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Seasonal Flu Strikes Early

CDC recommends a flu shot for everyone older than 6 months.

When the CDC recently announced that this season's flu was hitting earlier than it had in almost a decade, Nichole Bobo, MSN, RN, thought, "I am so thankful I got my vaccine again this year."

The director of nursing education for the National Association of School Nurses, Bobo says the CDC's announcement of an uptick in flu cases corroborates with what school nurses are seeing in some parts of the country.

"School nurses are indeed reporting increased rates of influenza and influenza-like illness in the schools," she said.

A school nurse in Ohio reported sending home 18 students in a single day, bringing the absentee count to 70 students in a school of 400 children.

"One mom is an emergency room doc, and she states they are inundated with flu and RSV," the nurse told the association. "Parents are sending children back to school to attend Christmas concerts. ... We have never had it this bad."

States Hit Hardest

"It looks like it may be shaping up to be a bad flu season, but only time will tell," the CDC's Tom Frieden, MD, MPH, announced Dec. 3.

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While flu typically peaks in January, the CDC noticed what Frieden first called a peak then rephrased as a "general uptick" in flu activity in late November and early December. ("We don't know when the peak will happen until we begin to see it beginning to fall," he clarified.)

So far, the southeastern and south central regions of the country have been hit hardest, with high-level activity reported in five states: Tennessee, Mississippi, Alabama, Louisiana and Texas.

"Tennessee has been hard hit, and it is being demonstrated in school closures. Several counties scattered across the state have closed schools from two to five days to help decrease the outbreaks," said Janice Harris, MSN, RN, assistant professor at Middle Tennessee State University School of Nursing, Murfreesboro.

"I spoke with a colleague who works in a pediatric emergency department, and they have seen an increase in patients with flu-like symptoms as well as increases in parents seeking treatment for their children in the public health department system," she said.

Missouri and Georgia reported moderate influenza-like illness, according to the CDC.

"As of week 49, we are at a high influenza intensity for the state," confirmed Kelly Knight, BSN, RN, immunization coordinator with the Georgia Department of Public Health, Dublin. "We did not experience this level of activity during all of last year's influenza season."

In Georgia, the 5- to 24-year-old demographic has been hit particularly hard, Knight said. As of mid-December, however, no deaths had yet been linked to seasonal flu.

Cynthia Goodstein, RN, vice president of clinical services at the 524-bed Workmen's Circle MultiCare Center, Bronx, NY, told ADVANCE the elder care and rehabilitation center had yet to see a single case of the flu this season.

"We have been very fortunate," Goodstein said, adding that 87 percent of residents there elected to receive flu vaccination this fall.

Immunization High Among Nurses

Nationwide, an estimated 40 percent of children and 35 percent of adults - or approximately 112 million people - had received this year's flu vaccine as of the CDC's Dec. 3 media briefing.

The percentages are expected to rise slightly as the season progresses. During the 2011-2012 season, 48 percent of the general population received immunization by season's end.

The CDC has recommended since 2010 that everyone older than 6 months be vaccinated.

"Just to clarify, flu is unpredictable. That's probably the most predictable thing about it," Frieden said during the briefing. "The only thing we know for certain, beside unpredictability, is that getting vaccinated is the best way to protect yourself."

Among healthcare providers, vaccination rates are much higher than in the general population. According to CDC numbers from early November, 81.5 percent of nurses, 83.8 percent of physicians and 88.7 percent of pharmacists have received vaccination.

Healthcare workers in hospitals averaged an 83.4 percent vaccination rate.

Almost half of immunized healthcare workers said they received flu vaccination to protect themselves. Another 16 percent cited mandatory flu vaccination policies at work as their reason for getting vaccinated.

More than 400 hospitals across the country have mandatory flu vaccination policies, according to the Chicago Tribune. The newspaper reported on a local critical-care nurse defying her hospital's mandate because she considers it a violation of her personal rights.

"Something that I uphold and honor so deeply is being taken away from me," she told the newspaper. "It's an argument of patient safety over patient rights."

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Not Too Late to Protect Yourself

With an estimated 123 million seasonal flu vaccine doses sent out to providers, the CDC says plenty of vaccine is still available for people seeking vaccination.

And experts say it's not too late to seek protection for January, the typical month of flu peak, since it takes about 2 weeks post-vaccination for antibodies to develop.

"I know the vaccine may not cover all circulating strains for a virus, but I also know this year's vaccine is a good match for the majority of the circulating influenza virus strains," said Bobo.

The National Association of School Nurses urges school nurses to lead by example and receive flu vaccination if they haven't already done so. The group also urges school nurses to advocate for flu vaccination within their local communities.

"If the school is not providing the vaccine, the school nurse can provide information about where the vaccine can be obtained," she said.

To help nurses promote vaccination and health hygiene, the National Association of School Nurses hosts educational materials, including Fighting the Flu Happens at School on its Seasonal Influenza webpage. Included are sample monthly messages that nurses can use to educate students and parents on flu prevention and care via a variety of channels, such as the school website, facebook, email, text messaging, and hard-copy fliers and newsletters.

"Using multiple channels affords further reach," Bobo coached.

Word of Warning

Mary Foley, PhD, RN, director at the Center for Nursing Research and Innovation at the University of California San Francisco School of Nursing and former president of the American Nurses Association, supports public health messages promoting flu vaccination. But she cautions nurses and other healthcare providers administering shots to protect themselves while doing so.

"The only concern it raises for me may be the 'rush' factor when large numbers of the public appear for their vaccination," said Foley, chairperson for the needle safety group Safe in Common.

"In some cases, the flu 'campaigns' lead to large clinics in stores, parking lots, schools and other settings where safe equipment (like disposal boxes) may not be provided, and experienced personnel may not be doing the injections, preparing the doses or involved in clean up. Those situations increase the risk of accidental injury due to a needlestick," she said.

Nurses and other personnel offering vaccinations should do so only in well-lit, clean workspaces while wearing gloves, Foley reminded. Furthermore, disposal devices should be used to prevent accidental injuries to staff, the public and maintenance personnel.

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Vaccination Success

In 2009, New Jersey began requiring children ages 6 months through 59 months to receive the seasonal flu vaccine by Jan. 1 in order to continue in their early childhood programs.

A school nurse there recently reported a significant drop in illness levels in the 240-student preschool where she worked.

"We have seen a great improvement in kids' health over the winter months, many fewer absences for flu-like illnesses, fewer pneumonias and hospitalizations for kids with (and without) asthma," she wrote to the National Associated of School Nurses.

"At first, many parents really resisted this new law about a required flu vaccination, but I'm seeing a lot less resistance to it this year and last. Now I am more likely to hear from parents who don't want their kids going to school with any child who is not vaccinated!"

Jolynn Tumolo is a frequent contributor to ADVANCE.

Articles Archives

I am one of the healthcare workers that was made to get the flu shot when i did not want it. Turned out i got the flu. I think this is horrible that we were made to get the flu shot to help prevent us from getting the flu because it is for the good of the country, and guess what, we are getting the flu anyway. And It was stated that this flu shot hit right on the nose of the virus. I would rather have gotten it natural and let my body fight it by itself.

Laura ,  RNDecember 30, 2012

many persons refuse the vaccine,because of negative responds from others.

Edwina  King-Ince ,  Surveillance Nurse,  Scarborough Health CentreDecember 28, 2012

The current flu being experienced in Chicago area is obviously not captured in the vaccine. Just a many persons who were vaccinated are becoming ill with flu symptoms as those who were not. Test does show influenza A.

Barbara Lupo,  RN ConsultantDecember 26, 2012
Skokie, IL


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