Anticipating Flu Season
By Brandi Redding

Physicians should encourage older adults, a high-risk population for contracting influenza, to receive the flu vaccine annually and ideally before the start of flu season.

With the start of flu season approaching, it’s time to discuss the flu shot with patients. Many may not realize the importance of this vaccine or the necessity to be vaccinated every year. Indeed, even fellow health care workers who want to protect themselves and their patients may not realize all the benefits of being vaccinated.

Two vaccines will be available this year: the standard three-strain vaccine and a new quadrivalent vaccine. The three-strain version includes two strains of the more common A virus and one of the B virus and will be widely available for use.

The quadrivalent, or four-strain vaccine, includes two strains of both the A and B viruses. In previous years, the vaccine provided protection against only the single B strain that was estimated to be the dominant strain. However, for the past two years, two active B virus strains have circulated, leading to concern in the health care industry, especially for high-risk patients, and to the creation of the quadrivalent vaccine.

Despite limited production, it may be available for patients with chronic medical conditions and those with compromised immune systems, providing them extra protection. Patients need not worry about increased side effects associated with the vaccine, as they will be similar to the standard vaccine.

Early Is Better
Because there is no way to predict when the flu season will start, Brian Currie, MD, MPH, an infectious disease specialist and the vice president and medical director for research at Montefiore Medical Center in New York City, suggests getting the vaccine as early as possible to protect against an early onset of flu season. There is no harm in vaccinating early, and if the flu season should run extra long and there is concern that the provided immunity will decrease, a booster shot can safely provide added protection.

“We don’t yet know how severe this year’s flu season will be, but we’re preparing now to try and confront it head on,” Currie says. “We continue to strongly encourage everyone to get their flu shot early in the season—September is best.”

An annual flu vaccination is recommended for everyone 6 months and older, Currie says, except for those for whom the shot is contraindicated. They include mainly individuals with egg allergies or a history of Guillain-Barré Syndrome in reaction to the vaccine. However, for those with egg allergies, it’s important to note that there are now vaccines available that are safe for this population.

Although there is some controversy regarding the flu vaccine’s efficacy in older adults, the vaccine will still protect against severe infection, diminishing the effect of the illness if the individual were to get sick. In addition, an estimated 20,000 people will die from flu-related infections, especially among high-risk populations such as elders and very young children, making it all the more important to encourage vaccination in these groups.

For patients who believe the previous year’s vaccination will protect them, Currie says professionals should inform them that while it may offer some coverage, it will be minimal. The body tends to “forget” the exposure from the vaccine and the protection it offered. That’s why it’s important to get a shot every year and, in some circumstances, to get a follow-up shot during lengthy flu seasons.

It’s also important to encourage coworkers to be vaccinated. For instance, nursing home outbreaks often originate in one of the workers and quickly spread to the patients, according to Currie. Therefore, a new state regulation in New York requires health care workers who do not get the flu shot to wear facemasks when interacting with patients.

The regulation will help protect patients, but it’s not infallible. “We still strongly recommend influenza vaccination of all health care workers as the best way to protect themselves and their patients from influenza infection,” Currie says.

The takeaway message for geriatricians is to “get the word out about the vaccine to patients and to coworkers, and encourage them all to get vaccinated,” Currie says.

— Brandi Redding is the assistant editor of Today’s Geriatric Medicine.