our beliefs. Fortunately for flu, a lot of studies support our beliefs, and one that we’ve always known is around cardiovascular disease. We certainly see that patients who have congestive heart failure can decompensate and get multiorgan system failure and go into respiratory distress and die in the ICU [intensive care unit]. We know that cardiovascular disease and flu is linked.
We’re also seeing evidence that shows more of a direct benefit beyond preventing the disease. The recent meta-analysis that you referred to showed that the flu vaccine had a 34% lower risk of major cardiovascular events. If you got the flu vaccine, you’re less likely to have a major heart attack or decompensation in the hospital. The primary effect is very likely prevention of flu, but it didn’t explain all of it. There’s also the secondary effect. Even for people who got influenza, we’ve discussed throughout the presentation that it has effects beyond preventing flu but also preventing severe disease. We’ll continue to see more evidence that the flu vaccine prevents not only flu but also complications in those who get the flu. That’s a strong benefit from using the flu vaccine.
Mitchel Rothholz, RPh, MBA: Jeff, one of the groups you mentioned was pregnant individuals. Is there any specific time during pregnancy that an individual should get vaccinated? What’s your guidance for the audience?
Jeff Goad, PharmD, MPH: We used to say to avoid the first trimester. Not that there was ever any evidence that teratogenicity was going on, but it was one of those recommendations. Since then, for many years, we made it very easy. You can vaccinate them in any trimester. It’s unlike a Tdap [tetanus, diphtheria, pertussis] vaccination, where you’re trying to time the vaccine to the development of antibodies for the developing fetus. It’s different for influenza. Any time during pregnancy is appropriate. Of course, it’s best to give it before they deliver or at least a bit further from delivery, so they can get the benefit for both the mom and potentially for the baby, but more for mom than baby for influenza.
Transcript edited for clarity.