Pandemic or not, it’s time to get a yearly flu vaccine

As if we didn’t have enough to worry about with COVID-19, it’s now September and we’re soon entering the 2020-21 flu season. While we await a safe and effective vaccine and treatment for the novel coronavirus, it’s more important than ever that we leverage the resources we do have to lessen the chances of contracting viruses such as influenza that can weaken our immune response to COVID, our existing comorbidities and other illnesses that could come our way.

Starting with COVID but now ramping up again this fall, there’s the usual heated discussions on social media forums about the safety and efficacy of influenza vaccination. As a healthcare professional in the year 2020, this truly pains me. I hear push back every year about the safety and efficacy of vaccines, particularly about the flu, but I’ll never stop being amazed after decades of scientific evidence on their overall effectiveness.

The Centers for Disease Control and Prevention (CDC) bottom lines it for all of us: “Vaccination is still the most effective way to prevent flu.”

While it’s been around all of our lives, influenza and its effects are no laughing matter. Yes, some people get sick for a few days with no perceived serious or permanent effects. Others die from it. (See CDC’s Flu Symptoms & Complications). And some people are particularly at high risk of developing flu-related complications, which can increase our chance of contracting COVID-19 or other highly contagious diseases. These illnesses can take a deadly toll on our own health, of those around us, and the already-strained resources of our health system.

As a mom of 2 small children, it terrifies me to know that 166 children died of the flu last year. Yes, blessedly that statistic was lower than 188 in the 2017-18 season, but still higher than other recent seasons. Nearly two-thirds of last flu season’s pediatric deaths were due to influenza B viruses, which are known to cause severe illness in children.

Children younger than 5 years old — especially those younger than 2 — are at a high risk of developing serious flu-related complications. That’s why the CDC recommends an appropriate annual flu vaccine for everyone 6 months and older. Since children’s immune systems are still developing, often flu vaccines require two doses for children 6 month through 8 years, with 4 weeks or more apart, before the end of October. So it’s time.

I know, I know…last year’s vaccine was only about 45% effective, so why bother, or run the incredibly small risk of any notable vaccination complications. But remember that the flu vaccine cut the overall risk and expense — especially important during this year’s pandemic — of having to seek medical care by almost half. The appropriate vaccine is still the most-effective way to prevent or minimize the effects of the flu, while reducing the chances of passing it along to others.

2020-21 vaccines for a constantly evolving virus

There are many different flu viruses and they’re constantly evolving. That’s partly why it’s recommended that you get a new one each year. The other reason is that people’s immunity/protection  wanes over the course of the year and needs to be boosted.

The composition of U.S. flu vaccines is reviewed annually and updated as needed to match circulating flu viruses. The CDC reports that this year’s vaccines protect against the three or four viruses (depending on the vaccine) that research suggests will be most common:

Trivalent (three-component) egg-based vaccines are recommended to contain:

  • A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus (updated)
  • A/Hong Kong/2671/2019 (H3N2)-like virus (updated)
  • B/Washington/02/2019 (B/Victoria lineage)-like virus (updated)

Trivalent flu shots made using an adjuvant — an ingredient that helps create a stronger immune response are approved in particular for people 65 years of age and older.

Quadrivalent (four-component) egg-based vaccines, which protect against a second lineage of B viruses, are recommended to contain:

  • The three recommended viruses above, plus B/Phuket/3073/2013-like (Yamagata lineage) virus

Fluzone High-Dose Quadrivalent is the only licensed high-dose inactivated influenza vaccine, and is approved only for people aged 65 years and older. A high-dose vaccine has 4 times the normal amount of viral antigen (active ingredient) versus the standard-dose flu shots for better protection of older adults. 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 that age relative to a standard-dose vaccine.

Cell- or recombinant-based vaccines, which do not use viruses grown in eggs, are recommended to contain:

  • A/Hawaii/70/2019 (H1N1)pdm09-like virus (updated)
  • A/Hong Kong/45/2019 (H3N2)-like virus (updated)
  • B/Washington/02/2019 (B/Victoria lineage)-like virus (updated)
  • B/Phuket/3073/2013-like (Yamagata lineage) virus

Flucelvax Quadrivalent is the only cell-based inactivated flu vaccine that has been licensed by the FDA for use in the U.S., for appropriate patients ages 4 years and older.

Remember that the estimated number of total U.S. deaths due to influenza last season (Oct. 1, 2019-April 4, 2020) was between 24,000 and 62,000 deaths. That was much better than most years, but since flu strains and thus vaccine effectiveness varies from year to year, especially considering the pandemic, people should receive vaccines ASAP.

So how do I as a patient know which vaccine to get?

Hopefully at this point you’re thinking about popping down to your local pharmacy to get your flu shot, or incorporating it into an upcoming doctor’s office appointment, if you have one. (Remember: There’s often a supply shortage the longer you wait, so get it soon!) But how do you know which vaccination you should receive?

Of course, your doctor or pharmacist will know your health history and medications, so those medical professionals will recommend which is likely best for you. The quadrivalent flu vaccine is being offered as the first-line option in most pharmacies and doctor’s offices. In the last few years, most insurance companies are finally paying for the quadrivalent vaccine. Choosing the vaccine with more coverage is now no longer a cost consideration (it used to cost $15 to $20 more), so I would definitely recommend inquiring about this one when you go in for your annual influenza vaccination. But as always, listen to your medical professional’s knowledgeable advice.

Do I have to get a shot? I hate shots!

I know; most of us — especially kids — say the same thing, quick though the shot is. Again this year, there’s a live attenuated influenza vaccine (LAIV, mentioned above) made with a weakened live virus that’s given by nasal spray. The nasal spray flu vaccine is approved for use in healthy non-pregnant individuals 2-49 years of age. People with certain medical conditions should not receive the nasal spray flu vaccine, so again, check with your pharmacist or doctor.

The CDC reports there hasn’t been any effectiveness estimates for the nasal spray vaccine in the U.S. since LAIV has used new influenza A(H1N1) vaccine virus ingredients and LAIV was again recommended in the U.S. for the 2018-19 season. Data from other countries have demonstrated protection from LAIV to be similar to that of standard-dose, egg-based inactivated flu vaccine in children.

A last reminder

It may be trite to use this analogy for a vaccine often involving eggs, but the early bird does indeed catch the worm…I mean, vaccine. We’ve all seen how the pandemic has affected availability of things we take for granted — toilet paper, paper towels, eggs, meat and more. So I cannot stress enough the importance of getting a flu shot for you and yours as soon as possible. And everyone please follow your pharmacy’s or physician’s office’s COVID-19 safety protocols…including wearing a mask over your nose and mouth!

Hoping you and yours a safe flu season. Stay safe and protected.


FAQs for 2020-21 Flu Season (CDC)

Making the Vaccine Decision: Addressing Common Concerns (CDC)

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — US, 2020–21 Influenza Season (CDC website)

Growing Up with Vaccines: What Should Parents Know? (CDC interactive guide)

Kristen Engelen, PharmD
Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.