But health officials warn that the flu season is far from over, with a surge expected shortly. “Folks try not to seek care during the holiday season, so we see these divots in the surveillance graphs each year, but it is very probable that during the next weeks, we’ll see an upsurge of cases,” Eduardo Azziz-Baumgartner, MD, of the CDC Influenza Division, told CBS News.

Another expert concurred. “Just because we’ve seen cases go down a little bit in the last week doesn’t mean we don’t still have another bump in cases yet to come,” said Céline Gounder, MD, a CBS News medical contributor and editor-at-large for public health at KFF Health News. “Later in January, February is very often the peak of the influenza season, so just because we’ve seen a recent drop in flu cases doesn’t mean that there aren’t more to come.”

So far this season, the flu has caused at least 14 million illnesses, 150,000 hospitalizations and 9,400 deaths, according to the CDC. An additional 13 pediatric deaths were reported this week, bringing the total number to 40 for the season.

The increase in deaths among kids is worrying, Gounder noted. “Unfortunately, I think a lot of people coming out of the COVID pandemic are fatigued and tired of talking about vaccinations, getting vaccinated, but kids under 5 are very much at risk for hospitalization and even death from respiratory illnesses, including influenza, COVID, and respiratory syncytial virus,” she explained.

CBS News Article

On behalf of the Advisory Committee on Immunization Practices (ACIP), Neil Murthy, MD, MPH, from the US Centers for Disease Control and Prevention in Atlanta, and colleagues break down the Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2024.

The authors note that changes to the 2024 adult immunization schedule include new COVID-19 vaccine recommendations, including that all adults should receive at least one dose of the updated vaccine. Respiratory syncytial virus vaccination is a new addition to the adult immunization schedule, with routine use of Abrysvo (Pfizer) recommended during pregnancy (at 32 to 36 weeks of gestation); for older adults (aged 60 years and older), shared clinical decision-making is recommended for vaccination with either Abrysvo (Pfizer) or Arexvy (GlaxoSmithKline).

“The CDC’s Advisory Committee on Immunization Practices’ Recommended Adult Immunization Schedule, United States, 2024 confirms ACIP’s competence in preparing current, evidence-based vaccination recommendations,” Scott C. Ratzan, MD, from City University of New York’s Graduate School of Public Health and Health Policy in New York City, and colleagues write in an accompanying editorial. “However, it also demonstrates that CDC has not moved sufficiently beyond merely providing information to clinicians and the public to persuasive communication.”

Abstract/Full Text

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Add the novel coronavirus to the list of things that can be effectively pulverized by a laser blast. 

A research team, working with a laser manufacturer, found that light at specific wavelengths can do serious damage to either the RNA or protein structures within COVID-19.

Although senior living and care facilities may not have the budget for some tech innovations, new UV-light disinfection tools are becoming available that can help render community spaces sterile and virus-free. 

“Our work provides fundamental evidence that helps understand molecular targets of UVC wavelengths and dosage requirements for high throughput disinfection systems and devices to prevent the transmission and spread of airborne diseases, including COVID-19,” the study authors explained.

COVID remains a threat to long-term care residents, particularly in winter, as older adults remain at greater risk for more severe symptoms and new COVID strains take advantage of a lag in vaccine or booster adoption. Community spaces, such as nursing homes and senior living communities, are inherently more conducive to transmitting airborne or surface disease.

As of last month, approximately 30% of nursing home residents were up to date on COVID shots, according to data collected by the Centers for Medicare & Medicaid Services. 

Some operators have turned to UV light systems for help since the start of the pandemic period. Over the past year, reports about the effectiveness of UV-light disinfection systems have been mixed. 

Although it depends on the actual wavelength, using a UVC light system to kill germs was no more effective than more conventional sanitation practices, such as washing hands, one recent study showed. 

The last study, which called out UVC wands, suggested that they also could produce harmful radiation. Indeed, using some UV air filtration systems could merely be swapping out germs for other harmful particulates like ozone, McKnight’s reported last year.

That doesn’t mean, however, that the jury is out. One study that began last summer is conducting a long-term assessment of ceiling-mounted UV lights in long-term care facilities and whether they can more effectively remove COVID from the environment.  

Another promising technology, a light-striking robot manufactured by Xenex, received US Food and Drug Administration clearance last fall and even inspired a new FDA classification for such robotic disinfection devices. 

Increasing COVID-19, influenza and respiratory syncytial virus vaccination rates in older adults is going to require a village to battle vaccine reluctance in the form of misinformation, hesitancy and fatigue, according to senior living experts.

The Centers for Disease Control and Prevention recently released two reports on vaccination coverage and treatment for respiratory viruses. The agency found that vaccine fatigue, inaccurate health information and vaccine hesitancy contributed to lower vaccination rates in older adults. 

A significant challenge is that many people now tend to equate COVID-19 with catching a cold, Argentum Vice President of Government Relations Paul Williams told McKnight’s Senior Living. 

“We need to continue to emphasize how serious these respiratory viruses can be for our residents, who tend to have multiple comorbidities and chronic conditions, putting them at greater risk for serious complications, and even death,” Williams said. “At this point, so many people have made up their minds on vaccination, and trying to get folks to reconsider is an uphill task.”

Many people are “done with COVID” and any discussion of vaccines, he added.

“Vaccine fatigue is real, even though it remains a threat to the older adults we serve,” Williams said.

Raising vaccination rates

According to the CDC, uptake of the updated COVID-19 vaccine is approximately 37% in adults aged 75 or more years, compared with the national average of 19% among all adults. The statistics aren’t much better for the flu and RSV vaccines — only 34% of adults aged 65 or more years had received the flu vaccine as of Oct. 28 and only 17% of adults aged 60 or more years reported receiving an RSV vaccine as of Dec. 23.

Nursing homes have national reporting requirements for resident and staff member vaccination rates, making statistics more readily available than in assisted living, which does not have such requirements. And not all states are mandating or tracking vaccination in senior living community staff members for COVID, RSV or flu.

Williams said that Argentum is hearing that communities with strong leadership often have higher vaccination rates, and that staff members who trust and respect community leaders are more receptive to calls for vaccination and the importance of helping to protect residents and colleagues in the community.

“Communities that involve trusted nurses and clinicians to educate residents and answer questions on the risk and benefits of vaccines have higher rates,” he added. “The use of toolkits and talking points have proven to be helpful but the main barrier to increasing compliance remains ‘vaccine fatigue.’”

Challenges of vaccine reluctance

The challenge in battling vaccine reluctance is not unique to senior living or nursing home providers; it is systemic among the US population at large, according to the American Health Care Association / National Center for Assisted Living.

“As a country, we face significant challenges with vaccine reluctance that require a collective endeavor by public health officials, other healthcare providers and the public,” an AHCA/NCAL spokeswoman told McKnight’s Senior Living. “Assisted living providers remain persistent in talking to family members and residents about their vaccine concerns and appreciate the partnerships of the larger healthcare system to help reinforce the importance of the vaccines.”

Last week, US Department of Health and Human Services Secretary Xavier Becerra met virtually with representatives from LeadingAge and AHCA/NCAL to express concerns about low vaccination rates among residents of nursing homes, which are supported by federal dollars through the Medicare and Medicaid programs. LeadingAge said in a statement after that meeting that it had urged HHS to help ease logistical issues that have slowed vaccination rates and to encourage hospitals to offer vaccines on discharge. 

David Gifford, MD, MPH, chief medical officer of AHCA/NCAL, writing in a column in McKnight’s Senior Living sister publication McKnight’s Long-Term Care News last week, discussed the need for the nation to collectively combat vaccine reluctance. He opined that strides in the right direction since the pandemic have been taken with vaccines, especially in the long-term care industry, but much collective work remains to be done by the healthcare profession to combat widespread hesitancy.

Vaccine fatigue and hesitancy, Gifford said, are “rampant,’ but especially so when it comes to COVID-19 and RSV vaccines. And although vaccine uptake in skilled nursing facilities is higher than in the general community (a number easier to know for nursing homes due to federal reporting requirements), he called for a doubling down on efforts to increase those numbers.

Gifford called for the ready availability of vaccines for residents through on-site vaccine clinics, provider reimbursements and consistent public health messaging. He said many new admissions arrive at an assisted living community or nursing home without being offered or having received the vaccine during visits with physicians in other healthcare settings.

AHCA/NCAL created a #GetVaccinated website last year with resources for providers to secure and administer vaccines on site, as well as resources to help encourage residents and staff members to receive vaccines.

• In discussions, lead off by talking about the more popular flu vaccine.
• Be consistent in your messaging about the safety and effectiveness of both vaccines.
• Address people’s vaccine-specific beliefs, such as the limits of protection from prior COVID infections. 

The research, which included a July survey of more than 2,000 adults, including 659 of whom were aged 50 or more years, 71% of the older adults said it was “very likely” or “somewhat likely” that they would get the flu vaccine, and 64% said it was very or somewhat likely that they would get the updated COVID vaccine. Forty-nine and 50% of the older adults, respectively said they thought that the flu and COVID vaccines were “very effective,” and 65% and 51%, respectively, thought that they were “very safe.”

The survey results also reveal the most common reasons that some respondents said they are hesitant about vaccination, which can help you with your talking points.

Among those 50 and older who said they were “not very likely” to get the flu vaccine, the top three reasons were that they would prefer to get natural immunity from becoming ill (35%), that they don’t trust the government agencies that promote vaccination (33%) and that they feel as if people are expected to get too many vaccines in general (31%).

Among those 50 and older who said they were “not very likely” to get the COVID vaccine, the top three reasons were that they want to see more research done on the vaccine (62%), that they are worried about the vaccine’s safety (59%) and that they don’t trust the government agencies that promote vaccination (55%).

(You can read about the other concerns of respondents, including those aged 18 to 64, here.)

Other recent research also provides motivation for staying current with vaccines:

• For instance, an analysis of more than 10 million cases of COVID-19 in adults between May 2020 and February 2022, published in December in the Journal of the Royal Society of Medicine, found that among adults aged more than 50, the case fatality risk was 10 times higher in the unvaccinated compared with those who had been vaccinated within six months before testing positive for COVID-19.
• Research published in December in Lancet Infectious Diseases indicates that people hospitalized with seasonal flu also can end up with “long flu,” long-term, negative health effects, especially involving their lungs and airways.

See the Centers for Disease Control and Prevention’s website for more information and resources about COVID and flu vaccination for long-term care residents or workers — long-term care workers have relatively low vaccination rates compared with other healthcare personnel.

Lois A. Bowers is the editor of McKnight’s Senior Living. Read her other columns here.

Hannah E. Reses, MPH, from the CDC in Atlanta, and colleagues examined COVID-19, influenza and RSV vaccination coverage among US nursing home residents during the 2023 to 2024 respiratory virus season. The researchers found that 33.1% of nursing home residents were up to date with COVID-19 vaccination as of Dec. 10, 2023. Coverage with influenza and RSV vaccines was 72.0 and 9.8%, respectively, among residents at 20.2 and 19.4% of facilities that elected to report.

Carla L. Black, PhD, from the CDC in Atlanta, and colleagues used data from the National Immunization Survey-Adult COVID Module for adults aged 18 years and older to monitor influenza, COVID-19 and RSV vaccination coverage. The researchers found that an estimated 42.2 and 18.3% of adults aged 18 years and older reported receiving an influenza and updated 2023 to 2024 COVID-19 vaccine, respectively, by Dec. 9, 2023; 17.0% of adults aged 60 years and older had received an RSV vaccine. There was variation noted in coverage by demographic characteristics.

“Although influenza, updated COVID-19 and RSV vaccination has slowed for the 2023 to 24 respiratory season, vaccination is recommended to continue while viruses are circulating, and many unvaccinated persons continue to report intent to be vaccinated,” Black and colleagues write.

Abstract/Full Text – Reses

Abstract/Full Text – Black

Amber Hsiao, PhD, MPH, from the Kaiser Permanente Vaccine Study Center in Oakland, CA, and colleagues conducted a cluster-randomized observational study to compare the effectiveness of recombinant vaccines as compared with standard-dose vaccines against influenza-related outcomes in adults under the age of 65 years. During the 2018 to 2019 and 2019 to 2020 influenza seasons, facilities routinely administered either a high-dose recombinant influenza vaccine (Flublok Quadrivalent) or one of two standard-dose influenza vaccines to adults aged 50 to 64 years and 18 to 49 years.

Data were included for 1,630,328 individuals aged 18 to 64 years who received vaccines (632,962 in the recombinant-vaccine group and 997,366 in the standard-dose group). The researchers identified 1,386 and 2,435 cases of polymerase chain reaction (PCR)-confirmed influenza diagnosed in the recombinant-vaccine and standard-dose groups, respectively. Among participants aged 50 to 64 years, 2.00 and 2.34 cases per 1,000 tested positive for influenza in the recombinant-vaccine and standard-dose groups, respectively (relative vaccine effectiveness, 15.3%). The relative vaccine effectiveness against influenza A was 15.7% in the same age group. Compared with the standard-dose vaccines, the recombinant vaccine was not significantly more protective against influenza-related hospitalization.

“Participants between the ages of 50 and 64 years who received the recombinant vaccine had more protection against confirmed influenza than those who received a standard-dose vaccine,” the authors write.

The study was funded by Sanofi, the manufacturer of the Flublok vaccine.

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Although the original COVID-19 drama appears to have waned, infectious disease and medication management experts were guarded heading into this fall’s flu season.

“Something new this year is that two new vaccines were recently approved by the FDA to protect against pneumonia due to respiratory syncytial virus in adults age 60 and over,” said Erica Johnson, chair of the Infectious Disease Board of the American Board of Internal Medicine. 

“While there has been a fair amount of media attention surrounding the new vaccine [for seniors], it may prove to be a bit more challenging to incorporate into the core group of routine vaccines we are accustomed to,” warns Erin Marriott, RPh, director of clinical and regulatory support at Guardian Pharmacy Services.

Erin Donatelli, PharmD, vice president of clinical and consulting services for Remedi SeniorCare, stresses that treatment options and outbreak procedures for COVID-19 and the flu should follow a tight timeline after symptoms or a positive test.

Pharmacists and others expressed confidence in the preparation and efficacy of new COVID boosters and vaccines. Still, work remains to be done.

“As a country, we are still dealing with misinformation, mandates and some poor communications from government leaders,” says Chad Worz, PharmD, chief executive of the American Society of Consultant Pharmacists. “It will take a huge effort by doctors, nurses and pharmacists to rebuild confidence in vaccines.”

Meanwhile, experts are mixed about a repeat of drug shortages. Andrew Agan, a spokesperson for Guardian Pharmacy Services, said that drug shortages remain a major issue. “From atropine to lidocaine, there’s a large list of drugs currently in shortage,” he says.

As for parting advice, experts have plenty.

“Get ahead of potential outbreaks,” Worz says. Residents should be vaccinated and evaluated in anticipation of needed antiviral treatments that could involve possible interactions with other medications, he adds.

And finally, “work collaboratively with your pharmacy partner on securing access to any of the needed vaccines,” Marriott says. 

Air filtration systems may be more the norm in long-term care facilities post-pandemic, but a new study says they can’t stop people from getting viral infections.

A team from the University of East Anglia reviewed multiple studies evaluating technologies such as air filter devices, germicidal lights and ionizers.

The new study clashes with previous understanding about how effective the above sanitation tools can be and clouds the picture for how senior living and care operators may keep residences free of COVID-19 or flu. 

“Air treatment technologies can be expensive. So it’s reasonable to weigh up the benefits against costs, and to understand the current capabilities of such technologies,” study co-author Paul Hunter, MD, said in a statement.

Such costly technologies on the market include disinfecting robots that move around and deploy ultraviolet lights; those robo-cleaners even now have an FDA-classification. 

The team assessed details from 32 studies on microbial infections or symptoms in people exposed or not to air treatment technologies. The studies all were performed in real-life settings such as nursing homes and schools. 

“In short, we found no strong evidence that air treatment technologies are likely to protect people in real world settings,” Julii Brainard, PhD, a report author also from UEA’s Norwich Medical School. 

The study team appeared to hedge their conclusion in part by noting that a handful of studies on air treatment solutions launched during the COVID-19 pandemic haven’t been published, but would be “welcome to the evidence base.”

Some recent studies that have been published, however, have found that air purification interventions do reduce COVID in nursing homes.

The East Anglia study authors seem to indirectly acknowledge this, writing that “There is a lot of existing evidence that environmental and surface contamination can be reduced by several air treatment strategies, especially germicidal lights and high efficiency particulate air filtration (HEPA).” 

In addition, the study team cited “weak evidence” that the air treatment methods lowered the risk for infection but that these studies were “biased or imbalanced.”

They conclude that their meta-analysis overall shows that the “combined evidence” of these various technologies suggests they “don’t stop or reduce illness.”

Equally concerning, whether or not UV-light filters kill germs, some systems may produce new, unrelated toxins in the air, such as ozone, one recent study found.

The East Anglia study was published Nov. 16 in Preventive Medicine.