The best protection against the 2018 flu season is to get the vaccine
Professor William Rawlinson, Senior Medical Virologist with NSW Health Pathology, looks back on influenza in 2017 and discusses what we can expect in from the flu season this year:
“2017 was a year with the highest level of flu cases that we’ve had in the last five years. In NSW, we had almost twice as many outbreaks reported, when compared to 2016. When we look at the levels of flu, we’re talking about it in terms of total numbers and the numbers of outbreaks, all of the figures were up last year.”
“Almost two thirds of outbreaks were the H3 sub-type (A/H3 type) and yet, this is something we have been seeing causing infections globally for over 30 years. Unfortunately, the A/H3 component of the 2017 vaccine didn’t match the circulating wild virus very well and, although that may have contributed to the increase in infections, it’s extremely unlikely that this was the only cause, as every year other factors such as mass gatherings, the weather, co-circulating viruses and unexpected events contribute.”
Prof Rawlinson explains that Australia is not seeing a rise in the cases of influenza year on year. In fact 2016 was a very quiet year.
“What we typically see is a busy year, followed by a quieter year, probably because there’s a lot of population immunity, especially evident for the B strains. I attended an influenza meeting earlier this week, discussing the summary of the 2017 season and the planning for 2018. Part of this is assessing how the vaccines can be optimised and how we can protect the population who are most at risk, such as the elderly, people of any age with underlying conditions such as diabetes, asthma, cancer and heart disease, and pregnant women.”
“The importance of vaccinating people in institutions such as nursing homes, both those who live there and health care professionals, and how best we can vaccinate the elderly, are all critical to the discussion in order to reduce the number of outbreaks. Health care workers’ vaccination rates are only 30-40%. It is vitally important that we increase this rate Australia-wide and encourage health care professionals to get yearly vaccine, as not only will it benefit them personally and their families, but also they really will be doing the best to help their patients.”
An important point is that, even though vaccines may not always prevent influenza, flu vaccinations provide some protection against other illnesses and also prevent deaths.
“If you look at the population who are vaccinated repeatedly, they often do much better if they have had four or more years of vaccination. Also, influenza vaccinations reduce the rate of heart attacks. This is due to the protection against the effects of the flu such as increased heart rate and inflammation. When you have the flu, the reason you get sore joints, headaches and other symptoms is due to virus-induced inflammation. If you imagine the same thing is happening in your heart, it’s easy to understand how preventing influenza by getting a flu vaccine can offer protection against other illnesses and even death, which is a very important message.”
“There are also interesting discussions taking place regarding the possibility that immunity wanes more quickly in the elderly; therefore, for these people, it might be better to judge the timing of their vaccines more carefully, receiving their vaccine as close to the start of the flu season as we can provide. This should be addressed in talking with their GP. Alternatively, providing the elderly, who are at very high risk, with a double-dose of vaccination or vaccines on two occasions before and during winter, is also being discussed.”
Currently, WA, NSW and QLD all offer free vaccines to children under the age of five years. Professor Rawlinson says, “This is mainly due to the fact that we’re now recognising that complications in children with influenza are more frequent than many previously thought. There are some diseases, such as EBV infection (a cause of glandular fever), where young children get a bit of a fever, but usually they have fewer symptoms than adults. Historically, we hadn’t fully explored that kids can get really quite sick on the severe end of the spectrum with influenza. In New Zealand, influenza vaccinations are free for people who are most at risk1. ”
“In one Australian paediatric study of severe cases of flu where hospital admission was required, almost 10% of the children suffered from neurological complications, which is surprising to most people. Almost half of the children admitted for influenza suffered from seizures and further complications, with approximately half of the children suffering from these complications as a result of the flu having another underlying health issue.”
“There’s always lots of discussion in relation to matching the vaccine to the circulating strains and how that can be done more accurately. One of the things we do is to study those viruses circulating and causing infections in the northern hemisphere towards the end of the northern winter. We look at their viruses, and we base our vaccine production with these viruses in mind. We have already looked at their viruses and designed our vaccines around what they have been seeing. Canada seems to be having a busy year - they are also seeing the H3 sub-type circulating. The U.S. has seen a lot of the troublesome A/H3, whilst Europe and China are seeing a lot of influenza B. So it does vary from country to country, by hemisphere and by season.”
“The vaccine changes in subtle ways each year. It’s particularly when the virus shifts and has a major change that we need to make a major change in the vaccine. The vaccine for this year has changed the H3 component; however, the B component of the vaccine has not changed so much.”
“The start of the flu season varies from year to year. It’s usually in May or June and the season runs into September or October. The best thing for all patients to do is to talk to their own GP about the timing of their vaccination to ensure they are protected. Also, everyone should seek advice from their GP to ensure no-one is at an unnecessary risk. For instance, pregnant women have a very low vaccination rate, but they can suffer badly from influenza any year and they have a high risk factor for severe influenza and even death, particularly during pandemics as we saw in 2009.”
“It’s important that everyone, particularly those at risk of severe complications, receives a flu vaccination, to protect themselves but also those around them. Of course, it’s true that no vaccine is 100% effective. But, when people say that if people are getting the flu, then the vaccine isn’t working at all – that simply isn’t true. The best way to prevent the flu is to take sensible hygiene precautions, and to get the vaccine every year.”
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This article appeared in the February 2018 Edition of ePathWay which is an online magazine produced by the Royal College of Pathologists of Australasia (http://www.rcpa.edu.au/Library/Publications/ePathway).
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