Originally published by our sister publication Infectious Disease Special Edition
By Ethan Covey
As the respiratory season heats up, two recent reports from the CDC detail how vaccination for influenza, respiratory syncytial virus (RSV) and COVID-19 is lagging among America’s adults.
Among U.S. adults 18 years of age and older, an estimated 35% had received a flu vaccine and nearly 18% a COVID-19 vaccine for the 2024-2025 respiratory virus season. An estimated 40% of adults 75 years and older and more than 31% of adults from 60 to 74 at increased risk for severe RSV disease had received the recommended one-time dose of an RSV vaccine (MMWR Morb Mortal Wkly Rep 2024;73[46]:1044-1051).
While some of the numbers among adults showed increases over those found during last year’s respiratory virus season, experts cautioned that they are below ideal levels.
“As of Nov. 9, COVID-19 vaccination coverage was higher for the current year as compared with the same time during the 2023-2024 season for adults aged 18 years and older (4.7 percentage points higher) and ages 65 years and older (13.7 percentage points higher),” said Jennifer L. Kriss, PhD, an epidemiologist with the CDC’s Immunization Services Division, National Center for Immunization and Respiratory Diseases. “However, these data show that COVID-19, RSV and influenza vaccination coverage remain suboptimal for adults.”
The report found that approximately 35% and 41% of adults, who were at least 18, reported they definitely or probably plan to receive or are unsure about receiving the influenza and COVID-19 vaccines, respectively, and 40% of adults 75 and older reported they definitely or probably plan to receive or are unsure about receiving an RSV vaccine, suggesting they are open to vaccination.
“There is still time to get vaccinated for respiratory virus season,” Dr. Kriss said. “Healthcare providers and immunization programs still have time to expand outreach activities and promote vaccination to increase coverage in preparation for the height of the respiratory virus season.”
A second report focused on individuals living in nursing homes, which found generally low vaccination rates among this particularly vulnerable population (MMWR Morb Mortal Wkly Rep 2024;73[46]:1052-1057).
As of Nov. 10, 30% of nursing home residents had received a 2024-2025 COVID-19 vaccine. Among the 59% of nursing homes that choose to report vaccination rates against influenza, 58% of residents had received a flu vaccine, and 18% had been vaccinated against RSV.
“While nursing home residents are disproportionately impacted by COVID-19, influenza and RSV, vaccination against these vaccine-preventable diseases is low this respiratory virus season,” said Hannah Reses, MPH, an epidemiologist and the lead for the CDC’s Prevention and Therapeutics Unit. “Improvements in COVID-19 and RSV vaccination coverage from the same time last season were modest, and flu vaccination coverage has decreased. We hope that these data serve as a call to action for innovative approaches that might improve vaccination among nursing home residents.”
Ms. Reses told Infectious Disease Special Edition that increasing vaccination coverage among nursing home residents may be accomplished through multiple avenues, starting with individuals’ healthcare providers.
“Healthcare providers are patients’ most trusted source of health information, including information about immunizations,” she said. “In addition, if a person is hesitant about a vaccine, they may accept the vaccine during a future interaction with their healthcare provider. With this in mind, nursing homes can prioritize vaccination by preparing their staff to answer questions about vaccination and providing time to have these discussions with residents and their families, perhaps more than once. This will make it easier for residents and their families to overcome hesitancy.
“In our study, we saw that coverage with all three vaccines was highest in small nursing homes, suggesting that staff might be able to build trust with residents and families and reduce barriers to vaccination,” she added. Increasing the availability of on-site vaccinations would also likely help nursing home residents.
“We have learned in other contexts, such as healthcare worker vaccination, that on-site vaccination can make it easier get a vaccine,” Ms. Reses said. “Developing the systems to provide on-site respiratory virus vaccination to every eligible resident could overcome access barriers. CDC, in partnership with CMS [Centers for Medicare & Medicaid Services] and other federal agencies, has developed a number of resources to help nursing homes deliver vaccinations on-site (available in the Viral Respiratory Pathogen Toolkit for Nursing Homes). Nursing homes can also utilize pharmacy and public health partners to ensure access to vaccines for residents.”
Future investigation and improved messaging also may clarify and address existing barriers preventing residents from becoming vaccinated.
“Although CDC and other federal agencies have programs in place to address barriers to vaccination in nursing homes, further study is needed to investigate the extent to which the low vaccination coverage is due to factors related to access (e.g., billing and reimbursement challenges), versus factors related to residents and families,” Ms. Reses said. “These two types of factors will require very different interventions to address. Additionally, having more information about the burden of influenza and RSV in nursing homes could help us advance messaging for nursing home residents. A new CMS rule requiring nursing homes to report weekly counts of influenza and RSV vaccination, cases, and hospitalizations among residents to NHSN [National Healthcare Safety Network] will take effect on Jan. 1, 2025, and this will provide additional information about the national burden of these pathogens among residents.”
The sources reported no relevant financial disclosures.