by Robert Strang MD, M.H.Sc., FRCPC
Medical Officer of Health, Capital Health District

As recognized leaders in the health care system, pharmacists can play a key role in heightening awareness of the yearly impact of influenza and placing greater emphasis on influenza prevention through annual immunization. The literature shows that a clear recommendation from a pharmacist is a significant factor in determining whether individuals receive influenza vaccine.

Due to changing viral strains, influenza epidemics occur annually, with rates of illness in the general community usually ranging from 10 percent to 20 percent. In closed populations, such as nursing homes and schools, illness rates can reach over 50 percent. The medical and social costs of these annual epidemics are tremendous: in a typical influenza season in Nova Scotia there are over 400 deaths, 2,500 hospitalizations, and 20,000 physician visits attributable to influenza.

Immunization of individuals at high risk for severe influenza and its complications and their close contacts remains the cornerstone of influenza prevention and control.

Groups eligible to receive free influenza vaccine in Nova Scotia are:

• adults and children with chronic heart or lung disease, diabetes mellitus and other metabolic diseases, cancer, immunodeficiency, immunosuppression (due to underlying disease and/or therapy), renal disease, anemia, and hemoglobinopathy
• children and adolescents (age 6 months to 18 years) with conditions treated for long periods with acetylsalicylic acid (e.g., rheumatoid arthritis patients)
• people of any age who are residents of nursing homes and other chronic care facilities
• those 65 or older
• those who live or care for someone in the above groups
• health care workers [includes all staff and volunteers in acute or long-term care facilities, home care/home support agencies, community-based offices (including physicians, pharmacists, dentists, and physiotherapists) or other community settings] and students in a health care profession educational program
• first responders (EHS, fire, and police)

NEW All children from 6 to 23 months of age NEW

Please remember, children less than 9 years of age receiving influenza vaccine for the first time require two doses of the vaccine, with an interval of 4 weeks between doses.

The National Advisory Committee on Immunization (NACI) has recommended children aged 6 to 23 months for annual flu immunization because this age group is at increased risk of being hospitalized due to severe influenza or complications (e.g., pneumonia) from influenza. These rates of hospitalization are equal to those seen in other groups identified as being at high risk from influenza.

Despite the central role of immunization in influenza prevention, immunization rates remain sub-optimal in Nova Scotia. Table 1 shows community immunization rates for 2003–04.

a This represents the entire population under age 65; data limitations do not allow determination of how many of these had a high-risk condition.

b This is the national target for those < 65 with a high-risk condition.

In both their community and hospital roles, there are many opportunities for pharmacists to promote and support annual influenza immunization:

• Ensure that high-risk individuals are advised about influenza vaccine at every clinical encounter during the fall and early winter.
• Encourage and support initiatives to provide influenza vaccine within health care facilities such as at outpatient specialty clinics (e.g. diabetic daycare), as part of discharge planning for admitted patients, and in emergency rooms.
• Be a positive role model for other HCW by being immunized themselves, encouraging co-workers to be immunized, and providing factual information on influenza vaccine.
• Promote and support the allocation of resources to implement comprehensive influenza immunization programs for both the public and HCW.
• Work with other partners, such as Public Health, to increase opportunities for the public to access influenza immunization.

For more information on influenza vaccine contact your local public health office or look at the following websites: www.gov.ns.ca/health/opmoh/flu.htm or www.influenza.cpha.ca.