Study offers reassurance of flu vaccination during COVID-19 pandemic
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Influenza vaccination did not increase the incidence of COVID-19 or worsen outcomes related to the disease, researchers reported.
Encouraging data that suggest efforts to curb the COVID-19 pandemic — including masking and physical distancing — have led to a global decline in influenza cases, but there are still concerns that the influenza season could stress hospitals that are already strained because of the pandemic.
“Taking everything into consideration, our patients should be encouraged to receive their flu shot this fall,” Joe G. Zein, MD, PhD, of the pulmonology department at the Cleveland Clinic, told Healio Primary Care.
Zein and colleagues analyzed data from 13,220 patients in Florida and Ohio who were tested for COVID-19 between March 8 and April 15 — including 4,138 who received unadjuvanted influenza vaccination for the 2019-2020 season (mean age, 61.5 years; 39.9% men; 73.7% white) and 9,082 who did not (mean age, 49.3 years; 44.6% men; 65.9%, white).
In an unadjusted analysis, Zein and colleagues found that patients vaccinated against influenza were less likely to test positive for SARS-CoV-2. Among patients with a positive SARS-CoV-2 test, those who were vaccinated against influenza last season were more likely to be hospitalized and consequently, more likely to be admitted to the ICU and die during hospitalization.
Using an overlap propensity score weighting method, the researchers found that influenza vaccination was unrelated to the incidence of SARS-CoV-2 infection (adjusted OR = 0.79; 95% CI, 0.62-1). Among the 1,434 patients who had COVID-19, the 309 who also received influenza vaccination had no higher risk for hospitalization (aOR = 1.29; 95% CI, 0.72-2.31), ICU admission (aOR = 0.65; 95% CI; 0.22-1.79) or hospital mortality (aOR = 0.98; 95% CI, 0.39-2.43).
Zein stressed that influenza vaccination is safe.
“Extra precautions have been put into place to ensure the safety of patients and caregivers as flu vaccinations are provided to our patients” he said.
He encouraged the scientific community to “continue to collect data on both infections — and vaccination — and prospectively monitor the convergence of seasonal influenza and COVID-19.”
Perspective
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Edgar Sanchez, MD
With an estimated 60,000 deaths a year, influenza is one of the deadliest respiratory pathogens in the United States. Unlike COVID-19, influenza vaccination is available and can mitigate the number of deaths tied to influenza.
One of the concerns patients may have regarding the influenza vaccine may be its effectiveness. Last year, there were reports that the vaccine provided 45% overall effectiveness against the 2019-2020 seasonal influenza A and B viruses. But even at that rate, influenza vaccination can prevent hundreds of thousands of hospitalizations. In addition, the 45% rate comes from those patients who contracted the flu. It is important to note, though, that vaccinated people who end up contracting the flu, on average, are less likely to be severely ill or die.
The article by Zein and colleagues illustrates how vaccinations do not increase COVID-19 risk. It is always important to vaccinate against influenza to lower the risk for this disease, more so during this pandemic. Vaccinating against influenza will decrease the number of COVID-19 tests needed and the burden on our already taxed health care system.
Perspective
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William Schaffner, MD
The recommendation from this study could not be simpler. If you have a patient who is older than 6 months, he or she needs to be vaccinated against the flu even though we are in the middle of a COVID-19 pandemic.
I know that the influenza vaccination is not perfect and that it cannot prevent COVID-19. But the influenza vaccine does prevent many, many severe instances of the flu. It is often underappreciated that even if a patient still gets the flu after receiving the influenza vaccination, that patient’s influenza will be a lot less severe, and he or she will be less likely to need ICU care and be less likely to die.
Admittedly, some patients will show certain reluctance to go to their health care provider to get the flu shot because they are afraid of exposure to COVID-19. Though there is some validity to those concerns, many practitioners are providing mechanisms for patients to pop in, get their vaccine and pop right out again, such as holding special flu clinics early in the morning or late in the afternoon. This year, it is more important than ever that we do this so that health care workers can focus on making patients with COVID-19 well again.
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