Blog entry by Rcgp Learning
Flu season starts in late September/early October and lasts until the following March/April. During this time, GP consultations for flu-like symptoms usually increase from a baseline of 30 per 100,000 population. If the consultation rate rises above 200 per 100,000 population, a flu epidemic is declared¹.
Anyone infected with the flu virus is contagious up to a day before the onset of symptoms and for 5-7 days after the symptoms start. Even if patients are asymptomatic, they can still pass the virus on to others¹. The flu vaccine is the most effective protection against flu offered in the UK, and although it doesn’t guarantee that patients won’t catch flu, it is likely that any flu-related illness they contract after the vaccination will be milder and short-lived². During the 2017/18 flu season it’s estimated that around 14 million adults and children in England were vaccinated against flu³, and changes to the 2018/19 flu vaccination programme mean that it will be offered to around 24 million people this year⁴. The recommended composition of the vaccines is determined by the World Health Organisation, who reviews the types of flu that have circulated in all parts of the world and chooses the strains to be included in the vaccine for the following autumn. A summary of the recommended vaccines for 2018/19 can be found here. In 9 out of 10 years, the vaccine matches the flu strains circulating that year but sometimes there can be unexpected changes to the virus that affect the efficacy of the vaccine³.
One of the biggest changes to the 2018/19 flu vaccination programme is the addition of a new vaccine, which will be offered to over 65s. The adjuvanted trivalent vaccine (aTIV) contains adjuvant MF59, a substance that strengthens the body’s immune response³, as older adults’ immune systems can get progressively weaker over time, leaving them more susceptible to catching flu and suffering complications due to a reduced production of B and T cells and reduced functioning of mature lymphocytes¹. The vaccine is inactivated and protects against the three strains which are most likely to circulate this season. Public Health England (PHE) predicts that the introduction of this vaccine could reduce GP consultations in England by 30,000, admissions by over 2,000 and prevent over 700 deaths from flu⁴.
The Office of National Statistics (ONS) estimated that there were around 34,300 excess winter deaths in the 2016/17 period, with one third due to respiratory illnesses⁵, concluding that this was likely to be due to the predominant strain that year having a significant impact on elderly patients. Catching flu can place a considerable strain on the body in elderly patients: current estimations are that around two thirds will be temporarily housebound and a quarter will become temporarily bedbound. Amongst those that survive hospitalisation, around 13% will face disability and potential loss of independence and quality of life¹. There is also a risk of fatal co-morbidities, such as stroke, congestive heart failure and pneumonia¹.
All healthcare professionals can access the RCGP’s new Influenza in the elderly eLearning course for free, which is worth 0.5 CPD points. A detailed description of the different 2018/19 flu vaccines can be found in PHE’s guide for healthcare professionals.
¹ Royal College of General Practitioners. Influenza in the elderly eLearning course. [Internet]. Available from: https://elearning.rcgp.org.uk/course/view.php?id=294
² NHS. Vaccinations. The flu vaccine. [Internet]. Available from: https://www.nhs.uk/conditions/vaccinations/flu-influenza-vaccine/
³ Oxford Vaccination Group. Inactivated Flu Vaccine. [Internet]. Available from: http://vk.ovg.ox.ac.uk/inactivated-flu-vaccine
⁴ Public Health England. Press release: New flu vaccine available this winter for those aged 65 and over. [Internet]. Available from: https://www.gov.uk/government/news/new-flu-vaccine-available-this-winter-for-those-aged-65-and-over
⁵ Office of National Statistics. Excess winter mortality in England and Wales: 2016 to 2017 (provisional) and 2015 to 2016 (final). [Internet]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/excesswintermortalityinenglandandwales/2016to2017provisionaland2015to2016final