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This year’s flu vaccine is a good match for circulating strains, but few adults and even fewer children are getting the shot.

Could a flu shot push help curb pediatric hospitalizations?

Provinces are stepping up their influenza vaccination efforts in a bid to curb hospitalizations among children, but so far uptake of flu shots has been low and slow.

Pediatric hospitalizations for seasonal influenza have been up to 20 times higher than usual so far this year, partly driven by an increase in influenza A (H3N2) infections, which cause more serious illness in children. Children under five have had the highest rate of hospitalizations, even compared to seniors, who normally face the highest risk.

British Columbia launched its flu shot campaign two weeks earlier than usual this year, followed by a drop-in vaccination blitz for kids after the deaths of four children and two teens.

For the first time, the province is offering free flu shots without an appointment to everyone older than six months. People over 65 are eligible for an enhanced influenza vaccine, which is also free.

Other provinces have likewise boosted their vaccination efforts. Like B.C., Quebec is offering free flu shots as an exceptional measure – the province is one of the few that doesn’t normally cover the vaccine.

In Ontario, the Children’s Hospital of Eastern Ontario is pleading with families to get vaccinated after opening a second intensive care unit and calling in the Canadian Red Cross to support staff dealing with surges in admissions.

“Unfortunately, the pace and volumes are not expected to slow because this viral season is not over,” the hospital stated in a release.

A strong flu shot push helped Australia curb a similar crisis earlier this year. That country’s 2022 flu season – which provides an early preview of how the northern hemisphere’s season might play out – was early and vicious, too, at least initially.

“At the start of winter there was a lot of talk about how this was the worst influenza season ever on record,” explained Robert Ware, a clinical epidemiologist at Griffith University in Queensland, in an article in Nature. After the vaccination push, however, “cases almost disappeared in the second half of the winter.”

Influenza A is a notoriously difficult target for vaccines because it tends to change rapidly, but according to public health officials, this year’s flu shot appears to be a good match for circulating strains.

“We see 35% decreased rates of hospitalization even when we don’t have a good match, which really just emphasizes when we do have a good match, how much more effective it will be,” stated Rochelle Walensky of the United States Centers for Disease Control and Prevention in a December briefing.

Even so, uptake of this year’s flu vaccine has been lower than usual in Canada. Roughly 40% of adults typically get the shots, including 70% of those over age 65.

As of mid-December, B.C. had the highest flu vaccination rates of the jurisdictions reporting data. Nearly a third of that province’s general population, including a quarter of children under five, have received flu vaccines this season.

In Alberta, 24% of the general population have received flu shots, including 17% of children under five.

In both Manitoba and the Northwest Territories, roughly one in five people have received the flu vaccine, including one in 10 of those under age five.

Quebec reported similarly low flu vaccination rates among health workers, only 21% of whom have received the shots.

“We had a discussion this morning with all the CEOs responsible for all the institutions and of course, we think that it’s not enough,” Quebec’s public health director, Luc Boileau, said in a news conference. According to Boileau, vaccination rates among health workers who deal directly with the public are likely higher at 35-40%.

Some experts blame pandemic vaccination fatigue and misinformation for low uptake. However, the flu vaccine also suffers from uniquely bad PR, which is not helped by the shot’s varying efficacy year to year.

For most people, the COVID-19 pandemic didn’t change their overall view of vaccines; more than a quarter now hold more positive views of vaccination, according to a recent report from the National Institute of Aging at the Toronto Metropolitan University.

Yet less than half of people who believe they are up to date on recommended vaccinations have received an annual flu vaccine – suggesting room for improvement in public education about the importance of the shots.

Administering flu shots at the same time as other vaccines, providing free access to enhanced influenza vaccines for older adults, and making vaccines more widely available through pharmacies, primary care clinics, and community pop-ups may also help boost uptake.

“The COVID-19 vaccine rollout demonstrated that when vaccinations are adequately promoted and prioritized, we can mobilize to quickly get the vast majority of Canadians vaccinated,” the report concluded.

Public health officials in Ontario and Alberta are hopeful that influenza season has passed its peak, however, Canada’s chief public health officer warned that infection levels continue to exceed those typically seen this time of year.

RSV and COVID-19 cases appear to have peaked already, according to Theresa Tam, although more immune evasive Omicron variants are expected to drive another uptick in respiratory illness in the new year.

“With the increased prominence of these variants in Canada, at a minimum, we could see a slower decline and a higher plateau in the number of infections, as well as hospital admissions in Canada as this respiratory virus season plays out,” Tam said.

Photo credit: Mauricio Toro/iStock via Getty Images

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