Discussion About the Importance of the Annual Flu Shot

AUGUST 09, 2019
At the 9th annual Directions in Pharmacy conference, Rupal Mansukhani, PharmD, FAPhA, CTTS, from the Ernest Mario School of Pharmacy, Rutgers University, in Piscataway, New Jersey, discussed influenza vaccinations and how pharmacists can address common patient concerns and improve population health.

During the last influenza season, 185 children died of influenza. Among those children, 80% were unvaccinated. This statistic underscores the Healthy People 2020 Objectives that specifically recommend that health care professionals must increase the percentage of children between the ages of 6 months and 18 years who are vaccinated annually against seasonal influenza. In addition, the Healthy People 2020 Objectives indicate that health care personnel must work to increase vaccination rates among the following populations: (1) health care workers (slightly less than half of health care workers are unvaccinated), (2) people who are institutionalized, and (3) pregnant women.

Dr. Mansukhani suggested that pharmacists target these at-risk populations. Dr. Mansukhani demonstrated seasonal flu vaccine effectiveness in the United States between 2008 and 2018 using a bar graph. During the 2009-2010 and 2010-2011 flu seasons, vaccines’ effectiveness was most robust, estimated at 56% and 60%, respectively. In recent years it has hovered around 40%. In the past flu season, overall vaccine effectiveness was 40%, but protection varied by virus type and subtype. It was most effective (65%) against influenza A (H1N1).

Health care professionals in the United States follow the Centers for Disease Control and Prevention’s (CDC) immunization schedules. Dr. Mansukhani reviewed those schedules and stressed that the CDC now recommends routine annual influenza vaccination for all individuals who are older than 6 months and who do not have contraindications. She noted that the quadrivalent vaccine is only indicated in children who are aged 3 years or older.

Next, Dr. Mansukhani reviewed the types of vaccines that are available including the inactivated influenza vaccine; the recombinant influenza vaccine, trivalent or quadrivalent; and the live attenuated influenza vaccine, quadrivalent. Intranasal influenza vaccine has received significant media attention, and for this reason research has accelerated to ensure that it is effective. After a brief period during which it was not recommended by the CDC, it is once again recommended. The recombinant hemagglutinin influenza vaccine does not contain eggs, and pharmacists should note that its shelf life is slightly shorter than other vaccines. It expires within 9 months of production.

Dr. Mansukhani also reviewed certain vaccines that are licensed for individuals who are 65 years or older; these include the trivalent high-dose influenza vaccine and the adjuvanted inactivated influenza vaccine. High-dose influenza vaccines have been associated with higher effectiveness than the regular-dose products. Since their licensure in 2019, the trivalent high-dose influenza vaccines have been included in several studies. The adjuvanted vaccine, approved in 2015, has also undergone intense scrutiny.

Dr. Mansukhani noted that the only contraindications to vaccine administration are severe (life-threatening) allergies to eggs, to any vaccine component, or to a previous dose of influenza vaccine. Health care providers should exercise caution if patients have moderate to severe acute illnesses with or without fever, or have experienced Guillain-Barré syndrome within 6 weeks of a previous influenza vaccination.

Finally, Dr. Mansukhani dispelled some myths about immunization. She urged pharmacists to educate patients, clarifying that too many vaccines cannot overwhelm the immune system and the fact that even though we have eliminated or reduced the incidence of disease does not mean we should stop vaccinating. Vaccination is not government interference; it is science-based medicine. Even if vaccines are not 100% effective, they reduce influenza’s severity and duration.

When treating patients who are opposed to vaccinations, it is important for pharmacists to listen to the patient’s concerns and acknowledge them in a nonconfrontational way. Pharmacy staff should discuss vaccines’ benefits and the low likelihood of adverse events. Citing the number of lives saved by immunization can be helpful (as opposed to citing death statistics). It is also important to develop a set of questions to start discussions with patients to address cultural, religious, or personal beliefs about vaccinations; previous serious adverse events; personal concerns; and what the patient would like to know.