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What GPs should know about the constantly changing face of flu



The director general of the WHO said that the one thing that worried him more than anything was the global threat of a flu outbreak.

The continual evolution of flu poses a unique challenge to those involved in its management, as every season is different.

Last month, around 90 UK stakeholders in flu policy and implementation attended Flu Forum in London, organised and funded by Seqirus UK Ltd. Experts from the RCGP, PHE, NHSE, WHO and others shared insights on how the landscape of flu management (prevention, monitoring and vaccine development) is evolving, including the following points. 

Prevention

Flu is highly contagious, affecting people of all ages and placing burden on patients and healthcare systems.

The UK has made great progress in flu prevention recently by implementing and expanding immunisation programmes and adopting pharmacy-led initiatives, to identify those who should be vaccinated and widen access to vaccination.

That being said, there are further steps at local and national levels to improve our flu management practices to reach our targets: order vaccines and put systems in place early for the next season, monitor vaccine uptake using GP practices’ IT systems, with the help of mechanisms such as the RCGP Research Surveillance Centre database, to ensure that we vaccinate those who are eligible, until the end of March.

Monitoring

The delivery of vaccine programmes in the UK is complex and requires effective monitoring. We’ve seen progress in our global flu monitoring capabilities since the WHO’s Global Influenza Surveillance and Response System launched in 1947. Improvements in our understanding of flu viruses, as well as monitoring and data sharing practices, allow us to effectively track the movement of strains worldwide, so we can determine what’s new.

It’s critically important that flu is on the public agenda too

Using this to predict what will come next enables us to prepare accordingly in the case of a pandemic, and recommend, with a reasonable degree of confidence, which strains should be included in the flu vaccine.

Measuring the impact of vaccines, or vaccine effectiveness, throughout the season is another key component of the monitoring process and an important tool when determining how well a vaccine programme works.

Methods used to measure vaccine effectiveness have evolved in the last decade, with the implementation of an internationally agreed-upon system, which produces reliable data to be compared between countries annually. Further improvements in this monitoring system from season to season will likely provide better estimates for vaccine effectiveness – increasingly important when making recommendations as the vaccine landscape continues to evolve and diversify.

Flu vaccine landscape

With the evolving landscape of flu vaccines, we are moving towards a more segmented national flu immunisation programme.

We are seeing a shift in the recommendations from trivalent to quadrivalent formulations; the introduction of alternative manufacturing methods, such as cell-based platforms and recombinant technology (the latter not currently licensed in the UK); and the development of vaccines indicated for specific age groups (adjuvanted and high-dose vaccines for 65+, and intranasal vaccine for specific age range of children).

While we are making progress in developing vaccines that protect everyone, the constant changes in circulating strains still require us to vaccinate annually.

It’s likely that the introduction of new technologies, that harness the immune system in alternative ways, may lead to the development of vaccines that provide even better and longer-lived protection against different strains.

In summary, the landscape of flu isn’t just changing in terms of the viral strains in circulation, but also by the processes used to monitor and manage it, and the types of vaccines used to protect against it.

It’s critically important for us as GPs that flu isn’t only on our agenda, but on the public one. By staying up-to-date with flu, we can ensure that we are well prepared for each season and evolve our practices to keep up.

Dr George Kassianos is national immunisation lead at the RCGP, president of the British Global and Travel Health Association, and a GP in Berkshire

As the sponsors of the Flu Forum, Seqirus has reviewed this article for scientific accuracy but has had no editorial input into the development of this piece