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Complete Health Indicator Report of Immunization - Influenza, Adults

Definition

Number of adults who reported receiving an influenza vaccination in the past 12 months.

Numerator

Number of survey respondents who reported receiving an influenza vaccination in the past 12 months.

Denominator

Number of survey respondents.

Data Interpretation Issues

Adult data for Utah and U.S. is also available from the FluVaxView Influenza Vaccination Coverage web page, which is estimated annually by CDC utilizing data from several nationally representative surveys. These surveys include the National Health Interview Survey (NHIS), the Behavioral Risk Factor Surveillance System (BRFSS), the National Immunization Survey (NIS), and in 2009-10, the National 2009 H1N1 Flu Survey (NHFS). For the 2010-11 influenza season, additional assessment systems were developed to provide timely coverage estimates for selected populations. These include: rapid household telephone surveys and cell phones conducted nationally and in 20 selected local areas, internet panel surveys of pregnant women and health care workers, and use of third-party medical claims data. Beginning in 2011, BRFSS data include both landline and cell phone respondent data along with a new weighting methodology called iterative proportional fitting, or raking. This methodology utilizes additional demographic information (such as education, race, and marital status) in the weighting procedure. Both of these methodology changes were implemented to account for an increased number of U.S. households without landline phones and an under-representation of certain demographic groups that were not well-represented in the sample. More details about these changes can be found at: [https://ibis.health.utah.gov/pdf/opha/resource/brfss/RakingImpact2011.pdf]. The survey question for this measure changed in 2011 to "During the past 12 months, have you had either a seasonal flu shot or a flu vaccine that was sprayed into your nose?". In previous years the question was "A flu shot is an influenza vaccine injected in your arm. During the past 12 months, have you had a seasonal flu shot?".

Why Is This Important?

Influenza, or flu, is an acute viral infection involving the respiratory tract that can occur in epidemics or pandemics. Influenza can cause a person, especially older persons, to be more susceptible to bacterial pneumonia. It was estimated that from 2010-2011 to 2015-2016 flu seasons, flu related hospitalizations in the U.S. ranged from 140,000 to a high of 960,000. ^1^ The annual direct medical costs (hospitalization, doctors office visits, medications, etc.) for influenza in adults are estimated at $8.7 billion including $4.5 billion for adult hospitalizations resulting from influenza-attributable illness. Influenza is also responsible for substantial indirect costs ($6.2 billion annually), mainly from lost productivity.^2^ __References__ #Centers for Disease Control and Prevention (CDC). ''Seasonal Influenza-Associated Hospitalizations in the United States''. Retrieved from: [http://www.cdc.gov/flu/about/qa/hospital.htm] #Centers for Disease Control and Prevention (CDC). ''Workplace Health Promotion - Adult Immunization''. Retrieved from: [http://www.cdc.gov/workplacehealthpromotion/health-strategies/flu-pneumonia/index.html]

Healthy People Objective IID-12.12:

Increase the percentage of adults aged 18 and older who are vaccinated annually against seasonal influenza
U.S. Target: 70.0 percent

Other Objectives

Utah's 42 Community Health Indicators[[br]] CSTE Chronic Disease Indicators

How Are We Doing?

The percentage of Utahns aged 65+ who received a flu vaccine is measured by the Behavioral Risk Factor Surveillance System (BRFSS) survey, and was found to be 56.0% in 2017 as compared to 54.9% in 2016. There was a decrease in coverage rates from 2007-2010 using the old BRFSS methodology and we saw a continuation of this decreased trend in 2011 and 2012 using the new methodology that was implemented in 2011. Using the new methodology, there was an increase in coverage rates from 2013-2015. In 2016 the coverage rate decreased again, but increased in 2017. The data can fluctuate year to year, and it will be useful to look at the data in the future to see which way the trend will go.

How Do We Compare With the U.S.?

In Utah, 56.0% of adults aged 65+ surveyed on the Behavioral Risk Factor Surveillance System (BRFSS) in 2017 reported receiving a flu shot in the previous 12 months. Nationwide for the same age group, the rate was 60.5%.

What Is Being Done?

The UDOH Immunization Program and Office of Epidemiology educate health care providers, clinic staff, and the public about prevention methods and support investigation of outbreaks. ==Who Should Get Influenza Vaccine?== For the 2018-2019 season, the Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for everyone six months and older with any licensed, appropriate influenza vaccine with no preference expressed for any one vaccine over another. Some vaccines are not recommended in some situations and health conditions, and some people should not receive influenza vaccines at all (though this is uncommon). ===The Influenza (Flu) Shot=== ====People Who can get the flu shot==== *Different flu shots are approved for people of different ages. Everyone should get a vaccine that is appropriate for their age. *There are inactivated influenza vaccines that are approved for people as young as six months of age. *Some vaccines are only approved for adults. *Flu shots are recommended for pregnant women and people with chronic health conditions. [[br]] ====People who SHOULD NOT get the flu shot:==== *Children younger than six months of age are too young to get the flu shot. *People with severe, life-threatening allergies to flu vaccine or any ingredient in the vaccine. This might include gelatin, antibiotics, or other ingredients. [[br]] ====People who should talk to their doctor before getting the flu shot:==== If you have one of the following conditions, talk with your healthcare provider: *If you have an allergy to eggs or any of the ingredients in the vaccine. Talk to your doctor about your allergy. *If you ever had Guillain-Barr Syndrome (a severe paralyzing illness, also called GBS). Some people with a history of GBS should not get this vaccine. Talk to your doctor about your GBS history. *If you are not feeling well, talk to your doctor about your symptoms. [[br]] ===Nasal Spray Flu Vaccine:=== ====People who can get the nasal spray flu vaccine:==== *The nasal spray vaccine is approved for use in people 2 years through 49 years of age. It is an option for healthy, non-pregnant people in this age group. [[br]] ====People who SHOULD NOT get the nasal spray vaccine:==== *Children younger than two years *Adults 50 years and older *Pregnant women *People with a history of severe allergic reaction to any component of the vaccine or to a previous dose of any influenza vaccine *Children 2 years through 17 years of age who are receiving aspirin- or salicylate- containing medications *People who are immunocompromised *Children 2 years through 4 years who have asthma or who have had a history of wheezing in the past 12 months *People who have taken influenza antiviral drugs within the previous 48 hours *People who care for severely immunocompromised persons who require a protected environment (or otherwise avoid contact with those persons for 7 days after getting the nasal spray vaccine). [[br]] ====People who should talk to their healthcare provider:==== If you have one of the following conditions, talk with your healthcare provider. He or she can help decide whether vaccination is right for you, and the select the best vaccine for you situation: *People with asthma aged 5 years and older *People with underlying medical conditions that can put them at higher risk of serious flu complications. These include conditions such as chronic lung diseases, heart disease, kidney disease, liver disorders, neurological and neuromuscular disorders, blood disorders, or metabolic disorders. *People with moderate or severe acute illness with or without fever *People with Guillain-Barr Syndrome within 6 weeks following a previous dose of influenza vaccine [[br]] __Reference__[[br]] Centers for Disease Control and Prevention (CDC). "Vaccination: Who Should Do It, Who Should Not and Who Should Take Precautions". Retrieved from: [https://www.cdc.gov/flu/protect/whoshouldvax.htm].

Available Services

Available services for influenza include: * All influenza and pneumococcal vaccinations are covered for seniors with Medicare Part B. * Low-income and/or homeless adults can be immunized for a reduced fee based on income level at many Community Health Clinics. * Adults who are not U.S. citizens may also receive lower cost immunizations based on their income level at many Community Health Clinics. * Drive-by clinics are offered by some providers throughout the state for persons with limited physical mobility. * Immunizations can also be given to the home-bound through many private providers and county services. [[br]] Call the Immunization Hotline at 1-800-275-0659 for a list of Community Health Clinics, County Health Departments, Aging Services, and other providers who can assist you. Additionally, information about influenza and pneumococcal vaccinations can be found on the Utah Immunization Program website at: [http://www.immunize-utah.org].


Related Indicators

Relevant Population Characteristics

Age is a risk factor for influenza. Adults 65 years of age and older are at increased risk of contracting influenza due to a natural decline in the strength of their immune system. Children younger than five years, but especially younger than two years of age are considered high-risk for influenza. However, people of all ages with immune deficiencies or other high-risk conditions are at increased risk for influenza.

Related Relevant Population Characteristics Indicators:


Health Care System Factors

All Health Insurance Marketplace plans and most other private insurance plans must cover Influenza vaccines without charging a copayment or coinsurance when provided by an in-network provider. This is true even for patients who have not met a yearly deductible. For older adults, Medicare part B does cover influenza and pneumococcal vaccinations, and Medicaid covers influenza and pneumococcal for children recommended to receive vaccine. A new long-term care facilities licensing rule has been implemented to guarantee consistent screening for influenza and pneumococcal vaccinations, for standing orders to give vaccines, for keeping immunization histories of all residents and employees, for the offer of a one-time pneumococcal vaccination for the residents, and for the annual offering of an influenza vaccination for both the residents and employees. This new rule should raise immunization rates for adults who reside in institutional settings.

Related Health Care System Factors Indicators:


Risk Factors

Risk factors for serious complications of influenza include: * Children younger than five years, but especially younger than two years * Adults 65 years of age and older * Pregnant women (and women up to two weeks postpartum) * Residents of nursing homes and other long-term health facilities * American Indians and Alaskan Natives * People who have chronic medical conditions including: ** Asthma ** Neurological and neurodevelopment conditions ** Chronic lung disease ** Heart disease ** Blood disorders ** Endocrine disorders ** Liver disorders ** Metabolic disorders ** Weakened immune system due to disease or medication ** People younger than 19 years of age who are taking aspirin or salicylate-containing medications ** People with extreme obesity (BMI of 40 or greater) [[br]] __Reference__ #Centers for Disease Control and Prevention (CDC). ''Are you at High Risk for Serious Illness from Flu''. Retrieved from: [https://www.cdc.gov/features/fluhighrisk/index.html]

Related Risk Factors Indicators:


Health Status Outcomes

Based on current recommendations for influenza and pneumococcal vaccines, any person with a risk factor for influenza or pneumonia should be screened by their health care provider for immunization status and be vaccinated. Any person with a risk factor for influenza or pneumonia who has been hospitalized for illness in the last year should have been immunized before leaving the hospital based on current recommendations, unless they decline vaccination or have a contraindication for receiving the vaccine. Any person with a risk factor for influenza or pneumonia who resides in a nursing home or long-term care facility should have received these immunizations upon entry into the facility based on current recommendations, unless declined or contraindicated. Since pneumonia is the most common serious complication of influenza, a pneumococcal vaccination could save their life.

Related Health Status Outcomes Indicators:




Graphical Data Views

Influenza Vaccination in the Past 12 Months, Utah and U.S. Adults Aged 65+, 1995-2017

::chart - missing::
confidence limits

BRFSS Utah vs. U.S.YearCrude Percentage of Adults Age 65+Lower LimitUpper Limit
Record Count: 40
UT Old Methodology199570.2%65.2%74.8%
UT Old Methodology199766.2%60.3%71.5%
UT Old Methodology199975.1%70.1%79.6%
UT Old Methodology200168.7%63.1%73.8%
UT Old Methodology200271.1%66.4%75.3%
UT Old Methodology200374.8%70.4%78.7%
UT Old Methodology200475.5%72.1%78.6%
UT Old Methodology200569.6%66.2%73.0%
UT Old Methodology200672.1%68.8%75.4%
UT Old Methodology200776.2%73.2%79.0%
UT Old Methodology200873.3%70.2%76.2%
UT Old Methodology200968.8%66.6%70.9%
UT Old Methodology201068.2%66.0%70.3%
US Old Methodology199560.1%60.1%60.1%
US Old Methodology199766.1%66.1%66.1%
US Old Methodology199967.6%67.6%67.6%
US Old Methodology200167.3%67.3%67.3%
US Old Methodology200268.6%68.6%68.6%
US Old Methodology200370.2%70.2%70.2%
US Old Methodology200468.0%68.0%68.0%
US Old Methodology200565.7%65.7%65.7%
US Old Methodology200669.6%69.6%69.6%
US Old Methodology200772.0%72.0%72.0%
US Old Methodology200871.1%71.1%71.1%
US Old Methodology200970.1%70.1%70.1%
US Old Methodology201066.6%66.1%67.1%
UT New Methodology201156.9%54.6%59.1%
UT New Methodology201256.0%53.9%58.1%
UT New Methodology201357.4%55.1%59.7%
UT New Methodology201457.9%55.9%60.0%
UT New Methodology201559.0%56.4%61.4%
UT New Methodology201654.9%52.5%57.3%
UT New Methodology201756.0%53.5%58.4%
US New Methodology201161.3%61.8%60.8%
US New Methodology201259.4%58.9%59.9%
US New Methodology201361.6%61.1%62.2%
US New Methodology201459.9%59.3%60.4%
US New Methodology201560.8%60.3%61.3%
US New Methodology201658.8%58.3%59.4%
US New Methodology201760.5%59.8%61.1%

Data Notes

In 2011, the BRFSS changed its methodology from a landline only sample and weighting based on post-stratification to a landline/cell phone sample and raking as the weighting methodology. The data for 2011 and later on this graph are based on the new methodology (landline/cell phone sample; raking). Due to changes in both sampling and the question format, data for 2011 and later should be interpreted with caution compared to previous years. U.S. data are the average for all states and the District of Columbia; they do not include the U.S. territories. These rates are crude rates, not age-adjusted, given that the Healthy People 2020 Objective is based on crude rates.

Data Sources

  • Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health
  • U.S. Data: Behavioral Risk Factor Surveillance System (BRFSS), Division of Behavioral Surveillance, CDC Office of Surveillance, Epidemiology, and Laboratory Services


Influenza Vaccination in the Past 12 Months by Local Health District, Utahns Aged 65+, 2017

::chart - missing::
confidence limits

The survey question for this measure changed in 2011 to "During the past 12 months, have you had either a seasonal flu shot or a flu vaccine that was sprayed into your nose?". In previous years the question was "A flu shot is an influenza vaccine injected in your arm. During the past 12 months, have you had a seasonal flu shot?".
Local Health DistrictCrude Percentage of Adults Age 65+Lower LimitUpper Limit
Record Count: 15
Bear River55.7%45.7%65.2%
Central44.9%35.5%54.7%
Davis County49.5%41.6%57.3%
Salt Lake County61.2%56.6%65.7%
San Juan**
Southeast46.3%35.6%57.3%
Southwest45.2%38.1%52.6%
Summit51.7%34.6%68.4%
Tooele61.3%48.1%73.1%
TriCounty50.8%40.8%60.6%
Utah County58.0%51.9%64.0%
Wasatch39.1%26.3%53.7%
Weber-Morgan68.1%60.2%75.0%
State of Utah56.0%53.5%58.4%
U.S.60.5%59.8%61.1%

Data Notes

^^**The estimate has been suppressed because 1) The relative standard error is greater than 50% or when the relative standard error can't be determined. Consider aggregating years to decrease the relative standard error and improve the reliability of the estimate. 2) the observed number of events is very small and not appropriate for publication, or 3) it could be used to calculate the number in a cell that has been suppressed. These rates are crude rates, not age-adjusted, given that the Healthy People 2020 Objective is based on crude rates. U.S. data are the average for all states and the District of Columbia; they do not include the U.S. territories.

Data Sources

  • Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health
  • U.S. Data: Behavioral Risk Factor Surveillance System (BRFSS), Division of Behavioral Surveillance, CDC Office of Surveillance, Epidemiology, and Laboratory Services


Influenza Vaccination in the Past 12 Months by Race, Utah Adults 18+, 2017

::chart - missing::
confidence limits

Race/EthnicityCrude Percentage of AdultsLower LimitUpper Limit
Record Count: 7
American Indian, Alaskan Native31.8%23.0%42.2%
Asian35.3%25.7%46.3%
Black, African American24.7%14.4%39.0%
Native Hawaiian, Pacific Islander39.6%22.7%59.3%
White38.2%36.9%39.5%
Other32.4%27.4%37.8%
All Races/Ethnicities37.5%36.3%38.7%

Data Notes

NOTE: INCLUDES ALL ADULTS 18+. These rates are crude rates, not age-adjusted, given that the Healthy People 2020 Objective is based on crude rates.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health


Influenza Vaccination in the Past 12 Months by Ethnicity, Utah Adults 18+, 2006-2017

::chart - missing::
confidence limits

Ethnicity and MethodologyYearCrude Percentage of AdultsLower LimitUpper Limit
Record Count: 24
Hispanic/Latino, Old Methodology200624.6%18.9%31.5%
Hispanic/Latino, Old Methodology200724.2%18.9%30.4%
Hispanic/Latino, Old Methodology200834.1%27.8%41.1%
Hispanic/Latino, Old Methodology200927.5%23.0%32.6%
Hispanic/Latino, Old Methodology201035.6%30.3%41.4%
Non-Hispanic, Old Methodology200634.5%32.7%36.3%
Non-Hispanic, Old Methodology200741.3%39.3%43.2%
Non-Hispanic, Old Methodology200840.2%38.3%42.1%
Non-Hispanic, Old Methodology200941.0%39.5%42.4%
Non-Hispanic, Old Methodology201044.2%42.6%45.7%
Hispanic/Latino, New Methodology201132.1%28.2%36.2%
Hispanic/Latino, New Methodology201232.4%28.3%36.8%
Hispanic/Latino, New Methodology201328.8%25.1%32.9%
Hispanic/Latino, New Methodology201431.0%28.0%34.3%
Hispanic/Latino, New Methodology201534.2%30.4%38.2%
Hispanic/Latino, New Methodology201627.7%23.7%32.0%
Hispanic/Latino, New Methodology201731.6%27.8%35.6%
Non-Hispanic, New Methodology201138.3%37.1%39.5%
Non-Hispanic, New Methodology201236.7%35.6%37.8%
Non-Hispanic, New Methodology201337.8%36.6%38.9%
Non-Hispanic, New Methodology201438.9%37.9%39.9%
Non-Hispanic, New Methodology201540.2%39.0%41.4%
Non-Hispanic, New Methodology201637.4%36.1%38.7%
Non-Hispanic, New Methodology201738.4%37.1%39.7%

Data Notes

NOTE: INCLUDES ALL ADULTS 18+. In 2011, the BRFSS changed its methodology from a landline only sample and weighting based on post-stratification to a landline/cell phone sample and raking as the weighting methodology. The 2011-2017 data on this graph is based on the new methodology (landline/cell phone sample; raking). Due to changes in both sampling and the question format, 2011-2014 data should be interpreted with caution compared to previous years. These rates are crude rates, not age-adjusted, given that the Healthy People 2020 Objective is based on crude rates.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

References and Community Resources

More information on the Behavioral Risk Factor Surveillance System may be found on the website of the Centers for Disease Control and Prevention - [http://www.cdc.gov/brfss/] To find clinics that provide flu vaccine in your community, please utilize the HealthMap Vaccine Finder at: [https://vaccinefinder.org/]

More Resources and Links

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

Page Content Updated On 02/25/2019, Published on 02/26/2019
The information provided above is from the Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.state.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Wed, 24 July 2019 0:48:28 from Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.gov ".

Content updated: Thu, 20 Jun 2019 13:03:27 MDT