UK GPs should be prepared. Australia is in the grip of a major influenza epidemic,1 which is often a harbinger of a bad flu season in the northern hemisphere.
Professor Paul Van Buynder, of Australian Gold Coast Health and the Immunisation Coalition, warns: ‘This is not just the biggest recorded year in our data, but it’s also the largest flu outbreak that we’ve seen for quite some time.’
NHS England chief executive Simon Stevens has already spoken about the potential problems, warning on 11 September that there is a ‘great deal of work to do over the next six to eight weeks… to put the NHS on the right footing for the winter ahead’.
This is an understatement – if events in Australia are replicated in the UK the pressure will be immense, with the likelihood of significant mortality.2 After all, between 10,000 and 15,000 extra deaths are attributed to flu in the UK each winter in a normal season.
In terms of the vaccine itself, there are likely to be problems. The World Health Organization’s recommendation for vaccination in the northern hemisphere is similar to that for the southern hemisphere. However, it seems that the H3 strain has evolved during the season and the WHO is reviewing its vaccine as a result.
Due to the time it takes to manufacture the vaccine, it is too late to modify the vaccine for this season and that does not bode well. Of course, it should be noted the vaccine still contains two or three other components, depending on whether it is trivalent or quadrivalent, and vaccination should still be encouraged. And there are other things GPs can do. The Department of Health’s Flu Plan Winter 2017/18 makes GPs responsible for the education of their patients, particularly those in high-risk groups, and for ensuring the Government’s strategy is implemented.3
There are pointers from Australia. We know adults aged 85 years or older have been most seriously affected, so vaccination of over-65s is strongly recommended.
But the issue outside GPs’ control is that we also know that children appear to be ‘super spreaders’, with young children aged between five and nine years also badly affected, despite both the elderly and children being included in the Australian vaccination campaign.1
Recent years have seen problems with vaccinating children in the UK, despite the Government recommending vaccination for all children aged between two and eight years, and up to age 18 for those in at-risk groups.
This is in part due to the Centers for Disease Control and Prevention in the US reporting that the ‘live attenuated influenza vaccine’ (LAIV) with four components was ineffective and recommending against its use.
This is not necessarily the case in the UK,4 but such a distinction has been lost on the UK media and, as a result, some ill-informed commentators have recommended against using any form of the LAIV vaccine in children.That is a mistake. Unfortunately, the Government’s information campaigns on childhood vaccination have been lamentable and need to be substantially improved. Given the role of children in spreading the virus and the warnings from Australia about their ‘super spreader’ status, the vaccination of children should be strongly encouraged.
In the longer term, research continues on a universal influenza vaccine, one that stimulates multiple components of the immune system such that it can cover multiple seasons, potentially even a pandemic virus such as those seen in 1918, 1957, 1968 and more recently 2009.5
Successful development of a universal vaccine could mean annual vaccination against influenza will no longer be necessary. Until then, however, the yearly battle with flu, in which GP practices are on the front line, will continue. And this year it looks set to be quite a conflict.
Dr Martin Johnson is RCGP clinical lead on chronic pain and a former GP in Yorkshire, and Dr Rob Lambkin-Williams is executive scientific advisor at the hVIVO Group
1 Department of Health. Australian Influenza Survellane Report No. 7, 2017 5-18 August 2017. health.gov.au/flureport.
2 Fauci A. What Australia’s bad flu season means for Europe, North America. CNN. Online 4 Sep, 2017. tinyurl.com/fauci-flu.
3 Department of Health. Flu Plan Winter 2017/18. tinyurl.com/DH-flu2017.
4 Pebody R et al. Live attenuated influenza vaccine: recent effectiveness results from the USA and implications for LAIV programmes elsewhere. Arch Dis Child. 2017. Online, 30 Aug 2017.
5 de Vries RD et al. Universal influenza vaccines: a realistic option? Clin Microbiol Infect. 2016;22 Suppl 5:S120-S4.