How to respond to flu vaccine doubters
Cleveland Clinic Journal of Medicine
Influenza Resources for Healthcare Professionals
Flu severity varies from year to year, but the flu always poses serious consequences. Deaths from pneumonia and influenza combined are the 9th leading cause of death among Hispanics.
Recommended Immunizations for Adults
The CDC recommends that everyone aged six months and older receive an annual influenza vaccine to protect against seasonal flu strains. High-risk groups, including those with chronic conditions, pregnant women, older adults, and residents of long-term care facilities, should be especially diligent about getting vaccinated. For those aged 65 and older, high-dose or adjuvanted vaccines are recommended to enhance effectiveness.
Source: Center for Disease Control. Recommended Adult Immunization Schedule, United States, 2024. Accessed 20 August. 2024.
Flu Vaccines for Seniors
In June 2022, ACIP voted in favor of a preferential recommendation for certain flu vaccines over others for adults 65 years and older in the United States. ACIP voted to preferentially recommend the use of higher dose flu vaccines (Fluzone High-Dose vaccine and Flublok recombinant vaccine) or adjuvanted flu vaccine (Fluad vaccine) over standard-dose unadjuvanted flu vaccines. If one of these vaccines is not available at the time of administration, people in this age group should get a standard-dose flu vaccine instead. This recommendation was based on a review of available studies which suggests that, in this age group, these vaccines are potentially more effective than standard dose unadjuvanted flu vaccines.
Learn MoreIncreasing Vaccination Coverage in the Hispanic Population
Hispanics are the largest ethnic or racial minority group in the United States, representing 62 million or 18.7% of the nation’s population.[1] Despite improved access to health care services by the Affordable Care Act, Hispanics face challenges of mistrust or working for employees that cannot afford insurance and have high rates of being uninsured. Other barriers arise from social determinants of health and lack of healthcare services that are culturally competent. Cultural and linguistic barriers, as exacerbated by a shortage of Hispanic health care providers relative to their growing patient population, as well as underinsured and uninsured status remain as major obstacles to health care access.[2]
The World Health Organization (WHO) acknowledges immunization as one of the most successful and cost-effective public health interventions, preventing between two to three million deaths every year.[3] Although racial/ethnic disparities in childhood vaccination coverage have improved throughout the past decade, substantial disparities among adults aged 65 years and older have persisted.[4] Deaths from pneumonia and influenza combined are the 11th leading cause of death among Hispanics.[5] In addition, the data states that the Hispanic population has been disproportionately affected by COVID-19 pandemic.[6]
Immunization Standards
The National Vaccine Advisory Committee (NVAC) revised the Standards for Adult Immunization Practice in 2013.[7] These standards require that ALL health care professionals, whether routinely administering vaccines or not, to take steps to ensure that adult patients are fully immunized.
The Advisory Committee on Immunization Practices (ACIP) updated its seasonal influenza vaccination recommendations because of COVID-19. The common symptoms of COVID-19 (e.g., fever and cough) can also occur with influenza illness. As such, during the continued circulation of COVID-19 with the influenza virus in the fall and winter, ACIP suggests that influenza vaccination of persons of more than 6 months in age can “reduce prevalence of illness cause by influenza, and can also reduce symptoms that might be confused with those of COVID-19.”[8] ACIP further recommends that for persons who have acute illness with suspected or laboratory-confirmed COVID-19, “clinicians can consider delaying influenza vaccination” until patients are no longer acutely ill.
Nevertheless, patients should be reminded to return for the influenza vaccination once they have recovered. The influenza vaccine should be administered by the end of October, but vaccination should continue to be offered as long as influenza viruses are circulating locally and unexpired vaccine is available.[9] Additionally, as FDA-approved COVID-19 vaccines are now available, the COVID-19 and the influenza vaccine are able to be administered during the same visit.[10]
See the following for more information:
CDC: Factsheet on Vaccine Documentation
Prevention
Misconceptions about Seasonal Flu and Flu Vaccines
CDC
Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2020–21 Influenza Season
CDC
Seasonal influenza vaccine in immunocompromised persons
Taylor & Francis Online
Influenza Vaccination: Updated Recommendations from ACIP
American Family Physician
Flu Vaccination Decision-Making Guide
National Forum for Heart Disease and Stroke Prevention
Sanofi
With this digital flu education tool, you can have control of the messages you share with your patients.
Vaccination for Adults with Diabetes
Adults with diabetes have three times higher risk of death and six times increased risk of hospitalization. The annual flu vaccine significantly reduces admission rates for stroke, heart failure, and all-cause death during the flu seasons in adults with type 2 diabetes. They are also at an increased risk for renal and cardiovascular complications. Health care professionals should inform their patients with diabetes about the dangers of the flu and strongly recommend they get vaccinated each year after thoughtful and shared decision making with the provider and patient.[14]
See the following for more information:
- CDC: What You Need to Know about Diabetes and Adult Vaccines
- CDC: Lo que necesita saber sobre la diabetes y las vacunas para los adultos
- CDC: A Resource for Nurses: SHARE Vaccine Recommendations for Patients with Diabetes
- CDC: Healthy Living with Diabetes: The Simple Step You May be Missing
- Immunization Action Coalition: Vaccination for Adults with Diabetes
- NFID: The Dangers of Influenza: Why People with Diabetes Need to Get Vaccinated
Vaccination for Adults with Cardiovascular Disease
People with heart disease and those who have had a stroke are at a higher risk of developing complications from the flu.[15] A 2020 study that looked at more than 80,000 U.S. adults hospitalized with influenza over multiple flu seasons (2010-11 to 2017-18) found that sudden, serious heart complications were common and occurred in 1 out of 8 patients.[16] These startling figures demonstrate the importance of providers discussing the benefits and risk of the flu vaccine with patients, especially those with underlying heart disease.
See the following for more information:
Vaccination Coverage and Safety
NHMA is committed to empowering physicians to lead efforts that improve the health of Hispanics regardless of insurance coverage and status. Most state and local public health departments, Federally Qualified Health Centers (FQHCs), and free clinics offer free or reduced-cost services and vaccines. Pharmaceutical companies may also provide vaccines and other medications for reduced or at no cost regardless of insurance status. If your patient does not have health insurance, please visit: www.healthcare.gov to learn more about affordable health coverage options.
Vaccine Safety
The public continues to raise concerns about vaccine necessity and safety. Myths and misinformation about vaccine safety can confuse those trying to make a sound decision. The U.S. Department of Health and Human Services has launched several information/education outreach efforts, including [1] Additionally, the CDC continuously monitors vaccine safety. Vaccines are rigorously tested for years before they are granted licensure, and after a vaccine is licensed, the CDC continues to monitor its use, efficacy, safety, and side effects.
Effective outreach and education about vaccines requires knowledge of your population and individual community, reliability, and trustworthiness. For Hispanic communities, culturally competent communication is essential and includes access to patient-oriented resources in both English and Spanish. Below are links to key websites and brochures.
Paying for the Flu Vaccine
NHMA is committed to empowering physicians to lead efforts that improve the health of Hispanics regardless of insurance coverage and status. Most state and local public health departments, Federally Qualified Health Centers (FQHCs), and free clinics offer free or reduced-cost services and vaccines. Pharmaceutical companies may also provide vaccines and other medications for reduced or at no cost regardless of insurance status. If your patient does not have health insurance, please visit: www.healthcare.gov to learn more about affordable health coverage options.
[1] “Influenza (Flu) Including.” Centers for Disease Control and Prevention, 26 Sept. 2019, http://www.flu.gov/.
Tools for Patients and Providers
In 2021, approximately 85% of Hispanics utilized smartphones. Many health providers are taking advantage of new technological resources available to improve patient care.
CDC ‘I Get It’ Campaign:
The CDC released its Digital Media Toolkit for 2021-22 Flu Season. Known this season as the ‘I Get It’ campaign, the Digital Media Toolkit is designed to assist partners in communicating about the importance of the influenza vaccination. Social media has become an effective tool for expanding providers’ reach within the Hispanic community, as well as for fostering engagement and increasing access to credible, science-based health messages. The Digital Media Toolkit provides various resources for social media, including: social media frames, social stories panels, social media graphics, and sample posts for social media accounts.
CDC: Herramientas de Comunicación en Español:
[1] O’Dea, S. “Smartphone Ownership in the US by Ethnicity 2021.” Statista. Statista Inc., 12 May 2021. Web. 24 Sept. 2021. https://www.statista.com/statistics/195001/percentage-of-us-smartphone-owners-by-ethnicity/
Health care provider/clinician apps:
The CDC website has links to free mobile apps for health care providers. Many apps are available for download, including:
The CDC offers numerous education and training programs for health care professionals
The CDC has created a CDC Vaccine Schedules app for iOS and Android to track vaccines.
Additional Resources in Spanish
Resources in English
CDC: Vaccine Safety Information for Health Care Providers
CDC: Vaccine Safety on Influenza (Flu) Vaccines
CDC: Talking to Patients about Vaccine Safety
CDC: Common Vaccine Safety Questions and Concerns
CDC: Vaccine Adverse Event Reporting System (VAERS)
California Department of Health: Vaccine Safety: Answers to Parent’s Top Questions
Immunization Action Coalition: Vaccines Work!
Institute for Vaccine Safety, Johns Hopkins University: Components of Vaccines
Recursos en Español
Departamento de Salud Pública de California: La Seguridad de las Vacunas: Respuestas a las Preguntas Más Frecuentes de los Padres
Centro para el Control y la Prevención de Enfermedades (CDC): Los Adultos también necesitan vacunarse
Página con información sobre el sistema a cargo de vigilar la seguridad de las vacunas: Sistema Para Reportar Reacciones Adversas a las Vacunas
American Academy of Pediatrics: Seguridad de las vacunas: conozca los hechos
CDC: ¿Tiene Influenza?
Instagram Live 2: Managing the Risks of Heart Disease & Flu Among Latinos - Feat. Expert Panel
This video is a recording of the Managing the Risks of Heart Disease & Flu Among Latinos Instagram Live here at @nhmamd on February 25th at 3 p.m. ET.
We joined medical experts and community leaders to discuss the importance of protecting yourself this flu season.
Instagram Live: Facing the Flu in Times of COVID-19 - Feat. Expert Panel
This video is a recording of the Facing the Flu in Times of COVID-19 Nationwide Instagram Live here at @nhmamd on Oct. 21,2021 at 3 p.m. ET. We joined medical experts and community leaders to discuss the importance of protecting yourself this flu season.
NHMA Phoenix Chapter: Advocating for Latinx Community from the Grassroots
The NHMA Phoenix Chapter partners with LatinaStrong to discuss how we can impact our local communities with grassroots efforts.
NHMA thanks Sanofi Pasteur for their support and funding on this project.
Citations
<< Click Here To See More >>
[1] Bureau, US Census. Hispanic Heritage Month 2021. 24 Sept. 2021, https://www.census.gov/newsroom/facts-for-features/2021/hispanic-heritage-month.html; Explore Census Data. Web. 24 Sept. 2021. https://data.census.gov/cedsci/profile?q=United%20States&g=0100000US
[2] Velasco-Mondragon, Eduardo et al. “Hispanic health in the USA: a scoping review of the literature.” Public health reviews vol. 37 31. 7 Dec. 2016, doi:10.1186/s40985-016-0043-2
[3]“Vaccines and Immunization.” World Health Organization. World Health Organization. Web. 24 Sept. 2021. https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1
[4] “Fact Sheet: Health Disparities in Influenza Vaccination Coverage.” Center for Disease Control and Prevention, U.S. Department of Health and Human Services, http://www.cdc.gov/minorityhealth/CHDIR/2011/FactSheets/FluVaccine.pdf
[5] “FastStats – Health of Hispanic or Latino Population.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 07 May 2021.
Web. 24 Sept. 2021. https://www.cdc.gov/nchs/fastats/hispanic-health.htm.
[6] Rentsch CT, Kidwai-Khan F, Tate JP, Park LS, King JT, Skanderson M, Hauser RG, Schultze A, Jarvis CI, Holodniy M, Lo Re V, Agkun KM, Crothers K, Taddei TH, Freiberg MS, Justice AC. COVID-19 by Race and Ethnicity: A National Cohort Study of 6 Million United States Veterans. medRxiv [Preprint]. 2020 May 18: 2020.05.12.20099135. doi: 10.1101/2020.05.12.20099135. PMID:32511524; PMCID: PMC7273292
[7] “Standards for Adult Immunization Practices.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 02 May 2016. Web. 24 Sept. 2021. https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/index.html
[8] Kent, Casey, Dott. Et al,. The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC) MMWR Recomm Rep 2020;69(No.8):1-28. https://www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6908a1-H.pdf
[9] Center for Disease Control, CDC. “Summary of Recommendations.” Centers for Disease Control, 26 August 2021, https://www.cdc.gov/flu/professionals/acip/summary/summary-recommendations.htm. Accessed 23 Sept. 2021
[10] “Frequently Asked Influenza (flu) Questions: 2021-2022 Season.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 22 Sept. 2021. Web. 24 Sept. 2021. https://www.cdc.gov/flu/season/faq-flu-season-2021-2022.htm#coadmin
[11] Centers for Disease Control, CDC. “Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2020–21 Influenza Season.” Center for Disease Control, 21 August 2020, https://www.cdc.gov/mmwr/volumes/69/rr/rr6908a1.htm. Accessed 21 Oct. 2020
[12] Center for Disease Control. “Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2018–2019 influenza season.” Center for Disease Control www.cdc.gov/flu/about/burden/2018-2019.html. Accessed 19 Oct. 2020.
[13] Center for Disease Control. “CDC Seasonal Flu Vaccine Effectiveness Studies.” Center for Disease Control, 1 July 2020, www.cdc.gov/flu/vaccines-work/effectiveness-studies.htm. Accessed 19 Oct. 2020.
[14] National Foundation for Infectious Diseases. “The Dangers of Influenza (Flu): Why People with Diabetes Need to Get Vaccinated.” Accessed 19 Oct. 2020.
[15] Center for Disease Control. “Flu & People with Heart Disease or History of Stroke.” Center for Disease Control, August 26, 2021. https://www.cdc.gov/flu/highrisk/heartdisease.htm. Accessed 24 Sept. 2021.
[16] Chow, Eric, et al. “Acute Cardiovascular Events Associated with Influenza in Hospitalized Adults.”