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VA research in action

Improving flu and pneumonia vaccination rates

March 3, 2020

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(Photo: © iStock/Pornpak Khunatorn

As a result of VA Health Services Research and Development research in the 1990s, VA has made considerable progress  in increasing the rates of flu and pneumonia vaccination among VA patients and health care workers. This research has especially improved flu and pneumonia vaccination rates for VA patients with spinal cord injuries and other vulnerable populations, such as the elderly and those with chronic diseases.  

The studies led researchers to a number of important conclusions:

  • All people, not just the elderly and at-risk groups, should consider annual vaccinations. This includes all VA patients and employees (except those with medical contraindications).
  • Vaccination is cost-effective.
  • Vaccination of healthy working adults decreases absenteeism from work due to flu.

This research led to efforts to increase education about vaccinations. VA provided education to patients and staff that emphasized the seriousness of the flu and how safe and effective the vaccine is. Vaccine instructions and reminders were posted in exam rooms and disseminated throughout VA. Since the research was published in the 1990s, VA has made huge  strides in boosting the rates of influenza and pneumonia vaccination among VA patients and health care workers. A 2007 study found that Veterans who receive care through VA have 10% higher rates of flu vaccination than Veterans getting their health care elsewhere.

As part of these efforts, VA Spinal Cord Injury Quality Enhancement Research Initiative (SCI-QUERI) researchers found that only 13% of Veterans with SCIs were vaccinated for flu and pneumonia in 1996. They also found that persons with SCI had a 37% higher likelihood of death from flu or pneumonia than the general public. Based on this research, VA made a concerted effort to increase vaccination rates and educations. By 2008, vaccination rates in this population had risen to 76% for the flu and 91% for pneumonia.

Selected publications:

Interventions to increase influenza vaccination rates in Veterans with spinal cord injuries and disorders. Weaver FM, Smith B, LaVela S, Wallace C, Evans CT, Hammond M, Goldstein B. Journal of Spinal Cord Medicine. 2007;30(1):10-19.

Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. Nichol K, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. New England Journal of Medicine. 2003;348:1322-1332.

Use of preventive care by Veterans receiving care through the Veterans Health Administration, Medicare FFS, and Medicare HMO Plans. Keyhani S, Ross JS, Herbert P, Dellenbaugh C, Penrod JD, Siu AL. American Journal of Public Health. 2017 Dec;97(12):2179-85.

Effectiveness of influenza vaccine in the community-dwelling elderly. Nichol K, Nordin J, Nelson D, Mullooly JP, Hak E. New England Journal of Medicine. 2007;357(14):1373-81.


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