By: Fawad Piracha, Pharm. D Candidate c/o 2016
The 2012-2013 influenza season has developed into one of the greatest nationwide flu outbreaksof the decade.1 Amid this crisis, many flocked to healthcare providers with flu-like symptoms, while others scoured doctors’ offices, clinics, and pharmacies for the vaccine. With the flu claiming many lives throughout the U.S., and many consequent region-wide declarations of health emergencies, healthcare professionals continue to educate patients of the benefits and risks of vaccines. Using a joint effort, professionals’ goals is to administer vaccinations to as many individuals as possible.2 The CDC considers vaccinations as one of the most efficient measures of disease prevention and one of ten greatest public health feats of the twentieth century.3 Millions of lives have been saved since the introduction of vaccines in the late eighteenth century.4 Although vaccination prevents many illnesses, it has entered the scope of a pharmacist’s practice only recently. The pharmacist’s right to administer vaccines has been realized due in large part to the organized efforts of special interest groups, such as the American Pharmacists Association (APhA). These groups promote and advocate greater forms of pharmacy practice. By October 2009, all 50 states permitted pharmacists to administer various vaccines and immunizations.5 This flu season reveals the profound impact that pharmacists can have on public health crises.
Influenza, commonly known as the flu, is a highly contagious and mutable virus. The predominant serotype widespread in the 2009 swine-flu pandemic was H1N1, one of several serotypes confirmed in human beings. The CDC estimates that 43 million to 89 million people contracted H1N1 between April 2009 and April 2010.6 They estimate between 8,870 and 18,300 H1N1-related deaths.6 The symptoms common to flu patients include fever, cough, nasal congestion, severe cold, fatigue, body aches, and shivering.7
The most widely prescribed medicine for flu patients is oseltamivir phosphate (Tamiflu®). Oseltamivir phosphate is an antiviral drug used to prevent or treat influenza. Tamiflu® comes in two dosage forms: capsule and oral suspension and is approved for use in infants, children, adults, and even the elderly. The FDA recently approved the administration of Tamiflu® to infants over two weeks of age.8 The effects of the drug are not very pronounced. According to Roche, “children aged 1-12 years who received Tamiflu® within 48 hours of first flu symptoms recovered up to 26% (36 hours) faster than those who didn’t receive Tamiflu®.”9 Frequently, entire households are prescribed an antiviral medication even if only one member is diagnosed with the flu.
Although many pharmacists and physicians deem oseltamivir phosphate (Tamiflu®) not very effective, its demand spiked during this season, causing a shortage. Many pharmacists were forced to compound oral suspensions from the Tamiflu® capsules while others counseled parents of young children to sprinkle the contents of the Tamiflu® capsules on food. Even with these different methods being applied, there was still a shortage this season. Although Tamiflu® can be used to treat or prevent flu-related illnesses, the flu vaccine is the superior measure to prevent the infiltration of the virus. The CDC reports that early season flu vaccine effectiveness is 62%.10 This figure encompasses the effectiveness of the vaccine against the two most widespread flu virus strains: H3N2 and H1N1.
Pharmacists have played an important role in combating some of the fears that have resulted from the shortage of primary care physicians, especially during this past flu season. A causative factor of this is the dominance of managed care in healthcare today. More and more frequently, physicians and other healthcare professionals are constricted in treating patients due to various factors, including cost containment. Regardless of constraints, people still need to be treated and so this has led to an emergence of greater opportunities for other healthcare professionals, particularly for pharmacists. For example, it is less costly for managed care entities to have their patrons receive flu shots from pharmacists than from physicians. For this reason, insurance plan providers encourage their patients to receive flu shots from a pharmacist. This is a model that has been inspired by Medicare, whereby flu shots are covered under Medicare Part B. Another contributing factor to the growth of vaccine administration by pharmacists is the fact that pharmacists are more accessible than any other health care professional. Appointments are often not required and the vaccine administration process, from being billed to being bandaged, does not take a great deal of time. Convenience is indeed a major factor that has led patients to prefer receiving vaccines from a pharmacist. The pharmacist is especially preferred for customers who do not have health insurance. Without insurance, someone could pay more than $100 to just see a physician.11 At a chain pharmacy, a flu shot costs around $30. And so, the savings and the convenience resonate particularly well for individuals who are bereft of health insurance.
In administering vaccines, it is important to understand the importance of targeting high-risk individuals. Healthcare personnel, the afflicted, the aged, and the young are among the groups of individuals who are amongst this group. People who meet the criteria of this category are strongly encouraged to be vaccinated, preferably early on. Employers of healthcare personnel often obligate their subordinates to be vaccinated. The rationale is rather elementary: healthcare personnel are more susceptible to being infected by the flu virus from direct or indirect contact and are also more likely to transmit viruses and the like to their subjects, who are frequently immunocompromised patients. Individuals who suffer from chronic conditions including asthma, diabetes, or HIV/AIDS are prone to more critical symptoms upon exposure of the flu virus, which can progress to fatal conditions in the absence of intervention.12 Age is an important factor in determining the risk level of an individual as well. Severe influenza complications are most common in children who are under two.13 As well, the CDC estimates that “90 percent of seasonal flu-related deaths and more than 60 percent of seasonal flu-related hospitalizations in the United States each year occur in people 65 years and older.”14 This can be attributed in large part to atrophied immune defense. And so, it is evident that influenza can be fatal to people who are 65 years and older. Numerous deaths have been reported this season as a result of the flu. Many of the deceased included children and elders who were more susceptible to being affected by exposure to the flu strain, yet did not receive influenza vaccinations. The deaths of such individuals make manifest the heightened importance that should be placed on receiving vaccines.
The increasing role of pharmacists in administering vaccines and in educating patients on methods to prevent the onset and contagion of the flu has indeed resulted in a less severe flu season. It is a privilege for pharmacists to serve patients in this regard and it ought to be regarded as such. Pharmacists have contributed to healthcare in recent flu seasons in a very public health oriented manner. Vaccine administration and educating patients are indeed paradigms of prophylactic care. It is imperative for pharmacists and professional entities to document and publish the impacts that pharmacists have had in the course of recent flu seasons. The findings will prove to lawmakers that pharmacists are deserved of administering vaccines. This would certainly set a precedent, which would make greater forms of practice for pharmacists imminent.
- Soboroff J. Flu outbreak in 2013 earliest, one of the worst in a decade; at least 18 children already dead. Huffington Post. January 9, 2013. Available at http://www.huffingtonpost.com/2013/01/09/flu-outbreak-in-2013-earliest-worst-decade-18-children-dead_n_2440695.html
- Begley S. Flu reaches epidemic level in U.S., says CDC. Reuters. January 11, 2013. Available at http://www.reuters.com/article/2013/01/11/us-usa-flu-idUSBRE9080WD20130111
- Mallone K. and Hinman A. Vaccine mandates: The public health imperative and individual rights. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/vaccines/vac-gen/policies/downloads/vacc_mandates_chptr13.pdf
- How vaccines prevent disease. Centers for Disease Control and Prevention. January 11, 2013. Retrieved from http://www.cdc.gov/vaccines/vac-gen/howvpd.htm
- Terrie Y. Vaccinations: The expanding role of pharmacists. Pharmacy Times. January 15, 2010. Available at http://www.pharmacytimes.com/publications/issue/2010/January2010/FeatureFocusVaccinations-0110
- Pandemic flu history. flu.gov. August 2010. Available at http://www.flu.gov/pandemic/history/index.html
- Urban M. Influenza. The Merck Manual Home Health Handbook. November 2009. Available at http://www.merckmanuals.com/home/infections/viral_infections/influenza.html?qt=&sc=&alt=
- Warner J. FDA approves Tamiflu for infants. WebMD. December 21, 2012. Available at http://www.webmd.com/cold-and-flu/news/20121221/fda-approves-tamiflu-infants
- Genetech USA. Tamiflu for children. 2013. Retrieved from http://www.tamiflu.com/tamiflu-for-children
- What you should know for the 2012-2013 Influenza Season. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/flu/about/season/flu-season-2012-2013.htm
- The Cost of Getting the Flu. Investopedia. October 9, 2012. Retrieved from http://www.investopedia.com/financial-edge/1012/the-cost-of-getting-the-flu.aspx
- HIV/AIDS and the Flu. Centers for Disease Control and Prevention. October 29, 2010. Available at http://www.cdc.gov/flu/protect/hiv-flu.htm
- Children, The Flu, and The Flu Vaccine. Centers for Disease Control and Prevention. August 29, 2012. Available at http://www.cdc.gov/flu/protect/children.htm
- What you should know and do this flu season if you are 65 years and older. Centers for Disease Control and Prevention. July 13, 2012. Available at http://www.cdc.gov/flu/about/disease/65over.htm