4 Things Experts Want PAs to Know About Flu Vaccines

Patients benefit when PAs tailor their flu vaccine recommendations to each patient

November 3, 2023

By AAPA Research

When counseling patients on flu vaccines, it’s important for PAs to keep each individual patient’s needs in mind. AAPA Chief Medical Officer Dr. Jennifer Orozco, DMSc, PA-C, DFAAPA, recently discussed the impact of flu vaccines for patients most at-risk for complications with three PAs: Dr. Melissa Soester, PA-C, PhD, CAQ-EM, DFAAPA, PA Takeia Horton, MMSc, PA-C, MPH, and Dr. Sarah McQueen, DMSc, PA-C.

Soester spent 13 years working in federally qualified health centers (FQHC), rural health clinics, and critical access hospitals within family medicine and emergency medicine. Horton spent five years with the National Health Service Corps, providing healthcare to underserved communities with limited access and limited resources. Finally, McQueen is a PA in family medicine and is the AAPA representative to the ACIP Combined Immunization Schedules Work Group.

In their conversation, these experts shared the importance of flu vaccines for at-risk populations and their strategies for discussing the importance of flu vaccines with these patients.

1. Flu vaccines are not 100% effective, but they may reduce complications.
How many PAs have heard patients say, “I don’t want to get a flu shot because I get the flu anyway”? We know that flu vaccines are not 100% effective in protecting against the flu. In fact, between 2009 and 2022, flu vaccine effectiveness ranged from a low of 19% to a high of 60%, with an average of about 43%. There are many reasons for this, including how well the vaccines “match” the flu virus that year and patient characteristics.

Messaging may make a difference. While flu vaccines are not 100% effective, they may still reduce the complications from the flu. Due to the COVID-19 pandemic, data on the most recent flu seasons are not as robust. Looking to the 2019-2020 season, however, the CDC estimated that 7.5 million cases of the flu and 105 thousand hospitalizations were prevented.

During recent flu seasons, 9 out of 10 people hospitalized with flu had at least one underlying health condition. Specifically, during the 2022-2023 flu season, 63.9% of patients hospitalized for the flu last year had hypertension, 44.2% had a metabolic disease, and 40.5% had obesity. A 2020 study that looked at more than 80,000 U.S. adults hospitalized with flu over eight flu seasons (2010-11 through 2017-18) found that sudden, serious heart complications occurred in one out of every eight patients (~12% of patients). Flu vaccination also has been associated with reduced hospitalizations among people with diabetes (79%). Hear more from our PA experts on this topic.

2. Older adults are at greater risk for complications.
Let’s look at older adults. During most flu seasons, adults aged 65 years or older have the greatest disease burden. In recent years, for example, it’s estimated that between 70 and 85% of seasonal flu-related deaths have occurred in people 65 years and older, and between 50 and 70% of seasonal flu-related hospitalizations have occurred among people in this age group.

According to the CDC, “People 65 and older should get a higher dose or adjuvanted flu vaccine, including: Fluzone High-Dose Quadrivalent, Flublok Quadrivalent, or Fluad Quadrivalent. High dose vaccines have four times the antigens compared to standard vaccines. A review of existing studies suggested that, in this age group, these vaccines are potentially more effective than standard dose flu vaccines. If one of these vaccines is not available at the time of administration, people in this age group should get a standard-dose inactivated flu vaccine instead. Any licensed influenza vaccine appropriate for age and health status can be administered, without preference for any product or formulation as soon as doses are available.”

If you only have one formulation in the office and/or the higher dose or standard flu vaccine recommended for older adults, become an advocate and talk to the vaccine purchaser to include it in their orders. Learn how our PA experts talk to their older patients about their risk.

3. Vaccination rates for the flu are lower for some groups of people.
Only half of all adults were vaccinated for the flu in the 2022-2023 flu season. This varies by age: 36.2% of people ages 18 to 49 were vaccinated for the flu whereas 71% of people 65 years or older were vaccinated.

This also varies by race and ethnicity. While the overall vaccination rate is 47.4% for the flu, it ranges from 52.8% of all white adults down to 35.2% of Hispanic adults, 39.1% of American Indian/Alaskan native adults, and 39.3% of Black, non-Hispanic adults.

Along with lower vaccination rates for persons from some races and ethnicities is a higher rate of hospitalizations and ICU admissions. For example, compared to white patients, Black patients had nearly 2 times higher flu hospitalization rates and 1.7 times higher flu-related ICU admission rates when age-adjusted. Learn more from PA experts on how you can make a difference.

4. All PAs should recommend flu vaccines for their patients, regardless of their specialty, setting, or location.
During the 2020-2021 season, more adults received their flu vaccine at a pharmacy or retail store than at a physician’s office or at an HMO, so not carrying the vaccine in the office does not preclude PAs from making recommendations. You may be the only clinician your patients see this flu season. Even if their office does not carry the flu vaccines, PAs can still make recommendations based on their patients’ needs and discuss how it will help with their patients, and refer them to a location that does have the vaccine available.

To address health inequities, the CDC has the following recommendations for all healthcare providers. Learn how our PA experts put some of this advice into practice.

  • Strongly recommend flu vaccination to all patients 6 months and older.
  • Check vaccination status at all medical visits.
  • Work with healthcare systems to provide vaccines where people live and work.
  • Provide culturally appropriate vaccine recommendations, answering all questions from the patient.
  • Provide a referral if vaccine is not in stock.
  • Vaccinate all clinic staff and educate them on how to discuss vaccination.

The current recommendations from the CDC Advisory Committee on Immunization Practices for the seasonal flu vaccines were updated in late August 2023. Get updated on the recommendations for the 2023-2024 flu season including timing for the flu vaccine as well as guidance for specific patient populations.

Noël Smith is AAPA’s Senior Director of PA & Industry Research & Analysis. She can be reached at [email protected].


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