Despite the new challenges presented by coronavirus disease 2019 (COVID-19), this year it is more important than ever to get an influenza vaccination.

It is estimated that influenza vaccination coverage in the United States for the 2019-2020 season included 63.8% of children (> 6 months through 17 years old) and 48.4% of adults.1 These percentages rose from the 2018-2019 season by 1.2% and 3.1%, respectively.1 Despite these increases, the Healthy People 2020 national target of 70% of children and adults vaccinated against influenza was not achieved.2 Reflecting this lack of substantial progress for adults, the newly launched Healthy People 2030 target for vaccination of individuals 6 months and older has also been set at 70%.3

Influenza vaccination coverage has increased over the past 2 seasons. However, there are still ethnic and racial disparities. Non-Latino African American children had lower vaccination coverage than children in all other ethnic and racial groups. Additionally, Latino adults and non-Latino African American adults had lower coverage than non-Latino white adults.1

An influenza vaccination not only reduces the risk from the illness but may also help conserve potentially scarce health care resources. During the COVID-19 pandemic, reducing the overall burden of respiratory illnesses is important to protect vulnerable populations at risk for severe illness, the health care system, and other critical infrastructure. Therefore, health care providers should use every opportunity during the vaccination season to administer influenza vaccines to all eligible individuals.1

COACHING POINTS
There are many reasons to get an influenza vaccine each year. Pharmacists whose patients are on the fence as to whether to get the vaccine can draw their attention to several benefits of vaccination and to supporting information from selected scientific studies.

An influenza vaccination can:
  • Prevent influenza. The vaccine prevents millions of illnesses and doctor visits every year. During the 2018-2019 season, vaccination prevented an estimated 4.4 million influenza cases, 2.3 million related medical visits, 58,000 related hospitalizations, and 3500 associated deaths.4

The results of a 2014 study showed that the vaccine reduced children’s risk of influenza-related admission to a pediatric intensive care unit (ICU) by 74% during the influenza seasons from 2010 to 2012.5 Older adults who received the vaccine in recent years experienced a reduction of influenza-associated hospitalizations of about 40%.6 Influenza vaccination among adults can reduce the risk of being admitted to an ICU with the illness by 82%.7 The results of a 2020 study showed that the vaccination reduced influenza-associated hospitalizations by 41% and related emergency department visits by half among children during the 2018-2019 season.8
  • Help individuals with chronic health conditions. Influenza vaccinations have been linked to lower rates of some cardiac events in patients with heart disease, especially those who have had a cardiac event within the past year.9 They have also been known to reduce worsening of and hospitalizations for influenza-related chronic lung disease, such as chronic obstructive pulmonary disease.10 In separate studies, the vaccine has been shown to reduce hospitalizations among individuals with diabetes11 and chronic lung disease.12
  • Protect women during and after pregnancy. Influenza vaccination reduces the risk of related acute respiratory infection among pregnant women by about half.13 In addition, the results of a 2018 study14 that included influenza seasons from 2010 through 2016 showed that getting a flu shot reduced a pregnant woman’s risk of hospitalization with the illness by an average of 40%. According to results from several studies,15 a vaccine given during pregnancy helps protect the infant from influenza for several months after birth.
  • Be lifesaving in children. The results of a 2017 study16 found that the estimated influenza vaccine effectiveness is 65% against laboratory-confirmed influenza-associated deaths among children. This percentage was lower in patients with underlying medical conditions, but the protection was still significant.
  • Reduce the severity of illness in people who get vaccinated but still get sick. According to results from a study16 published in 2017, influenza vaccinations reduced deaths, ICU admissions, ICU length of stay, and overall duration of hospitalization in patients with the illness. The results of a 2018 study7 showed that adults hospitalized with influenza were 59% less likely to be admitted to the ICU if they had been vaccinated than were unvaccinated patients. In addition, those who were vaccinated spent an average of 4 fewer days in the hospital than unvaccinated individuals.
  • Protect those around you. This includes those who are more vulnerable to serious influenza illness, such as babies, older individuals, those with certain chronic health conditions, and young children. Vaccination can also help protect those who are unable to be vaccinated because of contraindications.

ADDITIONAL TIPS
Based on years of research into vaccine motivators, the CDC has developed a mnemonic device to help health care providers perform effective patient coaching. This method, known as SHARE,17 can help pharmacists coach patients on vaccine recommendations and provide important information to enable them to make informed decisions about vaccinations.

SHARE stands for:
S: Share the reasons why a flu shot is right for the patient, given his or her age, health status, lifestyle, occupation, or other risk factors. The CDC recommends an annual vaccination for everyone 6 months and older with any age-appropriate, licensed influenza vaccine, expressing no preference for one vaccine over another.
H: Highlight positive experiences with influenza vaccines, personal or in the practice, as appropriate, to reinforce the benefits of and strengthen confidence in influenza vaccination.
A: Address patient questions and concerns about influenza vaccines, including adverse effects, effectiveness, and safety, in plain and understandable language.
R: Remind patients that influenza vaccines protect them and their loved ones from serious illness and influenza-related complications.
E: Explain the potential costs of getting influenza, including serious health effects and time lost, such as missing family obligations or work.

COMPOSITION OF VACCINES
There are many different influenza viruses, and they are constantly changing. The composition recommendations for US flu vaccines for the 2020-2021 flu season are:18

Trivalent (3-component) egg-based vaccines are recommended to contain:
A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus A/Hong Kong/2671/2019 (H3N2)-like virus B/Washington/02/2019 (B/Victoria lineage)-like virus

Quadrivalent (4-component) egg-based vaccines, which protect against a second lineage of B viruses, are recommended to contain: The 3 recommended viruses above, plus B/Phuket/3073/2013 (B/ Yamagata lineage)-like virus

Cell- or recombinant-based vaccines are recommended to contain: A/Hawaii/70/2019 (H1N1)pdm09-like virus A/Hong Kong/45/2019 (H3N2)-like virus B/Phuket/3073/2013 (B/Yamagata lineage)-like virus B/Washington/02/2019 (B/Victoria lineage)-like virus
 
Kathleen Kenny, PharmD, RPh, has more than 25 years of experience as a community pharmacist and is a freelance clinical medical writer based in Colorado Springs, Colorado.


REFERENCES
  1. Flu vaccination coverage, United States, 2019-20 influenza season. CDC. October 1, 2020. Accessed October 14, 2020. https://www.cdc.gov/flu/fluvaxview/hcp-coverage_1920estimates.htm
  2. Immunization and infectious diseases. HealthyPeople.gov. Accessed October 14, 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases
  3. Increasing the proportion of people who get the flu vaccine every year–IID-09. HealthyPeople.gov. Accessed October 14, 2020 https://health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination/increase-proportion-people-who-get-flu-vaccine-every-year-iid-09
  4. Estimated influenza illnesses, medical visits, and hospitalizations averted by vaccination. CDC. Updated November 22, 2019. Accessed October 14, 2020. https://www.cdc.gov/flu/vaccines-work/burden-averted.htm
  5. Ferdinands JM, Olsho LEW, Agan AA, et al; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Effectiveness of influenza vaccine against life-threatening RT-PCR-confirmed influenza illness in US children, 2010-2012. J Infect Dis. 2014;210(5):674-683. doi:10.1093/infdis/jiu185
  6. Rondy M, El Omeiri N, Thompson MG, Levêque A, Moren A, Sullivan SG. Effectiveness of influenza vaccines in preventing severe influenza illness among adults: a systematic review and meta-analysis of test-negative design case-control studies. J Infect. 2017;75(5):381-394. doi:10.1016/j.jinf.2017.09.010
  7. Thompson MG, Pierse N, Huang QS, et al; SHIVERS Investigation Team. Influenza vaccine effectiveness in preventing influenza-associated intensive care admissions and attenuating severe disease among adults in New Zealand 2012-2015. Vaccine. 2018;36(39):5916-5925. doi:10.1016/j.vaccine.2018.07.028
  8. Campbell AP, Ogokeh C, Lively JY, et al. Vaccine effectiveness against pediatric influenza hospitalizations and emergency visits. Pediatrics. 2020;146(5):e20201368. doi:10.1542/peds.2020-1368
  9. Udell JA, Zawi R, Bhatt DL, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA. 2013;310(16):1711-1720. doi:10.1001/jama.2013.279206
  10. Bekkat-Berkani R, Wilkinson T, Buchy P, et al. Seasonal influenza vaccine in patients with COPD: a systematic literature review. BMC Pulm Med. 2017;17(1):79. doi:10/1186/s12890-017-0420-8
  11. Colquhoun AJ, Nicholson KG, Botha JL, Raymond NT. Effectiveness of influenza vaccine in reducing hospital admissions in people with diabetes. Epidemiol Infect. 1997;119(3):335-341. doi:10.1017/s095026889700825x
  12. Nichol KL, Baken L, Nelson A. Relation between influenza vaccination and outpatient visits, hospitalization, and mortality in elderly persons with chronic lung disease. Ann Intern Med. 1999;130(5):397-403. doi:10.7326/0003-4819-130-5-199903020-000003
  13. Thompson MG, Kwong JC, Regan AK, et al; PREVENT Workgroup. Influenza vaccine effectiveness in preventing influenza-associated hospitalizations during pregnancy: a multi-country retrospective test negative design study, 2010-2016. Clin Infect Dis. 2019;68(9):1444-1453. doi:10.1093/cid/ciy737
  14. Flu & pregnant women. CDC. Updated September 22, 2020. Accessed October 14, 2020. https://www.cdc.gov/flu/highrisk/pregnant.htm#anchor_1565116373
  15. Flannery B, Reynolds SB, Blanton L, et al. Influenza vaccine effectiveness against pediatric deaths: 2010-2014. Pediatrics. 2017;139(5):e20164244. doi:10.1542/peds.2016-4244
  16. Arriola C, Garg S, Anderson EJ, et al. Influenza vaccination modifies disease severity among community-dwelling adults hospitalized with influenza. Clin Infect Dis. 2017;65(8):1289-1297. doi:10.1093/cid/cix468
  17. Make a strong flu vaccine recommendation. CDC. August 2020. Accessed October 14, 2020. https://www.cdc.gov/flu/pdf/professionals/vaccination/make-strong-flu-vaccination-rec-2020.pdf
  18. Influenza vaccine for the 2020-2021 season. FDA. Updated October 30, 2020. Accessed October 31, 2020. https://www.fda.gov/vaccines-blood-biologics/lot-release/influenza-vaccine-2020-2021-season#:~:text=The%20committee%20recommended%20that%20the%20quadrivalent%20formulation%20of%20cell%2D%20or,virus%20(B%2FVictoria%20lineage)%3B