As cases of the Delta variant start to wane, infectious disease specialists have a new concern this fall — flu and pneumonia, especially in vulnerable populations like older adults.
Experts from the National Foundation for Infectious Diseases (NFID) and the CDC expressed concern about a potentially serious flu season at a video press briefing on October 7. Flu cases during 2020-21 were extremely low— just 2,124 confirmed cases between Sept. 27, 2020, and May 15, 2021— thanks in large part to people working from home, wearing masks, social distancing and practicing good hand hygiene.
But as more communities ease restrictions, the flu could surge this year, impacting many more people. For seniors, whose immune systems are weaker than younger adults, that could mean an increase in hospitalizations, cases of pneumonia, or even deaths.
“The medical and public health community are preparing for a potentially vigorous respiratory virus session in the United States,” said William Schaffner, M.D., NFID medical director, who moderated the briefing. “The best way to prepare is to get your flu vaccine.”
Vaccination is especially important among at-risk populations, including adults 65 and older, and those with certain chronic conditions according to Schaffner.
Currently, the U.S. is on track for similar flu vaccination rates as 2020, about 52% overall, according to CDC director Rochelle Walensky, M.D., M.P.H., who participated in the briefing. That rate may not be good enough this year to keep case rates low.
A recent NFID survey revealed that even among those who are at high risk for complications, nearly 1 in 4 (23%) were not planning to get vaccinated this season. While most people over age 65 (71%) said they will get a flu shot, 30% of seniors would remain unprotected, leading to potentially serious consequences.
Why older people need vaccines
As our immune system declines with age, the risk of complications from flu increases. According to NFID, flu amplifies the risk of heart attack as much as five-fold and stroke by two to three times during the first two weeks of infection for those 65+. That risk remains elevated for several months. Seventy to 85% of seasonal flu-related deaths occurred in people age 65 and older; 50 to 70% of seasonal flu-related hospitalizations occurred among people in this age group in recent years, according to the CDC. The death rate from flu among those over 65 is six times that of all other groups combined.
What these results show is that health providers, public health officials and the media need to do a better job of educating this group, according to panelist Cedric “Jamie” Rutland, M.D., CEO of West Coast Lung and COVID-19 medical director, Private Health Management. In addition, older adults should be in regular communication with their primary providers if they think they’re coming down with the flu.
Treatments are available that can help keep people out of the hospital or mitigate complications if administered early. It’s also important to rule out COVID, since symptoms may be similar. “For my own patients, I need to communicate with them daily to see if they’re demonstrating symptoms that warrant an ER visit or hospital admission — because older adults are more likely to get infected by pneumonia,” Rutland said.
“We’ve been so focused on COVID vaccination. This is the year to really double down on flu,” Preeti Malani, M.D., an internal medicine physician at Michigan Medicine who specializes in infectious disease and geriatric care told AHCJ in a phone interview. “What we need to do is also look at who’s around them. Just like with COVID vaccinations, the way we protect vulnerable people is by protecting everyone around them.”
Malani is anticipating a bad flu season. “Last year it was non-existent, but we actually have seen the first flu case on our campus,” she said. Her concern is that students and others who travel for the upcoming holidays will infect more at-risk family members like parents or grandparents. “Many families, including my own, ended up separated last year. This year, many of us are hoping to make up for lost time,” she said.
The takeaway and some additional resources
There’s no time like right now to get your flu shot, Malani emphasized, adding that people should check with their providers to determine whether they also need a pneumococcal vaccine. Medicare and Medicaid will pay for the vaccine so cost should not be a barrier. Many retail pharmacies, supermarket chains, clinics, and other locations offer walk-in services.
Infectious disease core topic editor Bara Vaida covered NFID’s comments and recommendations about other high-risk populations, including children and pregnant women.
Additional resources for journalists covering flu and pneumonia in older populations include:
- Influenza and Older Adults (NFID)
- Understanding Pneumococcal Disease (NFID)
- CDC’s Flu View Interactive (tracks illnesses and hospitalizations weekly)
- Vaccinations for Older Adults (National Institute on Aging)
- Vaccine efficacy in seniors remains strong, according to this study comparing older and younger adults.
- AHCJ infectious disease tip sheet on influenza