At a round-table discussion with health care providers at US Southwestern Medical Center today Governor Greg Abbott said, “The time period for getting a flu vaccine begins in September,” urging all Texans to get a flu shot early this year.

Dr. John Hellerstedt with the Texas Department of State Health Services says he welcomes news that the hospitalization rate of Covid patients has flattened or declined in most areas. “The even better news is that in the case of influenza we have an excellent vaccine that has proven to be very effective in the flu season in the Southern Hemisphere, and that’s the flu vaccine we’ll be using here.” Hellerstedt said distinguishing between seasonal flu and Covid will be a challenge for physicians as they both present with upper respiratory symptoms, and stressed the need for testing.

In 2013 the CDC launched “Flusight,” a new approach to the annual flu season, forecasting its anticipated effects rather than only reporting on cases after the fact. Their website today indirectly speaks to the challenges they face in analysis of the 2020-2021 flu season.

Current Flu Forecasting:

Each week during the influenza season, CDC displays the forecasts received through the Epidemic Prediction Initiative (EPI). Forecasting for the 2019–2020 influenza season has ended. Forecasting for the 2020–2021 influenza season will resume later in 2020, pending developments with the ongoing COVID-19 pandemic.

Whatever form the flu presents this year, it will be an upper-respiratory inflammation that will look similar to Covid 19 and may require testing to determine which a patient suffers from.

This is the information the CDC has posted for providers about development of this year’s flu vaccine:

What viruses will the 2020-2021 flu vaccines protect against?

There are many different flu viruses and they are constantly changing. The composition of U.S. flu vaccines is reviewed annually and updated as needed to match circulating flu viruses. Flu vaccines protect against the three or four viruses (depending on the vaccine) that research suggests will be most common.

For 2020-2021, trivalent (three-component) egg-based vaccines are recommended to contain:

• A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus (updated)

• A/Hong Kong/2671/2019 (H3N2)-like virus (updated)

• B/Washington/02/2019 (B/Victoria lineage)-like virus (updated)

Quadrivalent (four-component) egg-based vaccines, which protect against a second lineage of B viruses, are recommended to contain:

• the three recommended viruses above, plus B/Phuket/3073/2013-like (Yamagata lineage) virus.

For 2020-2021, cell- or recombinant-based vaccines are recommended to contain:

• A/Hawaii/70/2019 (H1N1)pdm09-like virus (updated)

• A/Hong Kong/45/2019 (H3N2)-like virus (updated)

• B/Washington/02/2019 (B/Victoria lineage)-like virus (updated)

• B/Phuket/3073/2013-like (Yamagata lineage) virus

Are there any changes to the 2020-2021 Northern Hemisphere vaccines from what was included in this season’s 2019-2020 U.S. flu vaccines?

Yes, this season’s flu vaccines were updated to better match viruses expected to be circulating in the United States.

• The egg-based H1N1 vaccine component was updated from an A/Brisbane/02/2018 (H1N1)pdm09-like virus to an A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus.

• The cell- or recombinant-based H1N1 vaccine component was updated from an A/Brisbane/02/2018 (H1N1)pdm09-like virus to an A/Hawaii/70/2019 (H1N1)pdm09-like virus.

• The egg-based H3N2 vaccine component was updated from an A/Kansas/14/2017 (H3N2)-like virus to an A/Hong Kong/2671/2019 (H3N2)-like virus.

• The cell- or recombinant-based H3N2 vaccine component was updated from an A/Kansas/14/2017 (H3N2)-like virus to an A/Hong Kong/45/2019 (H3N2)-like virus.

• The B/Victoria lineage vaccine component was updated from a B/Colorado/06/2017 (B/Victoria lineage)-like virus to a B/Washington/02/2019 (B/Victoria lineage)-like virus.

• The B/Yamagata lineage vaccine component was not updated.

Are there any new vaccines licensed for use during the 2020-2021 flu season?

There are two new vaccines licensed for use during the 2020-2021 flu season.

• The first is a quadrivalent high-dose vaccine licensed for use in adults 65 years and older. This vaccine will replace the previously licensed trivalent high-dose vaccine.

• The second new vaccine that will be available is a quadrivalent adjuvanted vaccine licensed for use in adults 65 years and older.

o This vaccine is similar to the previously licensed trivalent vaccine containing MF59 adjuvant, but it has one additional influenza B component.

What flu vaccines are recommended this season?

For the 2020-2021 flu season, providers may choose to administer any licensed, age-appropriate flu vaccine (IIV, RIV4, or LAIV4) with no preference for any one vaccine over another.

Vaccine options this season include:

• Standard dose flu shots.

• High-dose shots for people 65 years and older.

• Shots made with adjuvant for people 65 years and older.

• Shots made with virus grown in cell culture. No eggs are involved in the production of this vaccine.

• Shots made using a vaccine production technology (recombinant vaccine) that do not require having a candidate vaccine virus (CVV) sample to produce.

• Live attenuated influenza vaccine (LAIV). – A vaccine made with attenuated (weakened) live virus that is given by nasal spray.

Do we need to get a flu vaccine earlier this year (i.e. July/August)?

While the Advisory Committee on Immunization Practices has not yet voted on the flu vaccine recommendations for 2020-2021, CDC does not anticipate a major change in the recommendation on timing of vaccination. Getting vaccinated in July or August is too early, especially for older people, because of the likelihood of reduced protection against flu infection later in the flu season. September and October are good times to get vaccinated. However, as long as flu viruses are circulating, vaccination should continue, even in January or later.

Will there be changes in how and where flu vaccine is given this fall and winter?

How and where people get a flu vaccine may need to change due to the COVID-19 pandemic. CDC is working with healthcare providers and state and local health departments to develop contingency plans on how to vaccinate people against flu without increasing their risk of exposure to respiratory germs, like the virus that causes COVID-19.

Some settings that usually provide flu vaccine, like workplaces, may not offer vaccination this upcoming season, because of the challenges with maintaining social distancing. For more information on where you can get a flu vaccine, visit www.vaccinefinder.govexternal icon.

How many flu vaccines are expected to be available for the 2020-2021 flu season?

Flu vaccine is produced by private manufacturers, so supply depends on manufacturers. For the 2020-2021 season, manufacturers have projected they will provide as many as 194-198 million doses of flu vaccine, which is more than the 175 million dose record set during the 2019-2020 flu season.

Flu and COVID-19

What is the difference between Influenza (Flu) and COVID-19?

Influenza (Flu) and COVID-19 are both contagious respiratory illnesses, but they are caused by different viruses. COVID-19 is caused by infection with a new coronavirus (called SARS-CoV-2) and flu is caused by infection with influenza viruses. Because some of the symptoms of flu and COVID-19 are similar, it may be hard to tell the difference between them based on symptoms alone, and testing may be needed to help confirm a diagnosis. Flu and COVID-19 share many characteristics, but there are some key differences between the two.

While more is learned every day, there is still a lot that is unknown about COVID-19 and the virus that causes it. This table compares COVID-19 and flu, given the best available information to date.

To learn more about COVID-19, visit Coronavirus (COVID-19).

To learn more about flu, visit Influenza (Flu).

Will there be flu along with COVID-19 in the fall and winter?

While it’s not possible to say with certainty what will happen in the fall and winter, CDC believes it’s likely that flu viruses and the virus that causes COVID-19 will both be spreading. In this context, getting a flu vaccine will be more important than ever. CDC recommends that all people 6 months and older get a yearly flu vaccine.

Can I have flu and COVID-19 at the same time?

Yes. It is possible have flu (as well as other respiratory illnesses) and COVID-19 at the same time. Experts are still studying how common this can be.

Sources

Clinical Questions about COVID-19: Questions and Answers: Testing, Diagnosis, and Notification

Will a flu vaccine protect me against COVID-19?

Getting a flu vaccine will not protect against COVID-19, however flu vaccination has many other important benefits. Flu vaccines have been shown to reduce the risk of flu illness, hospitalization and death. Getting a flu vaccine this fall will be more important than ever, not only to reduce your risk from flu but also to help conserve potentially scarce health care resources.

Is COVID-19 more dangerous than flu?

Flu and COVID-19 can both result in serious illness, including illness resulting in hospitalization or death. While there is still much to learn about COVID-19, at this time, it does seem as if COVID-19 is more deadly than seasonal influenza; however, it is too early to draw any conclusions from the current data. This may change as we learn more about the number of people who are infected who have mild illnesses.

What is CDC doing to promote flu vaccination during the COVID-19 pandemic?

To address the importance of influenza vaccination, especially during the COVID-19 pandemic, CDC will maximize flu vaccination by increasing availability of vaccine, including purchasing an additional 2 million doses of pediatric flu vaccine and 9.3 million doses of adult flu vaccine, by emphasizing the importance of flu vaccination for the entire flu season, and by conducting targeted communication outreach to specific groups who are at higher risk for complications from flu. These same groups are often at higher risk for COVID-19 too, so protecting them from influenza is important to decrease their risk of co-infection. Communication strategies for providers and the public will include:

• Educational outreach activities by CDC, including social media, press conferences, web page spotlights, radio media tours, op-eds, and other publications,

• A digital campaign to educate the general public and people with who are at increased risk from influenza and COVID-19 complications,

• Special educational efforts to inform the general population, people with underlying health conditions, and African American and Hispanic audiences about the importance of flu vaccination, and

• Updated vaccination websites for the public and providers that highlight the safety precautions being implemented in healthcare facilities during the pandemic.

photo: getty images

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