As we move into the 2021–2022 influenza season with a surge in COVID-19 activity due to the delta variant, vaccination against both viruses will be critical to our overall social and economic well-being.
Influenza vaccines have been in existence for over 75 years, with hundreds of millions of Americans have received the vaccine. Flu vaccines have a great safety record and are routinely administered to some of our most vulnerable populations, including pregnant women and infants starting at six months.
Despite this track record, vaccine hesitancy remains a concern. While we saw an increase in the percent of adults vaccinated against influenza in the 2020–21 season (50–55%; up from 48% in the year prior), the Centers for Disease Control and Prevention (CDC) estimates that vaccination rates in children, pregnant women and health care providers dropped.
We can and must do better.
Remind patients that the influenza vaccine cannot give you the flu. If they are avoiding the vaccine due to egg propagation—whether based on allergies or personal beliefs—remind them that there are egg-free options like Flublok and Flucelvax. If needles are problematic, the nasal spray Flumist is an option for many.
As a health care provider, you have a unique opportunity to lead by example as well as dispel these and other common vaccine misconceptions. Here’s what you need to know about this flu season and the importance of getting vaccinated.
Vaccines are misunderstood
As health care providers, we often hear the argument that vaccines aren’t effective because some vaccinated patients still get sick. However, this is a misconception. A vaccine does not keep a virus from entering your body and infecting you. Rather, a vaccine helps your body to recognize the virus as the enemy and fight it—decreasing your risk of becoming ill (symptomatic) or at least reducing the severity of symptoms and keeping you out of the doctor’s office or hospital.
The influenza vaccine cannot give you the flu. Any virus contained in the vaccine has been killed and/or modified to merely resemble the active form of the virus. If the vaccine causes you to feel poorly (e.g. have muscle aches or low-grade fever), this is an indication that your body has reacted appropriately and is learning how to recognize and fight off the virus more easily and rapidly.
We have not yet had enough overlap of circulating influenza and COVID-19 to truly understand the risk and severity of co-infections. However, both viruses can be deadly; in particular, we know populations at higher risk for flu complications include our very old, very young and immunocompromised patients. Doing everything we can to reduce the potential severity of these infections is key—with vaccination being at the top of the list.
The flu is unpredictable
We don’t know exactly when and how influenza will “hit”. Here in the northern hemisphere, influenza activity usually peaks sometime between December and February, but there have been years it has peaked as early as October and as late as March. The season can last as late as May.
We see different types of influenza circulating throughout a season and every year is different. Some strains of the virus hit children harder; some affect the elderly more. Plus, the virus undergoes small changes year after year, which helps it to evade your immune system. Depending on the circulating strains, the severity of the flu season (i.e. number of hospitalizations and deaths) will also vary year over year. This is why a new vaccine is developed every year, whereas other vaccines can protect you for years or even a lifetime.
While it’s still too early to know exactly when and how the coming flu season will present, health care providers are encouraged to monitor current activity (including laboratory-confirmed cases and circulating strains) in the U.S. through the CDCs FluView website.
Becoming indifferent to the flu
Respiratory viruses such as influenza and respiratory syncytial virus (RSV) saw historically low activity in 2020; the CDC notes that measures such as social distancing, mask use and reduced global travel in place during the COVID-19 pandemic likely contributed to this decline. Conversely, as we saw a decrease in COVID-19 cases and began to relax some of these measures in 2021, we began to see an increase in circulation of other viruses such as parainfluenza, adenoviruses and RSV. The current activity of these viruses is inconsistent with when they typically present; for instance, RSV activity has been increasing since April 2021, whereas activity is usually high in the fall and winter.
Experts caution we may be in for a tough flu season. Our population is generally exposed to the influenza virus year over year; our body recognizes the virus and keeps our immune system prepared to fight the infection. However, in 2020 we had the lowest influenza activity on record; thus, our population’s immunity to the flu virus has likely diminished over the past year. This, in combination with factors such as resumed travel, in-person work and learning, decreased social distancing and masking mandates may lead to both an increase in the number of cases and severity.
It is important to know that you can be infected with both influenza and COVID-19 at the same time. There has been a multitude of documented cases that prove this point and co-testing is recommended by both the CDC and the National Institutes of Health.
Vaccines are more convenient to get than ever before. A primary care provider is not required to administer flu vaccine, and our experiences with large COVID-19 vaccination clinics have provided more places to get vaccinated.
Although flu vaccines are generally offered throughout the flu season (even through January or later), don’t put off getting a vaccine. Don’t defer getting your vaccine to wait for a specific product, a different provider or a scheduled appointment in the coming months. Getting a U.S. Food and Drug Administration-approved vaccine today will keep you from getting sick tomorrow while waiting to reschedule. The most useless vaccine is the one sitting on the shelf and not in an arm protecting someone who needs it.
While getting vaccinated early (e.g. July or August) may result in reduced protection against flu later in the season, the CDC recommends that you get the vaccine by the end of October.
Vaccines have taken on an important meaning to social and economic growth in the era of COVID-19; they have gotten us back to life closer to normal. Essential workers have moved beyond police/fire/EMT to encompass all health care workers, teachers and food industry. Kids learn better in a classroom. Social interactions are crucial to our overall mental health. Resetting our values as to what is important has also heightened our sense of community, looking out for our neighbors and each other.
Embrace the opportunity to lead by example by getting your flu shot and helping to dispel common vaccine misconceptions.
Vizient recently published an Influenza Vaccine Reference for products available for the 2021–22 season. This quick reference guide has been consolidated into two pages for ease of posting at clinic workstations or where the vaccine is stored.
About the authors:
Julie Beckman is currently a pharmacy director, network services at Vizient. In this role she leads the strategic sourcing initiatives for the Independent Hospital Network (IHN). Dr. Beckman received her doctor of pharmacy degree from the University of Nebraska and masters in pharmacy administration at the University of Kansas. Dr. Beckman has seven years with Vizient and prior to that 15 years of health system pharmacy leadership experience in operations and purchasing. In addition to serving as the Pharmacy Director for IHN she is also a subject matter expert in influenza vaccines and leads the networks contracting initiatives in this area.
Amanda Melton is a senior clinical manager with the Center for Pharmacy Practice Excellence at Vizient, where she serves as a subject matter expert in emergency medicine and helps to oversee pharmacy pipeline monitoring. Prior to joining Vizient, Amanda was an emergency medicine pharmacist in the Dallas-Fort Worth metroplex. Amanda holds a Pharm.D. from Texas Tech University Health Sciences Center School of Pharmacy and is a Board-Certified Pharmacotherapy Specialist.