New data released last week by the National Foundation for Infectious Diseases (NFID) revealed that only 52 percent of U.S. adults plan to get vaccinated against influenza (flu) this season. Representatives from NFID and other leading public health and medical organizations urged the public and healthcare professionals to follow the CDC recommendation for everyone age 6 months and older to get vaccinated against flu annually.
“Many people underestimate the severity of flu, yet we know flu causes hundreds of thousands of hospitalizations and tens of thousands of deaths each year in the United States,” said Secretary of Health and Human Services Alex M. Azar, II. “When it comes to protecting people from flu, our best preventive tool is an annual flu vaccine. It can safely prevent flu illnesses, hospitalizations, and deaths,” added Azar.
In reviewing vaccine coverage estimates from the Centers for Disease Control and Prevention (CDC) for the 2018-2019 flu season, Azar noted, “we are making important gains in flu vaccination coverage in some groups of people, especially children, but in adults we see a disappointing plateau. We are under-utilizing this potentially life-saving resource.”
Overall, CDC estimates show that flu vaccination coverage has increased over the past decade. Flu vaccination coverage among children age 6 months to 17 years was 63 percent for the 2018-2019 flu season, after plateauing for several seasons. Overall, it is an increase from 51 percent in 2010-2011. The most noteworthy improvement since 2010-2011 has been in coverage among teens age 13 to 17 years, which increased by almost 20 percentage points to 52 percent last season, although this age group still has the lowest coverage among children. Vaccination coverage among adults has increased slightly over the past decade, but remains about 45 percent, which leaves more than half of US adults unprotected against flu each year.
Flu vaccination coverage varied significantly by state. During last flu season, vaccination coverage in adults ranged from 34 percent in Nevada to 56 percent in Rhode Island. Flu vaccination coverage in children ranged from 46 percent in Wyoming to 81 percent in Massachusetts. Non-Hispanic white adults had higher coverage rates than non-Hispanic black, Hispanic, Asian, and American Indian/Alaska Native adults and adults of other or multiple races. Among children, Asian children had higher coverage rates than children in all other racial/ethnic groups.
Amid national conversations on vaccine hesitancy and suboptimal flu vaccination rates in the US (despite the recommendation for everyone age 6 months and older to get vaccinated each year), NFID commissioned a survey to better understand beliefs about flu and pneumococcal disease, as well as attitudes and practices around adult vaccination.
“Our survey revealed that nearly a quarter of US adults at highest risk of flu-related complications—those who are 65 and older or who have an underlying condition like asthma, diabetes, and heart disease—do not plan to get vaccinated against flu this season. Nearly 60 percent of these individuals, who are also at increased risk for pneumococcal disease, report that they have never been advised to get vaccinated against pneumococcal disease,” said William Schaffner, MD, medical director of NFID. “We must continue to educate everyone, especially older adults (age 65 years and older) and those with chronic health conditions, about their risk for flu and pneumococcal disease. Pneumococcal vaccines can be given at the same time as a flu vaccine, so it’s a great time to speak with a healthcare professional about which vaccines are best for you.”
Azar and Schaffner were joined at last week's press conference by Patricia N. Whitley-Williams, MD, president-elect of NFID and professor at Rutgers Robert Wood Johnson Medical School, and William B. Borden, MD, associate professor of medicine and health policy at George Washington University, and chief quality and population health officer at GW Medical Faculty Associates. The panelists all led by example and got vaccinated against flu, along with Daniel B. Jernigan, MD, MPH, CDC Influenza Division director and Mark May, NFID flu ambassador and 1980 Outland Trophy winner.
“As a pediatrician specializing in infectious diseases, I have seen first-hand the devastating impact that flu and its complications can cause in children,” said Whitley-Williams. “During the 2018-2019 flu season, 135 flu-related pediatric deaths were reported to CDC. Unfortunately, we have heard about pediatric deaths even over the summer. The time is now to prioritize flu vaccination. It is so important that children get vaccinated before flu begins spreading in their communities.”
Vaccination rates among adults age 18-49 years with at least one chronic health condition putting them at higher risk for flu-related complications was only 40 percent during the 2018-2019 flu season. “We need to do better,” said Dr. Borden, a preventive cardiology specialist. “Last flu season, approximately 93 percent of adults hospitalized for flu-related complications had at least one underlying medical condition, such as heart or lung disease. Vaccination against flu and pneumococcal disease must be part of disease management for people with chronic health conditions.”
Influenza Vaccine Supply and Options
For the 2019-2020 season, vaccine manufacturers have estimated that up to 169 million doses of influenza vaccine will be available in the US. The composition of the vaccines available this season has been updated to protect against the influenza viruses that research suggests will be most common during the 2019-2020 season.
For the 2019-2020 season, CDC recommends the use of any licensed, age-appropriate flu vaccine as soon as it is available in your community. Options include the following:
- Standard influenza vaccine, which includes four influenza viruses (quadrivalent—two influenza A and two influenza B), for children and adults age 6 months or older;
- Adjuvanted vaccine and high dose vaccine for adults age 65 years and older, both of which are designed to help initiate a more robust immune response;
- Flu vaccine grown in cell-culture (not eggs) for children age 4 years and older;
- Flu vaccine made using recombinant technology (another alternative to egg-based vaccine production) for adults age 18 years or older; and
- Live-attenuated influenza vaccine (LAIV) that is given via nasal spray for children and adults (who are not pregnant) age 2-49 years
All vaccine options may not be available at all locations, so experts emphasized that people should not wait to get vaccinated if their first choice of vaccine is not available. To find locations where vaccines are available by zip code, visit https://vaccinefinder.org/.
Although not a substitute for getting an annual flu vaccine, health officials also stressed the importance of everyday preventive actions to decrease the spread of flu and the appropriate use of influenza antiviral drugs to treat influenza as part of the CDC “Take 3” approach to fight flu. Four licensed influenza antiviral drugs are recommended for use in the US this flu season: oseltamivir, zanamivir, peramivir, and baloxavir marboxil.
All vaccination coverage estimates from the 2018-2019 flu season were published online and are available on the CDC FluVaxView website at www.cdc.gov/flu/fluvaxview/1819season.htm. The composition of 2019-2020 U.S. flu vaccines is available at http://bit.ly/19-20flu-vaccines.
National Poll Reveals Attitudes about Flu and Pneumococcal Disease Prevention
Influenza (flu) is a highly contagious viral infection that can cause mild to severe symptoms and life-threatening complications, including death, even in healthy children and adults. Pneumococcal disease is caused by bacteria and can cause various types of illness, including pneumonia, meningitis, ear and sinus infections, and sepsis.
Given that fewer than half of U.S. adults typically receive an annual flu vaccination (despite the recommendation for everyone age 6 months and older to get vaccinated each year), the National Foundation for Infectious Disease (NFID) commissioned a survey to better understand beliefs about flu and pneumococcal disease, as well as attitudes and practices around vaccination. The survey included 1,002 complete responses—916 via the web and 86 via telephone—with U.S. adults age 18 years and older representing the 50 states and the District of Columbia.
Summary of Key Results
Attitudes and Practices Around Flu Vaccination
Overall, most US adults believe vaccination is the best protection against flu, but many do not plan to get vaccinated.
60 percent agreed that flu vaccination is the best preventive measure against flu-related deaths and hospitalization, but only 52 percent said they plan to get vaccinated against flu this season and 18 percent said they are not sure
Top reasons cited for not getting a flu vaccine include:
51 percent do not think flu vaccines work
34 percent are concerned with side effects from the vaccine
22 percent are concerned about getting flu from the vaccine
One in four who are at higher risk for flu-related complications said they were not planning to get vaccinated this season
Sources of Information about Flu Vaccination
Healthcare professionals are the most trusted source of information about flu and vaccination. Social media is viewed with skepticism, and many are in favor of implementing reforms to prevent the spread of misinformation.
The majority of U.S. adults get information about flu vaccines from a healthcare professional, with more than six in 10 indicating this as their primary source of information
Many have also used online platforms to learn more about flu vaccines. Fifty-five percent report using online platforms. Google and news articles were the most cited sources.
Healthcare professionals are trusted for flu vaccine information far more than other sources. Seventy-one percent of US adults say they trust their doctor a great deal/a lot, and 61 percent trust their nurses a great deal/a lot.
70 percent do not trust social media as a source of information about flu vaccines, and 60 percent agree that social media platforms should implement policies to reduce inaccurate information about flu vaccination
Access to Flu Vaccination
Among those who have received a flu vaccine, the majority report receiving their last vaccination in a healthcare setting. Even when vaccines are offered in the workplace, the majority of US adults reported they were not inclined to get vaccinated.
62 percent report receiving their last flu vaccine in a healthcare setting (e.g., doctor’s office, pharmacy, hospital, or health department)
Only 8 percent of US adults reported receiving their last flu vaccination at their workplace, even though 40 percent of adults indicated that flu vaccines were available at their workplace
A majority of US adults (63 percent) reported that they were not more likely to be vaccinated if their employer were to offer flu vaccines
Knowledge and Attitudes Around Pneumococcal Disease
Among adults age 65 years and older, or those with an underlying health condition who are at increased risk for pneumococcal disease, there are gaps in awareness and understanding about pneumococcal disease and vaccination.
Nearly half (46 percent) of individuals at higher risk2 were unfamiliar with pneumococcal disease
Nearly 60 percent of individuals at higher risk report that they have never been advised to get vaccinated against pneumococcal disease
Among the high-risk group of individuals, 32 percent report they have received a vaccine to prevent pneumococcal disease, 42 percent have not, and 25 percent are unsure of their vaccination status
Among the high-risk individuals, 70 percent report that they are not planning on receiving a vaccine to prevent pneumococcal disease
Top reasons for not getting pneumococcal vaccine include:1
42 percent are concerned with side effects from the vaccine
20 percent don’t like needles
12 percent don’t think pneumococcal vaccines work very well
These survey findings highlight the importance of addressing misconceptions about flu and pneumococcal vaccine safety and effectiveness.
Flu vaccine can vary in how well it works, but even in cases when flu vaccination does not prevent infection completely, it can reduce the severity and duration of disease and prevent serious complications.5
For more than 50 years, hundreds of millions of individuals in the US have safely received seasonal flu vaccines.6
Pneumococcal vaccines are safe and effective; most side effects are mild, such as arm swelling or soreness, and last one or two days.
The survey findings also underscore the need to educate populations at increased risk, including people with chronic health conditions such as lung disease, heart disease, and diabetes.
 Top responses reflect survey respondent answers when asked to select “all that apply.”
 People at higher risk for complications from the flu as defined in the survey include those age 65 years and older, smokers, and those with diabetes, asthma, heart disease, or kidney disease.
 Responses reflect survey respondents ranking selections on scale of “trust a great deal/a lot,” “trust somewhat,” and “trust a little/not at all.”
 Underlying conditions are defined in the survey as smoking, diabetes, asthma, heart disease, or kidney disease.
5 Misconceptions about Seasonal Flu and Flu Vaccines | CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/prevent/misconceptions.htm. Accessed July 10, 2019.
6 Centers for Disease Control and Prevention. Flu Vaccine Safety Information: Q&A. www.cdc.gov/flu/prevent/general.htm. Accessed August 15, 2019.
7 Centers for Disease Control and Prevention. Adults: Protect Yourself with Pneumococcal Vaccines. https://www.cdc.gov/features/adult-pneumococcal/. Accessed August 12, 2019; Centers for Disease Control and Prevention. Pneumococcal Vaccine Side Effects. https://www.cdc.gov/vaccinesafety/vaccines/pneumococcal-vaccine.html. Accessed August 29, 2019.