Although many patients are aware of the risks associated with influenza, they may still be hesitant about getting the flu vaccine each year. CDC data indicates that only 49% of Americans received a flu vaccination in the 2018–2019 flu season. “Influenza vaccine hesitancy is common, even among patients who are comfortable receiving vaccinations for other health conditions,” says Katrina M. Byrd, MD. “Those who refuse the flu vaccine may believe it will make them sick or give them the flu. Others think they don’t need it because they never get the flu, or they’ve been told they can’t receive it because they have an egg allergy. Others simply do not trust vaccines at all.”

In an article published in the Rhode Island Medical Journal, Dr. Byrd presented strategies for talking to patients about the flu vaccine to help them embrace seasonal vaccination. “A recommendation from a healthcare provider can go a long way towards getting patients vaccinated,” she says. “We can establish trust with our patients by seizing opportunities to educate them on the rationale for flu vaccinations. It’s also important to identify and address misconceptions that patients may internalize from family, friends, coworkers, and/or social media.”

Addressing Misconceptions

Many patients question why they need a flu shot every year, according to Dr. Byrd. “Patients should understand that the virus changes every year and the vaccine changes to include protection against the most predominant strains of a given year,” she says. In some cases, healthy people may believe that vaccination is unimportant because they never get the flu. For these individuals, it is important to provide information on how vaccinations protect other vulnerable populations (Table). This may help them better understand the risks they place on other people.

“The most common misconception I encounter is that the influenza vaccine makes people sick,” says Dr. Byrd. “This is where educating patients becomes especially important. We need to inform them that the flu vaccine protects against 40% to 60% of circulating influenza strains each year. When patients question the rationale because it doesn’t offer 100% protection, it is our opportunity to further educate them on how the vaccine decreases the degree of illness and post-influenza complications, even if they’re infected with a strain not covered by the vaccine.”

When patients get the flu shot, Dr. Byrd says it is important to tell them they are receiving an inactivated vaccine and thus cannot get the flu from it. “Anticipatory guidance is key when giving this vaccine,” she says. “Patients should be informed that they may have a fever up to 24 hours after vaccination and soreness at the injection site for a few days. They should also understand it takes 2 weeks post-influenza vaccination to develop full protection from the vaccine. This means that patients infected with the virus a few days prior to vaccination or within 2 weeks post-vaccination will still have influenza. By explaining these points to patients, we can empower them to make informed decisions.”

Taking Action

The influenza vaccine should be offered to every patient who does not have a contraindication to it, according to Dr. Byrd. “If time constraints are a concern, one strategy that might help is to have medical assistants ask patients if they’ve had the flu vaccine. If not, it should be offered. If the patient accepts, the medical assistant can have the physician order the vaccine. If the patient declines, the physician can talk to the patient to identify reasons for vaccine hesitancy. Messages can then be personalized to patients to emphasize key points as to why they should get vaccinated.”

Other practice changes may increase influenza vaccination rates, such as sending reminders about upcoming flu shots, posting facts about influenza in exam rooms, and creating standing orders or order sets in electronic medical records to facilitate these conversations with patients. “Our work to promote seasonal flu vaccinations is especially important given the current COVID-19 pandemic,” Dr. Byrd says. “These efforts are critical to achieving our overarching goal of taking all necessary precautions to prevent respiratory infections.”

References

Byrd KM. Talking to patients about the influenza vaccine. R I Med J (2013). 2020;103(6):29-33. Available at: http://rimed.org/rimedicaljournal/2020/08/2020-08-29-vaccine-byrd.pdf.

Rondy M, El Omeiri N, Thompson MG, Levêque A, Moren A, Sullivan SG. Effectiveness of influenza vaccines in preventing severe influenza illness among adults: A systematic review and meta-analysis of test-negative design case-control studies. J Infect. 2017;75(5):381-394.

Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger JA. Vaccine hesitancy: an overview. Human Vaccines Immunother. 2013;9(8):1763-1773.

Bridges CB, Hurley LP, Williams WW, Ramakrishnan A, Dean AK, Groom AV. Meeting the challenges of immunizing adults. Vaccine. 2015;33:D114-D120.

Grohskopf LA, Alyanak E, Broder KR, Walter EB, Fry AM, Jernigan DB. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices—United States, 2019–20 influenza season. MMWR. 2019;68(3):1.