After last challenging flu season, Johnson County Public Health prepares for changes to COVID-19, flu vaccinations

CEDAR RAPIDS — The beginning of fall means back to school, cooling temperatures and the start of respiratory illness season — influenza, COVID-19 and RSV.

But this season also is bringing a flurry of changes. This year, COVID-19 vaccines come with new restrictions from the U.S. Food and Drug Administration, and flu vaccines are being produced without thimerosal as vaccine skeptic Robert F. Kennedy Jr. leads the U.S. Department of Health and Human Services.

Danielle Pettit-Majewski, director of Johnson County Public Health since 2021, spoke with The Gazette recently to offer clarity on the changes and guidance for those trying to keep their families healthy over the next several months as respiratory illnesses spike.

This interview has been edited for length and clarity.

“Whatever doesn't kill you mutates and tries again. That’s why it’s so important for as many people as possible to get (vaccinations.)”

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Q: Last year seemed to bring a challenging flu season. Are you anticipating any similar challenges this fall and winter?

A: What we saw last year was a really low uptake in seasonal influenza (vaccines). I think we had about 40 percent of folks get their seasonal influenza vaccine. Seasonal influenza on its own kills thousands of people every year.

So the concern we have with that is just the impact that it has to our health care resources and the impact that it has on health outcomes. So we always want to encourage folks to get vaccinated for flu if they are eligible to do so.

By Aug. 23, 278 flu-associated pediatric deaths occurred (in the United States) during the last flu season, 2024 to 2025. This is the highest number of pediatric deaths reported in any non-pandemic flu season since flu-related deaths in children became reportable in 2004.

Ninety percent of reported pediatric deaths this season have occurred in children who were not fully vaccinated against flu.

I do just want to stress, because this last season was so awful for pediatric deaths: Even if your child is healthy, flu can kill them. I don’t say that to fear-monger. It’s just a reality.

The other thing that we have to be concerned about with seasonal influenza is that if you have a high level of seasonal influenza, there is an increased risk of getting another highly pathogenic avian influenza. Because when you have high levels of seasonal flu, and then you have either avian flu or other types of flu in animals, it increases the chance that both diseases can be in one host and then make a human-to-human transmission of an avian influenza.

Even if you still get sick … (a vaccine) is going to keep you out of the hospital, it’s going to keep you out of the doctor’s office. It’s going to maybe make sure that you can recuperate at home.

The more people who get vaccinated, the less likely we (are to) see the damages from flu get throughout community.

Q: How do you think this year will compare to previous years?

A: It's too soon for us to make a determination. There's been a lot of things happening.

I think that we need to do everything that we can to protect ourselves from flu being really bad. And if we have an opportunity to get vaccinated against (respiratory illnesses) we should take it.

We have tools in our toolbox. There are things that are in our locus of control.

It’s a good tool to have in our toolbox that can help prevent either costly hospital stays, time out of school, or time out of work.

Q: For many, vaccinations have become very familiar. Do you think people tend to forget their value as a public health tool?

A: Oh my goodness, yes, I do.

I say a lot that we don't have the institutional memory to think about life before vaccines. And I think about this a lot in terms of during the pandemic, when we had the COVID vaccine, and we were first scheduling mass vaccine clinics — just talking to my elderly neighbors, who are in their 80s.

(I was preparing myself to address their concerns) and they didn't (have any). They remembered polio. They remembered a life before their children had these vaccines, before they had these vaccines. They remember people not surviving some of these diseases that we don't worry about now.

They wanted to live. They did not want to go to the hospital. They did not want this to impact their health any more than it would already.

Seat belts and speed limits are kind of like vaccines. You wear your seat belt to protect yourself, but you also follow speed limits on the roads to protect yourself and to protect others.

No vaccine is perfect, but it still helps with anything that we can do to reduce our disease burden.

Q: The latest COVID-19 boosters were released recently. Tell us about this year's latest vaccination updates.

A: Yes, and the (Advisory Committee on Immunization Practices) will meet (this) week to do the final sign-off (on recommendations for vaccines).

There’s been a lot of confusion around the COVID vaccine. The updated vaccine formula is targeting two omicron subvariants. You have two mRNA vaccines — Moderna or Pfizer — or a protein-based vaccine, Novavax.

Q: Are the new formulations of COVID-19 boosters, which target omicron subvariants, expected to offer better protection this year?

A: Currently, those are the subvariants that are circulating.

There’s two schools of thought. It’s going to give about 30 to 60 percent protection against illness and severe disease.

What unfortunately happens is, the more disease you have, the more opportunity there is for those viruses to mutate. So the more it mutates, the less effective the vaccine is, because it keeps changing.

Whatever doesn't kill you mutates and tries again. That’s why it’s so important for as many people as possible to get (vaccinations.)

Q: Who is eligible for the COVID-19 booster?

(The Food and Drug Administration has imposed new restrictions on who is eligible to get the COVID-19 vaccine. Primarily, patients must 65 or older, or have qualifying health conditions. Patients may also be prescribed COVID-19 boosters by their health care providers.)

A: All children 6 to 23 months are eligible for vaccines. Any child 2 to 17 years are eligible for vaccines if they have risk factors or if their parents desire vaccination. So you can have that conversation with your provider. I know I am a parent of a daughter who will almost be 3, and she's absolutely getting her COVID vaccine, because I want to make sure that she is protected.

Pregnant women are also eligible, and adults are eligible if they have an underlying health condition. Most adults qualify for the underlying health condition — pregnant people, people with diabetes, a disability, being overweight or obese, cancer, a mental health condition.

The list will likely be changed during the ACIP meeting, but right now, that’s where those recommendations are.

Unfortunately, these guidelines make it just a little bit more confusing, but the science has not changed.

Q: Why are these guidelines changing?

A: Because we have a U.S. Health and Human Services secretary who put in a new ACIP committee. There were 17 members of the ACIP committee who were removed, and our new Health and Human Services secretary put in new individuals with different thoughts.

Q: Most adults now will be required to attest they have a qualifying condition to receive a COVID-19 booster. Are you expecting that to inhibit the uptake?

A: It certainly concerns me.

One of the things that we want to ensure is that there are no barriers to vaccination. Anything that removes that barrier improves public health.

So I do have concerns that the extra barrier is going to make people think, “well, I don't qualify.” ... I do think all of the confusion around eligibility and criteria is going to be a deterrent.

Q: Who is eligible for an RSV or flu vaccine?

A: The RSV vaccine is for older adults — that is all adults 75 and above, and adults 50 to 74 with risk factors. They should get one lifetime dose of an RSV vaccine, and that reduces the risk of severe disease by 82 to 86 percent, so protection is durable.

If you are 32 to 36 weeks pregnant during September to January, you’re going to be offered the RSV vaccine while you’re pregnant.

There’s also a monoclonal RSV antibody for infants. This doesn’t teach the body to make antibodies, but rather it’s a medication that provides antibodies (for) all infants younger than 8 months and children 8 to 19 months with a risk factor if their mom didn’t receive the vaccine during pregnancy.

That reduces the risk of hospitalization by 80 to 96 percent and is typically offered between October and March.

Q: What is the expected efficacy rate for flu vaccines?

A: Usually, year over year, it’s between 40 percent and 60 percent.

Q: Does the timing of when someone gets their vaccine or booster matter? Is there such a thing as getting your flu shot too early in the fall?

A: If you’ve had active COVID within the last 6 months, wait until it’s been six months (before getting) your booster.

We’ll probably see another wave around November. You want to get it ahead of that, probably about (at least) two weeks. Give your body time to build up some antibodies.

We always say “flu before boo.” Get it before Halloween. That’s typically a good rule of thumb.

Having (vaccines) especially before the holidays is going to be beneficial.

Q: Aside from vaccinations, what are some of the best things folks can do to keep their families healthy over the coming months?

A: If you’re sick, stay home. That’s the best thing you can do, because then you're not going to spread it to other people.

Wash your hands, don't touch your face, cover your cough. Those types of things are always helpful.

Also, if you're going to be in large group settings, or you're going to be traveling, masking is still a great way to protect yourself from getting sick. You know, there's a reason why we saw such a slow flu season during the COVID pandemic, when more people were masking. It's because (masks) work.

So if you're going to be in a large area with lots of people, if you're going to be on a plane, I would still put on a mask.

These are just the truisms of how to prevent respiratory illness.

Q: How can people stay up to date on the latest information?

A: There's lots of information in the news and lots of information coming out from the Health and Human Services secretary or ACIP and the (U.S. Centers for Disease Control and Prevention), but remember also to talk to your provider, talk to your doctor, talk to your local public health if you have questions.

We're still going to talk to you about the science. We're still going to talk to you about what's in the best interest of your family, and how to keep yourself healthy.

It is confusing. There's lots of information, so talk to those trusted health professionals who are going to be able to give you accurate information with the science and to help you make a decision to stay healthy.

You can always call the health department. We are always going to be a good resource for you around immunizations.

But I do always just want to remind people that your provider knows you, understands your health history, is going to give you a good recommendation for questions. (Choose) that over what you might see on TikTok, what you might see on social media misinformation.

Comments: (319) 398-8340 or elijah.decious@thegazette.com.