Flu season stages early resurgence

This isn’t last year’s flu season.

The 2011-2012 influenza outbreak was one of the mildest on record. Not so this year: Even early on in fall 2012, there were strong indications that this winter would see a marked resurgence of the flu bug.

The U.S. Centers for Disease Control and Prevention reported that the influenza season started early, and warned that it could be a severe flu season. “This is the earliest regular flu season we’ve had in nearly a decade, since the 2003-2004 flu season,” said CDC director Thomas Frieden in early December. “That was an early and severe flu year, and while flu is always unpredictable, the early nature of the cases, as well as the specific strains we’re seeing, suggest that this could be a bad flu year.”

As reported by DSN, 417 people were hospitalized between Oct. 1 and Dec. 1 for influenza-associated conditions, a population rate of 1.5 per 100,000. More than 3-out-of-4 of those patients — 76.5% — were admitted with symptoms related to influenza A, while 21.6% showed signs of influenza B. Among patients hospitalized with influenza A, 96.6% of cases were attributed to H3 and 3.4% to 2009 H1N1.

The CDC reported widespread early flu activity in eighteen states at the beginning of December.

That news helped trigger an upswing in the number of Americans seeking vaccinations by pharmacists and retail clinic nurse practitioners. And on the plus side, the CDC noted, about 90% of the flu strains submitted to the agency for review were well-matched to this year’s flu vaccines.

“Especially in the days following [the CDC announcement], we have seen stronger demand” for immunizations, Walgreens spokesman Jim Cohn said. “The message we and other healthcare providers stress is that now is the time to get a flu shot if you haven’t gotten one already. It takes up to two weeks to build up full immunity.”

CVS Caremark also saw a surge in demand, both in its 7,400-plus CVS and Longs Drugs pharmacies and at its more than 600 MinuteClinic locations. “We’re very pleased that so many of our customers have heeded the message to get a seasonal flu shot this year … in rates far exceeding last year and even our own expectations for this flu season,” chief medical officer Troyen Brennan said.

Walgreens started offering flu shots Aug. 6, and by the end of November had already administered 4.6 million flu shots through its 8,057 pharmacies and roughly 350 Take Care in-store clinics nationwide, according to Cohn.

“Our objective is to … provide flu shots in all of our stores every day, throughout the flu season,” he said. “Through greater access, we’ve been able to have a positive impact on immunization rates.”

All of Walgreens’ more than 27,000 pharmacists are certified to provide immunizations, Cohn told DSN.

The company continues to step up its vaccination outreach efforts, he added. For instance, customer surveys conducted by Walgreens “found a significant lack of awareness as it relates … to other adult immunizations,” Cohn said. “So we’re using our flu program this year as an opportunity to educate our patients about the importance of other adult immunizations, like whooping cough, shingles and pneumonia. We added an immunizations assessment this year, free with every flu shot, so a patient coming in for a flu shot can sit down with a pharmacist or nurse practitioner and … find out what immunizations [they] might need based on age, health condition, etc.”

Because many customers can’t come in for a shot during regular business hours, immunizations at Walgreens are offered “at all hours” that the pharmacies or clinics are open, Cohn said. In a survey done two years ago, “we found that nearly a third of all the flu shots we had administered that season were administered during off hours — evenings, weekends and holidays,” he said.

Drug makers also are stepping up their efforts. The first vaccine to contain four strains of the influenza virus, FluMist Quadrivalent from Astra Zeneca’s MedImmune division, was approved by the Food and Drug Administration in February 2012, for use in people ages 2 years through 49 years. The product contains two strains of influenza A and two strains of influenza B, and is expected to be widely available for the 2013-2014 flu season.

The FDA approved GlaxoSmithKline’s new four-strain flu vaccine in late December. Several other companies — including Sanofi Pasteur and Novartis — also are developing quadrivalent vaccines that could be available in 2013.

Beyond that, there were “no new vaccine products anticipated this season,” noted Lisa Grohskopf with the agency’s National Center for Immunization and Respiratory Diseases’ influenza division.

Federal health officials, meanwhile, ramped up a public outreach campaign to boost immunization rates, particularly among higher-risk groups like those older than 65 years, those with compromised immune systems, young children, pregnant women and people with chronic health conditions. The CDC also continued to promote the health benefits of convenience and accessibility, noting that retail pharmacies, clinics and other nonphysician health resources provide a significant public service by offering flu shots.

“The most common places for vaccination among both adults and children were at medical locations, but retail settings and work places were other important venues for adults,” noted Teresa Smith, health communication specialist with the CDC’s Immunization and Respiratory Diseases Center. During the 2011-2012 season, she reported, 46% of U.S. residents were vaccinated for influenza, with immunization rates highest among non-Hispanic whites.

According to the American Academy of Family Physicians, one recent study by Canadian researchers at the University of Alberta, Edmonton, found that influenza and pneumococcal vaccination rates go up when physicians offload the task of vaccinating patients to local nurses, pharmacists and other allied professionals. “Our results suggest that shifting vaccine administration from physicians to members of the primary care team with clear responsibilities for chronic and preventive care, and activating patients through personal outreach, may stand the best chance of improving vaccination rates in community-dwelling adults,” researchers noted.