October 17, 2018
3 min read

How to encourage influenza vaccination in primary care

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Matthew Zahn 2018
Matthew Zahn

Influenza season is underway and proper protection against the disease is imperative to stave off its harmful effects.

After a well-publicized down year in terms of the efficacy of the influenza vaccine last year, many patients may be wary of getting vaccinated; however, US officials emphasize the need for everyone aged 6 months or older to receive the vaccination, since during the 2017-2018 influenza season an estimated 900,000 people were hospitalized and 80,000 died.

2018-2019 influenza recommendations

The CDC recently released its updated influenza guidelines for the 2018-2019 season in which the main recommendations remain the same.

“Everyone over the age of 6 months who doesn’t have a contraindication should receive flu vaccination,” Matthew Zahn, MD, member of the Infectious Disease Society of America and pediatric disease specialist at the Children’s Hospital of Orange County, told Healio Internal Medicine.

Influenza season is underway and proper protection against the disease is imperative to stave off its harmful effects.
Source: Adobe Stock

“There are a couple of significant changes in the CDC’s recommendations,” he said. “Probably the most important one is that the live attenuated influenza vaccine — the nasal flu vaccine — is again recommended as an option for patients who are 2 to 49 years of age who don’t have a contraindication to receive that vaccine.”

Expectations for this influenza season

To better reflect the viruses that are projected to circulate this year and potentially cultivate greater effectiveness, the components of the influenza vaccine were modified slightly, David Cennimo, MD, assistant professor of medicine at Rutgers New Jersey Medical School, told Healio Internal Medicine.

Determining whether the virus strain that is predominant is likely to lead to a severe year and whether the strains that are circulating are mismatched to the strains used to develop the influenza vaccine can help establish the expectations for the current influenza season, Zahn said.

“However, this year, there isn’t a great deal of evidence on the national or international level,” he said. “It’s been relatively quiet for flu activity internationally for the last couple of months.”

The southern hemisphere gave some indication of the severity of the season that was coming to us last year, but right now that information is not available, he said.

“As always, it is difficult to predict,” Cennimo said. “We had a very active season last year and it could happen again.”

Encouraging uptake of the influenza vaccine

Higher influenza vaccine effectiveness would be beneficial for the health care system, Zahn said.


“It’s important to note that tens of thousands of hospitalizations are prevented each year from the flu vaccine even in a ‘down year,’” he said. “There is a great deal of disease and severe disease that’s prevented with vaccination.”

While the vaccine cannot completely eradicate the risk for contracting the influenza, it provides protection and greatly lowers the odds of developing symptoms or becoming seriously ill, which is why it is important for all eligible patients to get vaccinated, he said.

“The effectiveness of the vaccine is only known in retrospect. However, some protection is better than none,” Cennimo said. “Any individual patient may be the person protected and not get sick or, if they do fall ill, may have an easier course because of partial vaccine protection. Everyone should be encouraged to get the vaccine. I think we should be honest in what we know about the vaccine effectiveness but also stress that this is the only protection available and something is better than nothing.”

The most important thing primary care physicians can do is mention the influenza vaccine to their patients, Zahn said.

“In busy clinical situations, it can be hard to find the time to discuss immunizations,” Zahn said. It is important for PCPs to remember that they can also give the vaccine during visits that are not for regular health checkups, he said.

“One of the largest issues from a public health side is that each year, opportunities to vaccinate patients get missed just because there are always so many other things going on in clinical practice,” he added.

“Think about it, be aware of it and be sure to offer it,” he advised.

Some patients may be concerned that getting vaccinated too early may reduce the protection from the vaccine over time, Zahn said. In trying to find the perfect time to get vaccinated, the opportunity may be missed altogether, he said.

Now that we are in October, this should not be a concern and if patients have not received the influenza vaccine yet, they should do so now, he said.

“It doesn’t pay to wait any longer. Many flu seasons will start to pick up as early as November, and anyone still waiting to be vaccinated runs the risk of not being protected when flu season is already here,” Zahn said. – by Alaina Tedesco



Grohskopf LA, et al. MMWR Recomm Rep. 2018;doi:10.15585/mmwr.rr6703a1.

Disclosures: Cennimo and Zahn report no relevant financial disclosures.