Influenza Vaccines: Raising Awareness Among High-Risk Populations

Looking beyond access, cost, and misconceptions
December 2015, Vol 3, No 12 - Inside Influenza Readiness
Lisa Waldowski, MS, APRN, CIC

What does a hypothetical man aged 76 years have to do with raising awareness for flu vaccines among high-risk populations? More than you think.

Let’s say that the elderly gentleman comes into a healthcare facility reporting pain in his right elbow. He is admitted, and the nurses and physician ask him a number of questions: What was he doing when the pain started? Does he have a history of elbow pain? Where on the elbow is the pain? Every inquiry’s purpose is to help identify the root cause of the pain. Because of his age, they will most likely also ask about his health history: Is he taking any medications? Has he had any other ailments? But once the solution to the elbow pain is identified, he will probably be treated and released.

This seems like a job well done—except for one missed question that may save him not only a return trip to the doctor, but perhaps his life: have you gotten your flu shot?

The Flu and High-Risk Populations

In the United States, it is estimated that anywhere from 5% to 20% of the population gets the flu each year, and >200,000 people are hospitalized for flu-related complications, according to the Centers for Disease Control and Prevention.1 Those relatively low numbers might explain why only an average of 40% of adults in the United States choose to get vaccinated every year.2

In the case of high-risk populations, the numbers and facts are not as forgiving. During recent flu

seasons, approximately 80% to 90% of flu-related deaths occurred in people aged ≥65 years.3 In addition, pregnant women have a higher risk for serious complications from influenza than nonpregnant women of reproductive age.4 Furthermore, an average of 20,000 children aged <5 years are hospitalized for influenza complications each year5; these children represent approximately 10% of all patients hospitalized for the flu.

A study that looked at flu vaccine effectiveness during the course of 3 flu seasons estimated that flu vaccinations lowered the risk for hospitalizations by 61% in people aged ≥50 years.6 Other studies showed that giving flu vaccines to pregnant women was 91.5% effective in preventing hospitalization of infants for the flu during the first 6 months of their lives,7 and that flu vaccines reduced children’s risks for flu-related pediatric intensive care unit admissions by 74% during flu seasons from 2010 to 2012.8

The facts clearly point to the importance of vaccinating patients in high-risk populations. In addition, it has never been easier for these populations to get vaccinated, thanks to various types of flu vaccines and methods for administration.

Different Types of Flu Vaccines Available

Traditional, trivalent flu vaccines are available in various forms, and are administered based on the age of the patients receiving them.9 For instance, although most vaccines of this type are administered via needle, one standard-dose trivalent shot can also be given to patients aged 18 through 64 years with a jet injector. For those aged ≥65 years, there is a high-dose trivalent shot.

Even patients who don’t like shots have few excuses not to get vaccinated these days. The intradermal quadrivalent shot, which uses a much smaller needle than the regular flu shot, is injected into the skin instead of the muscle; it is approved for people aged 18 through 64 years. There are even quadrivalent nasal spray vaccines, approved for people aged 2 through 49 years.

Unfortunately, the pub­lic may not be aware that all of these options exist, and even if they are, there is also the misinformation barrier to take into consideration. Many people think that getting the flu shot can give them the flu, which is completely false.9 The most common side effects of the flu vaccine are soreness, redness, tenderness, or swelling at the injection site. Low-grade fever, headache, and muscle aches are not as common.

However, as damaging as the lack of information, or misinformation, regarding flu vaccines can be, I do not believe they are not the biggest issues we face. Even if someone knows about different options and is accurately informed, there is still a good chance that we as a healthcare system missed our opportunities to vaccinate.

Raising Awareness About Vaccines

One of the most convenient vaccination plans to date is the provision of immunization services by retailers, such as Walgreens and CVS Health. The idea is that while people are out running errands, they can also quickly get a flu shot without needing to make an extra stop or an appointment. Walgreens and CVS Health advertise these facts regularly in-store and through advertising campaigns. In 2013, the 2 chains alone reported giving 11.7 million flu vaccinations, up from 7.8 million the year before.

This ease of accessibility does not seem to be as prevalent in other healthcare settings. However, in order to raise awareness—and, subsequently, the amount of people getting vaccinated—among high-risk populations, there needs to be a true push toward awareness and accessibility. Imagine if the elderly patient with elbow pain, when he walked into the healthcare facility, noticed a poster at the entrance about flu shots. When he gets to the counter to check in, there are handouts with information about influenza vaccines, and when he sits in the waiting room, he sees a video about flu shots and how quickly he can get one there at the hospital.

In this case, the patient has not even met with a nurse or physician, yet the seed that he should at least look into a flu shot has been planted. He may now actually go into his examination for his elbow pain with the notion to also ask about a flu shot. Even if he doesn’t, once the examination is complete, the physician can ask whether the patient would be interested in also getting a flu vaccination, and because he has already at least thought about it—if even for a second—he may be more receptive to receiving it.

However, there certainly can be some complications with this. Although some patients may simply say okay and receive the vaccine, others may want more information, or even need convincing; this can disrupt the patient flow of the office or clinic.

Still, the short-term headaches until the plan is fully implemented far outweigh the long-term gains, particularly with high-risk patients. Taking the time to speak to a pregnant mother or elderly patient about the benefits of getting vaccinated are the essence of patient safety.

After all, healthcare personnel ask thousands of questions to benefit the health of others. Imagine what asking just 1 more question to a hypothetical man aged 76 years could do for improving awareness of vaccinations.


  1. Centers for Disease Control and Prevention. Seasonal influenza Q&A. Updated September 18, 2015. Accessed November 6, 2015.
  2. Centers for Disease Control and Prevention. New CDC reports shows benefits of flu vaccine last season but fewer than half of Americans say they have been vaccinated this season. Updated December 11, 2014. Accessed November 6, 2015.
  3. Centers for Disease Control and Prevention. What you should know and do this flu season if you are 65 years and older. Updated August 17, 2015. Accessed November 6, 2015.
  4. Centers for Disease Control and Prevention. Pregnant women & influenza (flu). Updated August 17, 2015. Accessed November 6, 2015.
  5. Centers for Disease Control and Prevention. Children, the flu, and the flu vaccine. Updated August 21, 2015. Accessed November 6, 2015.
  6. Talbot HK, Griffin MR, Chen Q, et al. Effectiveness of seasonal vaccine in preventing confirmed influenza-associated hospitalizations in community dwelling older adults. J Infect Dis. 2011;203:500-508.
  7. Benowitz I, Esposito DB, Gracey KD, et al. Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants. Clin Infect Dis. 2010;51:1355-1361.
  8. Ferdinands JM, Olsho LE, Agan AA, et al. Effectiveness of influenza vaccine against life-threatening RT-PCR-confirmed influenza illness in US children, 2010-2012. J Infect Dis. 2014;210:674-683.
  9. Centers for Disease Control and Prevention. Key facts about seasonal flu vaccine. Updated October 2, 2015. Accessed November 6, 2015.
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Last modified: December 29, 2015
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