Early, Low Estimates for Flu Vaccination Coverage in Some Groups Raise Concerns at CDC

October 27, 2021—CDC’s first estimates for flu vaccine uptake among children and pregnant people so far this flu season are lower compared to the same time last season, which could be dangerous for many of the people in these groups who may be at higher risk of developing serious flu complications. Flu vaccine can be lifesaving in children, and flu vaccination helps protect pregnant people during and after pregnancy. Flu and COVID-19 vaccination are both important and both are recommended. A flu vaccine is needed to protect against flu. COVID-19 vaccines will not protect against flu.

A 6-percentage point drop in flu vaccination coverage among children from the same time last year is very concerning, especially since vaccination coverage among children overall last season was down from the 2019–2020 season. End of season coverage among children last season dropped to about 59% compared to about 64% for 2019–2020. Children younger than 5 years and children of any age with certain chronic medical conditions are at higher risk of developing serious flu complications. CDC estimates that up to 20,000 children are hospitalized from flu annually. During 2019–2020, 199 flu deaths in children were reported to CDC. This is the most pediatric deaths during a regular flu season reported to CDC since these deaths became nationally reportable. Statistical modeling suggests more deaths may have occurred in children that season. About 80% of the flu-related child deaths reported to CDC each season occur in children who were not fully vaccinated against flu.

A 15-percentage point drop in flu vaccination coverage among pregnant people from the same time last year could put many pregnant people at risk from flu. Flu is especially dangerous for pregnant people because changes in the immune system, heart, and lungs during pregnancy (and up to two weeks after delivery) can make people more vulnerable to flu and its potentially severe complications. Pregnant people, if they get flu, have more than double the risk of hospitalization compared to nonpregnant people of childbearing age. Additionally, among pregnant people, vaccine uptake was lower than last season at the same time across all racial and ethnic groups. Among pregnant people at the end of September 2021, coverage was

• 10 percentage points lower among non-Hispanic Black pregnant persons (from 21% to 11%).
• 14 percentage points lower among non-Hispanic White pregnant persons (from 37% to 23%).
• 16 percentage points lower among Hispanic and Latino pregnant persons (from 39% to 23%).
• 21 percentage points lower among non-Hispanic Asian pregnant persons (from 51% to 30%).
• 14 percentage points lower among non-Hispanic pregnant persons of other races and ethnicities (from 38% to 24%).

As of October 15, 2021, 139.7 million doses of flu vaccine had been distributed in the United States, so vaccine supply is unlikely to be causing these decreases. Possible reasons for drops in coverage include:

• Low flu activity last season
• Vaccine fatigue caused by ongoing COVID-19 vaccination efforts
• Confusion about the need for a flu vaccine this season, or belief that COVID-19 vaccine will protect against flu
• Changes in health care seeking behavior that result in people making fewer visits to vaccine providers

In a recent Harris poll, about one out of four people surveyed believed that a COVID-19 vaccine would protect against flu or vice versa.

Flu illness is cause by flu viruses, and COVID-19 illness is caused by a different virus. So, flu vaccines and COVID-19 vaccines protect against different viruses, and one vaccine is not a substitute or a replacement for the other. Flu vaccines protect against flu viruses, and COVID-19 vaccines protect against the virus that causes COVID-19. Both vaccines are recommended and it’s important that people be up to date on their recommended flu and COVID-19 vaccines. For adults and most children, a single dose of flu vaccine is needed annually.

CDC will continue to watch coverage estimates carefully to see whether these early indications of lower coverage remain consistent.