Public-health officials have expressed serious concerns that as the U.S. enters the 2021–2022 influenza season, influenza-associated morbidity and mortality could further overburden healthcare systems already reeling from the ongoing COVID-19 pandemic.

Higher influenza vaccine rates might be ameliorating some of those concerns. The CDC reports that during September–December 2020, overall influenza vaccine administration was 9.0% higher than average from September to December in 2018 and 2019. At the same time, however, the number of administered doses declined among children aged 6 to 23 months (13.9%) and 2 to 4 years (11.9%), according to the article in the Morbidity & Mortality Weekly Report.

"Continued strategic efforts are needed to ensure high influenza vaccination coverage among all eligible persons aged ³6 months, especially children aged <4 years," the CDC emphasizes.

The authors note that their findings are consistent with those of a 2021 study of influenza vaccination coverage using national survey data (National Immunization Survey-Flu and Behavioral Risk Factor Surveillance System). That survey determined that influenza vaccination coverage was lower among those aged 6 months to 17 years and higher among adults during the 2020–2021 influenza season, compared with coverage during 2019–2020.

"Whether this finding was attributable to influenza immunization campaigns was unclear; these campaigns emphasized the importance of receiving the annual influenza vaccine to help reduce the spread of influenza viruses," the report states. "Although the flu vaccine does not protect against COVID-19, influenza vaccination was part of a public health strategy to flatten the curve of respiratory illnesses overall, protect essential workers from influenza, and preserve medical resources for care of COVID-19 patients."

The article also recounts how influenza activity during the 2020–2021 season was unusually low in the U.S. and worldwide, attributing that to public-health measures enacted to limit the spread of SARS-CoV-2. Those measures included wearing face masks, implementing stay-at-home recommendations, promoting good hand hygiene, closing schools, restricting travel, increasing the ventilation of indoor spaces, and maintaining physical distancing.

"Since these COVID-19 mitigation strategies also reduced the spread of influenza viruses, these measures, combined with the transition to hybrid or fully virtual learning, might have led parents to perceive that their children were at lower risk for contracting influenza," the authors suggest. "Decisions about whether to vaccinate children against influenza might have been influenced by the time of year children received an annual well-child check-up, or by COVID-19–related barriers to health care access, including provider office closures or fear of contracting COVID-19 while getting the influenza vaccine."

They point out that routine pediatric vaccination other than for influenza declined, indicating that these barriers might have also discouraged parents and guardians from seeking routine pediatric care for their children, including annual influenza vaccination.

Public-health officials are strongly urging influenza vaccination, explaining, "Given that the 2021–22 influenza season will coincide with the ongoing COVID-19 pandemic, strategic efforts are necessary to ensure high influenza vaccination coverage among all age groups, especially children aged 6 months–4 years, who are not yet eligible to receive a COVID-19 vaccine."

Routine annual influenza vaccination is recommended for all Americans aged >6 months who have no contraindications.

"With the continued effort to safely keep schools open for in-person learning, and workplaces and businesses resuming in-person activities, CDC recommends that health care providers consider co-administering COVID-19 vaccines with routine vaccines such as influenza," notes the MMWR article.

The goal is to both reduce the spread of influenza this fall and winter and ease patient load for healthcare systems dealing with high patient loads caused by COVID-19, the researchers advise.

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