Flu Vaccines
Rachel Balick
On July 6, a member of the Pharmacy Staff for COVID-19 Support Facebook community posed a question to their peers: “What is your prediction for this coming flu vaccination season?”
Most indicated they expected increased demand. “I had people asking for [flu shots] in May and June. I’ve never seen so many people upset that they can’t get flu shots until mid-August,” one pharmacy staff member responded. “Normally it’s like pulling teeth to get people to get one.”
Another community member reported the chain they work for is aiming to deliver double the number of shots it did last year—18 million versus 9 million. Others said their district leaders have tripled pharmacists’ goals over last season.
“I think most people will be looking for any kind of protection against anything,” a comment read. “It’s going to be insane,” read another. One poster said their patients are asking about the shingles vaccine as well as flu.
A May 2020 Reuters/Ipsos poll backs them up. About 60% of the 4,428 respondents said they planned to get the flu shot this year. In any given year, fewer than one-half of American adults get the immunization.
CDC updates
CDC’s influenza vaccination planning for the coming season includes maximizing supply, outreach to those at increased risk, additional infection prevention and control for providers and patients, considerations of potential social distancing needs, aligning flu messaging with COVID-19 messaging, and tailoring communication to communities of color that efforts have not traditionally been effective in reaching. The agency is working with vaccine manufacturers to ensure supply is higher than usual.
CDC recognizes the need to provide guidance and clarification for immunizers, said Ram Koppaka, MD, PhD, of the CDC Immunization Services Division. “We understand that the guidance will inform planning that must begin now if vaccination is to occur in a safe manner in the fall.”
Timing
The CDC Advisory Committee on Immunization Practices (ACIP) notes in its recent updates that the unpredictable nature of influenza makes it difficult to know when the season will peak or decline, and the ideal timing is usually an educated guess.
Evidence has shown that the immunization can wane in effectiveness over the course of the season, particularly for older adults. Although demand for flu shots is already picking up, ACIP still says July and August are too early in most seasons—especially for older adults—but that shots should be administered by the end of October.
Immunization recommendations in CDC’s Guidance for Pharmacists and Pharmacy Technicians in Community Pharmacies during the COVID-19 Response
- Provide adult vaccinations based on local conditions (consult state and local public health authorities to judge conditions).
- Evaluate provision of routine clinical preventive services, including adult vaccinations, that require face-to-face encounters.
- Based on local conditions, evaluate the risk of an in-person encounter versus the benefit using the Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic. Read that guidance at https://apha.us/NonCOVIDCare.
- Adult vaccination should be considered if the service can be delivered during a visit with no additional risk to the patient or the health care provider.
- Consideration should be given to prioritizing older adults or adults with underlying conditions for vaccination due to their increased risk of disease and complications if vaccination is deferred.
- Pharmacies should develop a strategy for screening patients for fever and symptoms of COVID-19 (fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea) prior to providing vaccinations.
- Health care providers should follow standard precautions and adhere to additional PPE recommendations, including use of a face mask at all times while in the facility. Use of eye protection is recommended in areas with moderate to substantial community transmission. For areas with minimal to no community transmission, eye protection is considered optional, unless otherwise indicated as part of standard precautions.
- Hand hygiene should be performed before and after vaccine administration. If gloves are worn, they should be changed, and hand hygiene should be performed between patients.
- Provide clinical services according to the Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic (https://apha.us/NonCOVIDCare), which includes considerations for delivering non-COVID-19 care by the degree of community transmission and potential for patient harm if care is deferred.
- Implement universal use of face coverings. Medical or surgical face masks are generally preferred over cloth face coverings for health professionals for source control. Cloth face coverings should NOT be worn instead of a respirator or face mask if more than source control is required.
- Individuals without coronavirus symptoms (“asymptomatic”) and those who eventually develop symptoms (“presymptomatic”) can transmit the virus to others before showing symptoms. This means that the virus can spread between people interacting in close proximity—for example, speaking, coughing, or sneezing—even if those people are not exhibiting symptoms.
Source: CDC Guidance for Pharmacies, https://www.cdc.gov/coronavirus/2019-ncov/hcp/pharmacies.html
Focus on the patients at highest risk
With COVID-19 and influenza likely to cocirculate, flu vaccination is more important than ever to reduce burden on health care—preventing doctor’s visits, hospitalization, and diagnostics. Campaigns to encourage influenza immunizations should target those at highest risk for COVID-19.
- Adults age 65 or older
- Black Americans
- Latinos
- Adults with underlying illnesses
- Adults who are part of the critical infrastructure
- Staff and residents of long-term care facilities
Source: CDC Immunization Services Division
Influenza immunization demand by the numbers
- 60% of respondents said they plan to or definitely will get the flu shot this season.
- 40% of respondents said that they’d gotten a flu shot every year for the past 5 years; 30% had not gotten a flu shot over the past 5 years.
- 62% of white respondents, 46% of Black respondents, and 59% of Hispanic respondents said they plan to or definitely will get the flu vaccine.
- 57% of respondents who live in rural areas, 61% of those in suburban areas, and 59% of those in urban areas said they plan to or definitely will get the flu vaccine.
- 55% of people in households earning less than $50,000 annually, 63% in households earning between $50,000 and $100,000, and 67% in households earning more than $100,000 said they plan to or definitely will get the flu vaccine.
- 67% of those with a college degree said they plan to or definitely will get the flu vaccine, while 56% of those without a college degree said they plan to or will get the vaccine.
Source: Reuters/Ipsos poll conducted May 13 through 19, 2020
Key messages for patients around flu vaccine this season
- Although we can’t predict what will unfold with the flu this fall and winter, because COVID-19 activity will likely be ongoing, the coexisting issues make it more important than ever to get an influenza immunization.
- Flu shots will not protect you from COVID-19.
- Flu shots will help protect you from the flu.
- Getting a flu shot this fall will
- Reduce your risk of ending up in a crowded medical setting
- Help conserve scarce health care resources
- Help protect frontline health care workers, including pharmacists and pharmacy technicians
- Help protect your loved ones, your local community, and the public at large
- July and August are probably too early to get the flu vaccine, as evidence shows its effectiveness may wane over the course of the season—particularly for older adults
- September and October are good times to get the vaccine. Consider taking advantage of lulls in COVID-19 activity in September and October to get immunized.
- Get the vaccine even after flu activity has already begun, into December and beyond. The shot is still beneficial.
Source: Erin Burns, MA, lead, CDC Influenza Division Communications Team
Key messages for health care providers around flu vaccine this season
- Ongoing COVID-19 activity may affect where, when, and how flu and other vaccines are administered.
- Patients may need to get immunized at a different place or in a different way (e.g., socially distanced vaccination).
- CDC is working with manufacturers to ensure adequate supply of vaccine.
- CDC is working with providers to develop contingency plans so patients can receive vaccinations in a safe environment.
- Consider taking advantage of lulls in COVID-19 activity in September and October to push immunizations.
- Continue vaccinating into December or later, even if flu activity has already begun.
Source: Erin Burns, MA, lead, CDC Influenza Division Communications Team