Flu and Pneumococcal Disease: What Will This Year Bring?

While COVID-19 vaccines have made headlines this year, it’s important to encourage people to also get their influenza and pneumococcal vaccines as we head into the colder months. The National Foundation for Infectious Diseases (NFID) recently sponsored a media briefing addressing this topic, featuring speakers who explained the risks of contracting influenza and pneumococcal disease in the midst of a still-flourishing Covid-19 pandemic.

Moderated by NFID Medical Director William Schaffner, MD, a professor in the division of infectious diseases at Vanderbilt University School of Medicine in Nashville, and featuring keynote speaker Rochelle Walensky, MD, director of the Centers for Disease Control and Prevention (CDC), the virtual conference allowed for a lively discussion that incorporated advice from a panoply of experts.

A big concern among infectious disease clinicians is that respiratory infections other than COVID-19, particularly influenza, are expected to make a comeback after being largely dormant this past year thanks to masking and distancing. Walensky explained that when influenza levels are high, people who become infected acquire some level of immunity that can carry forward. “That immunity actually helps us year over year, and especially for those who might not have gotten vaccinated,” she said. “If they had gotten the flu last year, they may have some residual immunity against getting the flu again this year. So we have not a lot of protective immunity from last season.”

Flu is not the only threat looming. Respiratory illnesses such as respiratory syncytial virus, or RSV, have been circulating in significant numbers in the past few months--atypical this early in the season. This viral surge is another signal that we may be in for a difficult flu season. Pneumococcal disease, which can be a serious consequence of influenza, is another risk that’s particularly dangerous for people aged 65 and older or who have certain underlying conditions.

During the 2020-2021 season, an estimated 52% of people 6 months and older received a flu vaccine, a level that has held steady for several years. But that figure obscures age- and race-related imbalances in vaccination. “While we see increases in vaccination coverage among adults, flu vaccination coverage among children decreased by about 5 percentage points, from 64% to nearly 59%,” Walensky said. “This decrease in coverage is likely related to the ongoing pandemic disrupting access to routine medical care. And this is a concerning drop because flu can be especially dangerous for children. During the 2019-2020 flu season, 199 flu deaths among children were reported to CDC, a record number for a single flu season. Consistent with findings in other seasons, about 80% of those children were not vaccinated.”

Walensky also noted worsening disparities in vaccine rates among racial and ethnic groups. This year, flu vaccine uptake among white people at least 6 months of age rose to about 56%, while for Black individuals it decreased to 43%. Among the Hispanic population, the rate this past year held steady at about 45% vaccinated against flu. “These differences are simply unacceptable and contribute to overall poorer outcomes in our minority communities,” she said.

The panel’s experts stressed that pregnant women should get vaccinated against influenza, as the immune response generated benefits babies and infants too young to be vaccinated. According to Laura Riley, MD, chair of the department of obstetrics and gynecology at Weill Cornell Medicine in New York, pregnancy is a risk factor for severe disease and death from flu.

Another reason to get the flu shot? Protection against a host of other conditions. The inflammation that results from congested air sacs in the lungs during a bout of influenza can persist for weeks, even after an individual recovers from influenza, and can increase the risk of heart attacks and other complications, according to Cedric “Jamie” Rutland, MD, CEO of West Coast Lung Clinic in Newport Beach, California. “When people develop inflammation of those airways secondary to an organism like influenza, that inflammation ramps up across the body, and those individuals...do have a higher risk of having mild myocardial infarction in the subsequent weeks,” Rutland said. “And so when you get vaccinated and you prevent that inflammation, you’re also controlling other conditions and exacerbations of other conditions like a COPD exacerbation, like an asthma exacerbation, and also like preventing stroke and reducing mild myocardial infarctions or heart attacks.”

Providers fear this message isn’t being heard widely enough. A recent study released by the NFID revealed that 44% of adults in the U.S. did not plan to get a flu shot, or were not sure they would get a flu shot, including 23% of those considered to be at higher risk of poor outcomes from flu. When it comes to pneumococcal disease, the picture is even bleaker: 51% of respondents are not familiar with it, and less than a third (32%) have been told to be vaccinated against it. The good news is that of those advised to get the pneumococcal vaccine, 84% said they did so.

The onus is on clinicians to be proactive and talk to patients about flu vaccines and other inoculations, something that often falls by the wayside, participants in the briefing noted. “As healthcare professionals, our recommendations matter,” Schaffner said. “We need to insist that our patients are up to date on pneumococcal and flu vaccines.”

Riley went even further: “[W]hat we really need to do is, every time a patient shows up for care, offer them the shot.”