Should NIP flu vaccines be extended to 50 year olds?

Pharmacist administers a vaccine. Source: PSA.
Pharmacist administers a vaccine. Source: PSA.

A new study has examined the effect of flu vaccine in preventing heart attack – while one expert warns of subpar overall uptake and the Guild calls for vaccine harmonisation

A study presented at the Cardiac Society of Australia and New Zealand Annual Scientific Meeting 2019 in Adelaide last week found extending National Immunisation Program (NIP) flu vaccines to 50 year olds could potentially prevent up to 1,482 heart attacks.

Pointing out there is growing evidence suggesting that flu is a contributor in coronary heart disease (CHD), and flu vaccination’s association with a reduction of risk of CHD outcomes, the researchers concluded that extending the NIP to adults aged 50 to 64 is likely to be cost beneficial to the Federal government.

The researchers, an independent team at the University of New South Wales, performed a cost-benefit analysis from a government perspective, informed by publicly available databases and available literature.

In their case-based scenario, the proposal could prevent 1,482 acute myocardial infarctions (AMI), 314 influenza/pneumonia and 388 other respiratory hospitalisation in a year, they said.

Most of the cost savings would be due to averted heart attack hospitalisations.

This would mean a cost saving to the Government of $8.03 million with an incremental benefit-cost ratio of 1.40.

“Extension of the NIP to adults aged 50-64 is likely to be cost beneficial to the government, owing to substantial savings in averted AMI hospitalisations,” said the researchers.

“This is sensitive to vaccine administration cost, which varies if provided through general practitioners or pharmacists; and to variation in vaccine effectiveness.

“This study may be one of the first economic evaluations to incorporate the protective effect of influenza vaccination against AMI in the Australian setting.”

Professor Raina MacIntyre, Head of the Biosecurity Research Program, Kirby Institute, UNSW Medicine and an Immunisation Coalition member, commented on the study, saying that “Evidence from several studies indicates that annual vaccination against seasonal influenza reduces cardiovascular morbidity and mortality in patients with cardiovascular conditions”.

“Studies indicate that the influenza vaccine almost halves the risk of heart attacks in older adults,” she said.

“The Immunisation Coalition recommends influenza vaccination for patients with Acute Coronary Syndromes (ACS) prior to discharge from hospital and as part of comprehensive secondary prevention in persons with coronary and another atherosclerotic vascular disease.

“Healthcare providers, including specialists, who treat individuals with cardiovascular disease can help improve influenza vaccination coverage rates by asking about vaccination status, strongly recommending and providing vaccination before and throughout the influenza season.”

Meanwhile Professor Paul Van Buynder, from Griffith University’s School of Medicine, has spoken to the ABC following the death of Toowoomba nail technician and mother of three Jacinta Foulds, who died aged 35 of the flu last week. She was the 83rd person to die in Australia of influenza this year, according to the ABC.

Ms Foulds’ husband, Daniel Foulds, spoke to the media encouraging Australians to get the flu vaccination each year.

Prof Van Buynder said that only around 30-40% of Australians are vaccinated against flu this year.

“This is not ‘everybody got vaccinated and we’re seeing record numbers’, this is a third to two-fifths of Australians got vaccinated and we’re seeing a record number of cases, which wouldn’t happen if the other 60% went out and rolled up their sleeves,” Professor Van Buynder said.

The general public, including the Foulds family – which had been among those not vaccinated – simply did not understand how severe influenza and its complications can be, or that the vaccine is effective, he said.

“They think it’s just something that gives them a runny nose so they don’t see the point of a vaccine.

“There’s this belief out there that this vaccine is no good, or that the vaccine gives you the flu, or that the vaccine has bad side effects — and none of those things are correct.”

A Pharmacy Guild spokesperson told the AJP that “In this year’s particularly bad flu season, we have seen hundreds of thousands of patients choosing the convenience of getting their flu vaccination at their local pharmacy, administered by a fully trained immunising pharmacist.

“However, in some states vaccines under the National Immunisation Program for older and at-risk patients are available through pharmacy, but not available in other jurisdictions.

“We have no data on exactly how many of those vaccinated in pharmacies would otherwise have gone without seeking a vaccination, but surveys and anecdotal evidence suggest there are many people who are getting vaccinated only because of the accessibility of their local pharmacy.”

The spokesperson pointed out that in all jurisdictions across Australia, trained community pharmacists can legally administer vaccinations, but the range of vaccinations and the allowable age of patients varies from one jurisdiction to another.

“It would make great sense for Australians, regardless of where they live, to have the same option of accessing vaccinations conveniently and safely from their local pharmacist,” they said.

“It’s time pharmacists nationwide are authorised to safely administer the same vaccines to their patients in the interests of herd immunity and a better, more efficient health system.”

To date, Immunisation Coalition figures show that there has been a total of 210,658 laboratory confirmed notifications of Influenza in Australia for 2019, as at the start of 12 August.

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  1. Anthony Zehetner

    Immunisers should wear gloves — maybe you should fix the picture before the GP’s get angry again!

  2. Anthony Zehetner

    I was disheartened to see that the latest issue of Australian Pharmacist (August 2019) showed a pharmacist interacting with a customer without her “Ben Casey” uniform buttoned up. I know this might sound like a petty thing to comment on, however when I was a pharmacist and wore the same uniform, my preceptor/manager/boss would be horrified if I did such a thing and I would be reprimanded. Even in the Australian summer heat, I would have my Ben Casey buttoned up as it was professional. Rather like wearing a tie not properly done up, a poor state of ‘undress’ does not project professionalism and respect to the customer or one’s occupation.

    Possibly the thinking is that it makes this pharmacist more ‘casual’ and ‘accessible’ for the public. However at a time when the profession is under close scrutiny by others (such as the AMA and GPs) I feel we must lift our game and portray the best and most professional image of Australian Pharmacy that we can.

    I think this is ammunition for doctors to state that pharmacists are not providing professional standards.

    I just wish that we would be more mindful of the images we portray of ourselves and that constructive criticism should come from within before external stakeholders take further aim at us.

    I welcome any feedback from other pharmacists!

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