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November 16, 2021

Flu Season May Be Severe—It’s Time to Get Your Shot

Flu Season May Be Severe—It’s Time to Get Your Shot

While COVID-19 retains its grip on the world, another respiratory virus, influenza, is off many people’s radar. That may be partly due to the fact that the 2020-2021 flu season was unusually mild. But the flu isn’t going anywhere. Flu season is back, and some experts believe we need to brace for a bad one.

It’s time for your seasonal flu shot.

The Centers for Disease Control and Prevention (CDC) recommends that nearly everyone aged 6-months or older receive a flu vaccine each year. This is true—even if you’re wearing a mask and social distancing to protect yourself and others from COVID-19.

Why? Flu activity is already on the rise and cases in your community could increase at any time. Meanwhile, COVID activity is high in more than 70 percent of U.S. counties. Getting vaccinated can reduce the risk of serious flu complications not only for you, but also for vulnerable people around you.

September and October are the best months for a flu shot. Ideally, everyone should be vaccinated by the end of October. That goes for children, too. Kids 6-months or older are eligible.

But so far this year, flu vaccinations are off to a slow start.

As of October 29, 158.7 million doses of flu vaccine have been distributed across the United States, reports the Centers for Disease Control and Prevention (CDC). Only about 23 percent of adults have already gotten their flu shot—though roughly 34 percent say they plan to get the seasonal jab, according to CDC surveys collected in early October.

Meanwhile, however, about 17 percent aren’t sure if they will get vaccinated and more than 25 percent of the adults polled admit they have no plans to get their flu shot this year.

Compared to this time last year, fewer kids are vaccinated too. As of October 23, some 24.3 percent of kids got their flu shot. But last year, more than 32 percent of kids received the seasonal flu vaccine by this point in the season.

Flu vaccinations are also down 16 percent among pregnant women—another group at high risk for flu-related complications.

In the United States, many people routinely skip their flu shot. But this preventative measure may be more important this year than ever. With the COVID vaccine on everyone’s mind, whether you’re fully vaxed or you’re ready to take that step, you may have questions about whether or when to get the flu shot, too.

Here’s important news for your health: you can and should get both. And if you do need a COVID shot (whether it’s your first, second or booster dose), the CDC says you can get it at the same time as your flu shot. That means you don’t have to choose between protecting yourself from COVID or the flu.

The last flu season was mild
In 2020, as the cold months approached, health officials worried a bad flu season could compound the nation’s COVID pandemic. Some warned that a “twindemic” could further strain health care resources.

Thankfully, that didn’t happen. The nation saw a very light flu season. Among more than 818,000 flu tests in the U.S. last season, just 0.2 percent tested positive. That low percentage is probably because the same measures that protect people from COVID can also help ward off the flu—such as masking, shutdowns and social distancing. A record number of flu vaccine doses were distributed last year around the country, too, which may have also helped.

But it’s unclear if we’ll get that lucky again this season, flu-wise. People are gathering again, filling sports arenas and heading back into workplaces, schools, and retail businesses where masks and vaccines may be optional. Now that last year’s COVID protection policies are no longer in effect in many areas, influenza may well make a comeback.  

Why we might have a bad flu season this year
Some researchers are predicting a severe flu season. Not only is the nation taking fewer infection precautions than it did last season, but also our overall flu immunity might be lower than usual since so few people caught it last year.

Influenza may not seem scary. But it can and does turn deadly. The CDC estimates that since 2010, influenza has resulted in between 9 million and 45 million illnesses, between 140,000 and 810,000 hospitalizations and between 12,000 and 61,000 deaths each year.

A research group at the University of Pittsburgh used computer models and published two preliminary studies that have yet to be peer reviewed to make a prediction about what we’ll face this year. One of the studies found that the likeliest scenario is a worse-than-usual flu season this year, which could be eased by higher-than-usual vaccination rates. Those researchers also warned that young children could be at higher risk than usual, since that group got almost no flu exposure last year. The other study also concluded that we’re likely facing a “large, compensatory” flu season—a rebound of sorts after last year’s mild season and low natural immunity—but that if 50 percent more people get the flu shot or if it’s 50 percent more effective than usual, we could avoid skyrocketing hospitalizations.

In 2019-2020, only about 52 percent of Americans got a flu shot. But if that rate rose by even a little, we could ward off thousands of hospitalizations this flu season.

Don’t be deterred by the fact that the flu vaccine isn’t a perfect shield (its average efficacy is about 40 percent to 60 percent, far less than the 90s-range the new COVID vaccines have achieved).

The percentage of people who get the vaccine is far more important to public health than its efficacy. For example, a flu vaccine that’s only 20 percent effective could still save nearly 62,000 lives if 43 percent of the population got one, a 2018 study published in Proceedings of the National Academy of Sciences found. Boost that vaccination rate to 50 percent of the population, and nearly 8,500 additional flu deaths are avoided.

Timing your flu shot and COVID vaccine
Whether you’ve already been immunized against COVID and are eligible for a booster, or you’re ready for your first dose, the CDC advises that you can get a flu shot at any time—even on the same day.

Previously, experts advised people to separate these two different diseases’ vaccines by 14 days. That was an initial precaution put in place because the COVID vaccines were new—not because there were any known hazards, in particular.

There is now abundant research on the safety of the COVID vaccine. And in addition to what we already know about how flu vaccine behaves when given with a variety of other vaccines, the CDC is now confident that giving COVID shots at the same time as other vaccines is both safe and effective.

Preliminary results of a recent British study reinforce this recommendation. The study involved 679 study participants who had already gotten one dose of either the Pfizer/BioNTech or the Oxford/AstraZeneca COVID-19 vaccine. When they returned for their second shot, half of them received a flu shot in the opposite arm, and the other half got a placebo shot.

The volunteers reported mild to moderate side effects only, with 97 percent saying they’d be willing to get both vaccines at once in the future. The researchers concluded it’s safe to get flu and COVID-19 shots on the same visit. Importantly, there was no negative effect on the double-vaxed participants’ ability to mount an immune response to both viruses. (The results are slated to undergo peer review.)

The CDC also says that side effects are about the same whether a vaccine is given alone or at the same time as other vaccines. (Children and people about to travel abroad, for example, routinely get multiple vaccines on the same visit without incident.) Some data from other studies of flu vaccination along with other vaccine types have suggested higher rates of adverse reactions when the flu vaccine is given with others, but these reactions have, again, been mostly mild to moderate.

One caveat: some flu vaccine types are likely to trigger a stronger immune response that could lead to, say, a sore and tender muscle. The CDC advises providers who are simultaneously giving COVID shots and other shots that are more prone to lead to that kind of localized reaction to inject them in different limbs, if possible. (If given on the same arm, the two injections should be spaced at least one inch apart.)

Bottom line? For most people, it’s safe to get immunized against both the flu and COVID, whether on separate occasions or at the same time—and it’s wise not to wait. That way you have a good shot at protecting yourself and others from these serious illnesses this season.

Sources:
Centers for Disease Control and Prevention. “Weekly U.S. Influenza Surveillance Report.” Nov 6, 2021.
Centers for Disease Control and Prevention. “Weekly National Flu Vaccination Dashboard.” Nov 3, 2021.
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Centers for Disease Control and Prevention. “Frequently Asked Influenza (Flu) Questions: 2021-2022 Season.” Last reviewed Sep 1, 2021.
Centers for Disease Control and Prevention. “CDC COVID Data Tracker.” Sep 14, 2021.
Associated Press. “Crowded stadiums, pandemic create combustible mix this fall.” Sep 11, 2021.
Deloitte. “Executives share their plans for returning to the workplace.” Accessed Sep 13, 2021.
The New York Times. “Reopening Plans for the 100 Biggest School Districts Are Changing Fast.” Aug 13, 2021.
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CNBC. “Health experts are anxious to prevent a ‘catastrophic’ winter flu season.” July 7, 2021.
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Centers for Disease Control and Prevention. “Disease Burden of Influenza.” Last reviewed June 11, 2021.
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Centers for Disease Control and Prevention. “Flu Vaccination Coverage, United States, 2019–20 Influenza Season.” Oct 1, 2020.
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Centers for Disease Control and Prevention. “Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States.” Last updated Aug 31, 2021.
Grohskopf LA, Alyanak E, Ferdinands JM et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021–22 Influenza Season. MMWR Recomm Rep 2021;70(No. RR-5):1–28.

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