Respiratory Virus Vaccines: A Q&A With AAFP President Steven Furr, MD

_{Image courtesy of the American Academy of Family Physicians}

In light of the US Food and Drug Administration’s August 22, 2024, decision to approve and grant emergency use authorization for updated mRNA COVID-19 vaccines for this upcoming respiratory virus season, Patient Care Online wanted to highlight a recent interview with Steven Furr, MD, president of the American Academy of Family Physicians (AAFP). Dr Furr, who also cofounded Family Medical Clinic of Jackson in Alabama, sat down with Patient Care to discuss vaccine coverage decreasing in kindergarten-aged children, how clinicians can combat vaccine hesitancy, key changes in recommendations for adult vaccination, and more.

The following transcript has been edited for clarity and brevity.

Patient Care Online: According to the US Centers for Disease Control and Prevention (CDC), vaccination coverage among kindergarten students decreased from approximately 95% during the 2019-2020 school year to 93% during 2022-2023. In your opinion, why did coverage decline and how can primary care clinicians ensure more kindergarten-aged children receive the recommended immunizations this year?

Steven Furr, MD: Part of that is the effect of the COVID-19 pandemic and the fact that a lot of kids got out of the routine of going in for their yearly well-child visits. In our clinic, a lot of times children come in for a sick visit. If they're just in because of an earache or something else and they don't have a high fever, we'll say to them, "do you want to go ahead and get your immunizations while you're here?" You can't always rely on them coming in for a well visit.

PCO: According to the CDC, there have been 203 reported cases of measles as of August 1st in the US. The majority (86%) of cases are among unvaccinated individuals. Upticks like this in measles cases appear to be more frequent now. Do AAFP members have thoughts on what might be causing the increase? How can clinicians ensure patients are up-to-date on their measles vaccination?

Dr Furr: As you mentioned, the reason for the increase is the number of people who are unvaccinated, they are just not getting their vaccinations. We're so dependent on herd immunity, but people don't understand that when you vaccinate yourself or your child, you're not only protecting them, but you’re also protecting all the people around you. When patients come in, it is important to check their immunization profile to see if they're up to date. If not, bring it to their attention at their visit. We've been fortunate, we've lived in a time where vaccinations have been available for whole groups of diseases we don't see anymore. People have forgotten how deadly those diseases were. Growing up, my grandmother had polio and she had a weakened leg because of that. When I came along and was first practicing, there was an infection called haemophilus influenza. Well, we've got a vaccine for that, and we never see those cases anymore. We used to see children with meningitis and horrible epiglottitis. We never see that anymore due to the vaccinations.

PCO: There is still a lot of concern about the surge in vaccine hesitancy and misinformation that came along with the COVID pandemic. Do you feel as though the situation has improved as we move farther away from the public health emergency?

Dr Furr: There's still a lot of misunderstanding because there's so much that has changed. There are additional vaccines and new vaccines, such as the RSV vaccine. To tell you the truth, people are kind of confused and lost track, even us physicians, trying to keep up with the recommendations. One recommendation, RSV, changed this year. It's important for patients to see their primary care physician so they can help them understand what vaccines they need, and whether it is time to get a COVID-19 vaccine booster. Some of the vaccine hesitancy is a lack of understanding of [which] vaccines are needed. In fact, patients can get multiple vaccines at once. They can get their influenza vaccine, COVID-19 vaccine, and RSV vaccine (if due), all at the same time.

PCO: How should family physicians and other primary care clinicians continue to address vaccine hesitancy and misinformation among patients and families?

Dr Furr: There was a recent study that showed the main reason people don't get vaccinated is because their physician didn't suggest it to them. Often, physicians don't wait for the patient to come in and say, "I'm here to get this vaccine." When they're there for a well visit or to get their blood pressure or diabetes checked, you look in their record and tell them they are due for a COVID-19 or influenza vaccine. You want to get it done while the patient is there. Often, if you suggest it, they will agree to do it. In fact, about one-quarter of the vaccinations I give are not for the patient I am seeing, but for their spouse who is there with them. For example, a husband came in for a visit and I said to his wife, "he's going to get his flu vaccine today, do you want to get yours too?" She said, "yeah, let's go ahead and do it while we're here." It's just a matter of asking.

PCO: Shifting gears to adults, what do you feel are the most important changes in recommendations for adult vaccination as we head into the respiratory virus season?

Dr Furr: For [a few] years, there has not been a huge uptick in COVID-19 cases, so people have forgotten that they actually need to get a vaccine and booster each year. That is going to be the recommendation going forward, so we're going to encourage them when they come in for their influenza vaccine, to get their COVID-19 vaccine at the same time. All the influenza vaccines now are trivalent, and the COVID-19 vaccines should help protect against strains going forward. The other new recommendation is that patients 75 years or older should get an RSV vaccine, which is a 1-time vaccine. At this stage, there's no recommendations to get subsequent vaccines. They can receive all 3 vaccines at once or 2 vaccines one day and the third either a day or a week later. The other recommendation for the RSV vaccine is that people aged 60 to 74 years who are at a higher risk for severe RSV—including those who are immunocompromised or with diabetes, chronic kidney disease, and COPD or asthma—should receive [the RSV] vaccine, even though they are not 75 years and older.

To watch the full interview with Dr Furr, please click here.