One Thing Leads to Another

“Why don't they do what you say?
Say what you mean… oh, babe
One thing leads to another.”

The Fixx “One Thing Leads To Another”

“All in good time, my little pretty. All in good time.”

 The Wicked Witch of the West

It is vitally important that all people aged sixty five years or older develop the healthy habit of keeping current with recommended adult immunizations.  None more so important than those immunizations that protect against flu related pneumonia.  Life or death important.

Influenza related pneumococcal disease, (pneumonia, septicemia, meningitis, and diarrhea), causes ten percent of all early deaths in seniors over the age of sixty five.  As the emerging problem-trend of antibiotic resistance by common pathogenic bacteria grows, so too will the number of lives claimed by these deadly diseases.  Likewise, as our overall population trends toward a preponderance of baby boomers over the age of sixty five… the risk of pneumococcal disease in seniors will increase.  Winter is coming.

An exemplary senior turns sixty five, gets an influenza vaccine every subsequent year, gets the first of two recommended pneumococcal vaccines, gets the second of the two pneumococcal vaccines a year later… and the prevention of a slow and miserable demise in a local hospital might well be the prize.  Eight out of ten seniors who fail to mimic this sage course of action risk a far-too-soon shuffle off this mortal coil.  In each of these instances… one thing leads to another.

The herd of seniors who are newly turned sixty five years of age, plus those who are older, properly immunizes against influenza and pneumonia only at a rate of about twenty percent.  A large portion of those who do immunize, are only partially immunized against pneumonia:  receiving only one of the two pneumonia vaccines, receiving the two pneumonia vaccines in the less than optimal order, or failing to receive recommended pneumonia booster doses after turning sixty five.

For a numeric perspective, consider my home state of Michigan… where millions of unimmunized seniors live at risk of early death from influenza related pneumococcal disease.  Thousands of them die in hospitals yearly.  Just fathom the nationwide preventable cost in lives and in treasure.

It is important to note that the influenza vaccines, and both pneumococcal vaccines, are offered cost-free under coverage through Medicare Part B via CMS coding and billing protocols.  Treatment of pneumococcal disease places a huge cost burden on Medicare.  The cost is largely preventable… a fact not lost on CMS.

Medicare charges no co-pays for vaccines that protect against influenza, pneumococcus, and hepatitis; to eliminate any financial barriers against immunizing.  Most other adult vaccines are similarly covered by Medicare Part D prescription coverage, but co-pays often apply.

Immunizing at-risk seniors against influenza related pneumococcal disease is a worthwhile mission of mercy.  Some simple practice rules apply:

• All persons sixty five years of age and older should be vaccinated against influenza and against pneumococcus regardless of prior immunization status.  Booster protection in seniors is the rule of the day.
• All persons aged sixty-five years or older should annually immunize against influenza, and should receive one pneumococcal conjugate vaccine (PCV-13) and one pneumococcal polysaccharide vaccine (PPSV-23).
• Superior protection against pneumococcal disease is afforded to seniors who receive both pneumococcal vaccines.  A large percentage of immunized seniors currently only receive the pneumococcal polysaccharide vaccine (PPSV-23).  These seniors are considered only partially immunized until the pneumococcal conjugate vaccine (PCV-13) is administered.
• Influenza vaccine and one of the two pneumococcal vaccines can be administered concurrently during the same immunizing visit, with one vaccine administered in each arm.
• All persons immunized against pneumococcus prior to the age of sixty five should additionally receive booster doses of both pneumococcal vaccines after turning sixty five.  Five years of spacing between the original doses and the booster doses of the pneumococcal immunizations is adequate.  Seniors who do not receive booster doses are considered only partially immunized.
• Optimal pneumococcal protection is offered to seniors by administering pneumococcal conjugate vaccine (PCV-13) first, followed one year later by pneumococcal polysaccharide vaccine (PPSV-23).  This order of administration is clinically important.
• The two pneumococcal vaccines must be spaced one year apart to provide optimal protection.  To promote this practice, Medicare Part B will only pay for pneumococcal vaccines that are spaced one year apart.

Pneumococcal disease causes up to ten percent of all deaths in unimmunized seniors sixty five years of age and older.  Ten percent of all unimmunized seniors admitted to hospitals for pneumococcal disease later die from the disease.  Ten percent of all hospital emergency room admissions for seniors are the direct result of influenza related pneumococcal disease.  Fifteen percent of all seniors admitted to hospitals for pneumococcal disease are later readmitted to those hospitals as very costly “Medicare readmissions in under thirty days.”

Immunizers who dedicate their time and efforts to protecting unimmunized seniors against influenza related pneumococcal disease have an opportunity to offer important humanitarian relief to millions of local people.  The good in need of being done is readily measurable… in both dollars and in lives.  How satisfying might be the good works of directly saving fellow human beings; family, beloved, friends, and neighbors?

An at-risk senior turns sixty five, is gently persuaded to get an influenza vaccine every subsequent year, to get the first of two recommended pneumococcal vaccines, and to get the second of the two pneumococcal vaccines a year later… and a single life is saved.  Then another life is saved, and another and another… like millions of dominoes toppling in a row.  Only a gentle nudge to the first piece in row is lacking.  And one thing leads to another.

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“We Speak Fluent Medicare”