MONTREAL — Influenza vaccines and antiviral drugs greatly reduce the incidence of and mortality associated with community-acquired pneumonia, but they are grossly underutilized, according to Dr. Grant Stiver, professor of medicine at the University of British Columbia, Vancouver.
“We are not optimizing the management of influenza by far—largely because of costs and political unwillingness to put out money,” he said at an international conference on community-acquired pneumonia (CAP). “We are the ones who influence policy. … We need to do a better job at campaigning for improved resources to reduce the morbidity and mortality due to influenza because it's quite clear that we're just not doing enough.”
Until now, influenza prevention has focused on so-called high-risk groups, but there is no reason why the net shouldn't be widened to include everyone, Dr. Stiver said. During the 2003–2004 influenza season, half of the 153 influenza-associated deaths among children in the United States were in those with no high-risk conditions (N. Engl. J. Med. 2005;353:2559–67).
“These were your normal children or grandchildren,” he said, adding that 70% of the deaths resulted from respiratory infection, and 47% of these were from confirmed CAP. “Pneumonia is a scary thing for the public, but influenza is not. Influenza is something that the public can trivialize until a member of their family dies from pneumonia. So if we show we can actually prevent pneumonia with the optimization of influenza vaccine and antivirals, we can probably get better public acceptance.”
Dr. Stiver said that to increase vaccination rates, it may be time to put more pressure on target groups such as health care workers. “We should make vaccination a condition of employment for health care workers, and if they don't want it, they can't work in a health care institution. We can play hardball and demand this,” he said. Essential service workers who are designated as first priority for antiviral prophylaxis in the event of a pandemic should be denied the drugs if they have not been previously vaccinated, he suggested at the meeting, which was sponsored by the International Society of Chemotherapy.