Surgeon General Jerome Adams, M.D., MPH, gets a flu shot at a Sept. 27, 2o18, press conference.

Federal health officials have a message for long-term care employers and employees: Don’t underestimate the importance of influenza vaccination.

Last year’s flu season was particularly severe, with a record-breaking estimated 900,000 hospitalizations and more than 80,000 deaths in the United States, officials said Thursday at a press conference at the National Press Club in Washington, DC. Approximately 70% of those hospitalizations and 90% of the deaths occurred in adults aged 65 or more years.

Although 78.4% of all healthcare workers were vaccinated during the 2017-2018 flu season, the vaccination rate was the lowest among those working in long-term care, at 67.4%.

U.S. Surgeon General Jerome M. Adams, M.D., M.P.H., said he was “embarrassed” by the low percentage, especially since those in assisted living, skilled nursing and similar settings care for people who are among the most vulnerable to flu complications.

“Getting the flu shot isn’t just about keeping you safe and healthy,” he said. “Getting the flu shot is about community. It’s about everyone else around you. Those 80,000 people who died last year from the flu? Guess what? They got the flu from someone. Someone passed the flu along to them.”

Vaccination among healthcare workers is highest when their employers require or promote it, Adams said. “So there are simple steps that employers can take to help keep their employees safe and healthy so that they come to work, and to keep the people they’re caring for safe and healthy,” he added.

In addition to getting vaccinated, Adams said, two other steps, preventive action — covering your mouth when you cough or sneeze and staying home if you’re sick — and taking flu anti-viral medications if they are prescribed can help prevent the spread of flu.

Flu vaccination has become even more critical as the understanding of post-flu illness has increased over the past 10 years, said William Schaffner, M.D., medical director at the National Foundation for Infectious Diseases. Lingering inflammation, for instance, can increase the risk of heart attack and stroke two to four weeks after recovery from flu, he said.

“What is it that old and frail people often fear the most? Disability — being unable to care for themselves,” he added. “I’m afraid we’ve also learned that after acute flu, recovery may not be complete. When people who are already frail or ‘on the edge’ get flu, they may never return to their pre-flu functional level. Flu can knock down that first domino of progressive decline, progressive disability.”

Those who are vaccinated also are less likely to get pneumonia, Schaffner said. He encouraged pneumococcal vaccination, too.

Types of vaccines

For the 2018-2019 season, the Centers for Disease Control and Prevention recommends the use of any licensed, age-appropriate flu vaccine as soon as it is available. Options:

  • Adjuvanted vaccine and high-dose vaccine for adults aged 65 or more years. Both types are designed to help initiate a more robust immune response.
  • Cell-based and recombinant vaccine that provides alternatives to egg-based vaccine production.
  • Standard influenza vaccine, which includes either three influenza viruses (trivalent — two influenza A and one influenza B) or four influenza viruses (quadrivalent — two influenza A and two influenza B).
  • Live-attenuated influenza vaccine that is given via nasal spray.

All vaccine options may not be available at all locations, so experts emphasize that people should not wait to get vaccinated if their first choice of vaccine is not available. To find a location where vaccination is available, visit

The CDC has posted information about flu vaccination for long-term care professionals online.

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