The Influenza Vaccine during COVID-19
Valley Preferred calls the need for influenza vaccines this year “critical.”
Data this month is showing spikes in COVID-19 cases in the Lehigh Valley, some as high as during the height of the pandemic in April. This comes as we enter fall, typically the start of influenza season, which peaks between December and February. As medical practitioners, we are faced with a new challenge: potentially battling not one, but two, viruses simultaneously.
Facing an unknown
“The truth is, because COVD-19 is new, no one knows what consequences would follow if someone contracts COVID-19 and influenza A, the more devastating strain, at the same time,” says Mark Wendling, MD, Executive Director of Valley Preferred and a family medicine practitioner. “What we do know is that the flu will arrive. Since no one can yet be vaccinated for COVID-19, it’s imperative that physicians and providers encourage patients, friends, and family – whenever possible – to get a flu vaccine.”
Flu vaccines last year provided about 40% coverage. This year, without a shift in antigens, the vaccine is expected to be more effective. No matter the percentage, even partial coverage is important for people of all ages this year. It’s also important to remember that people who are in historically high-risk categories for flu are also at high-risk for COVID-19. This includes those who are obese, have lung or heart diseases, and immune system deficiencies. For patients age 65 and above, it’s important to convey the options they have for the influenza vaccine.
High-dose vaccines for people 65 and older
Because of age-related changes in their immune systems, people 65 years and older may not respond as well to vaccination as younger people. Physicians and providers need to be ready to discuss Fluzone High-Dose Quadrivalent with older patients. This vaccine contains four times the antigen (the part of the vaccine that helps your body build up protection against flu viruses) than standard-dose inactivated flu vaccines. The higher dose of antigen is intended to give older people a better immune response, and therefore, better protection against flu.
Data from clinical trials comparing Fluzone (a trivalent standard dose vaccine) to Fluzone High-Dose (a trivalent high-dose vaccine) among persons aged 65 years and older indicate that a stronger immune response (i.e., higher antibody levels) occurs after vaccination with Fluzone High-Dose. A study published in the New England Journal of Medicine indicated that the high-dose vaccine was 24% more effective in preventing flu in adults 65 years and older relative to a standard-dose vaccine. Another study published in The LancetRespiratory Medicine reported that Fluzone High-dose was associated with a lower risk of hospital admissions compared with standard-dose Fluzone in adults 65 years and older, especially those living in long-term care facilities. This study was conducted during the 2013-14 flu season among more than 38,000 residents of 823 nursing homes in 38 states.*
Considering super-spreader situations
Even though people are taking unprecedented precautions to stop the spread of COVID-19, this will most likely not prevent the flu from having an effect. There are too many situations where groups are together in shared spaces and may not be able to protect themselves completely. It’s not always possible to keep health care workers, for example, or students in schools socially distant from one another. Dr. Wendling notes that with the limitations of remote learning, everyone is researching and somewhat eager to fully get back to the classroom. “However, kids, college students, high school students, and children in day care are at high risk for spreading the flu. If they get it they can spread it at home.”
Dr. Wendling says that, to understand the consequences in a worst case scenario, consider a child contracting both COVID-19 and influenza at the same time. On that note, his message for every clinician in every practice is to address the absolute criticality of getting a flu shot. “It’s far more important this year than any other,” he says. “Everybody should educate this at every opportunity, and know that there are more than enough flu vaccines available.”