Everything Nurses Need To Know For The 2020-2021 Influenza Season

By: Kathleen Gaines BSN, BA, RN, CBC

The 2020-2021 flu season is going to be one of the most important flu seasons in recent history due to the ongoing pandemic related to COVID-19. There is a heightened awareness to reduce the spread of respiratory illnesses, such as the flu, and a push for early vaccination. 

It’s impossible to determine how severe the flu season will be this year, partially due to the ongoing pandemic with some businesses still shuttered or functioning at reduced capacity, large gatherings forbidden, and children being educated from home. Furthermore, with the increasing use of facial masks when in close proximity to others, it is possible the flu season will be very mild. Unfortunately, it’s impossible to predict. For this reason, it is HIGHLY encouraged to become fully vaccinated against the flu. 

Flu Numbers And Statistics

While it is impossible to determine how bad a flu season will be, the Center for Disease Control and Prevention collects statistics at the end of a season to help determine numbers for the following year. 

The 2019-2020 flu season was shorter than previous years because of the ongoing pandemic related to COVID-19. The CDC suggests that due to quarantine and the closer of schools and businesses the flu became dormant quicker than in the past. 

Between October 1, 2019, and April 4, 2020, the CDC approximated,

• 39 million to 56 million have flu illnesses
• 18 million to 26 million saw a healthcare provider for the flu
• 410,000 to 740,000 flu hospitalizations
• 24,000 to 62,000 flu-related deaths

The range for hospitalizations and flu-related deaths is broad because hospitals are only required to provide the CDC with pediatric flu-related deaths. All others are collected at the state level. During the 2019-2020 flu season, 188 pediatric deaths were reported to the CDC. Unfortunately, only 21 percent of children eligible for vaccination were fully vaccinated against the flu. 

Among the 188 reported pediatric flu deaths:

• 43% (81) occurred in children younger than 5 years old
  • 12 occurred in children younger than 6 months 
• 57% (107) deaths occurred in children 5-17 years old
• 76 (43.4%) had a pre-existing medical condition
• Nearly two-thirds of the deaths were attributed to influenza B infections

What Flu Vaccines Are Recommended This Season?

There are numerous flu vaccines available to the general public, all of which are covered by private and public insurance. Those without insurance can often get a low-cost or even no cost flu vaccine at major pharmacies. The availability of specific types will vary based on location and population needs. The CDC recommends that all individuals over 6 months of age receive their annual flu vaccine by the end of October.

The four most common flu shots this year are:

• Standard dose flu shots. An inactivated influenza vaccine given via intramuscular injection.
• High-dose shots for people 65 years and older.
• Shots made with flu virus grown in cell culture. No eggs are involved in the production of this vaccine.
• Live attenuated influenza vaccine. A vaccine made with an attenuated live virus that is given by a nasal spray vaccine.

This table from the CDC has a complete breakdown of all the flu vaccinations available in the United States for the 2020-2021 flu season.

According to the CDC, the quadrivalent formula for the egg-based influenza vaccine contains the following:

• an A/Guangdong-Maonan/SWL1536/2019 (H1N1) pdm09-like virus;
• an A/HongKong/2671/2019 (H3N2)-like virus;
• a B/Washington/02/2019- like virus (B/Victoria lineage);
• a B/Phuket/3073/2013-like virus (B/Yamagata lineage).

According to the CDC, the quadrivalent formula for the cell or recombinant based influenza vaccine contains the following:  

• an A/Hawaii/70/2019 (H1N1) pdm09-like virus;
• an A/HongKong/45/2019 (H3N2)-like virus;
• a B/Washington/02/2019- like virus (B/Victoria lineage);
• a B/Phuket/3073/2013-like virus (B/Yamagata lineage).

There are very few contraindications for the standard dose flu vaccine but it is important to speak to your doctor if you have any questions.

The live attenuated nasal spray vaccine is contraindicated in the following populations according to the CDC:

• Children younger than 2
• Adults age 50 or older
• Pregnant women
• Children 2 years through 17 years of age who are receiving aspirin- or salicylate-containing medications.
• People who care for severely immunocompromised persons who require a protected environment
• People who have taken influenza antiviral drugs within the previous 48 hours such as Tamiflu.
• People who are immunocompromised (ex. Cancer patients or individuals living with HIV/AIDS)
• Children 2 years through 4 years who have asthma or who have had a history of wheezing in the past 12 months.

The high dose flu vaccine is specifically designed for people 65 years and older as it is intended to give older individuals a better immune response which will give better protection against the flu. The vaccine contains four times the antigen of a standard dose flu vaccine.

It’s important to note that the flu vaccine will NOT prevent COVID-19 or decrease the symptoms associated with COVID-19. Additionally, getting the flu vaccine will not cause COVID-19 or increase the likelihood of contracting COVID-19. 

What’s New This Flu Season?

Two new influenza vaccines have been approved for use in people aged 65 years and older: a quadrivalent high-dose influenza vaccine and a quadrivalent adjuvanted influenza vaccine. 

Individuals with confirmed COVID-19 or are quarantining due to COVID exposure should avoid receiving the flu vaccination until fully recovered and/or quarantine has ended.

Get fully vaccinated by the end of October

Flu Vaccines, Exemptions, and Religion

There are generally three types of exemptions for vaccinations including,

• Medical Exemptions—including severe, life-threatening allergies to the vaccine or other medical conditions
• Philosophical Exemption—a personal-belief exemption
• Religious Exemptions—based on the beliefs of an organized religion

Once a very controversial topic, there are currently only a few religions that prohibit the flu vaccine. In 2017, Islamic leaders signed the Dakar Declaration on Vaccination, which explains the need for vaccination to protect children and adults from infectious diseases. One thing to note: the nasal spray flu vaccine contains pork-gelatin and for individuals that practice Islam, consuming pork is forbidden. Muslims should only get the standard intramuscular flu vaccine.

The Church of Christ (Christian Scientists) believe in healing through prayer and while they have not openly stated their stance on vaccinations they generally do not think they are necessary. Other smaller Christian churches such as  Church of the First Born, End Time Ministries, Faith Assembly, Faith Tabernacle and First Century Gospel Church also believe in faith healing and do not endorse vaccination. The Dutch Reformed Church initially had fears of adverse reactions but believes vaccines may interfere with the relationship with God and it makes people less dependent on God. 

Flu Prevention

While the flu vaccine is the single best way to prevent the flu, there are other very important steps to prevent getting sick or spreading germs to others. These recommendations are more important than ever due to COVID-19. The CDC recommends you:

• Get vaccinated early!
• Avoid close contact with sick individuals
• Wear a mask when in public (currently COVID guidelines but applicable for the flu as well)
• Get plenty of sleep, reduce stress, increase physical activity, minimizing alcohol intake, and eat a nutritious well balanced diet 
• Practice good hand hygiene including washing your hands for 30 seconds and use hand sanitizer when soap and water is not available
• Stay home while sick for at least 24 hours after symptoms have stopped
• Cover your mouth and nose with a tissue when coughing or sneezing
• Avoid touching your eyes, nose, and/or mouth
• Clean and disinfect frequently touched surfaces including cell phones, iPads, and Apple watches

The influenza season will be taxing on healthcare providers as the ongoing pandemic has already left a strain on the healthcare system. Some hospitals have been working with decreased staff for an increased number of patients. If this flu season is as bad as recent years, then it is essential for individuals to be vaccinated, especially healthcare workers. Most healthcare employers mandate the flu vaccination for all workers unless there is a medical exemption. Check with your employer to find out the deadline. Some healthcare systems will suspend or even terminate employees that are not compliant.