Recent news from the Centers for Disease Control and Prevention (CDC) confirmed what circulating news reports were predicting: an early onset flu season.
What remains to be seen is how severe the season will be and how long it will last. But, what we do know is that pharmacists are playing an increasingly crucial role in stemming the spread of viruses and enhancing patient wellness this flu season.
Flu so far
Flu season in the United States usually ramps up in the fall and peaks most often between December and March. The flu season can continue as late as May. This winter, the CDC says there's a 40 percent chance the flu will have peaked in December based on activity so far. With the flu season officially underway, the CDC reported the virus in 6.4 million individuals — 55,000 have been hospitalized and 2,900 have died from influenza as of its December 28, 2019, weekly report (considered week 52 of flu season).
The most influenza activity is concentrated in the southern states so far this season. Notably, the CDC reports heightened activity of the B strain of the influenza virus. Typically, this strain of the virus does not show up until the spring. Specifically, CDC reports nationally influenza B/Victoria viruses have been reported more frequently than other influenza viruses, followed by A(H1N1)pdm09 and A(H3N2) viruses, with the predominant virus varying by region and age.
Influenza B/Victoria viruses are the most commonly reported influenza viruses among children age 0-4 years (46% of reported viruses) and 5-24 years (60% of reported viruses), while A (H3N2) viruses are the most commonly reported influenza viruses among persons 65 years of age and older (54% of reported viruses). Among adults aged 25-64 years, approximately equal proportions of influenza A (H1N1) pdm09 and B/Victoria viruses (35% and 34%, respectively) have been reported.
Flu activity is reported weekly by the CDC and accessible at: www.cdc.gov/flu/weekly/index.htm.
How pharmacists make an impact during flu season
Pharmacists and other vaccine providers should continue to tell patients to get vaccinated, a message featured prominently on the CDC flu website.
With the flu season still underway, elevated flu activity is expected to continue for weeks. The importance of being vaccinated should not be understated. The bottom line: it’s not too late to get vaccinated. Flu vaccination is the best way to reduce the risk from flu and its potentially serious complications and prevent flu and flu-related doctor’s visits. According to the CDC, during the 2017-2018 season, flu vaccination prevented an estimated 6.2 million influenza illnesses, 3.2 million influenza-associated medical visits, 91,000 influenza-associated hospitalizations, and 5,700 influenza-associated deaths. The CDC says during seasons when the flu vaccine viruses are similar to circulating flu viruses, flu vaccine has been shown to reduce the risk of having to go to the doctor with flu by 40 to 60 percent.
Yet, in spite of this compelling evidence of the value of influenza vaccination, 37 percent of U.S. adults say they do not plan to get vaccinated against influenza this year, according to a survey from NORC at the University of Chicago. Those saying they did not plan to get vaccinated cited concerns about vaccine side effects or said they did not think the vaccine works very well. Others said they did not get the flu, were afraid of needles, or thought the vaccine could cause the flu.
“Widespread misconceptions exist regarding the safety and efficacy of flu shots,” said Caitlin Oppenheimer, senior vice president of Public Health Research at NORC at the University of Chicago. “Because of the way the flu spreads in a community, failing to get a vaccination not only puts you at risk but also others for whom the consequences of the flu can be severe.”
The good news is that the CDC reports as of early November 2019, 44 percent of adults said they had received a flu shot while another 18 percent said they still planned to get vaccinated. Recent news stories about an early flu season and potential severity are helping to motivate patients to become vaccinated based on my observations in the pharmacy.
Providing vaccinations against a variety of diseases is an everyday occurrence in the pharmacy today. It was not always the case. I recall 15 years ago training all the pharmacists on providing vaccines in the regional grocery chain where I practiced. I had partnered with a colleague who had a closed-door pharmacy, and we jointly invested in the purchase of 1,000 influenza doses. He had the licenses, so we could create and set up billing and flu clinics at assisted living facilities. I wanted to experiment with hosting scheduled walk-in clinics at the pharmacy office. We planned well, were organized, and had schedules and supplies set and backend operations in order. Then a vaccine shortage hit. The Minnesota Department of Public Health was identifying providers with vaccines to match to high-priority patient needs. We began adapting our practice plan to accommodate a different walk-in patient population and the waiting lines at each of our scheduled clinics. We brought in hot coffee and soup to support patients while they waited. All told, what we had planned to be a three-month clinic/walk-in vaccination schedule was reduced to 45 days when all of the vaccine we had purchased was used!
That early innovative effort was motivated by my desire to “walk the walk and talk the talk.” I had been actively involved in moving the concept of pharmaceutical care forward, encouraging colleagues to implement new clinical services. I was part of the team among our national organizations that helped craft the strategic plan to make immunization services the first widespread clinical offering in pharmacy. It was no small feat, but a solid plan that encompassed the necessary legislation and regulation, education and training, and stakeholder outreach made this possible over the course of a decade or so. In 1995, around the time we began discussing immunizations as a widespread clinical service, only nine states allowed pharmacists to immunize. In 2009, Maine became the last state to pass enabling legislation allowing pharmacists to provide influenza vaccination.
Flash forward to this season. A number of associations and pharmacy organizations have been actively engaged in proactive outreach, with even more emphasis during National Influenza Vaccination Week, December 1-7, encouraging families to get their influenza vaccine. CDC reported through the end of November that 169 million doses of vaccine had been distributed.
As a practicing pharmacist, I witness firsthand the importance of suggesting flu vaccine to each patient at the pharmacy and how effective that outreach is in getting people to make the decision to be vaccinated. Having pharmacy-specific vaccination goals is a useful way to encourage this outreach. Special campaign days also are effective, especially with a little friendly competition among teammates. System tools can also provide support during the prescription-filling process, triggering the “ask” to a patient if they would like to receive the flu shot and proactively processing the claim, making vaccination conveniently ready when the patient decides to come in to receive it.
These efforts have helped increase influenza vaccination rates across the United States, rising above 40% in 2013 and undoubtedly higher now.
With the flu season upon us, now is the time to get your flu shot if you have not done so already! Remember, your pharmacist is easy to reach and ready to help!
Marsha K. Millonig, MBA, BPharm, is president and CEO of Catalyst Enterprises, LLC, and an Associate Fellow at the University of Minnesota College of Pharmacy’s Center for Leading Healthcare Change.
