The letter by Ashwell et al1 emphasises the importance of targeting influenza vaccination to those groups most at risk of influenza complications, and highlights the need for sufficient vaccine capacity to provide coverage for them.
Current targets for vaccine coverage even in highest risk groups are relatively conservative,2 and increasing vaccination rates closer to 100% will place additional strain on vaccine stocks even without increased uptake by groups less likely to benefit from vaccination.
An audit in our practice of 12 000 patients evaluated influenza vaccine uptake among patients on the COPD register. Patients with COPD are at high risk of complications from influenza and there is a considerable body of evidence supporting the benefits of vaccination in this group.2
During 2004 the practice influenza immunisation strategy focused on the whole target population for influenza vaccination rather than specific risk groups. The rate for COPD patients was 82.6% (n = 109). We implemented an intervention strategy in 2005 targeting COPD patients who had not attended for immunisation in 2004. In addition to the routine vaccine invitation letter sent to all over 65s, further written and telephone contacts were made, offering information and discussion about influenza vaccination. This was reinforced by updating staff about the benefits of vaccination in this high risk group.
In 2005, the influenza vaccination rate among COPD patients was 92.2%, a 10% increase in uptake over 2004. Overall rates of influenza vaccination remained stable within the practice at around 81% of the over 65s.
The aim of vaccination strategies should be to maximise coverage of at-risk groups and we agree with Ashwell and colleagues that there must be sufficient vaccine capacity for these priority patients.
We have shown the effect of a simple intervention in increasing uptake in a group with already high rates of vaccination. We achieved an increase of 10% among COPD patients, giving over 90% coverage. This approach could be applied to other high risk groups, resulting in greater requirement for vaccine. GPs have the potential and the incentive to vaccinate well over the minimum target of 70% of at-risk patients,3 and vaccine supplies must be adequate to support this.
- © British Journal of General Practice, 2006.
