nursing home patient check

About half the states require flu vaccines for employees of nursing homes and long-term care facilities or for those who have direct contact with residents.

State Vaccine Policies May Help Curb a Severe Flu Season

By Shannon Kolman | Oct. 31, 2022 | State Legislatures News | Print

Influenza can make people very sick, particularly young children, older adults and people with certain health conditions. According to the Centers for Disease Control and Prevention, the flu has resulted in as many as 41 million illnesses, 710,000 hospitalizations and 52,000 deaths in the U.S. every year from 2010 to 2020.

Annual flu seasons can also create enormous economic burdens amounting to billions of dollars from lost productivity and deaths, compounded by hospitalization costs and health care workforce shortages.

Immunity to respiratory viruses, such as the flu, wanes over time. To help mitigate the burden of the flu, the CDC recommends everyone 6 months and older get an annual flu vaccine, with rare exceptions, and strongly encourages vaccination for people at high risk of serious flu complications.

A Severe Flu Season May Be Looming

The U.S. has not suffered a severe flu season since the start of the COVID-19 pandemic. The 2020-21 and 2021-22 flu seasons were mild compared with pre-pandemic years, perhaps due to COVID-mitigation efforts. But the upcoming season could be a serious one, based on early warnings from the Southern Hemisphere.

Infectious disease experts look south of the equator, where winter arrives earlier in the year than it does in the north, for signs of what the U.S. flu season has in store. Australia has experienced its worst flu season in five years, with cases three times higher than average. This has disease experts concerned that the upcoming flu season in the Northern Hemisphere may have a severe impact on the U.S.

Flu Vaccination Rates in the U.S.

National estimates of flu vaccination rates for children ages 6 months to 17 years have decreased over the past two flu seasons to 55% in 2021-22 from 62% in 2019-20. In addition, there are racial and ethnic disparities in child flu vaccine coverage rates. Black, non-Hispanic children had lower flu vaccination coverage than children in all other racial and ethnic groups over the last three flu seasons, with rates 6-13 percentage points lower than white, non-Hispanic children.

Estimates of national flu vaccination coverage for adults ages 18 years and older range from 33% to 62%. Vaccination rates are higher for adults ages 65 and older than for younger adults, but they’re 17% lower for Hispanics and 16% lower for Black adults than for white, non-Hispanic adults.

New Flu Vaccines for 2022-23

Every year, data on influenza activity around the world is analyzed and the composition of the flu vaccine is updated to match the strains of flu expected for the upcoming season. Flu vaccines for the 2022-23 season are all quadrivalent vaccines, designed to protect against four different flu viruses. There are several flu shot options to choose from and different vaccines are approved for various age groups. For example, there are flu shots approved for children as young as 6 months old and there are vaccines  recommended for people 65 years and older. Rates of infection from seasonal flu are often highest among children, yet during most flu seasons, people 65 years and older bear the greatest burden of severe flu disease and account for most flu-related hospitalizations and deaths.

COVID-19 and Influenza

It’s likely that COVID-19 and the flu will both be circulating during the 2022-23 flu season. The two diseases share similarities, with both being contagious respiratory illnesses having common symptoms. But they are caused by different viruses and have separate vaccines. According to the CDC, it is possible to get a flu vaccine and a COVID-19 vaccine or booster at the same time if the eligibility and timing coincide.

State Policy Options

Some state strategies to decrease the spread of influenza include:

  • Increasing the number of professionals who can provide a vaccine, to allow for greater convenience and access.
  • Protecting vulnerable populations with the vaccine.
  • Supporting vaccine public information campaigns.
Vaccine Providers

States have turned to pharmacists as one way to increase the number of qualified vaccine providers. All states now permit pharmacists to administer the flu vaccine. Some states such as Indiana and Arkansas allow pharmacy technicians to administer flu shots. New Hampshire and West Virginia authorized pharmacy interns to administer the vaccine under the supervision of a pharmacist.

Certain states have also looked to other health professionals to expand the pool of qualified flu vaccine administrators. Ohio and California now allow podiatrists to administer the flu vaccine, and a few states, including New Jersey, allow optometrists to give the vaccine. Several states, such as Wisconsin, allow dentists to administer shots. Maryland recently authorized paramedics to administer the vaccine, and Virginia allows “persons who are otherwise authorized to administer controlled substances in hospitals” to administer it.

Protection for Vulnerable Populations

At least 16 states have passed laws that require offering flu vaccination to hospital patients. For example, New Mexico requires hospitals to offer the flu vaccine to patients 65 and older, and Ohio requires hospitals to offer the vaccine to each admitted patient. Georgia recently passed legislation that requires hospitals to offer flu shots to patients 50 and older prior to discharge.

Thirty-two states have flu vaccination provisions for patients or residents of long-term care facilities. For example, New Jersey requires such facilities to document evidence of annual flu vaccination for each resident. Virginia requires certified nursing facilities to provide or arrange for administration of flu shots for residents, and North Carolina requires flu vaccines for nursing home residents and employees.

Twenty-four states have provisions addressing flu vaccination for health care workers in all or specific long-term care facilities. For example, Kentucky requires vaccines for employees of long-term care facilities, and Missouri requires such facilities to assist in vaccinating workers who have direct contact with residents. In Georgia, nursing homes must offer the shots to health care workers and other employees with direct patient contact.

Information Campaigns

States can act to keep citizens informed about the benefits and availability of the flu vaccine. States such as New York and Kentucky have recognized Immunization Awareness Month in August to increase public knowledge of the benefits of vaccines. Kentucky also recently enacted legislation allowing licensed assisted living communities to provide residents with information or opportunities related to the vaccine by Sept. 1 each year.

Additional Resources

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