Time to Vaccinate! Preparing for the 2020-21 Flu Season

Time to Vaccinate! Preparing for the 2020-21 Flu Season

When it seems hard to persuade people in the grip of a pandemic to wear masks, it is understandable if you sigh at the prospect of reminding them to get vaccinated for this year’s flu viruses. Amid all the changes in our world, flu remains a constant. We can expect it to arrive on schedule, and as usual, it will take thousands of lives between fall and spring.

To reduce the burden of flu cases during the pandemic, public health officials are emphasizing the importance of vaccinating this year. At an August 20 livestream with JAMA (the Journal of the American Medical Association), CDC Director Robert Redfield said, “This fall and winter could be one of the most complicated public health times we have… This is a critical year for us to try to take flu as much off the table as we can. Our hospital capacity could get strained.” ​​​​

Manufacturers are preparing 194-198 million doses of flu vaccine for the 2020-21 season, and a nationwide media blitz is encouraging people to make use of those doses. According to the CDC, even the fairly mild 2019-2020 season led to over 410,000 hospitalizations and took at least 24,000 lives. While it is hoped that social distancing may reduce this year’s numbers, bypassing vaccination is a particularly dangerous gamble in a year when flu cases will be competing with COVID-19 for hospital beds. Sadly, it is an uphill battle to vaccinate even half of the population. In the 2018-2019 season, only 45.3% of American adults over age 18 got their shots, and a substantial majority were senior citizens.

Getting Vaccinated: Who Needs a Shot and When They Should Get One

It takes about two weeks for vaccine antibodies to become fully active and start protecting the body from the flu virus. The flu season usually peaks between December and February, but vaccines are already available. However, the CDC suggests that August is too early for vaccination as this can leave people with less protection later in the season. Seniors should get their shots in September or October, but even being vaccinated as late as January can prevent infections.

While everyone from the age of six months and upward should get vaccinated, many public officials agree with Redfield’s view that 2020-21 is “a critical year.” The state of Massachusetts has even taken the decisive step of making flu shots mandatory for all children attending child care, pre-school, kindergarten, K-12, and colleges and universities.

What if someone has COVID-19? The CDC recommends that patients with COVID-19 delay getting their influenza vaccine to ensure others in the healthcare setting are not exposed unnecessarily. All patients coming in for flu shots should be screened for COVID-19 symptoms before and during the visit.

The CDC also suggests that providers work to ensure certain adults at higher risk from COVID-19 get their flu shot, including:

  • Staff and residents of long-term care facilities
  • Adults with underlying illnesses
  • African Americans and Hispanics
  • Adults who are part of “critical infrastructure

Although no states have implemented a legal requirement for seniors to get flu shots, as members of the largest at-risk population most people over 65 should consider vaccination imperative. Because they are so vulnerable to serious complications, seniors constitute 70-85% of flu deaths and 50-70% of hospitalizations during an average flu season. Owing to the added dangers of contending with flu, most seniors receive special vaccine compounds. The most common form is the high-dose vaccine, which contains four times the amount of antigen as a standard flu shot. In a recent study, the incidence of flu among seniors receiving a high-dose shot was 24% lower than it was among those who had received a standard shot. A more recent compound for seniors is the adjuvanted flu vaccine, which creates a stronger immune response than the standard vaccine. Side effects are somewhat more likely to occur with the senior formulations, but reducing the danger of flu usually makes the risk of minor pain at the injection site, headache, muscle ache, and/or fatigue for one to three days seem negligible.

Where to Get Vaccinated

Locating a vaccine provider is easy. Those with internet access can go to VaccineFinder.org and enter their location and the type of vaccine they need (children, adults over age 18, and seniors receive different formulations, as do people with egg allergies as most vaccines are egg-based).

For the millions of newly unemployed whose jobs had provided their health insurance, getting vaccinated can pose a financial challenge. Public health departments in many larger cities offer free vaccinations, but in areas that lack this service, the price for vaccination varies. Non-seniors who live near a Costco can get a shot for less than $20.00, but most drug store chains charge around $40.00. See here for an overview of vaccination sources and prices.

But Will People Get Vaccinated?

While there are undeniable reasons to be concerned about vaccine hesitancy and past failures to vaccinate even 50% of the population, it is possible that more Americans will get their flu shots this season. Findings in the 2020 United Healthcare Wellness Checkup Survey indicated a heightened awareness of health concerns spurred by the pandemic and 30% of the surveyed respondents said they are more likely to receive a flu shot this fall.

Helping Patients Prepare for Flu Season

Helping Patients Prepare for Flu Season

It’s National Influenza Vaccination Week, and if you haven’t yet gotten a flu shot, you still have time. But why is it important to get the shot, especially if you’re not in any risk groups? And how can you encourage your patients and their family and friends to get it without being a nag? Jennifer Femino, FNP-BC, Family Nurse Practitioner/Director of Quality Improvement at North Shore Community Health and member of the American Association of Nurse Practitioners (AANP), explains why and how you can help your community prepare for flu season.

Why is it important for people to get vaccinated against the flu? Who is at the highest risk for having complications from it?

It is important for everyone 6 months and older to get vaccinated against the flu because it is a contagious respiratory illness, which can cause severe illness and even death in some people. Not only will receiving the flu vaccine help protect the individual, but it will also help prevent those they come in contact with from getting the flu, by helping to stop the spread of the virus. The best way to prevent the flu is to get the flu vaccine.

Those at highest risk for having complications from the flu include children under 5 years old, people 65 years and older, pregnant women, and people of any age with certain chronic medical conditions, such as asthma, diabetes, or heart disease.

How can nurses encourage their patients to get vaccinated? What should they say to those who have fears that the shot will give them the flu? What about those who believe that the vaccination will hurt them?

Nurse practitioners can encourage their patients to get vaccinated by addressing any specific concerns the patient has. They can also remind patients the flu can cause severe illness and death in some people, and the flu vaccine is a simple way to prevent this. Nurses can also get vaccinated themselves, and wear a badge advertising this; patients may feel reassured their trusted health care professional also gets vaccinated against the flu.

NPs also educate patients that the flu vaccine does not cause the flu. Flu vaccines are made with either inactivated flu or a weakened flu virus, neither of which can cause the flu. Some people may feel mild symptoms after receiving the flu vaccine, but nurses should emphasize that the symptoms are mild and brief, and are very different from the severity of symptoms of the flu.

Serious reactions to the flu vaccine are rare. People who have a severe allergy to the flu vaccine or any of its ingredients should not get the flu vaccine. Most people with egg allergies are able to get the flu vaccine. However, any patients with a history of an egg allergy or a history of Guillain-Barré Syndrome, should speak with their health care provider about options for flu vaccination.

What about families/friends of patients? How can nurses encourage them to get vaccinated? Suppose the patient has a compromised immune system? What can they say to get visitors to get vaccinated?

Nurses can talk with families and friends of patients about the importance of them getting the flu vaccine in order to help prevent the flu in their loved ones. NPs can also remind family members and friends it is not enough to simply avoid the patient if they are sick because they would likely be contagious with the flu even before they knew they were sick.

This is even more important for family members and friends of patients with a compromised immune system. It is imperative that they get the flu vaccine so that they do not spread the flu to the patient, who will likely not be able to fight it and is at serious risk for complications, including death.

Nurses can talk with patients and families about ways in which they can talk to their visitors about the importance of receiving the flu vaccine and can work with them to perhaps set limits or discourage visitors who have not been vaccinated.

Some people think that it’s fine to get the flu—it’s like getting a cold. It will go away. Explain why the flu is more serious and why vaccinations are crucial.

The flu is much more serious than a cold. The symptoms are much more severe and intense. The most important difference is that the flu can result in serious complications, including death. The flu vaccine is crucial, not only to prevent flu in an individual, but also to prevent the spread of flu to those who may be at higher risk of complications.

Are all health care providers required to get vaccinated?

Health care providers are strongly encouraged to get the flu vaccine. Policies regarding the flu vaccine vary from organization to organization. Many institutions have policies mandating the flu vaccine, and those who choose not to get the flu vaccine must wear a mask throughout the flu season.

What about those who say that they’ve gotten the flu shot in the past and still gotten the flu? How can vaccinations benefit them? How can you encourage them to get vaccinated?

Flu vaccines are not 100% effective, and sometimes the strain of flu circulating is not a perfect match for the flu strains in the flu vaccine. In some cases, people were exposed to the flu before their immune system had time to build a response to the flu vaccine.

There is evidence the flu can be milder and briefer in those who have been vaccinated against the flu. Although flu vaccines are not perfect, they are the best way to prevent getting the flu.

Anything else regarding the importance of vaccinations for influenza that you think is important for our readers to know?

The CDC is an excellent resource for information regarding the flu. They have a wealth of resources for nurses and patients on their website . They also are on Twitter (@CDCFlu).

Flu activity is starting to increase across the United States, so if you have not yet had your flu vaccine, now is the time!

The Nurse’s Guide to the Flu

The Nurse’s Guide to the Flu

As most nurses certainly are aware, this year’s flu season is exceptional. It has surged earlier than in previous years and as of mid-January is widespread across all 50 states. There has been a significant wave of flu cases in doctor’s offices and hospitals across the country, affecting everyone from children to the elderly. Emergency rooms (ERs) are inundated with flu patients, and in many cases patients line the hallways in overcrowded facilities without space or beds available due to additional patient volume. Patients are boarding and holding for inpatient beds in the ERs, which exposes additional patients, visitors, and staff to the flu. 

Below are some friendly flu reminders, tips, and tricks to keeping yourself and your patients healthy and safe this season and beyond.

Hand hygiene is the most effective way to stop the transmission of the flu. Flu spreads via droplets coughed or sneezed by infected persons onto shared surfaces. Washing your hands thoroughly and frequently and using alcohol-based gel sanitizers is an effective way to prevent flu. But one thing we often forget about is our patients’ hands. Especially when I work in triage, I’ve started asking my patients and their visitors to use hand sanitizer before triage and before they enter their patient rooms as well. 

If your hands are feeling the burn after so much vigorous washing and sanitizing, reach out to your infectious disease department to see if it can provide some hospital-approved pump-style lotions for your cracked hands. At home, try using Bag Balm or deep healing lotions and placing mittens on before bed to help salves and creams absorb overnight.

If you have flu symptoms, you should stay home from work. Not all employers have the same regulations regarding sick leave and doctor’s notes, and some are certainly more rigid than others. But the best thing you can do for yourself, your patients, and your colleagues when feeling under the weather is to stay home. This doesn’t just help you get better faster, but also prevents you from endangering your fellow nurses. The flu can spread so rapidly through a department that it can quickly decimate staff numbers and leave no one else to care for other ill patients. 

You should feel empowered to communicate with visitors about the flu. It is imperative that nurses educate family members and patient visitors about their role in flu prevention. If your facility hasn’t already done so, consider limiting visitors to your patient rooms, especially children. It is wise to limit visitors under the age of 12 to protect this vulnerable age group from germs. You should feel empowered to ask ill-appearing visitors not to enter a patient’s room if you are concerned for their health. The safety of patients is the utmost priority.

Tamiflu is not for everyone. Most cases of the flu do not require treatment with antiviral medication such as Tamiflu. Clinical judgment will determine whether a patient fits criteria for treatment with antivirals. In most cases, treatment is most effective if given within 48 hours of symptom onset. If you have cared for influenza patients and are starting to see symptoms in yourself, reach out to your employee or occupational health department as soon as possible. In some cases it may be taken prophylactically.

It’s not too late to vaccinate. Make sure to teach patients that even though the flu vaccine has been less effective this year, it still helps save lives by reducing the severity and duration of the influenza virus. Remind patients that it is not too late to receive their flu shot. Everyone six months and older should get the flu shot, especially children, the elderly, and pregnant women.

Mask yourself, mask your patients. If you suspect someone has the flu, you should immediately begin droplet precautions. Place a mask on the patient in triage or when leaving his or her room, and keep yourself protected with a mask and gloves at all times. Remind patients to cover their coughs to help keep you safe.

Resort to basic teaching. Effective discharge teaching can help prevent repeat doctor’s office or ER visits and can help patients stay healthy. Remind patients that the best place for them to be if they are feeling sick is at home. Most people who get the flu will have a mild illness that does not require hospitalization. Fluids, rest, and over-the-counter antipyretics are effective in treating most cases of illness. People with suspected flu should stay home until at least 24 hours after their fever has gone away. Emergency symptoms that require immediate evaluation in an ER include shortness of breath, difficulty breathing, sudden dizziness or confusion, severe or persistent vomiting or diarrhea, or pain or pressure in the chest or abdomen. In children or infants, watch for signs of dehydration, fast breathing, lethargy, and rash. 

Keep yourself as healthy as possible. In addition to washing your hands frequently (while at work and not), you should also try to boost your immune system by eating nutritious foods, including fruits and vegetables; staying hydrated; and getting exercise and sleep. Staying well rested and well hydrated can help keep your immune system in good shape to combat this flu season.