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Thousands Die for Lack of Vaccinations, Officials Say

October 25, 1988|JANNY SCOTT | Times Medical Writer

About 70,000 Americans die unnecessarily each year as a result of "missed opportunities" for simple, effective and relatively inexpensive vaccination against preventable diseases such as influenza, federal officials said Monday.

Only about one-fifth of all adults at high risk for pneumonia and other complications of influenza receive influenza vaccination, the officials said. Only about one-third of those at risk for hepatitis B, and one in 10 of those at risk for diseases caused by pneumococcal bacteria, have been immunized.

Experts blame the lack of immunization on the unwillingness of private and public insurers to pay for adult vaccinations. In addition, they say, physicians as well as patients have failed to recognize the value of immunization.

"I have been thoroughly shocked at the number of people who are not protected," said Dr. Richard J. Duma, president of the National Foundation for Infectious Diseases, speaking at a press conference at a microbiology convention in Los Angeles Monday.

"There are too many missed opportunities," said Dr. Alan Hinman, of the U.S. Centers for Disease Control, who participated with Duma in the press conference, which was aimed at calling the attention of physicians and the public to the country's failure to immunize adults, particularly the elderly.

In an effort to correct this, Hinman announced at the Interscience Conference on Antimicrobial Agents and Chemotherapy a new $25-million-a-year trial demonstration program under which the influenza vaccinations of more than 400,000 people will be covered by Medicare. The federal health care finance administration will assess the cost effectiveness of the two- to four-year program, which is being tried initially in seven counties and states from Pennsylvania to Arizona.

The "demonstration" program, which is scheduled to begin in coming weeks, is part of a broader nationwide drive by a newly formed coalition of public agencies and private professional groups that aims to elevate adult immunization levels to at least 60% of the so-called targeted or high-risk groups.

William E. Small, executive director of the National Coalition for Adult Immunization, said a delay in producing the flu vaccine this year should not affect the trial program, which will take a while to get fully geared up.

The vaccines that are under-used, in addition to the flu vaccine, prevent pneumococcal diseases and hepatitis B. Also available but under-utilized are vaccines for measles, mumps and rubella and for diphtheria and tetanus. The unnecessary deaths, and about 20 million cases of sickness annually, result largely from pneumonia and other respiratory complications caused by influenza and pneumococcal bacteria.

There are also 300,000 cases of hepatitis B infection each year, including 18,000 among health care workers exposed to blood products. Several hundred people die from that infection or related liver cancer.

Federal officials estimate the cost of treating those cases in the billions of dollars--far more than the cost of immunizing people at high risk. Yet Medicare has paid only for pneumococcal vaccine and most private insurers cover none of the vaccines, Hinman said.

In addition, physicians and health care workers have failed to take advantage of opportunities to immunize high-risk adults, particularly during hospital and office visits. As many as half of all people who die of pneumonia have been to a doctor during the previous year.

As part of the demonstration program, people targeted for the annual influenza vaccinations include those with serious and chronic heart and lung disease, people in nursing homes and healthy adults over 65. Also targeted are diabetics, people with anemia and kidney disease, and those who care for those groups.

The pneumococcal vaccine, which is administered just once, is recommended for many of those people as well as people with spleen problems, malignancies, alcoholism and sclerosis of the liver.

The hepatitis B vaccine is recommended for health care workers, intravenous drug users, gay men and the households and newborns of hepatitis B carriers.

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