The COVID-19 Pandemic and Influenza Vaccines

 

 

Rosie Geier, PharmD, is a clinical manager at Enclara Pharmacia. Each Enclara hospice client is assigned its own pharmacist clinical manager who helps monitor utilization and provides educational and operational support to help hospices achieve improved quality while managing costs.

Influenza season is always a concern for healthcare professionals and their patients. During my retail pharmacy days, flu season meant balancing the increased script volume with vaccine administration. But I always enjoyed vaccinating patients. I appreciated the one-on-one time because it allowed me to build trust with the patient. I mean, a patient has to have a lot of trust in you if they are going to let you poke them with a needle. It also created a private setting for the patient to open up about other clinical issues they were experiencing.

When I went to my local pharmacy to get my flu shot last week, it was an experience truly unique to 2020. The pharmacist was equipped with a face shield, face mask, and gown, in addition to the traditional vaccine safe-guards. And the pharmacist minimized our conversation, presumably to reduce the risk of COVID-19 transmission.

This sci-fi-like experience made me think about the impact of the COVID-19 pandemic on influenza vaccine rates. On one hand, more patients may be running to get an influenza vaccine in an effort to prevent respiratory illnesses this winter. On the other hand, patients may be even more fearful of the influenza vaccine than they already were previously. Some patients are afraid to leave their homes, let alone sit in a doctor’s office or pharmacy waiting room with other sick patients. Other patients may see the pharmacist, nurse, or doctor dressed in their personal protective equipment and may feel a pandemic is not the appropriate time to be receiving a vaccine. And still others may wonder if getting the influenza vaccine puts them at addition risk of transmitting COVID-19.

Below are some common questions that providers and patients may have during this unique flu season. My hope is that this will help instill confidence in the importance of influenza vaccines. Now if only I could convince my husband to go to the pharmacy and get his flu shot!

Should patients still get an influenza vaccine?
It is important to continue to get the influenza vaccine even during a pandemic1. The COVID-19 pandemic has created a situation where patients are falling behind on their routine vaccinations. This creates a multitude of public health issues and puts the population at risk of spreading vaccine-preventable illness.

Should a patient that is COVID-19 positive get an influenza vaccine?
The Centers for Disease Control (CDC) does not recommend administering the influenza vaccine to any patient with suspected or confirmed COVID-191. A COVID-19 infection itself is not a contraindication to the influenza vaccine. However, the CDC suggests waiting to administer the influenza vaccine until the patient no longer meets isolation requirements. This is due to an abundance of caution for the practitioner administering the vaccine.

How do you safely administer an influenza vaccine during a pandemic?
The CDC has released interim guidance for immunization services during the COVID-19 pandemic1,2. The guidance stresses the importance of minimizing risk of COVID-19 exposure to both the immunizer and the patient. Use of symptom screeners, face masks, gloves, protective eyewear, and proper hygiene can help to reduce the exposure risk. Both the intramuscular and intranasal vaccines are not considered aerosol-generating procedures. Thus, N95 level masks are not required to administer influenza vaccine. If the patient is not receiving the vaccine in their home, it is important to allow for proper social distancing in waiting rooms. Separating sick patients from healthy patients in waiting rooms should also be considered.

Are there additional risks?
Currently, the additional risks of administering the influenza vaccine during the COVID-19 pandemic relate to possible exposure to COVID-191. Aside from COVID-19 exposure, there do not appear to be any additional risks associated with vaccine administration at this time. Currently, there is no evidence that the immune response initiated by the influenza vaccine increases a patient’s risk of contracting COVID-19. However, much is unknown at this point in time, so it is important to stay up to date on current vaccine guidelines from the CDC.

Where can I find current influenza vaccination guidelines?
Please reference the CDC website for the most current vaccine guidelines.3

References:

  1. Frequently Asked Influenza (Flu) Questions: 2020-2021 Season. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/season/faq-flu-season-2020-2021.htm. Published October 20, 2020. Accessed October 23, 2020.
  2. Interim Guidance for Routine and Influenza Immunization Services During the COVID-19 Pandemic. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/pandemic-guidance/index.html. Published October 20, 2020. Accessed October 23, 2020.
  3. Flu Season. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/season/index.html. Published October 16, 2020. Accessed October 23, 2020.