On average, 5% to 20% of the U.S. population experience influenza (flu) infections every year, with 200,000 flu-related hospitalizations and 36,000 deaths due to flu (CDC, 2006).  Flu vaccination is an important way to reduce the risk of acquiring the flu.

Contrary to the common myth that getting a flu shot may make people sick, vaccines that contain killed flu viruses lack the ability to produce flu symptoms. Individuals who opt instead for the nasal spray flu vaccine that contains live, attenuated viruses may experience mild flu symptoms; this form of vaccine is only available to healthy individuals between the ages of 5 and 49 who are not pregnant.

PHMC’s 2004 Southeastern Pennsylvania (SEPA) Household Health Survey provides data on flu vaccination in the region. Using data from the 2004 survey, the following article examines flu vaccination among two vulnerable groups—children and older adults.

VACCINATIONS AMONG CHILDREN IN SEPA

The Centers for Disease Control (CDC) recently revised its flu vaccination recommendations for children. The new guidelines expand the recommended age range to include 2- to 5-year-olds, in addition to children 6 to 23 months of age. During the 2003-2004 flu season, over 6 out of 10 American children (63.0%) who died from flu complications were less than five years of age (CDC, 2006).  The total number of flu-related pediatric deaths was greater than the combined deaths from chickenpox, whooping cough, and measles.

In SEPA in 2004, approximately one out of three children (31.8%) aged 17 years or younger received a flu shot or nasal flu mist in the previous year; this percentage represents an estimated 289,800 children who were vaccinated against the flu. However, a considerable majority of children (58.5%) never had a flu vaccination, representing about 533,100 children in SEPA.  In addition:

- Poor children (39.6%) were more likely than non-poor children (30.6%) to have had a flu shot or flu mist in the previous year.

- Male children were equally likely as female children to be vaccinated against the flu in the previous year.

- Black/African-American children (41.5%) were most likely to have had their flu vaccinations in the previous year, followed by Latino (40.2%), Asian (34.5%), and White (26.2%) children.

- Among children with a regular source of care, 59.3% never received a flu shot or flu mist, compared to 44.5% of children without a regular source of care.

According to a CDC report, healthy children less than two years of age are at high risk for hospitalization if they contract the flu. Every year, the flu virus is responsible for more than 20,000 hospitalizations among children younger than 5 years of age (CDC, 2006). Children between 2 and 4 years of age are likely to seek medical care at the doctor’s office, urgent care center, or emergency room as a result of flu infections.

- In Southeastern Pennsylvania, nearly half of all children aged 1-2 years (46.2%) had never been vaccinated against the flu.

- Among children ages 3 to 5, 35.9% were vaccinated in the previous year but 53% (representing about 77,900 children), had never received flu vaccinations.

FLU VACCINATIONS AMONG OLDER ADULTS IN SEPA

Flu may develop into pneumonia, which is a more serious respiratory infection in the lungs. Studies have found that 90% or more of deaths attributed to influenza and pneumonia are among older adults aged 65 and above (CDC, 2006). Hence, vaccinations might save the lives of many older adults by offering protection against the flu virus.

Data from the 2004 Household Health Survey show that about 7 in 10 older adults (67.9%) aged 60 and above reported getting a flu shot in the previous year. Elderly persons aged 75 and above (78.0%) were more likely than adults aged 60 to 74 (61.3%) to have had a flu vaccination in the previous year. Among adults aged 60 and older, survey results further indicate that:

- Approximately one out of five older adults (21.2%) 60 years of age and older never had a flu shot. This percentage represents 147,600 elderly persons who were never vaccinated against the flu.

- A greater percentage of non-poor older adults (68.2%) than poor older adults (62.7%) reported receiving a flu shot in the previous year.

- A larger percentage of older adult males (69.5%) than females (66.8%) received flu shots in the previous year.

- Older White adults (70.2%) were most likely to get a flu vaccination in the previous year, followed by Asian (66.8%), Black/African-American (60.3%), and Latino (45.8%) adults.

- Notably, 40.2% of Latino older adults had never received a flu shot, compared to 27.4% of Black/African-American, 19.4% of White, and 18.6% of Asian adults.

- Older adults in fair or poor health (67.0%) were slightly less likely than older adults in excellent or good health (68.3%) to have received a flu shot in the previous year.

SUMMARY

The 2004 Household Health Survey results reveal that vaccination levels are relatively low among children aged 1 to 5, who are at increased risk of experiencing flu symptoms that are severe enough to warrant medical attention if they contract the flu. This may be partly due to the fact that the CDC has only recently assigned children 24 to 59 months of age as a priority group for flu vaccination. There may be an increase in the percentage of young children receiving flu shots or flu mist in future years. We look forward to the 2006 Household Health Survey results in order to watch for a change in incidence of childhood flu vaccination.  The 2004 survey data also reveal the need to address disparities in vaccination coverage among adults in Southeastern Pennsylvania. Flu vaccination among elderly Latino adults is much less common than among those in other racial/ethnic groups.

While the flu season can occur anytime from November through April (CDC, 2006), it often peaks in the winter during the month of February. It is therefore not too late for individuals who are at higher risk for developing flu-related complications to seek vaccination in the coming month.

For more information on the findings presented in this article, please contact Community Health Data Base staff members Xuan-Shi Lim, xlim@phmc.org, or Allegra Gordon, agordon@phmc.org.