Everything Nurses Need To Know For The 2019 Influenza Season
By: Kathleen Gaines BSN, BA, RN, CBC
Influenza, a contagious respiratory illness, does not discriminate about who, when, and where it strikes. It is crucial for nurses and other healthcare professionals to understand the flu’s etiology, symptoms, prevention, and treatment in the interest of their own health, as well as the well-being of their patients and communities.
Those most at risk from influenza are the elderly, newborn infants, as well as individuals with lung disease, immunocompromised conditions, asthma, and pre-existing heart conditions.
The exact timing of the flu season is unpredictable and varies from year to year; generally, the season peaks between December and February, although activity can last as late as May. The Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend getting vaccinated before flu season to maximize effectiveness.
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.
Between October 1, 2018, and May 2, 2019, the CDC approximated,
- 37.4 million to 42.9 million have flu illnesses
- 17.3 million to 20.1 million saw a healthcare provider for the flu
- 531,000 to 647,000 flu hospitalizations
- 36,400 to 61,200 flu-related deaths
TIME magazine reported that the 2018-2019 flu season was the longest in a decade, spanning over 21 weeks. If that is any indication of the flu season this year, get ready because it is going to be a long one.
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 2018-2019 flu season, pediatric hospitalizations were similar to the previous year but there were fewer pediatric deaths: 116 children died from the flu, compared to 183 the previous year. Approximately 80% of the deaths occurred in children who did not have the flu vaccine.
What’s New This Flu Season?
- According to the CDC, there have been several VERY important changes to the flu vaccinations available to the general public this year.
- Flu vaccines were updated to better match viruses expected to be circulating in the United States according to research from the last flu season.
- All regular-dose flu shots will be quadrivalent.
- This means that each vaccination fights FOUR different influenza strains.
- All four of the vaccine viruses were grown in cells, not eggs.
- Egg allergy? There is now a vaccine safe for anyone who was previously unable to get the vaccine due to an egg allergy.
- Children 6 months through 8 years of age who need 2 doses should receive their first dose as soon as possible after the vaccine becomes available to allow the second dose to be received by the end of October.
- Get vaccinated before the end of October.
- Recommended dosages have changed for pediatric patients.
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. The availability of specific types will vary based on location and population needs.
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 2019-2020 flu season.
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.
A 2014 study published in the New England Journal of Medicine found that the high dose vaccine was 24.2% more effective in preventing the flu in adults 65 years of age and older than the standard flu vaccine.
In 2017, The Lancet Respiratory Medicine reported that there was a significant decrease in the number of hospital admissions in individuals that received the high dose flu vaccine, especially those living in long-term care facilities.
The high dose vaccine is recommended for anyone over the age of 65, regardless of baseline health. If your healthcare provider does not have the high dose vaccine, the standard dose vaccine is still safe to receive. The most important thing it ensuring vaccination.
First Reported Flu-Related Deaths Of 2019
State health officials in New Mexico recently announced one of the first flu death of the 2019-2020 season. The woman was from Bernalillo County and was 90 years old. There were four additional confirmed cases throughout the state. Three of the cases were in Sandoval County and the fourth in Santa Fe County.
In early September, a four-year-old boy from California passed away after testing positive for the flu and became the first pediatric flu-associated death. According to health officials, the child had underlying health issues and resided in Riverside County.
Flu Vaccines and Religion
Once a very controversial topic, but there are 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) and the Dutch Reformed Church both openly discourage 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. Christian Scientists’ have not openly stated their stance on vaccinations but they do believe that disease can be cured through prayer.
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. The CDC recommends you:
- Avoid close contact with sick individuals
- Practice good hand hygiene
- 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
It is also recommended to practice other good health habits including getting plenty of sleep, staying physically active, managing stress, drinking plenty of water, minimizing alcohol intake, and eating a well-balanced diet.
Although it is still very early in the flu season, it is highly recommended that those who have not received this year’s vaccine receive one before the end of October. 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.
As nurses and health care providers, it is essential to speak to all patients about the risks and potential complications associated with not receiving the flu vaccine, as well as how to monitor for symptoms and when to seek medical attention.
It is increasingly important to have in-depth conversations about influenza with the elderly, those with newborn infants, individuals with multiple comorbidities, pregnant women, as well as other at-risk populations. With proper education of the general public, healthcare professionals have the ability to decrease the number of flu-related illnesses and deaths in their communities.