It’s Not Too Late to Vaccinate!

By Christine A. Garcia, MD, MPH; Stony Brook University Hospital, Department of Internal Medicine
November 19, 2012

We are well into the flu season now and with Thanksgiving around the corner, it becomes more and more important to remind and urge our patients to get vaccinated. With other chronic conditions and more pressing issues such as hurricane recovery, something simple like influenza may seem like the least of patients’ worries. However, the CDC estimates that anywhere between 3,000 to 49,000 people a year die from flu in the United States.

Last year, 128 million people, or about 42 percent of the U.S. population, got immunized against influenza. Recently, a CDC survey showed that two very important groups– healthcare workers and pregnant women– are still behind on being vaccinated.

Pregnant Women
Pregnant women are especially vulnerable to flu. Pregnant women become sicker with the flu, as it suppresses the immune system. The infection can potentially lead to miscarriage. Because influenza can be especially severe during pregnancy, the American College of Obstetricians and Gynecologists (ACOG) and the Advisory Committee on Immunization Practices (ACIP) recommend influenza vaccination for women who will be pregnant during the influenza season, regardless of trimester. The vaccine also protects a woman’s newborn, who cannot get the vaccine until age six months.

Physicians have an important role in informing patients about vaccines, especially in dispelling myths about the influenza vaccine. Recently, a CDC survey showed only 47 percent of pregnant women had a flu vaccine last year. A quarter of pregnant women women who refused the vaccine said they believed they could get flu from the vaccine.  Another 13 percent thought their babies were at risk. If their doctors both recommended and provided the vaccine, nearly 74 percent of pregnant women got the shot. When doctors did not offer the vaccine or bring up the topic, only 11 percent of pregnant patients received the vaccine. Clearly, physician recommendation to receive the flu vaccine makes a difference.

Health Care Workers
Health care workers are particularly an important group that has increased risk of exposure to acquiring the flu, but potentially devastating consequences of spreading the virus. In the most recent CDC health care work immnization survey, 33% of health care professionals reported not receiving influenza vaccine. Of those who were vaccinated in the 2011-2012 season, vaccination was most common among physicians (85.6%), followed by nurses (77.9%), and other HCP (62.8%).  Most strikingly, 52.4% among those in long-term care facilities (LTCFs) did not get vaccinated, a group that has greatest exposure to the elderly, whom are most likely to be hospitalized and die from influeza. When asked why they did not get vaccinated for influenza, 28% responded that they believed that they did not need it, 26% responded with concerns about vaccination effectiveness and 25% were concerned about side effects.

The results from these surveys show that more work needs to be done to help increase immunization rates and prevent unnecessary deaths and hospitalizations for influenza. Physician recommendation for getting an influenza vaccine really makes a difference. During my primary clinic experience, I have found that most patients that refuse or are reluctant to get the vaccine need only a little bit more reassurance and information that may change their opinion. So much misinformation is strewn all over the Internet and in rumored conversations with friends. Taking a moment to ask your patients about their concerns easily becomes a great opportunity to dispel myths about the vaccine and provide valid information. Several issues come up over and over again, and having answers ready may help increase acceptance of the flu vaccine.

Myth #1: “I got a flu vaccine last year, and it gave me the flu.”
The flu shot is an inactivated vaccine, which means that the virus on it has been killed. The vaccine triggers your immune system to start making antibodies that can protect you from the specific strains of the flu, but you cannot get influenza from the shot itself. It is impossible to get the flu from the flu shot. The nasal spray version of the flu vaccine contains active virus, and while you can have similar, milder flu-like symptoms, it still cannot give you the flu.

Myth #2: “I already got the flu vaccine last year, I don’t need another one.”
With strains evolving and mutating every season, everyone should get vaccinated on a yearly basis. Each annual vaccine protects against the most commonly circulating strains that season, which are usually different from the year prior.

Myth #3: “It’s November already. I made it through the season already without the flu.”
Flu season usually peaks in February, and flu vaccines are often still available in December and January. With Thanksgiving and other holidays coming up soon, it becomes even more important to protect yourself and your family, by minimizing the  chance of getting the flu and infecting others. No one wants to come back from Thanksgiving dinner with the flu!

As physicians, we have a profound effect of informing our patients with valid, trusted information to help prevent illness. The ACP Immunization Portal and CDC website are good sources of additional ideas for how to incorporate immunization into your workflow and increase vaccination rates. ACP also offers an ACP Immunization Advisor mobile app. Remind your patients and co-workers to protect themselves, their families and patients from getting the flu.

ACP Immunization Portal:

CDC healthcare worker influenza survey:

CDC pregnancy:

Health Map Finder:


Christine Garcia, MD, MPH
Stony Brook University Hospital, Department of Internal Medicine

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