The CDC characterized the 2025-2026 influenza season as moderate overall, but the burden in the United States was substantial, with suboptimal seasonal influenza vaccine uptake among adults and children. Stream this podcast, featuring audio from a live webinar led by experts Paul G. Auwaerter, MD, MBA, and Ravi Jhaveri, MD, FIDSA, FPIDS, FAAP, to help you optimize influenza vaccine uptake in your practice.
The CDC characterized the 2025-2026 influenza season as moderate overall, but the burden in the United States was substantial, with suboptimal seasonal influenza vaccine uptake among adults and children. It is important to communicate to patients that the clinical benefits of the influenza vaccine extend beyond prevention of disease and mortality, particularly for the most vulnerable populations. In anticipation of the upcoming influenza season, stream this podcast, featuring audio from a live webinar led by experts Paul G. Auwaerter, MD, MBA, and Ravi Jhaveri, MD, FIDSA, FPIDS, FAAP, to increase your competence in optimizing influenza vaccine uptake in pediatric and adult patients.
For more, and to download the accompanying slides, visit our program page.
Topics covered include:
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Presenters:
Paul G. Auwaerter, MD, MBA
Sherrilyn and Ken Fisher Professor of Medicine
Divisions of Infectious Diseases and General Internal Medicine
Johns Hopkins University School of Medicine
Baltimore, Maryland
Ravi Jhaveri, MD, FIDSA, FPIDS, FAAP
Division Head
Pediatric Infectious Diseases
Virginia H. Rogers Professor in Infectious Diseases
Ann & Robert H. Lurie Children’s Hospital of Chicago
Professor of Pediatrics
Northwestern University Feinberg School of Medicine
Chicago, Illinois
This transcript was automatically generated from the audio recording and may contain inaccuracies, including errors or typographical mistakes.
A Path to Protection Podcast 2: Purposeful Solutions to Power Up Influenza Vaccine Uptake
Dr. Paul G. Auwaerter (Johns Hopkins University): Hello. And I'm so glad you could join in another respiratory season. And that means: how can we best help our patients avoid illnesses? Sometimes serious illnesses. So, we're hoping this program would be helpful for your clinical practice for this upcoming season.
National Vaccination Coverage Update
So, what we do know is since COVID especially, there have been a variety of forces that have largely prompted many of our patients to forego what had been a traditional influenza vaccine, as well as other vaccines. Some of this, of course, is based on some social media misinformation or just a sense that they feel they've received too many vaccines in the past, or not quite as aware of all the issues that really go into making decisions about recommendations to receive vaccines, whether you're healthy or have significant health problems.
So, we do know from last season that some key folks, such as pregnant people who are at risk for severe illness with influenza, only a little over a third were immunized. And whether people are not going to the doctors or have access problems, there are many forces that are currently preventing reaching the goal that the ACIP and the CDC have set in past years to try to have people that are in good health have 70% immunized.
Influenza Vaccine Uptake in Adults: Below Target
We are really far below that,. So, I think there's a lot of opportunities. And myself as an infectious disease physician, I talk about vaccines sometimes with my patients, but I also do primary care. And I think this is where patients really come in a number of different flavors. It can be highly motivated to get vaccines. They're easy. But it's the people that are really, you know, either on the fence or have questions or really just don't want to have another vaccine. And sometimes they can't really articulate why. And so, that's why we'll hopefully provide some information here.
Influenza Vaccine Uptake in Children: Below Target and Declining
Children are another group where the traditional emphasis to try to increase immunization to 70% we are really far behind. And at least from children that unfortunately died due to influenza-associated illnesses last season, 90% of those children were not immunized. And maybe I might turn to Dr. Jhaveri for a moment. And do you have any comments from your perspective as a pediatric practice as to how this might be a little different than the adult populations? Because obviously a lot of children aren't making their decisions.
Dr. Ravi Jhaveri (Ann & Robert H. Lurie Children’s Hospital of Chicago): Yeah. Thanks, Paul. I - we have seen meaningful declines over the years since the pandemic. I try to be an optimist, and so I try to point out that we have - we did see some stabilization last season where we didn't decline further, but we've had a greater than sort of 10% decline since our peak vaccination rates prior to the pandemic. So, the 2019-2020 season.
And I think, yes, social media misinformation is out there, but I think we have had tangible changes in access. And I talked to many primary care pediatric providers who giving flu vaccine in their practices a challenge. And from a financial standpoint, and we don't have sort of the flu vaccine days that practices often used to have. And so, I think we need to sort of reimagine how we provide vaccine in a number of ways. And we'll get to that a little bit later.
Dr. Auwaerter: Okay. Excellent. Thank you. Yeah, it's been my sense that certainly the social media forces sometimes seem to be a little stronger in the parent-child sphere than sometimes in the adult vaccine world.
Preview From the Southern Hemisphere
One thing I'd like to just mention is how we actually develop, meaning we, the pharmaceutical industry and the public health authorities, in terms of achieving a flu vaccine.
Lessons From the Last Influenza Season: Even a Moderate Year Has Major Consequences
Now, influenza is one of those viruses that can really reassort itself. So, every year brings the potential for a somewhat new virus. Sometimes there's what's called a drift where there's minor changes. Of course, a pandemic is when there's a real antigenic shift.
Despite those challenges, even a year where there's a pretty good match with a vaccine, there's still a fair burden of illness. It's one of the most common respiratory illnesses. In fact, over the last year or two, COVID no longer is in the leading role. And indeed, influenza has sort of reclaimed its major morbidity and mortality during the respiratory season.
Also, medical visits to offices, time missed from work, and so on all contribute to really the seriousness that influenza brings even to healthy people.
Current Southern Hemisphere Surveillance
So, how the vaccines are developed are taking a look to provide some context for the flu season, which is just wrapping up in the Southern Hemisphere; particularly, we look at continents like Australia and others. And what we sort of see, or what has happened over the last year or two, is, one of the influenza A viruses, this subclade K from H3N2 influenza A, really emerged rather rapidly. And so that's now been incorporated into the vaccine for this upcoming flu season.
Flu Isolates in Southern Hemisphere
So, the formulations really are developed way back in our spring, looking at some of the early weeks of the flu season in the Southern Hemisphere, and you can sort of see Influenza B tends to occur later in the season. Flu B is a little bit milder. And there's really only been one major type.
So, what that means is that our current formulations are all trivalent. We used to have a quadrivalent when there were two different influenza B circulating, but now there's only one. And we have generally two influenza A types that are circulating at high percentages. So, we have a trivalent vaccine with some minor variations depending on the formulation.
Influenza Vaccine Selection
Benefits of Influenza Vaccination Extend Beyond Infection Prevention: Patient Counseling
I think one of the interesting things nowadays are we have lots of influenza vaccines available in terms of different formulations, which we'll get to. But one of the core things I always try to convey is that the influenza vaccine in any given year might absolutely prevent influenza 20 to 60% of the time, depending on the match of the vaccine with the circulating seasonal influenza strains.
But what I think is much more important are the following: if you're a relatively healthy person, what the flu vaccine does tends to really reduce the severity of illness such that maybe you don't feel like you have to go to the doctor or urgent care center, and perhaps the illness will be a bit more abbreviated. But for those, especially with comorbidities, it's clear that the vaccine helps reduce hospitalizations, severe illness and flu-related mortality, which isn't always a direct consequence of the viral infection itself, meaning pneumonia or bacterial infection complicating pneumonia. But that the flu infection provides such stress to the body that it can cause a flare of your respiratory illness, if someone has emphysema, for example, or provoke a stroke or heart attack, for example. And it's really those features that I really find most compelling, to try to help convince people that this is major benefit.
For people that are in good health, one of the more interesting studies from years ago found, interestingly, that even non-influenza illnesses were reduced - respiratory illnesses - in people that were immunized, and they also missed less work or missed opportunities that were such that they had to stay home from work or school, and their children had to miss school or vice versa. So, the flu vaccine does help on those aspects as well.
Range of Available Influenza Vaccines
As I already mentioned, there are lots of different influenza vaccines available. The ones that I think were most used and most familiar, the so-called protein subunit vaccines, these are inactivated. They're not a live infection. And there's the standard trivalent dose, which you only need one shot per season, two potentially,.
Then there's the high-dose and adjuvanted. These are true to help combat immune senescence in people over 65, where they don't respond as well to the standard vaccine. And it looks like both these formulations, if they're available and people receive them, have better vaccine efficacy, meaning fewer influenza illness and less severe illness, hospitalizations, and so on.
Now, one of the questions frequently is about egg-based vaccines. And the CDC now for several years has said that any influenza vaccine is acceptable, whether they're egg-based or not, because the risk is really so minor that as long as you have standby equipment to deal with a potential allergic reaction you really do not have to worry about egg vaccine - egg-based vaccines at all. So, really, any vaccine is acceptable.
There are recombinant vaccines, though, that are not egg-based that are approved for anyone nine and older. And there has also been a live attenuated vaccine, which is given intranasally, which just last year could be given in the home aspect as well as in offices and pharmacies. Now, that's only for people under 50 years and over 2, and they can't have health problems because - serious health problems like immunosuppression, pregnancy, for example, or receive immunosuppressive drugs or have organ transplants because it is a live attenuated vaccine.
And maybe I'm going to turn to Ravi again and just ask for his experience with this vaccine. This is the second year where it can be delivered to the home, so it avoids a hospital visit, and if people are needle-averse, there's some benefits.
Dr. Jhaveri: Yeah. I think we like to talk about offering many options. And I think many of the senior physicians on the call are providers. Remember when we just had one option, and now we have so many, which is terrific. But we did some work in prior projects showing that there was up to 10% of people that if you didn't have the live-attenuated nasal spray version, they were not going to get vaccinated. And so, I think the point about having multiple options and offering people different options that may align with their preferences or with their specific medical histories or lifestyle, I think is a real plus.
Dr. Auwaerter: Yeah. And I wanted to ask you just one other question about the two-vaccine issue. And, you know, a lot of times the children should be immunized in July or August, for example, to get that first dose in when they're younger. So, maybe six months later is December or January. Do you give that second dose in that year? Let's say it's April or May. How do you handle that?
Dr. Jhaveri: Yeah, we optimally will give it during the same season because you want to prime and then boost with the same vaccine. And as you highlighted in your earlier slides, from season to season, the vaccine may be an entirely different formulation. And so you're not exactly boosting the prior dose. And so if you're within the season, you want to try to give those two doses. Optimally, 30 days apart because that's when the original studies were done. But I often get asked, you know, "It's the 28th day, do I really have to have them come back in two days?" And I say, "Don't let perfect be the enemy of good." We do so poorly, giving two doses that I say, "You should just do it whenever you can." But the ideal guidance is that four-week window.
Dr. Auwaerter: Yep. That's perfect. Thanks for clarifying that.
Dr. Jhaveri: Sure.
Dr. Auwaerter: Last thing I'm just going to close with is a new kid on the block for vaccines. So, an mRNA version of influenza has been approved by the FDA. Now, importantly, this has not yet been incorporated into ACIP or CDC guidance. And all that was really developed back in 2025. So, there hasn't been an opportunity to - to incorporate that. So, it's only FDA-approved, but it is another option.
mRNA Influenza Vaccine: August 2026 Approval
And I just thought I'd quickly go over the study just published in the New England Journal, regarding this mRNA vaccine, which really examined adults over the age of 50. And they compared it to standard-dose flu vaccine. And their main efficacy was, gosh, you know, did you prevent PCR acquisition or PCR testing - tested acquisition, flu virus.
And the vaccine efficacy was 26%, which again falls in the range that's usually expected. There was somewhat higher rates of adverse events, as you might expect, with an mRNA vaccine locally. Any of you have had COVID vaccines know this. But generally, it was safe and without serious adverse events.
Now, it was noninferior - it did reach a noninferiority state against standard vaccine; it is actually superior in some aspects, but for people over 65, it was only approved based on what's called immune bridging. So, they didn't really include that population. But people 65 and older can get it, but there isn't yet the clinical data to - to back it up in terms of outcomes. So, now I'm going to turn the program over to Ravi to talk about how to enhance our abilities to get our patients to receive the flu vaccine.
Integrating New Developments Into Practice
Dr. Jhaveri: All right. Thanks so much, Paul. I really appreciate that - those introductory comments.
So, I'm going to transition a little bit. We're going to talk about integrating new developments into practice.
Office and Pharmacy Administration
So, as I sort of alluded to in some of the comments, I think we need to pivot how we give vaccine. And certainly, over the last decade, we've really seen an expansion of options, particularly commercial pharmacy.
When we think about providing vaccine in other locales, at our institution, for instance, we try to vaccinate patients at any touchpoint within our health system. So, beyond just primary care, that might be in specialty outpatient clinics, it might be in the ED, it might be when they're admitted to the hospital for some other purpose. And actually, even when they're coming for elective surgery and/or under anesthesia.
And so, we have electronic health record prompts, our practice alerts, that we use to identify eligible patients and remind providers.
We have standing orders so that if patients are seen in these, we can have vaccine ordered to try to cut down on the time it takes to vaccinate a patient.
And then the commercial pharmacies, as we've talked about having partnership and access so that patients can receive them.
And then certainly nurse or pharmacist-led vaccine visits again to increase capacity and uptake.
So, when we think about common issues for staff: reviewing updates before peak season. We're at the point where we're about to launch our vaccine program.
We want to communicate and educate our clinical teams about any changes in season affecting implementation.
And then we're constantly updating our workflows, our standing orders, and our communications to make sure that the content is still relevant. Let's say, for some of the in-season differences that Paul alluded to, let's say that come up with variant strains and the like.
Reminder and Recall Systems
So, as we talk about outreach and reminders, we have direct patient contact, where it could be text messages, phone calls. For those within the EHR, there might be EHR messaging and patient portal reminders, as well as emails. I think any of these.
Within the patient portals, we talk about notifications, educational resources, FAQ sheets, and then there might be links to schedule appointments for a vaccine.
And then certainly, if a patient needs to come back for a vaccine, let's say they're seen for a primary care appointment in the late summer, there may be prompts for scheduling that follow-up to - to - to make sure they're vaccinated early in the season before flu starts to circulate.
Home Administration
Let's talk a little bit about home administration. Paul alluded to the fact that this is a fairly new update. Patients now have the ability to order the live-attenuated influenza vaccine for home delivery.
If you meet the eligibility criteria as far as age and lack of any other medical contraindication, you can order vaccine for yourself, for the children in your home. There is a video that teaches you how to give the vaccine. The shipment is made seamless in a cold pack, and provides instructions for giving the vaccine, for documenting vaccine, for returning the used syringe so there can be reconciliation, and also for after vaccine is confirmed to be administered for update of your medical record and also a state registry, perhaps let's say if it's for your children.
So, this is really, I think we've seen since the pandemic, more and more patients are comfortable with getting their medical care at home in various ways. And I think this is just further testimony to steps in that direction.
Ensure Access Through Effective Influenza Vaccine Workflow
So, when we think about how we provide influenza vaccine in the most effective workflow, certainly we can't underemphasize what a strong recommendation from you as healthcare providers means to your patients. Even in the era of social media and influencers and lots of information everywhere, a strong recommendation from healthcare provider is still the single most powerful driver of the decision to vaccinate.
That being said, just because a patient can get vaccine based on insurance coverage, it doesn't mean that they have the ability to easily access vaccine. And so, as we've talked about trying to make sure that patients can receive vaccine in a number of settings and number of ways at a number of times that are convenient to them.
Shared clinical decision-making, I think all of us appreciate that we're always talking with our patients that it's very rare that there's a setting of, I say, and you do. That we're always discussing, we're always recommending. And everything is really a shared decision. And so, we shouldn't make this some sort of checkbox where we both have to testify to shared clinical decision-making. This is already happening.
And really clinical workflows should promote equity. So, we should be reaching out to patients from all backgrounds of all different languages in all different community settings to make sure that everyone has access to vaccine so that we can be equitable in terms of our distribution of vaccine.
Frequently Asked Questions
Okay, let's move through some frequently asked questions.
How to Respond to Common Patient Questions
"My child has an egg allergy. Can they still receive influenza vaccine?" The answer is yes. Your child can safely receive flu vaccine even with an egg allergy. The studies have shown that there's such an infinitesimally small amount of egg protein that it's not a reaction. Okay, so we've made this very simple. This is not a contraindication.
How to Respond to Common Patient Questions
"My child has received their first influenza vaccine last August, eight months ago. Do they have to restart the series?"
No, we're in the same season; eight months later. You just need to give the second dose when you're seeing them in front of you. Okay? And ideally four weeks apart, but again, this scenario, vaccinate them when you're - when they're in front of you.
How to Respond to Common Patient Questions
Am I at risk for Guillain-Barré syndrome? Perhaps, Paul, I'll kick this one over to you.
Dr. Auwaerter: Yeah, sure. You know, I'm old enough. 1976 was the swine flu era. That's ancient history. And the concern really was prominent, now, almost 50 years ago, for influenza vaccine-related Guillain-Barré. The truth of the matter is, it's very hard to divorce trying to understand where Guillain-Barré occurs anyway versus that might be overlapping with a flu shot, which is such a common practice, or influenza itself.
So, really, there's not a contraindication. A lot of people think there's a contraindication if you've had Guillain-Barré. Now, I think a lot of people are so hesitant they don't want to, you know, upset the apple cart, as it were, from a patient perspective. But the risk is really very low and lower than it would be for acquiring the virus itself in stimulating influenza.
So, the only real issue is if you've had a recent history of Guillain-Barré syndrome, because the vaccine might sort of promote or enhance ongoing immune activation that might promulgate the - the - the neurologic condition.
So, because the vaccine risk is very low, and I've had a couple patients in my practice, and granted, you may be going uphill on this one, but I try to convince them, and I'll usually try to use a different formulation. They haven't had, perhaps, a recombinant vaccine or something of that nature, because almost always people have gotten the more common egg-based one. And it may not just be - and I also say the subunit and the components change every year. So, that's another important aspect.
Dr. Jhaveri: All right, I appreciate that. Thanks so much.
"Will the vaccine work for me if I'm immunocompromised?"
So, immunocompromised patients are at high risk for influenza. As we've talked about, vaccination still reduces hospitalization and severe outcomes. As Paul mentioned, we have several different versions of vaccine. And so, having a discussion and looking at your patient's background and medical history. It may be best to give them something like high-dose vaccine. There are emerging data to show that this is a better strategy for our immunocompromised population.
Dr. Auwaerter: Well, can I just add a quick note in the adult population?
Dr. Jhaveri: Yeah. Please, please.
Dr. Auwaerter: So, we know we - for the over-65 set, we have the adjuvant and the high-dose flu vaccine. So, for the past couple of years, for people that are immunosuppressed between 18 and 64 years, you can use those vaccines for someone that's immunosuppressed. An organ transplant patient would be the classic example. So, you can actually use that. Sometimes it's a little bit of an issue when you go to the drugstore to try to get it, because I think pharmacists are aware of it. Sometimes they ask for an attestation, and so on and so forth. But I just want everyone to know you can give people the high-dose vaccine if someone does fall into that immunocompromised category.
Dr. Jhaveri: Yeah. Thanks, Paul. And those studies are underway in children. I suspect we're going to fall in line quickly. The data is very promising, but those studies still have to be completed.
How to Respond to Common Patient Questions: Faculty Discussion
All right. So, let's talk a little bit about some of the other common patient questions. And, Paul, maybe you and I can go back and forth on these.
So, how about vaccine timing? What do you tell your patients when it comes to vaccine timing?
Dr. Auwaerter: Yeah, my - my super motivated patients, I say, "Do it in October." Certainly, you want to do it before early November. You know, Thanksgiving, the holidays, December holidays are prime time for these viruses to wreak havoc during gatherings. September and October. Now is the perfect time, especially if they're in your office. Take advantage of that.
Dr. Jhaveri: Yeah. And I think the other topic that comes up is people try to thread the needle in terms of getting vaccine not too early so that they feel like they have some protection later in the season. And there is some data about waning immunity, but you also risk the idea that if you wait too long, flu starts to circulate and then you get infected before you vaccinate. And so, I think most of us will say, get vaccine when you can get it. And don't worry about being perfect. Vaccine on board, for all the reasons you mentioned in your slides, is more important than trying to perfect some waning immunity later.
Dr. Auwaerter: Perfect. That's right.
Dr. Jhaveri: How about - I'm going to punt this one to you. You already sort of covered it. Preferred vaccines for individuals over 65, the enhanced vaccine.
Dr. Auwaerter: Yeah. Right. So, really the - the ones for the ACIP and CDC, it's going to be Fluzone or the adjuvanted influenza vaccine. Either of those have a very credible studies that show better immune responses and better outcomes.
Dr. Jhaveri: And you - would you include recombinant in that group as well as the enhanced?
Dr. Auwaerter: Certainly, that - that - that looks more promising and has some better immunogenicity, but it's not one of the ones that are specifically targeted for the 65 and over.
Dr. Jhaveri: Okay. I think we covered the fact that pregnant patients need flu vaccine protection, that the H1N1 pandemic in 2009 really showed us just how vulnerable pregnant patients are. That being said, I think our access systems are not as good as they should be. If - if we look at OB providers, they still are not as well equipped. Some are really vaccine advocates, but I think others prefer to - to not do it. And so, I think that very low number in pregnancy is still very much also an access issue. And all of us, I think, need to work to help our patients who are pregnant get their vaccine.
We touched a little bit on immunocompromised, and the idea of high-dose vaccines and other options again, because they're very vulnerable to the worst complications of flu.
Paul, do you want to talk a little bit about the real contraindications to getting flu vaccine?
Dr. Auwaerter: Yeah, it's really the true hypersensitivity to the vaccine and vaccine products, depending on the composition there. I think that's the main one for sure. And - and again, you can often play around with the formulations and move from the recombinant, or now there's mRNA, for example. So, I think we have a lot of options there.
Dr. Jhaveri: Yeah. And for the pediatric providers in the audience, what I would say is we've removed sort of the wording about mild febrile illnesses. I think that was often an excuse that people use to punt vaccine to a future visit. And we realized then that more and more kids were not getting vaccinated. And so, even mild febrile illnesses, it's okay to go ahead and vaccinate if the patient is there in front of you and willing to receive vaccine.
And then, coadministration: I think the vaccines that are given commonly with flu, the studies support the idea that they can all be given in combination. There's not any combo that I'm aware of that has been shown to significantly affect the - the - the antibody and immune responses.
Paul, would you agree?
Dr. Auwaerter: Yeah, completely. For convenience issues, we in our office often give it with the pneumonia vaccines, the pneumococcal vaccines, or RSV, for example, would be some of the common combinations in the fall. Sometimes, you know, people are behind on their Tdap and those sorts of issues. You can get them in the same arm or separate arms. Immune responses tend to be as good. And you don't need to separate it by two weeks. That was sort of older advice. If people do want to space it out, could even be a few days later, but you can also give them simultaneously.
Dr. Jhaveri: Yeah. Perfect. And - and obviously those - several of those are also recommended for pregnancy. And again, the same recommendations. There's no concerns about coadministration. They can be given together.
Key Points
All right. So, let's finish up with our key points.
So, influenza burden remains substantial despite available vaccines. Severe disease continues to occur in healthy adults and children.
Vaccine uptake remains the largest opportunity for improvement.
Newer vaccine formulations, platforms, and administrative options provide choice and options.
And workflow interventions can be as important as vaccine selection in improving outcomes.
Questions?
All right. So, here's where we jump in to try to answer a few of your questions. I see that we've got several in the Q&A here.
All right. So, first question I'll see on the top has to do with the two doses. So, yes, the recommendation is that kids between six months and eight years, if it's their first flu season when they're receiving vaccine, they should get two doses. Now, as I said, we don't do this nearly well enough, But this is the goal. And so, let's say you're seeing a young child and you know that they're coming back in a few months. Please do try to get that second dose as best as you can.
Paul, do you want to take that second question about high-dose vaccination in immunocompromised patients over 65?
Dr. Auwaerter: Yeah. And . . .
Dr. Jhaveri: No, under 65, you said.
Dr. Auwaerter: Yeah, so it's under 65. So, we sort of addressed that. So, between people who are 18 to 64, if they're immunocompromised, can get high-dose or adjuvanted vaccine. And - and - and again, that's a population that's tougher to have an immune response in general. So, the hope - so people do get better immune responses with those two vaccines.
I'll just mention someone put in a question: what's the best vaccine for a healthy 75-year-old? You know - you know, there's none that's really, truly superior in that age range that's been studied yet. I'll just mention that the recombinant and the - the mRNA vaccines may have more T-cell as well as B-cell responses. Whether that translates into better outcomes, I think is remains to be seen. So, I don't think anyone can say what's really best. I would just say you could easily just stick to the adjuvanted or the high-dose flu vaccine.
There is a question about: are we seeing improved vaccination rates with home administration? We don't have the data yet on numbers. I did highlight that I was just at the flu meeting, the Options flu meeting last week, and there was some data about the early experience with this program. And some of the provocative findings were that adults who ordered vaccine very frequently were ordering multiples for children in their home. And so, some of the intended improved access was happening. And people generally were satisfied with the option.
So, should we increase awareness? Yes. If you feel that that's an option that patients would appreciate, giving them the information so that they are aware is - can only help the situation.
Dr. Auwaerter: And Ravi, there's one question here. I think maybe we can wrap up with this one. One person said, I, you know, I always feel, you know, terrible after I get a flu shot, especially with the H1N1, the pandemic component. And, you know, a lot of people feel like, "Oh, I get the flu shot. It gives me the flu." And certainly, people can have a pretty vigorous immune reaction for a day or two. Can be moderated with acetaminophen or even ibuprofen, if necessary, but it's usually not as bad as you getting the actual influenza infection.
So, I'd say that's not uncommon. And, you know, then I sort of tell people, "Well, you know, you may want to just sort of time it when you don't really want to feel too bad for a day or two," but it's better than feeling awful, got awful, for five days or seven days.
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