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8 things doctors wish patients knew about flu shots

Oct 13, 2022

The flu season can be severe, but for the past couple of years it has been different. There remains the looming threat of a combination of a severe flu season and the current COVID-19 pandemic. This year, with the availability of a new bivalent COVID-19 vaccine booster in addition to the influenza vaccine, some medical experts are optimistic. Yet there is still concern about hospital capacity related to the spread of these viruses which is why doctors are urging people to get the influenza vaccine to reduce the risk of severe outcomes.  

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While 69% of adults in the U.S. agree that an annual influenza vaccination is the best preventive measure against flu-related deaths and hospitalizations, only 49% of adults in the U.S. plan to get an influenza vaccine during the 2022–2023 flu season, according to a survey from the National Foundation for Infectious Diseases.

Of those who said they will not be getting vaccinated, 41% noted that they didn’t think flu vaccines work very well and 39% had concerns over the side effects. Meanwhile, 28% said they never get the flu, 24% are concerned about getting the flu from the vaccine and 20% do not think influenza is a series illness.

The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines, especially throughout the COVID-19 pandemic.

In this installment, Kate Kirley, MD—a family physician and director of chronic disease prevention at the AMA—took time to discuss what doctors wish patients knew about the influenza vaccine to help clear up any misinformation.

The flu shot is made of pieces of the virus or inactivated virus, and “the nasal spray is a whole virus, but it’s an attenuated form of the virus, so neither kind can actually give you the flu,” said Dr. Kirley. “It’s not uncommon for people to have a low-grade fever or feel a little run down for a couple of days after they get their vaccine. That’s just their immune system responding to the vaccine and doing exactly what we want it to do.”

Patients will sometimes coincidentally come down with the flu shortly after receiving the vaccination, but that’s just a quirk of timing, Dr. Kirley said, noting that this is one of many common misconceptions about the flu and flu vaccines.

“It takes the vaccine a couple of weeks to generate a full immune response, so you don’t have your full protection until a couple of weeks after you get your shot,” she noted.

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The bivalent COVID-19 vaccine booster, designed to better match the BA.4 and BA.5 Omicron subvariants, is now available for patients 12 or older. And coadministration of flu and COVID-19 vaccines—even the bivalent booster—is permitted if you are eligible and the recommended timing coincides.  

“People heading to their doctor’s office or pharmacy for their COVID vaccine or booster can also get their influenza vaccine at the same visit,” said Dr. Kirley. “We hope everyone will take advantage of getting their new COVID booster, or starting their COVID vaccine series, if they haven’t already done so.” 

This means “people can get their flu shot on the same day—it’s safe and effective, so there’s no need to make multiple trips,” she emphasized.

“Every year, influenza causes hundreds of thousands of hospitalizations and tens of thousands of deaths in the United States,” she said, noting that “we’re still concerned about hospital capacity related to COVID, so it’s important to do everything we can to keep people out of the hospital and getting a flu shot is one of the best things we can do to stay healthy during flu season.”

Additionally, it is “possible to get influenza and COVID at the same time, and then you really have that double whammy in terms of two significant respiratory illnesses,” said Dr. Kirley. The flu vaccine is “really to get the protection against that scenario.”

“We typically don't know the effectiveness of the vaccine until we really get into flu season, and we can see what types of viruses actually end up circulating in the population,” said Dr. Kirley, adding that every year, the flu vaccine is adjusted to align with what is predicted to be the most likely strains circulating.

“It typically falls somewhere between 40% and 60% effectiveness,” she said. “Even when the vaccine is only 30% effective at preventing flu, that is still very meaningful and crucial for preventing hospitalizations and deaths.”

The general recommendation is to “shoot for September or October to get your flu vaccine,” said Dr. Kirley. “You can start to get your vaccine, ideally before the end of October, but if you don’t squeeze it in, go get it any time.”

“Ideally before January is what’s best. But we’ll tell people all throughout flu season, if you haven’t gotten the vaccine yet, it’s still OK to get it and you’re likely to benefit as long as influenza viruses are circulating,” she said.

“There are a couple reasons why someone might not be able to get the flu vaccine—that’s relatively rare,” said Dr. Kirley. “A real allergy to it might be the most common reason, but generally speaking, if you are older than six months old, you should definitely get the flu vaccine.”

“Our seniors, for sure, are a higher-risk population. They have slightly different vaccine options that are designed to protect them a little bit more,” she said. “Because they are also clearly one of those high-risk populations for COVID, it is even more important for them to protect themselves against the flu as well.”

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“The sprays are only approved for ages 2 through 49,” said Dr. Kirley. “There are some medical conditions or reasons why you may not be able to get the spray, or it may not be the best choice for you, but most people can take that option of getting the nasal spray if they really are anxious about getting the shot.

“We will definitely say, ‘If it means you end up getting a flu vaccine and you'd rather choose a nasal spray, get that nasal spray,’” she added. “It is typically pretty comparable to the shot in terms of effectiveness.”

“There are benefits to us as individuals: We're less likely to get the flu. Even if we do develop the flu, we're less likely to need to be hospitalized and it tends to be less severe if you get the vaccine,” said Dr. Kirley. “It is also about protecting others—your family, friends, community members.”

“The flu vaccine is most effective for all of us when more of us get it, so we can get closer to achieving—at least for flu season—that herd immunity,” she said. “Getting the flu shot is not just doing something for yourself, but it definitely is a way you can contribute to good health in your community.”

“You have a lot of options in terms of where you can receive the flu shot. We usually suggest that people reach out to their primary care doctor's office first,” said Dr. Kirley. “Primary care physician offices usually have lots of options for how you can come in and get your flu shot, but there are other places as well.”

“This year there still may be a decline in employers offering the flu shot with so many people working from home. That’s definitely a concern for me,” she said. “There's going to be a big awareness push to help people find where they can get their flu shots.”

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