As the Australian winter draws to a close, the flu season has been one of the most severe. The NHS is therefore prepared to vaccinate against several strains and up to 30 million people.
Last week I wrote about a possible cure for the common cold but this week we are revisiting the flu vaccine and there are very good reasons why. In an unprecedented move the NHS is rolling out the flu vaccine to about 30 million people. All primary school children, over-65s, pregnant women and those with existing illnesses will even be offered the vaccine for free. This is an ambitious move as during the previous winter the flu vaccine uptake was far from complete. Figures estimated that there was an uptake of 72.6% in 65+ year olds and 68.7% in healthcare workers.
So why is this year such an exceptional year?
In Winter 2019-20 the Flu Epidemic was Concern in the Southern Hemisphere
As the winter in the Southern Hemisphere draws to a close and ours begins predictions are not looking particularly optimistic. The Australian flu season not only started very early but was also comparatively severe. So far in 2019, there have been at least 135,952 cases Down Under, compared with an average of 17,349 in the previous five years.
Nick Scriven, the President of the Society for Acute Medicine, said the Australian figures “make grim reading and, if extrapolated to the UK, will cause major stress to an already overburdened system in terms of numbers if not severity”. He added: “One concern is that last year we saw predominantly one strain of influenzas but already there are reports of two or three strains significantly circulating in the population that could complicate vaccination.” It is therefore better to be prepared and have the flu vaccine.
Certainly, the NHS think so. England’s deputy chief medical officer, Prof Jonathan van Tam, said there had been “robust” planning put in place and he was confident there would not be any problems for those who chose to be vaccinated.
Figure 1. Per cent of calls to Healthdirect related to ILI, Australia, 1 January 2014 to 22 September 2019, by month and week of call.
In 2017 Australia had its worst flu outbreak for 20 years, this unfortunately translated to the Northern Hemisphere and in America for example there were an estimated 79,000 flu related mortalities that season (one of the worst in modern American memory). This year’s Australian outbreak began in April, two months earlier than usual, and persisted into October as the graph above demonstrates.
Specifically, in Australia direct comparisons between 2017 and 2019 mortality rates are difficult, because Australia counts only deaths in which a hospital declares influenza the key cause. This is said bearing in mind that flu triggers even more deaths from pneumonia, sepsis, heart attack and other illnesses. Despite what happened in 2017 in Australia and America only moderate levels of influenza activity were seen in the community in the UK that year, so there isn’t always a correspondence. However generally in the UK that year the health impact was predominantly seen in older adults, with increased numbers of care home outbreaks and excess mortality seen particularly in the 65+ year old age range. There was a high number of peak admissions of influenza to both hospital, high dependency units (HDU) and intensive care units (ICU) compared to previous six years. So, this why the NHS is targeting older age groups especially in 2019.
Misconceptions About the Flu Vaccine
There are some common misconceptions about having flu vaccines. Flu vaccines cannot cause flu illness. Flu vaccines given with a needle are currently made in two ways: the vaccine is made either with a) flu viruses that have been ‘inactivated’ (killed) and that therefore are not infectious, or b) using only a single gene from a flu virus (as opposed to the full virus) in order to produce an immune response without causing infection. Having said that some people report having mild reactions to flu vaccination. The most common side effects from flu vaccines are soreness, redness, tenderness or swelling where the shot was given. Low-grade fever, headache and muscle aches also may occur. If these reactions occur, they usually begin soon after the shot and last 1-2 days. In randomized, blinded studies, where some people get inactivated flu shots and others get salt-water shots, the only differences in symptoms was increased soreness in the arm and redness at the injection site among people who got the flu shot. There were no differences in terms of body aches, fever, cough, runny nose or sore throat.
Another significant point is that the government said it was confident the flu campaign would not be disrupted by a possible no-deal BREXIT. Manufacturers have been asked to ensure all supplies are in the UK by 31st October, when the UK is set to leave the EU. Currently, only one supplier (Sanofi) has indicated this deadline will be missed. Sanofi added it had contingency plans in place in case of problems using the Dover port – and was prepared to fly the doses in if necessary. Ministers have also ordered extra supplies from another manufacturer in case of difficulties.
