Are primary prevention strategies altering the course of the perfect storm?

February 23, 2021
Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN

As the 2020-2021 influenza season loomed, many in health care worried that the seasonal disease would add to the extraordinary burden of coronavirus disease 2019 and create a perfect storm. Have various prevention strategies helped prevent this potential issue?

In the summer of 2020, many health care professionals (HCPs) were concerned about the potential devastating effects of individuals contracting coronavirus disease 2019 (COVID-19) and influenza. For young pediatric patients, adding respiratory syncytial virus (RSV) to the ‘mixture’ of offending respiratory organisms was a major concern. Dr. Carnazzo discusses these issues in her article entitled, The perfect storm: Influenza and RSV during the season of COVID-19. The author provides a comprehensive presentation for COVID-19, influenza, and RSV with comparisons to one another that will enable HCPs to accurately diagnose the ill child presenting to an office-based practice or hospital settings.

Primary prevention: Influenza vaccine

I believe that the concerns expressed prior to influenza season by all HCPs laid the foundation for parents and adults to make informed decisions about vaccinating themselves, their family members, and most importantly for the pediatric populations for parents to have their infants, children, and adolescents vaccinated against influenza each year. Media coverage also supported influenza vaccinations to prevent the ‘perfect storm’ of COVID-19 colliding with influenza resulting in higher rates of respiratory illnesses and deaths.

It always concerns me that pediatric and adult patients die during the influenza season, when we have a primary prevention strategy: administering the influenza vaccine, to prevent influenza, community spread of influenza, and deaths. The Centers for Disease Control and Prevention has recommended an annual influenza vaccine. And yet, in the 2019-2020 influenza season, there were 38 million illnesses, 18 million medical visits, 405,000 hospitalizations, and 22,000 deaths related to influenza.1 Additionally, during the 2019-2020 influenza season, there were 254 children aged between 0-4-years and 180 children/adolescents aged between 5-17 years who died from influenza.1

In New York State, there are no reported pediatric deaths from influenza during the 2020-2021 influenza season as compared to the 2019-2020 influenza season in which 14 deaths were reported.2 Vaccinations, a primary prevention strategy, are an effective measure for the prevention of so many vaccine preventable diseases. Pediatricians and nurse practitioners should employ scientifically based strategies to support parents in their decision making prior to the influenza season and for all vaccines on the immunization schedule.

COVID-19 vaccines for children

At this time, Pfizer and Moderna are enrolling or planning to enroll children aged older than 5 years in studies to determine the efficacy of COVID-19 vaccines in the pediatric populations. Once the studies are completed and emergency use authorization from the Food and Drug Administration is issued, pediatricians and nurse practitioners will play a critical role in helping parents make the decision to vaccinate their children against COVID-19. Time will tell if the COVID-19 vaccine, once approved for children, will prevent multisystem inflammatory syndrome in children, the severe presentation of COVID-19 disease, that has presented in some children, especially in Black and Hispanic populations.3

References

1. Center for Disease Control and Prevention. Estimated influenza illnesses, medical visits, hospitalizations and deaths in the United States – 2019-2020 influenza season. Updated October 6, 2020. Accessed February 19, 2021. https://www.cdc.gov/flu/about/burden/2019-2020.html

2. New York State Department of Health. Weekly influenza surveillance report. Updated February 6, 2021. Accessed February 19, 2021. https://www.health.ny.gov/diseases/communicable/influenza/surveillance/2020-2021/flu_report_current_week.pdf

3. Hester, M. Certain groups may be at greater risk of MIS-C. Published December 4, 2020. Accessed February 10, 2021. https://www.contemporarypediatrics.com/view/certain-groups-may-be-at-greater-risk-of-mis-c