Fewer people in NC got flu shots last winter. That’s likely one reason so many died.

Fewer than half of North Carolinians got a flu shot last winter, the lowest vaccination rate in six years, and one likely reason why the state saw the most deaths from the flu in a decade.

Public health officials pointed to the drop-off in vaccinations released last week by the U.S. Centers for Disease Control to remind residents to get their flu shots soon, before temperatures drop and the virus becomes more active.

The CDC data showed that flu vaccinations declined nationwide, averaging 37.1 percent across the country last winter, dropping in 37 states, down from 43.3 percent in the previous flu season of 2016-17. That decrease is associated with 79,000 flu-related deaths nationwide, the highest flu-related death toll in more than three decades..

The decline was mirrored in North Carolina, where vaccination rates have long been above the national average. Last winter, the state’s vaccination rate dropped to 46 percent from 50.8 percent in the 2016-17 flu season, according to the CDC. At the same time, the state’s flu-related death count rose to 391, more flu-related deaths than any year since the flu became reportable in 2009 and was tracked consistently in subsequent years.

“Any drop-off is concerning,” said infectious disease specialist David Weber, a UNC professor in pediatrics and epidemiology. “The lower the vaccination rate, the more likely you are to have circulating flu.”

It’s not just that last year fewer people in North Carolina got their flu shots, but it’s a marked drop from past years. The state’s vaccination rate peaked at 52.4 percent in the winter of 2014-15 and hadn’t been below 50 percent since 2011-12, when it was 46.5 percent.

According to the CDC, 49 million people around the country got sick from the flu last winter, and 960,000 were hospitalized. Those numbers are based on computer-generated mathematical formulas, not the result of combining state totals, so that there are no corresponding figures for North Carolina.

Why so few get flu shots

Another contributing factor to the high number of flu deaths last winter was the dominance of the H3N2 flu strain, which is particularly virulent and resistant to vaccine. The CDC said that the vaccine used last winter was 40 percent effective overall, but only 25 percent effective against H3N2.

The low effectiveness of the flu vaccine, and persistent beliefs that it can make you sick, are likely reasons that so few people got their shots last winter, said Keith Ramsey, medical director for infection control at Vidant Medical Center in Greenville. He said as a society we remain far from achieving the CDC’s goal that 90 percent of the population be vaccinated by 2020.

Ramsey repeated the CDC’s position that even a relatively ineffective vaccine reduces the severity of the symptoms for those who do get sick, noting that “some antibodies are better than no antibodies.”

Several doctors who spoke to The N&O said they regularly see patients who refuse to get vaccinated. Some patients say the vaccine doesn’t work, some believe it can make them sick. The doctors said that the flu vaccine is made from dead virus particles and can’t make someone sick, although it can trigger an immune response that some people can experience as feeling sore and under the weather.

The flu vaccine is matched to circulating strains and manufactured months before the flu season arrives, requiring guesswork and resulting in imprecision.

“The flu vaccine is pretty good but it’s not great,” said Paul Cook, an infectious disease specialist at the Brody School of Medicine at East Carolina University. “The flu vaccine is kind of like a crap shoot.”

While its effectiveness is lower than many other vaccines, it has a very high safety level, Weber said.

“This is an incredibly safe vaccine,” Weber said. “The single most important thing to do is to take the vaccine.”

Nasal mists and high-pressure jets

The CDC recommends flu vaccinations for everyone aged 6 months or older, but says the vaccine is particularly important for older people, children and anyone with health complications, such as asthma, diabetes, heart disease and obesity, as they are more susceptible to health complications arising from a flu infection. Last winter, 290 flu-related deaths in the state were people aged 65 and older, and seven were under the age 18.

Of those who died, 42 percent were known to have been vaccinated, and 58 percent were either not vaccinated or had no documentation of flu vaccine, according to the N.C. Department of Health and Human Services.

For those who don’t like needle injections into the muscle, the CDC is recommends a nasal spray flu vaccine for people aged 2 years to 49 years. However, unlike other flu vaccines, the nasal mist is made from live flu virus that can cause an infection and is not recommended for people with certain medical conditions and sensitivities.

Additionally, the CDC recommends two vaccinations that are administered without a needle and instead use a high-pressure jet injector that penetrates the skin. Both jet injectors are available for people aged 18 years through 64 years.

The N.C. Department of Health and Human Services has not reported a single death in the current flu season, which began Oct. 1, and for which totals are updated once a week. However, at least one person died from flu-related causes before Oct. 1: Wake County school board member Kathy Hartenstine, 68, whose family said her death in September was caused by flu-related complications.

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