Boston Public Health Commission Issues Flu Advisory to Providers

BOSTON—December 15, 2022—The Boston Public Health Commission (BPHC) issued an advisory to Boston health care providers alerting them about concerning levels of flu activity during the early stage of flu season, as well as the slow uptake of flu vaccinations and COVID-19 boosters.  

BPHC is urging providers to apply the CDC’s Health Advisory Network (HAN) recommendations to address increased respiratory virus activity and to mitigate severe strain on the healthcare system. The recommendations call for COVID-19 and flu vaccination to prevent the spread of both illnesses; diagnostic testing to guide treatment and clinical management; treatment protocols for confirmed and suspected cases of COVID-19 and flu; and proactive messaging that supports public health outcomes to raise awareness about the current flu season.  

“The best way to avoid getting sick with the flu and to reduce your risk of severe infection is getting your annual flu shot. Now that the holidays are here, taking this important, yet simple step is vital for protecting yourself and others when celebrating with friends and family,” said Dr. Bisola Ojikutu, Commissioner of Public Health and Executive Director of the Boston Public Health Commission. “Everybody 6-months and older should get their flu vaccination as soon as possible.”  

The Boston Public Health Commission has set up several standing sites in communities throughout the city to make it quick and convenient for residents to get their annual flu shots, COVID-19 vaccines and boosters, and COVID-19 testing. All services are free for individuals ages 6-months and older, with no appointments or IDs required: 

• BCYF Hyde Park, 1179 River St., Hyde Park. 
  • Open Tuesdays from 12-8pm and Thursdays from 7am-3pm. 
• Lena Park Community Development Corporation, 150 American Legion Hwy., Dorchester. 
  • Open Sundays from 10am-2pm; Mondays from 9:30am-5:30 pm; Wednesdays from 12-7pm; and Fridays from 9:30am-5:30 pm 
• Josephine Fiorentino Community Center, 123 Antwerp St. 
  • Open Sundays from 12-4pm; Mondays through Wednesdays from 9am-3pm; and Thursdays from 5-9pm. 

• Bruce C. Bolling Building, 2302 Washington St., Roxbury. 
  • Open Tuesdays-Saturdays from 12-8pm. 
• Boston City Hall, Haymarket Room 240 (2nd floor), 1 City Hall Sq., Boston.  
  • Open Mondays from 7am-1pm and Wednesdays from 12-5pm.  

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 TO: Boston healthcare providers 

FROM: Bisola Ojikutu, Commissioner of Public Health for the City of Boston, Executive Director, BPHC 

Sarimer Sánchez, MD MPH Medical Director, Infectious Diseases Bureau, BPHC 

Public Health Advisory: Influenza activity in the City of Boston, 12/12/2022 

• As of December 3, 2022, a total of 1784 positive influenza results (PCR or Viral Culture) have been reported to the Boston Public Health Commission via MAVEN since October 1, 2022. Current counts of influenza do not include results from influenza rapid antigen testing, which has been reported in prior years.
• During the week of 12/2/2022, a total of 740 flu positive results were reported among Boston residents. This constitutes a rapidly rising level of flu activity at an earlier stage in the flu season than prior seasons.  
• Influenza-like illness (ILI) activity has remained very high across Massachusetts. For the week ending in December 2, 2022, 5.5% of visits to Boston Emergency Departments were attributed to ILI, which is defined as “fever (temperature of 100 degrees Fahrenheit or greater) in addition to cough and/or sore throat.” Last year, the % of ILI ED visits in Boston peaked at 3.7%. It is unclear how % ILI ED visits will continue to correlate with influenza activity given the possible confounding effect of COVID-19 and COVID-19-like illness (CLI).  
• Flu activity is higher among the following age, neighborhood, and demographic groups in Boston (see Figures 1, 2, and Table 1): 
• Children and teens under the age of 18 constitute 59% of all reported results, with 
  • 289 cases reported among infants and children <5 years old (16%) 
  • 762 cases reported among children and teens 5-17 years old (43%) 
• Black (34%) and Latinx/Hispanic residents (19%) comprise 53% of all reported results 
  • Black (39%) and Latinx/Hispanic (31%) residents comprise 70% of individuals 45-64 with reported results 
• Boston’s neighborhoods most disproportionately impacted by influenza include: Dorchester (02121, 02125), Dorchester (02122, 02124), Roxbury (02119, 02120), and Hyde Park  
• The estimated % of Massachusetts residents who have received an influenza vaccine this season is 38%.   
• The estimated % of Boston residents who have received any COVID-19 booster is 49.2%. The % of Boston residents who have received a bivalent COVID-19 booster is 11.8%. 

The Boston Public Health Commission wants to alert healthcare providers to this concerning level of flu activity, which is rising rapidly at an early stage of the flu season, as well as the slow vaccination uptake for COVID-19 boosters and influenza vaccination. We urge our Boston providers to apply the following recommendations, including from the CDC’s Health Advisory Network (HAN)  to address increased respiratory virus activity and mitigate severe healthcare outcomes and strain, particularly in these populations disproportionately impacted. Furthermore, given the importance of prompt initiation of treatments to mitigate severe outcomes and of influenza vaccines and COVID-19 boosters, we recommend additional strategies to increase awareness of these treatments and vaccines, especially among those at higher risk for COVID-19 and/or flu: 

• COVID-19 and Flu Vaccinations: 
  • Strongly recommend and offer vaccinations against influenza and COVID-19 for all eligible persons aged 6 months or older, and consider use of reminders across healthcare practices as well as data visualization and automated EMR tools to identify and address gaps in influenza and COVID-19 vaccination coverage; 
• Diagnostic testing  
  • Use diagnostic testing to guide treatment and clinical management for patients with suspected respiratory virus infections, particularly those at high risk for severe outcomes; 
• Support public health messaging around the severe nature of this flu season and rising rates of COVID-19 and encourage anticipatory planning and messaging for those at higher risk to test if they feel ill and have compatible symptoms, to report positive results, and to have a treatment plan for COVID-19 and/or flu, if eligible 
  • Co-infection with influenza A or B viruses and SARS-CoV-2 can occur and should be considered, particularly in hospitalized patients with severe respiratory disease 
• Treatment: 
  • Antiviral treatment is recommended as soon as possible for any patient with suspected or confirmed influenza who is hospitalized, has severe, complicated, or progressive illness; or who is at higher risk for flu, including adults 65 years and older, children younger than 2 years, and individuals with certain medical conditions according to CDC guidance.  
  • Treat outpatients and hospitalized patients with confirmed SARS-CoV-2 infection who are at increased risk for severe illness and meet age- and weight-eligibility requirement. Recent CDC data demonstrated that adults prescribed Paxlovid within 5 days of diagnosis had a 51% lower hospitalization rate within 30 days after diagnosis than those who were not prescribed Paxlovid, highlighting the benefits of prompt treatment to mitigate healthcare strain and adverse outcomes (Shah, 2022). 
  • Consider use of EMR tools to identify patients at higher risk for COVID-19 and/or flu who test positive and prompt providers to offer treatment if eligible and clinically appropriate; 
• Messaging: 
  • Support public health messaging around the severe nature of the current flu season and rising rates of COVID-19, including the need to stay home if sick, follow respiratory etiquette, including to mask while indoors if experiencing symptoms, and to get an annual flu shot 
  • Consider proactive messaging for those at higher risk to test and to call their provider as soon as possible if they have acute respiratory illness symptoms (with or without fever) for consideration of infection with influenza A or B viruses (and early antiviral treatment), SARS-CoV-2, and other respiratory pathogens, and to have a plan to request and obtain treatments, if they test positive 

The Boston Public Health Commission is offering free, walk-in COVID-19 testing as well as COVID-19 and influenza vaccinations for individuals of all ages (NO insurance or ID is needed) at: 

• BCYF Hyde Park, 1179 River St., Hyde Park.   
  • Open Tuesdays from 12-8 pm and Thursdays from 7 am-3 pm.  
• Lena Park Community Development Corporation, 150 American Legion Hwy., Dorchester.  
  • Open Sundays from 10 am-2 pm; Mondays from 9:30 am-5:30 pm; Wednesdays from 12-7 pm; and Fridays from 9:30 am-5:30 pm  

• Josephine Fiorentino Community Center, 123 Antwerp St.  
  • Open Sundays from 12-4pm; Mondays through Wednesdays from 9am-3pm; and Thursdays from 5-9pm.   
• Bruce C. Bolling Building, 2302 Washington St., Roxbury.   
  • Open Tuesdays-Saturdays from 12-8pm.  

• Boston City Hall, Haymarket Room 240 (2nd floor), 1 City Hall Square 
  • Monday: 7:00 a.m. – 1:00 p.m.  
  • Wednesday: 12:00 – 5:00 p.m.  

For questions, please call the Infectious Diseases Bureau at 617-534-5611. 

Figure 1. Weekly reported influenza positive results among Boston residents and % ILI ED Visits

Table 1. Characteristics of Reported Influenza Cases*, by Age Range, Boston, 2022

  Figure 2. Case rates by neighborhood of reported influenza positive results in Boston residents, 2022

References: 

CDC, “Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Professionals” https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html 

CDC, “People at Higher Risk of Flu Complications”, https://www.cdc.gov/flu/highrisk/index.htm 

CDC Health Alert Network, “Increased Respiratory Virus Activity, Especially Among Children, Early in the 2022-2023 Fall and Winter,” CDCHAN-00479, November 04, 2022, https://emergency.cdc.gov/han/2022/han00479.asp 

Data obtained from National Syndromic Surveillance Program data for Boston Emergency Departments, (downloaded December 7, 2022) for ILI*; Massachusetts Department of Public Health, Massachusetts Virtual Epidemiologic Network (downloaded November 22, 2022) for influenza positive results. 

Shah MM, Joyce B, Plumb ID, et al. Paxlovid Associated with Decreased Hospitalization Rate Among Adults with COVID-19 — United States, April–September 2022. MMWR Morb Mortal Wkly Rep 2022;71:1531–1537. DOI: http://dx.doi.org/10.15585/mmwr.mm7148e2 

 

Weekly Flu Report, Massachusetts Department of Public Health, Bureau of Infectious Diseases and Laboratory Sciences, Weekly Flu Report | Mass.gov, accessed December 12, 2022