September 27, 2018
Influenza was especially severe in the United States last year. According to new data released today at a news briefing held by the Centers for Disease Control and Prevention (CDC) and National Foundation for Infectious Diseases (NFID), 900,000 people were hospitalized and 80,000 died from the flu in the US last season.
The death toll for children in the 2017-2018 season was a record-breaking 180, that number surpassed the previous high of 171 for a nonpandemic influenza season, officials said at the briefing.
Leaders of the CDC and NFID, along with clinicians and officials in public health and medical organizations who were at the briefing in Washington, DC, urged the public and healthcare professionals to follow the CDC's guidance that everyone age 6 months and older get vaccinated against flu every year.
Vaccinations Decreased in Young Children
Vaccination rates among children 6 months to 17 years have fallen short of the 80% goal for the past few seasons. Last year, rates dropped from 59% to 57.9%. That was driven by a 2.2% drop in children 6 months through 4 years, which is concerning because of the high risk of that age group, the new data show.
Still, that age group had the highest vaccination rates (67.8%). The lowest was among children age 13 to 17 years (47.4%). States varied widely in vaccine coverage of children. Rhode Island had the most with 76.2%; Wyoming had the least at 43.2%.
US Surgeon General Jerome M. Adams, MD, MPH, noted the season was "especially deadly for older adults, pregnant women, people with chronic medical conditions, and children," adding that most of the children who died were not vaccinated. "Flu vaccinations save lives," he emphasized.
According to the CDC, about 70% of hospitalizations and 90% of deaths last year occurred in those age 65 years and older.
Three out of four healthcare workers were vaccinated, Adams said, but the lowest rates among healthcare workers are in long-term care providers, who work with a population at highest risk for complications.
He implored all healthcare workers to encourage patients to get the vaccination. "Post your pictures of your flu shots. Send them to me (@JeromeAdamsMD) so I can retweet them out," he said.
"The strongest predictor of whether a person gets a vaccination is whether or not they get a strong provider recommendation," Adams said.
The CDC's annual look at the numbers getting vaccinated show that progress has plateaued among pregnant women and healthcare workers. The decrease in vaccinations among kids between 6 months and 4 years is "very, very worrisome," Adams said.
One thing that may help this season is the return of the nasal live attenuated influenza quadrivalent vaccine (LAIV4; FluMist, MedImmune) to the list of recommended flu vaccines for the 2018-2019 season. The Advisory Committee on Immunization Practices (ACIP) has recommended it again after rejecting it the last 2 years.
Half of Pregnant Women Didn't Get Vaccinated
"Additionally one out of two pregnant women were not vaccinated against the flu last year," Adams said.
That has dangerous implications for both pregnant women and their babies who cannot be vaccinated for the first 6 months of their lives and have to get immunity from their mothers, said Laura E. Riley, MD, Given Foundation professor and chair of the Department of Obstetrics and Gynecology at Weill Cornell Medicine in New York City.
The message to pregnant women is that the vaccine is safe and absolutely necessary for all pregnant women and can be given in any trimester, she said. She urged all providers who take care of pregnant women to emphasize those points to their patients.
Although the vaccination goal is more than 80% for pregnant women, only 49% got it last season, Riley noted.
"Pregnant women who get the flu do very poorly. They do way worse than any other nonpregnant individual," Riley said.
As the pregnancy progresses, the likelihood of severe illness gets worse, she said.
Riley added, "As you get into the second and third trimester, you're more likely to die then, you're more likely to be hospitalized, and you're more likely to have severe respiratory illness."
The flu can also have serious effects on the fetus, she said. High fevers can cause birth defects and, far more commonly, can contribute to premature births.
"Flu participates in this whole issue of prematurity," she said. "It becomes for some babies a lifelong issue."
The panel of experts also included leaders such as William Schaffner, MD, NFID medical director; Scott Gottlieb, MD, FDA commissioner; and Daniel B. Jernigan, MD, MPH, CDC influenza division director. They and the other panelists all got vaccinated as part of the briefing.
Though the vaccine is the best way to prevent the flu, the experts also emphasized proper treatment. Three antivirals are recommended by the FDA this season: oseltamivir (generic version or Tamiflu, Genentech), zanamivir (Relenza, GlaxoSmithKline), and peramivir (Rapivab, Seqirus).