Florida has country's worst adult flu shot vaccination rate in 2022

Just in time for the start of another flu season, Florida's adult flu vaccination rate has hit rock bottom.

The Sunshine State ranked 51st in that category of WalletHub's annual States that Vaccinate the Most report, which included the District of Columbia and assessed 17 medical metrics.

Florida completed its journey to the bottom of the list, down from 50th in 2021 and 49th in 2020. The state in 2022 had half the adult flu vaccination rate of Rhode Island, which topped the list.

"There is a lot of supply, we just don't have a very big demand," said Dr. Julia Fashner, a family medicine physician at HCA Florida St. Lucie Medical Specialists in Port St. Lucie. "It's still important to get flu shots. It's our way to prevent the flu."

Without the mandatory immunizations often required of children for school and sports, adults tend to be behind schedule on their vaccinations, Fashner said, such as those for flu, pneumonia and shingles. In addition, the coronavirus pandemic has caused some people to neglect routine appointments with their primary care physicians, during which they'd catch up on their shots.

Widespread hesitancy to receive the COVID-19 vaccine and boosters hasn't helped. Over 3.1 million adults 20 and older statewide, about 18%, were unvaccinated as of Oct. 6, Florida Department of Health records show. Among Florida adults 18 and older who were fully vaccinated, over 7.4 million, or 55%, hadn't received any booster shots, according to the Centers for Disease Control and Prevention.

Florida ranked 49th overall in the WalletHub report with a score of 32.04, ahead of Oklahoma (31.99) and Mississippi (18.13). All six New England states were among the country's most vaccinated:

Massachusetts (83.67)

Vermont (80.51)

New Hampshire (75.46)

Rhode Island (74.87)

Maine (73.33)

Connecticut (70.81)

For vaccination rates by age, Florida ranked 50th among adults and the elderly, and 47th among children and teenagers. It ranked 48th in share of adults with a tetanus vaccination and tied Illinois for 47th in share of adults 60 and older with a zoster (shingles) vaccination.

The fallout from Hurricane Ian may further tarnish Florida's immunization status, Fashner said.

"In the areas that got hit, there's other things that have priority," she said.

Martin, Indian River among highest 2021-22 flu activity

Florida's past two flu seasons have been relatively mild, in large part due to the coronavirus. The 2020-21 season coincided with the infancy of the pandemic, when many people wore masks and practiced social distancing, thus preventing the spread of the influenza virus.

The most recent flu season, which the health department classified Oct. 3, 2021, through May 21, 2022, was expected to be worse, as COVID-19 restrictions were lifted and people resumed their pre-pandemic routines. The onset of the omicron variant of SARS-CoV-2, however, prompted people to put their guards up once again.

"The safer thing is to always wear a mask. I think that's why flu has been better — less often diagnosed — these past couple of years," Fashner said. "It will be interesting how it goes with mask-wearing this fall."

No vaccine is 100% effective, but getting immunized is an even more reliable method of protecting yourself and others from infection, Fashner said.

And while there's no wrong time to get a flu shot, the earlier the better. Past health department campaigns have encouraged people to get their flu "vaccine before Halloween." The body takes at least two weeks after inoculation to attain immunity.

Despite the 2021-22 flu season's comparative quiet, it came to a formal end with more activity on the Treasure Coast than in most of the state. The health department reported the following flu activity the week ending May 21:

None (9 counties)

Mild (53)

Moderate (4)

Elevated (1)

Polk was the lone county with elevated flu activity. Of the four with moderate activity, half were on the Treasure Coast: Martin and Indian River along with Manatee and Pinellas.

Martin and Indian River also were among the 30 counties where flu activity was increasing. St. Lucie recorded mild, plateauing activity.

Only three of Florida's 67 counties endured five or more outbreaks of the flu or influenza-like illnesses throughout the season: Martin, Pasco and Pinellas. St. Lucie and Indian River had none.

Nationwide, the 2021-22 flu season spurred 9 million illnesses, 4 million medical visits, 100,000 hospitalizations and 5,000 deaths, according to preliminary CDC estimates — the lowest since the 2011-12 season.

"A milder season is still impactful, still causing significant morbidity," said Dr. Richard Rothman, chief medical operations officer for Cleveland Clinic Florida. "As we look into what the cumulative burden of flu will be in 2023, I think our goal should be to try to minimize it."

CDC: 2022-23 flu season

showing early activity

Sporadic flu outbreaks are to be expected between seasons, according to the health department, and the Treasure Coast was no exception over the summer. Martin was one of five counties to experience three to four off-season outbreaks of flu and related illnesses between May 21 and Sept. 24, reports the agency's Florida Flu Review.

During the two weeks ending Sept. 24, still technically considered part of the 2021-22 flu season, disease activity increased and was "higher than expected levels for this time of year," the report stated. The percentage of emergency department visits during which patients were discharged with a flu diagnosis also increased and was higher than the three-year average for the 2018-21 seasons.

These trends are being reflected nationally. The 2022-23 flu season kicked off Oct. 2, and already the CDC has reported early increases of illness, which are highest in the southeast and south central U.S. Activity remains relatively low but could indicate an early start to flu season, according to the agency.

Everyone 6 months and older should receive an annual flu shot, the CDC recommends. That's because the vaccines are formulated differently each year, based in part on strains circulating in the Southern Hemisphere, which experiences flu season first.

The flu vaccine "particularly reduces the chance that a person will be hospitalized or end up in the intensive care unit," said Dr. Mary Jo Trepka, a professor at Florida International University. "Influenza is a much more serious illness than the common cold."

At least four Florida children died from the flu last season, according to the health department. Though the agency isn't required to report adult flu deaths in real time, it does publish combined deaths from flu and pneumonia, which can be triggered by the flu. In 2020, nearly 3,200 people died from the flu and pneumonia statewide, 95 of whom lived on the Treasure Coast.

"Other serious complications of influenza include inflammation of the heart (myocarditis) or brain (encephalitis)," said Trepka, chair of the epidemiology department at FIU's Robert Stempel College of Public Health and Social Work. "Ear infections and sinus infections are also complications."

Flu shots are available at pharmacies, grocery stores, urgent care clinics, community health centers and more. To find one near you, go to vaccines.gov. The vaccine may be free depending on your insurance. If you don't have insurance, visit your county health department office.

Lindsey Leake is TCPalm's projects reporter. Call her at 772-529-5378 or email her at [email protected].