Yes, COVID vaccines are front and centre. But don’t forget about your flu shot

Posted on April 3, 2021 by particularkev

Ian Barr, WHO Collaborating Centre for Reference and Research on InfluenzaAs the nights begin to close in and the temperatures cool, it’s clear winter is approaching again.

With the winter season comes the risk of the usual winter lurgies, most of which result from respiratory infections. Some of the usual suspects include rhinoviruses (the common cold), RSV (respiratory syncytial virus), and influenza.

This year, of course, we’re also contending with the possibility that SARS-CoV-2 (the virus that causes COVID-19) could escape from its quarantine status and circulate alongside these other viruses.

We don’t know yet how the winter season will play out in terms of respiratory viruses. But one important way we can prepare for it is by getting a flu vaccine.

What will winter bring?

In 2020 there was a paucity of seasonal winter viruses. Only rhinoviruses circulated widely, while the others were either vastly reduced (for example, we saw a very minimal flu season) or very delayed (RSV circulated later than usual in some states until spring or even summer).

So what’s going to happen in 2021? Will it be similar to 2020, or will it be like 2019, which saw very high levels of influenza? Or perhaps something completely different?

We simply don’t know for sure. With COVID-related restrictions having eased in all Australian states and territories — albeit to varying degrees — people are free to move around, come together in crowds, and attend schools, universities and offices.

These activities promote the transmission of respiratory viruses, which explains why we saw such different trends in the usual winter lurgies last year, when we were mixing much less.

But the virus circulation needs to start from somewhere. While some viruses are happy to circulate domestically, like rhinoviruses and adenoviruses, others, like influenza, are largely transported into the country each year. So it’s possible that if Australia’s international borders remain closed through winter, we may again have a less serious flu season in 2021.

On the other hand, if borders are opened and the flu does take hold, people might have reduced immunity to the viruses given the missed season last year, and be more susceptible.

A hand holds a thermometer. There is a cup of tea and tablets on a table in the background. — Last winter we saw significantly fewer cases of the flu than usual.
Shutterstock

A vaccine is your best bet

In the face of this uncertainty, the usual adage prevails: “prevention is better than cure”. The best measure we can take is to get our influenza vaccine.

The flu vaccines available in Australia in 2021 under the National Immunisation Program are:

for children aged six months to five years — Vaxigrip Tetra® (Sanofi) and Fluarix® Tetra (GSK)
for children and adults aged five to 64 years — Vaxigrip Tetra®, Fluarix® Tetra and Afluria® Quad (Seqirus)
for adults aged 65 and over — Vaxigrip Tetra®, Fluarix® Tetra, Afluria® Quad and Fluad® Quad (Seqirus).

The Fluad® Quad vaccine, which is slightly different and more potent than the others, is the preferred vaccine for the over-65 age group. It contains a component called an adjuvant, which helps boost the immune response in elderly people.

This season’s flu vaccines are made up of four different viruses — two influenza A types and two influenza B types. The 2021 vaccines have two changes (both in the influenza A types) from the 2020 influenza vaccines.

It’s very hard to predict in advance which strains will circulate, but the World Health Organization provides guidance on this every year, and recommends which components of the vaccine should be updated accordingly.

All the influenza vaccines used in Australia are inactivated virus vaccines, meaning the virus contained in the vaccine doesn’t replicate, so you can’t get the flu from the vaccination.

In addition to the flu vaccines under the National Immunisation Program, a new vaccine called Flucelvax® Quad (Seqirus) is available through retail outlets, like pharmacies, for people aged nine years and older.

This vaccine is the first influenza vaccine available in Australia which has been produced entirely in cell culture, rather than chickens eggs. This new vaccine may have some benefits over the traditional egg-based vaccines for certain people, for example those with severe egg allergies.

How effective are flu vaccines?

Flu vaccines are only moderately effective at preventing infection with influenza. On average, they offer around 60% protection across the population, although rates can often be higher in children.

While this is lower than we’d like, it’s the best measure we currently have to protect us from influenza infections. There’s also evidence it reduces the more severe consequences of being infected, such as being hospitalized or dying.

Scientists are continuing to work on new flu vaccines that may offer greater protection.

The practicalities

This year’s vaccines are already becoming available through pharmacies and some GP clinics, and will be available under the National Immunisation Program from GPs and other providers, such as workplace immunisation programs, in April.

The flu season generally starts in earnest around June, so it’s reasonable to get your vaccine any time between now and then.

Under the National Immunisation Program, some groups are eligible to receive the influenza vaccine for free. These include:

adults 65 and older
all Aboriginal and Torres Strait Islander Australians six months and older
children aged six months to five years
pregnant women
people with certain medical conditions.

For people who don’t fall into these groups, the vaccine costs as little as A$14.99.

Influenza vaccines are being rolled out this year alongside the COVID-19 vaccines. With both programs operating at the same time, there may be some confusion and logistical challenges.

The Australian Technical Advisory Group on Immunisation have recommended a 14-day gap between the COVID and flu vaccinations, regardless of which one you have first. This is something both individuals and providers will need to keep in mind and will mean some extra planning this year.

Ian Barr, Deputy Director, WHO Collaborating Centre for Reference and Research on Influenza

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The vaccine we’re testing in Australia is based on a flu shot. Here’s how it could work against coronavirus

Posted on May 28, 2020 by particularkev

Kylie Quinn, RMIT University and Kirsty Wilson, RMIT University

A new trial has begun in Victoria this week to evaluate a potential vaccine against COVID-19.

The vaccine is called NVX-CoV2373 and is from a US biotech company, Novavax.

The trial will be carried out across Melbourne and Brisbane, and is the first human trial of a vaccine specifically for COVID-19 to take place in Australia.

This vaccine is actually based on a vaccine that was already in development for influenza. But how might it work against SARS-CoV-2, the coronavirus that causes COVID-19?

What’s in the mix?

Vaccines trigger an immune response by introducing the cells of our immune system to a virus in a safe way, without any exposure to the pathogen itself.

All vaccines have to do two things. The first is make our immune cells bind to and “eat up” the vaccine. The second is to activate these immune cells so they’re prepared to fight the current and any subsequent threats from the virus in question.

We often add molecules called adjuvants to vaccines to deliver a danger signal to the immune system, activate immune cells and trigger a strong immune response.

The Novavax vaccine is what we call a “subunit” vaccine because, instead of delivering the whole virus, it delivers only part of it. The element of SARS-CoV-2 in this vaccine is the spike protein, which is found on the surface of the virus.

By targeting a particular protein, a subunit vaccine is a great way to focus the immune response.

However, protein by itself is not very good at binding to and activating the cells of our immune system. Proteins are generally soluble, which doesn’t appeal to immune cells. They like something they can chew on.

So instead of soluble protein, Novavax has assembled the SARS-CoV-2 spike protein into very small particles, called nanoparticles. To immune cells, these nanoparticles look like little viruses, so immune cells can bind to these pre-packaged chunks of protein, rapidly engulfing them and becoming activated.

The Novavax vaccine also contains an adjuvant called Matrix-M. While the nanoparticles deliver a modest danger signal, Matrix-M can be added to deliver a much stronger danger signal and really wake up the immune system.

The spike protein is formed into nanoparticles to attract immune cells, and Matrix-M is added as an adjuvant to further activate immune cells.
Author provided

Rethinking an influenza vaccine

The Novavax vaccine for SARS-CoV-2 is based on a vaccine the company was already developing for influenza, called NanoFlu.

The NanoFlu vaccine contains similar parts – nanoparticles with the Matrix-M adjuvant. But it uses a different protein in the nanoparticle (hemagglutinin, which is on the outside of the influenza virus).

In October last year, Novavax started testing NanoFlu in a phase III clinical trial, the last level of clinical testing before a vaccine can be licensed. This trial had 2,650 volunteers and researchers were comparing whether NanoFlu performed as well as Fluzone, a standard influenza vaccine.

An important feature of this trial is participants were over the age of 65. Older people tend to have poorer responses to vaccines, because immune cells become more difficult to activate as we age.

This trial is ongoing, with volunteers to be followed until the end of the year. However, early results suggest NanoFlu can generate significantly higher levels of antibodies than Fluzone – even given the older people in the trial.

Antibodies are small proteins made by our immune cells which bind strongly to viruses and can stop them from infecting cells in the nose and lungs. So increased antibodies with NanoFlu should result in lower rates of infection with influenza.

These results were similar to those released after the phase I trial of NanoFlu, and suggest NanoFlu would be the superior vaccine for influenza.

So the big question is – will the same strategy work for SARS-CoV-2?

The Novavax vaccine is one of several potential COVID-19 vaccines being trialled around the world.
Shutterstock

The Australian clinical trial

The new phase I/II trial will enrol around 131 healthy volunteers aged between 18 and 59 to assess the vaccine’s safety and measure how it affects the body’s immune response.

Some volunteers will not receive the vaccine, as a placebo control. The rest will receive the vaccine, in a few different forms.

The trial will test two doses of protein nanoparticles – a low (5 microgram) or a high (25 microgram) dose. Both doses will be delivered with Matrix-M adjuvant but the higher dose will also be tested without Matrix-M.

All groups will receive two shots of the vaccine 21 days apart, except one group that will just get one shot.

This design enables researchers to ask four important questions:

can the vaccine induce an immune response?
if so, what dose of nanoparticle is best?
do you need adjuvant or are nanoparticles enough?
do you need two shots or is one enough?

While it’s not yet clear how the vaccine will perform for SARS-CoV-2, Novavax has reported it generated strong immune responses in animals.

And we know NanoFlu performed well and had a good safety profile for influenza. NanoFlu also seemed to work well in older adults, which would be essential for a vaccine for COVID-19.

We eagerly await the first set of results, expected in a couple of months – an impressive turnaround time for a clinical trial. If this initial study is successful, the phase II portion of the trial will begin, with more participants.

The Novavax vaccine joins at least nine other vaccine candidates for SARS-CoV-2 currently in clinical testing around the world.

Kylie Quinn, Vice-Chancellor’s Research Fellow, School of Health and Biomedical Sciences, RMIT University and Kirsty Wilson, Postdoctoral Research Fellow, RMIT University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The coronavirus lockdown might help limit this year’s flu season – but you should still get your flu jab anyway

Posted on April 11, 2020 by particularkev

Lauren Bloomfield, University of Notre Dame Australia

Lockdown measures aimed at limiting the spread of COVID-19 should actually help cut the cases of flu this year. That’s because keeping people apart to reduce the spread of coronavirus will also help reduce the spread of flu.

That said, you really should receive a flu vaccine anyway.

In fact, getting your flu vaccination as soon as you can is a great way to help ease the strain on our health system, which is already expected to struggle to cope with the coronavirus outbreak.

Flu cases skyrocketed last year

There were 313,079 cases of influenza reported in Australia in 2019, up from 58,862 in 2018. That’s much higher than average over the past 20 years.

Many states and territories saw a large and very early uptick in the number of influenza cases last year.

The most common influenza strain circulating at the time was influenza A/H3N2. It was reported that some circulating A/H3N2 viruses were “less well matched” to those in the vaccine, which could account at least in part for the higher number of cases in 2019.

The high, early and prolonged season was unusual. Some suggested different international travel patterns may have also contributed, but the truth is it’s not entirely clear the 2019 flu season was so unusual.

The WHO has recommended changes to three of the four strains in the vaccine most of us will be offered this year. There’s no guarantee of a good match, of course, but we’re certainly hoping for one.

With COVID-19 already likely to put our health-care systems under immense pressure, we cannot afford to burden the system with extra influenza cases requiring hospitalisation.

Social distancing: it works for coronavirus and for flu

Influenza and COVID-19 share some similar symptoms. They are also both spread via respiratory droplets: coughing, sneezing and touching.

Protecting ourselves from COVID-19 through good hygiene and social distancing also means protecting ourselves from flu. This is a small silver lining in an otherwise extremely disruptive time.

We will almost certainly see the impact of social distancing with a reduction in a range of infectious diseases in Australia, from influenza through to sexually transmitted infections and food-borne disease.

In fact, the coronavirus pandemic is as a good reminder of how lucky we are to live in an era where vaccines for many diseases are available. The unprecedented coronavirus measures highlight the lengths we need to go to in order to reduce risk when there’s no vaccine or natural immunity.

Doing your bit to ease the strain on our health system

If we had a roll of toilet paper for every time we’ve heard the term “flattening the curve” in the last few weeks, we’d probably be a lot happier. There are, notably, no mentions of “eliminating the curve”.

Flattening doesn’t mean people will not get COVID-19. These measures are not designed to get case numbers down to zero.

Flattening the curve is another way of saying slowing the spread. The epidemic is lengthened, but we reduce the number of severe cases presenting at the same time, causing less burden on public health systems. The Conversation/CC BY ND

In fact, until a vaccine is available, “flattening the curve” means the same number of people still get infected, but at a slower rate, so our health services can cope and we have as few deaths as possible.

If easing the burden on the health services is important to you, you can do your bit not just by following the coronavirus social distancing measures and washing hands frequently, but also getting your flu shot.

The 2020 flu vaccine is now starting to become available for those aged over six months, and people should speak to their health-care provider about booking to get one sooner rather than later.

Lauren Bloomfield, Senior Lecturer, School of Medicine, University of Notre Dame Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The ‘dreaded duo’: Australia will likely hit a peak in coronavirus cases around flu season

Posted on March 22, 2020 by particularkev

C Raina MacIntyre, UNSW

The prime minister earlier today announced that from May 1, people need to be vaccinated against the flu before visiting an aged care facility.

The idea is to limit the risk of the “dreaded duo” of respiratory diseases – influenza and coronavirus – affecting the frail and elderly.

We’re concerned about the combined impact of the flu and the coronavirus on us and our health system. But we can minimise that impact.

Coronavirus peak set for flu season

The peak of COVID-19 cases in Australia is yet to come, with estimates numbers will double about every three to six days.

This exponential rise means Australia’s peak in COVID-19 cases may converge with our annual influenza season, which peaks on average in August each year.

Both influenza and coronavirus can cause severe illness, but the coronavirus is about ten times more deadly than the flu.

Both viruses cause severe pneumonia, so getting them together could be a serious blow to the lungs.

Severe infection with either virus can result in pneumonia and respiratory failure requiring mechanical ventilation, or even ECMO, a method of oxygenating the blood outside the body.

Health systems will be under more strain

Another impact of influenza and COVID-19 circulating simultaneously is on our health systems.

Every winter, we need to have extra hospital beds and staff to cope with influenza. However, for COVID-19, we will need to plan for more, as death rates, hospitalisation rates and ICU admission rates are higher.

So a severe epidemic of COVID-19 during our influenza season could result in a severely overloaded health system unable to cope, as we are seeing in Italy.

What can we do? Get the flu vaccine

We do not have a vaccine for COVID-19 yet, but we do have vaccines to protect against influenza.

So, if you’re at increased risk for influenza complications, make sure you’re vaccinated.

Influenza vaccination is recommended and funded in Australia for risk groups, such as people aged 65 years and over, people with chronic conditions such as heart, lung or neurological diseases, pregnant women, and for children six months to under five years old.

Flu vaccine is also recommended, but not funded, for people aged five to 65 years. Carers of vulnerable people, and people who work in health care, childcare or aged care should also get vaccinated.

Now that influenza vaccination is already available this season in pharmacies, it’s fast and convenient for busy working people to get vaccinated.

People at risk can be vaccinated any time from March to May. There is some evidence that flu vaccine immunity does not last a full 12 months, but timing of vaccination makes only a small difference to preventing influenza.

So if you forget to get the flu vaccine, it is still worth getting vaccinated any time later in the year.

What else can we do?

Both influenza and COVID-19 can be transmitted before symptoms occur or by people with no symptoms.

So to reduce the risk of transmission of either virus, the World Health Organisation recommends washing your hands frequently, coughing into your elbow, and cleaning and disinfecting frequently touched objects.

Indian cricket legend Sachin Tendulkar shows how to wash you hands properly.

Social distancing – such as maintaining spatial separation from other people, avoiding crowds, working from home – will also reduce the risk of both infections.

The more of these measures we use, combined with isolating sick people and quarantining their contacts, the more we can flatten the curve, to reduce the impact of both infectious diseases on individuals and the health system.

Older people and people with chronic diseases especially need to practice social distancing, and avoid unnecessary contact and travel.

We may even need to screen visitors to the home and ask them not to come if ill, especially if there are people at risk in the household.

Younger people, especially those living with older people, should be mindful of avoiding crowds and bringing infection into the household.

Aged care facilities will need to restrict visitors, as recommended in the latest health advice.

With winter almost upon us, we must use all these measures to reduce the combined impact of COVID-19 and influenza.

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Media hype and increased testing: this year’s flu numbers are high, but there’s more to the story

Posted on July 25, 2019 by particularkev

The media suggests we’re in the midst of a horror flu season, but there are nuances to consider.
From shutterstock.com

Craig Dalton, University of Newcastle

Over recent months, the news has been saturated with headlines claiming we’re experiencing a “killer flu season”. Researchers watching laboratory data are using the term “flunami”.

Data suggests this is a serious year for the flu, with a higher number of cases, hospitalisations and deaths recorded than at the same time point in previous years. But there’s more to the story.

Increased testing for influenza and a very early start to the flu season have driven these high figures. Meanwhile, we’ve seen heightened community awareness and concern as the media continue to report on the high numbers of flu cases.

Increased concern leads to increased testing

Tragically, influenza causes deaths every year, including among infants and healthy young people. This still comes as a surprise to many. News coverage of these deaths presents human stories that make the risk feel real and threatening.

We can see the impact of this by looking at the trends in Google searches for “flu deaths” and “flu symptoms” in Australia this year. The steep rise is closely aligned with media reporting of deaths from early May.

The Google search interest in deaths in 2019 dwarfs the 2017 interest, when media reports of influenza deaths appeared more sporadically.

The fear of a uniquely severe and dangerous flu season leads more people to go to their GP or emergency department for an assessment if they’re experiencing flu-like symptoms. In turn, it may also lead more doctors to test for influenza, resulting in increased influenza counts.

Every Monday morning in winter our Flutracking survey asks around 45,000 Australians about their influenza-like symptoms (fever and cough). We also ask ill Flutrackers if their doctor tested them for influenza.

Every year, more and more Flutrackers answer yes. Comparing the percentage of Flutrackers with cough and fever who reported being tested for influenza during April and May increased markedly from 2016, with a very significant increase in 2019.

The season is earlier, but it’s not more severe

Since at least 2011, there has been an increasing summer to autumn blip in influenza activity. That trend has been particularly pronounced this year.

Systems like Flutracking are showing higher levels of influenza-like illness for this time of year, but the figures are not nearly as high as the typical August to September peak seen over the last five years.

Flutracking is not perfect, tracking only “influenza-like” symptoms. Influenza surveillance relies on multiple imperfect streams of data; each contribute to our understanding of the whole picture.

Another system providing objective information on the severity of influenza is the New South Wales death registration data. It showed a few unseasonal spikes in February and March, but is otherwise low and around half the rate we see in the middle of a typical influenza season.

Hospitalisation rates for influenza are high across many hospitals for this time of year, and some may approach peak winter rates seen in 2017. But looking at the proportion of patients admitted to hospital with the flu requiring intensive care, there’s no indication the early influenza season is deadlier than usual.

The simplest way to describe the season is early, but average so far. The rates of influenza are high for this time of year, but the illness is no more severe compared to the typical peak we see in the middle of winter.

Comparing 2019 to 2018, which was a very mild year, further exaggerates the difference.

So when will it end?

In describing the season as “early”, the question arises as to how long it will last. No one knows. The dynamics of an influenza season are a mix of the particular strains circulating, underlying population immunity to the circulating strains from past infection or immunisation, levels of population density and interactions, and weather – all highly unpredictable factors.

If there is no change in the circulating strains then it’s possible the number of susceptible people in the community could be exhausted and the influenza season could “burn out”. If not, it could be a big year for influenza.

Note that this is a broad brush overview of a large country. Western Australia appears to be having a different experience this year with very high rates of laboratory notifications and influenza related hospitalisations. After experiencing a series of mild influenza seasons it may now have a much larger pool of people susceptible to influenza infection.

How worried should you be?

So far, the season is early but average. It’s not the worst flu season on record and not a “flunami”.

Is there any harm in the media being hyperbolic about the nature of each flu season? Some see no downside in using media interest as an opportunity to educate the public about influenza or promote research.

At the same time, there is a danger in tying reasonable public health advice to unreliable interpretations of what is actually happening. Crying wolf may undermine trust in public health messaging.

Hopefully, the messages around flu remain clear. You don’t want to get influenza, and if you do get it, you don’t want to spread it to other people. Immunisation, hand hygiene, anti-viral treatment and staying home if ill can all help.

If you would like to help Flutracking track the flu near you, you can join at Flutracking.net.

Sandra Carlson, the Flutracking senior analyst, contributed to this article.

Craig Dalton, Conjoint Senior Lecturer School of Medicine and Public Health, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Hand sanitisers in public won’t wipe out the flu but they might help reduce its spread

Posted on July 19, 2019 by particularkev

It’s quicker to use hand sanitiser than soap and water, which means people might be more likely to use it.
Shutterstock

Trent Yarwood, The University of Queensland

This year’s flu season is off to an early start, with 144,000 confirmed cases so far in 2019. That’s more than twice as many confirmed cases of the flu than for all of 2018 (58,000), and almost as many as the 2017 horror flu season (251,000).

The number of cases so far this year, including more than 231 deaths nationwide, led the NSW opposition health spokesperson to call for hand sanitisers in public spaces to help slow the spread.

Influenza spreads via droplets from coughing and sneezing, which is why it’s a good idea to catch your cough. But coughing into your hand can leave flu virus on your hands, which is why we recommend coughing into your elbow or sleeve and washing your hands afterwards.

Along with getting vaccinated and staying home if you’re sick, washing your hands is the best defence against getting the flu.

If the government can make this easier by providing hand sanitisers in public places, it may be worth the investment. It won’t solve our flu problem but it might be an important tool in the toolbox of measures to reduce its spread.

What does the research say?

The scientific literature on hand sanitisers isn’t so clear-cut.

A 2019 study in university colleges showed the use of hand hygiene and face masks didn’t protect against flu any better than mask use alone. But unlike some other countries, Australia doesn’t have a strong habit of mask use when people are unwell, so this may not be very helpful to us.

A 2014 study in New Zealand schools showed that providing sanitiser didn’t reduce the rate of absenteeism from school either.

While these studies make it sound like hand sanitiser is not very effective, that’s not the end of the story.

Other studies show a positive effect – a 16% reduction in respiratory illness in one and a 21% reduction in another. For some infections, the evidence is even stronger – for example, gastroenteritis, most of which is also viral.

However, few of these studies showing the benefits of hand sanitisers were done during a large disease outbreak, which means the potential benefit may be even greater.

Not all influenza-like illness is caused by the flu – it can be other viruses as well, so the estimates are a bit rubbery at best. Hand sanitiser trials which look at influenza-like illness or respiratory infections generally are more likely to show benefits than those that just look for influenza – meaning good hand hygiene prevents other infections as well.

If you have the flu, the best place to be is at home.
Tero Vesalainen/Shutterstock

Lessons from hospitals

Although preventing infection in hospitals is not the same as doing it in the community, there are two important lessons from hospital infection control.

First, in hospital hand-hygiene programs, hand sanitiser is more effective than soap-and-water hand-washing, provided your hands aren’t visibly dirty.

This is partly because of the rapid effect of the alcohol, but mostly because it’s much quicker and therefore more likely that staff will use it.

The second important point from hand hygiene and other areas of hospital infection control is that introducing a “bundle” of strategies usually reduces healthcare-associated infection rates – even when the individual parts of these bundles don’t show benefits alone.

This could be because the individual effect sizes are too small, or that change in practice highlights a “safety culture”.

Sanitisers can be one of many strategies

Installing hand rub in public areas won’t solve this year’s flu outbreak by itself. But it can be part of a bundle of strategies – as long as the dispensers are kept topped up.

And it’s certainly a safe intervention – despite some desperate hysteria about the safety of hand gels, or the risk of people drinking them, there is little evidence this actually occurs in reality.

Hand sanitiser is also likely to be easier to implement than fixing the much larger social problem of Australians going to work when they’re sick. This may be because of inadequate sick leave, concerns about “letting the team down”, or other logistical problems such as child-care.

Get your flu vaccine – even now it’s still not too late – and get it for your kids as well, for their sake as well as your own.

Remember to stay home if you’re unwell, and always to cough into your sleeve. And don’t forget to clean your hands – even if the government doesn’t end up making it easier for you.

Trent Yarwood, Infectious Diseases Physician, Senior Lecturer, James Cook University and, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

It’s a bad year for flu, but it’s too early to call it the worst ever – 5 charts on the 2019 season so far

Posted on July 17, 2019 by particularkev

The impact of the flu on a population can be measured by looking at figures including cases, hospitalisations and deaths.
From shutterstock.com

Ian Barr, WHO Collaborating Centre for Reference and Research on Influenza

From early this year it’s been apparent the 2019 Australian influenza “season” was going to be different. Normally, the flu season coincides with the winter months of July and August, sometimes stretching to September and October.

But this year, things have happened much earlier, with a record number of influenza cases reported in summer and autumn.

So what’s been happening, and is it really as bad as the media have been reporting? Here we look at some of the latest data on cases and their outcomes to see if it is indeed “a horror flu season”.

The impact of influenza on the community is measured in several ways. The most basic measure is to simply count the number of cases of people presenting to their GP with influenza-like illness.

Sometimes the doctor will take a swab, and these are tested in the laboratory to confirm that influenza virus is present (it’s possible another respiratory virus or bacteria might be causing the flu-like symptoms).

Cases of influenza-like illness were increasing in early March, peaked in early June, and are now decreasing. Laboratory confirmed cases (the results of which we see in the above chart) show a similar trend. We haven’t included July in this chart because it’s not finished yet, but we’re still seeing a high number of cases into July.

Compared to previous years, 2019 looks like a big year with more than 120,000 cases of lab confirmed influenza up to the end of June. But it’s not nearly as bad as 2017, which had more than 250,000 cases reported to the National Notifiable Diseases Surveillance System (NNDSS) by the end of the year. As this season occurred much later than 2019’s, 2017 had only 24,000 cases reported up to July 7.

The good news is that as the 2019 season started earlier, it’s also likely to finish earlier than usual. This is because once the main influenza season starts, it usually ends around 12-16 weeks later, when the number of susceptible people drops below the level required to maintain efficient circulation.

FluCAN (via Department of Health Influenza Surveillance Report), CC BY-ND

Another measure of how severe the influenza season is can be gauged by the number of hospitalisations, including admissions to ICU (intensive care units).

Hospital admissions show from April 1 to June 30 this year, there have been 1,309 admissions to the Australian sentinel surveillance hospitals (a number of hospitals where flu admissions are tracked each year).

This figure is much higher than previous years at the same time point. In 2018, there were 90 admissions, and in 2017, 311. But in 2017 the season arrived much later and more seriously and ultimately resulted in 3,969 admissions for that year.

It’s also useful to look at the proportion of people attending hospital with influenza infections who are admitted directly to ICU. In 2019 it’s been 6.7% of admissions compared to 2018 (a mild influenza year) with 8.1% of admissions, and 2017 (a very severe year) with 8.9% of admissions.

The 2019 ICU rate is at the lower end of historical figures which range from 8.7% in 2015 to 14.2% in 2013. By this measure, the 2019 season is of a similar severity to that seen in previous seasons and is therefore not exceptional.

While hospital admissions can be measured relatively easily, measuring deaths due to influenza is more complicated for a few reasons. The flu often paves the way for secondary bacterial infections, like pneumonia, which can lead to hospitalisation and death, particularly in the elderly. When this happens, it can be difficult to link death directly to an earlier influenza infection.

And, death data is often very delayed. So readily available death data collected by the NNDSS is considered a significant underestimate of the actual number.

To the end of June 2019, there were 231 influenza-related deaths reported to the NNDSS. Virtually all of these were due to the influenza A strain. They spanned all ages, but most deaths were in the elderly (80 years and older).

This compares to 24 and 21 deaths over the same period in 2018 and 2017 respectively. But these figures grew to 55 deaths and 598 deaths reported by the end of 2018 and 2017 respectively.

Clearly 2019 is more severe than 2018, based on the measures detailed above, but at this stage it looks like it will be less severe than 2017. However, we’ll need to wait for a number of weeks yet to be sure.

When we look at what’s happened in each state of Australia so far this year, we see some interesting differences in how the season has played out. Most states began to see significant rises in cases in April, while South Australia had already peaked in April and this number of cases was maintained into May. This means that most other states still have a number of weeks of influenza circulation to endure.

People of all ages are susceptible to influenza, and this is reflected in the wide range of ages at which people are infected. Young children (especially those under 10 years of age) and the elderly (especially those over 80 years of age) are more susceptible, and are often more severely affected by influenza infections – as are pregnant women.

Interestingly, different types of influenza affect different age groups, with influenza B and influenza A(H1N1) more common in the young and influenza A(H3N2) more common in the elderly.

At this stage we can conclude that the 2019 influenza season is quite different to our usual seasons and overall, is likely to be one of the more severe seasons seen in the last 20 years.

So while 2019 doesn’t appear to be the worst season we’ve ever seen – that’s likely to remain with 2017 – it may well run a close second place. But we’ll have to wait another month or two before we can be sure.

Ian Barr, Deputy Director, WHO Collaborating Centre for Reference and Research on Influenza

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The 2019 flu shot isn’t perfect – but it’s still our best defence against influenza

Posted on July 13, 2019 by particularkev

Early indications are that the vaccine has been a reasonably good match in the 2019 season.
Shutterstock

Lauren Bloomfield, Edith Cowan University

Over recent months, reports of “a horror flu season” causing serious illness and death have dominated the headlines.

The high number of cases has led some people to question the effectiveness of the flu vaccine, and whether it’s worth getting if it doesn’t guarantee you won’t get the flu.

The flu vaccine is designed to cover the strains of the flu anticipated to circulate during the season. But even with the most sophisticated scientific processes, determining the right strains to include in the vaccine isn’t 100% foolproof.

Sometimes the virus undergoes major genetic changes or “mutations” in a relatively short space of time. Reports of a “mutant strain” this year means there’s concern some people might catch a strain the vaccine hasn’t protected against.

It’s too soon to tell the full extent of the effects of this mutation on how well the vaccine has worked. But the 2019 vaccine is showing early signs of being a good match for the common strains of the flu circulating this season.

What’s in a name?

Influenza or “flu” isn’t just one virus; different strains circulate each season.

Flu viruses that cause seasonal epidemics in humans fit under one of two major groups: influenza A or B.

Most flu vaccines protect against four strains of influenza.
Image Point Fr/Shutterstock

Influenza A is further broken down into strains or subtypes based on surface proteins called hemagglutinin (H) and neuraminidase (N).

We’re currently concerned about two subtypes which cause outbreaks in humans: A/H1N1pdm09 and A/H3N2.

Influenza B viruses are similarly categorised into strains based on two distinct lineages: B/Yamagata and B/Victoria.

Understanding the circulating strains is important because it gives us clues as to which age groups will likely be worst affected. Influenza A/H3, for example, has historically been associated with higher rates of disease in people aged 65 and over.

But the circulating strains are also important because they inform how the vaccine will be developed. A good match between the vaccine strains and what is circulating will mean the vaccine offers the best possible protection.

So how do we decide which flu strains are covered by the vaccine?

Every year, a new vaccine is produced to cover the strains that are predicted to be circulating in the northern and southern hemispheres. The World Health Organisation (WHO) uses a range of measures to determine which strains should be included in the vaccine.

Many of us who were vaccinated this year would have received a quadrivalent vaccine. This means it covered four strains in total: two strains of influenza A, and two strains of influenza B.

People aged 65 and over are offered a “high-dose” trivalent vaccine, which covers both A strains, and one B strain.

The Australian Influenza Vaccine Committee (AIVC) reviews the results and makes recommendations for the Australian vaccine, which in 2019 covered the following strains:

an A/Michigan/45/2015 (H1N1)pdm09-like virus
an A/Switzerland/8060/2017 (H3N2)-like virus
a B/Colorado/06/2017-like virus (Victoria lineage) – not included in the trivalent vaccine recommendation
a B/Phuket/3073/2013-like virus (Yamagata lineage).

Do we always get it right?

The basic premise of forecasting is that it’s a “best guess”. It’s a highly educated guess, based on analysis and evaluation, but it’s not a guarantee.

The effectiveness of a vaccine depends on a number of factors, only some of which are within our control. While the choice for the vaccine is made on the best evidence available at the time, the viruses circulating in the population undergo changes as they replicate, known as antigenic “drift” and “shift”.

Flu viruses change every year so researchers have to make an educated guess about which ones might circulate.
Image Point Fr/Shutterstock

If the changes are only small, we can still get good cross-protection.

Less frequently, a big genetic “shift” happens. If this occurs after vaccine development has started and the strains have been chosen, we are dealing with a so-called “mutant flu” and the vaccine will likely not be a good match.

So is this year’s vaccine is working?

Data available for this year are showing the majority of influenza cases in Australia have been influenza A – with some states reporting more H3N2 than H1N1, and others reporting a more even mix of both.

The WHO Collaborating Centre in Victoria is also reporting that the majority of specimens of all four strains they’ve tested this year appear to be similar to the vaccine strains.

While early indications are that the vaccine has been a good match in the 2019 season, the WHO Collaborating Centre has also recently confirmed there has been a mutation in the A/H3N2 strain this season.

It’s not clear yet if this mutation will have a significant impact on vaccine effectiveness, but it may at least partially explain the high case numbers we’ve seen so far.

Large vaccine effectiveness studies done at the end of the flu season will help assess the impact of this mutation. In the meantime, a mismatch on only one strain means the vaccine will still provide reasonable protection against other circulating strains.

It’s still worth being vaccinated

In the same way wearing a seat belt is no guarantee we won’t be injured in a car accident, a flu vaccine is no guarantee we won’t develop influenza this season.

A person’s underlying susceptibility, due to factors such as their age and health, will also influence how well a vaccine works.

But the flu shot remains a safe and reasonably effective strategy to reduce your risk of serious illness.

While flu epidemics remain complex, advice to prevent flu transmission remains simple. Regularly washing our hands, covering our mouth when we cough or sneeze, and staying home when we’re unwell are things we can all do to help stop the spread.

Lauren Bloomfield, Lecturer, School of Medical and Health Sciences, Edith Cowan University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

You can’t get influenza from a flu shot – here’s how it works

Posted on June 27, 2019 by particularkev

You might feel a bit off after your flu shot but this doesn’t last long.
Rawpixel.com/Shutterstock

Allen Cheng, Monash University and Katherine Kedzierska, University of Melbourne

Influenza is a moving target for vaccines. Each year, up to four different strains circulate, and they are constantly evolving to escape our immune system.

So rather than childhood jabs giving long lasting immunity, we need annual flu shots to provide optimal protection against influenza.

But while you might sometimes get sick after having a flu shot, it’s a myth that having a flu shot can give you the flu.

A quick history of the flu vaccine

Influenza vaccines were first developed in the 1930s and 1940s, starting with the isolation of the influenza virus.

Back then, we learned there were many different influenza strains. To be effective, early research showed the vaccine needed to be matched to the circulating strains, and to be able to stimulate a response from the immune system.

The process to produce modern influenza vaccines now occurs on a much more refined and industrial scale. Hundreds of thousands of influenza viruses are collected by hundreds of national influenza centres around the world.

From these, four strains are selected for the annual flu vaccine, based on the viruses that are circulating at that time, how well the vaccines activate the immune system, how the strains are evolving, and the effectiveness of previous vaccines.

Modern flu vaccine development is slow and labour-intensive process.
hotsum/Shutterstock

Most modern vaccines are manufactured by growing large quantities of live virus – mostly in chicken eggs or less commonly animal cells – which are then purified, deactivated and split into smaller components. These vaccines are inactive and cannot replicate.

There are also two new “enhanced” vaccines that are used in older people, who don’t tend to respond as strongly to vaccines: Fluzone High Dose and Fluad, which is designed to better stimulate immunity and draw immune cells to the site of vaccination.

How the immune system fights the flu

The human immune system has several strategies to protect against infection. For viral infections such as influenza, the key strategy is known as adaptive immunity. This part of the immune system can “remember” previous exposure to pathogens.

When you get an influenza infection, the virus enters and hijacks the machinery of the host cell to replicate itself, before releasing these copies to infect more cells.

T lymphocyte cells of the immune system can recognise this viral incursion. T cells protect against further spread of the virus by activating pathways that cause infected cells to trigger a “suicide” process.

Another strategy the body uses is to produce antibodies, which are molecules produced by B cells that recognise components of the viral capsule. These antibodies work by sticking to the surface of the influenza virus to prevent it spreading and facilitating disposal.

Flu shots help mount a quicker defence

On a first exposure to a pathogen, our B cells take at least two weeks to ramp up production of antibodies. However, on subsequent challenges, antibody production occurs much more quickly.

Influenza vaccines harness this arm of the immune system, known as “humoral” immunity. By “practising” on viral components, vaccines allow the immune system to react more quickly and effectively when faced with the real virus.

The flu shot takes about two weeks to start protecting you against influenza.
DonyaHHI/Shutterstock

So why do you sometimes get sick after a flu shot?

There are several reasons why you might feel a bit off after getting your flu shot.

First, your flu shot only protects you against influenza and not other respiratory illness which might causes similar cold or flu symptoms. This includes RSV (respiratory syncytial virus), which is common in late autumn and early winter.

Second, stimulating the immune system can result in symptoms similar to that of influenza, although much milder and short-lived. These include local inflammation (redness, pain or swelling at the site of the vaccine) and more general symptoms (fever, aches and pains, tiredness).

Third, vaccine-induced protection isn’t complete. In some years, the vaccine is not well matched to circulating strains. Usually this is due to mutations that may develop in circulating strains after the vaccine strains are selected.

The flu vaccine also doesn’t “kick in” for two weeks after vaccine administration. In some people, particularly those who are older and those who have weakened immune systems, antibody production is not as strong, and the level of protection is lower.

Despite this, studies have consistently shown that vaccinated people are less likely to get influenza or complications from the flu than those who aren’t vaccinated.

A better way to protect against the flu

A problem with current vaccines is the reliance on eggs, which results in a relatively slow and labour-intensive production process.

Current work is aiming to speed up this process by using different technologies so that vaccine manufacturers can react more quickly to changes in circulating viruses.

The “holy grail” for influenza vaccines is to stimulate an effective immune response to a component of influenza that doesn’t change each year, so annual vaccination is not required.

These efforts have proved elusive so far.

A better strategy might be to harness T cell immunity. Recent work has shown that a type of T cell, known as “killer” T cells, can recognise other parts of the influenza virus, and therefore can provide broad protection against seasonal and pandemic strains.

But while we wait for a better alternative, getting an annual flu shot is the best way to avoid the flu.

Allen Cheng, Professor in Infectious Diseases Epidemiology, Monash University and Katherine Kedzierska, Academic, Microbiology and Immunology, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Sick with the flu? Here’s why you feel so bad

Posted on June 15, 2019 by particularkev

You might feel terrible. But your runny nose, sore throat and aches are signs your body is fighting the flu virus. And that’s a good thing.
from www.shutterstock.com

Stephen Turner, Monash University

“You never forget the flu”. This is the title of the Victorian health department’s current campaign, which highlights people’s recollections of having the flu.

‘The flu knocked me out for weeks’, part of the Victorian health department’s winter flu campaign.
Vic Dept Health & Human Services

Phrases include “I’ll never forget the pain of the fever”, “the flu flattened me”, “the flu knocked me out for weeks”.

This gives the impression that when you have the flu, you know you have it. What makes the flu so memorable is the severe symptoms. These include fever, aches and pains, a sore throat, runny nose, cough, and feeling weak and lethargic.

But what causes the flu? And why are the symptoms so severe?

What causes the flu?

Influenza is caused by a virus, a small microbe that needs to enter our cells to replicate and produce more viruses. The influenza virus infects cells that line our airways and so is easily transmitted via the spread of droplets released when we sneeze or cough.

Coughs, sneezes and the other symptoms we feel after getting the flu, are largely due to our bodies fighting the infection.

The immune response is a double-edge sword

When you are infected with the flu virus, your innate immune system kicks in. Special receptors recognise unique parts of the virus, triggering an alarm system to alert our bodies that an infection is under way.

This produces a rapid but non-specific response — inflammation.

Inflammation results from the action of small proteins called cytokines. A primary role of cytokines is to act locally in the lung to help limit the initial infection taking hold.

They can also make their way into the circulation, becoming systemic (widespread in the body) and act as a “call to arms” by alerting the rest of the immune system there is an infection.

Unfortunately, your body’s inflammatory response, while trying to fight your infection, results in the flu symptoms we experience.

Inflammation can trigger increased mucus production. Mucus (or phlegm) is a sticky substance that helps capture virus in the lungs and upper airways. The increased amount of mucus in the airways can trigger coughing and/or sneezing, and can lead to a runny nose. This helps expel the virus from our body before it can infect other airway cells.

Inflammation also results in an increase in body temperature or fever, which creates an inhospitable environment for the flu virus to replicate.

While an increased body temperature helps fight the infection, it also results in you feeling colder than usual. That’s because you feel a greater temperature difference between your body and the outside environment.

This can induce rapid muscle contractions in an effort to heat you up. This is why you can feel like you can’t stop shivering while at the same time burning up.

Finally, some of these inflammatory molecules act directly on infected cells to stop the virus replicating. They can do this by either interfering with the replication process directly, or alternatively, by actually killing the infected cell.

One of these factors is tumour necrosis factor alpha (TNF-alpha). While its actions limit where the flu virus can replicate, its side effects include fever, loss of appetite and aching joints and muscles.

Calling in the big guns

Inflammation induced by the innate response also helps alert the adaptive immune system that there is an infection.

While innate immunity provides an immediate, albeit non-specific, response to viral infection, it is the adaptive immune response that can efficiently clear the infection.

The adaptive immune system consists of specialised white blood cells called T and B cells that when activated provide a highly specific response to infection.

Your flu symptoms are likely the result of your body fighting off infection with the the tiny flu virus.
from www.shutterstock.com

Activation of flu-specific T and B cells in tissues called lymph nodes results in the generation of hundreds of thousands of clones, all specific for the flu virus. These can migrate into the lungs and specifically target the virus and its ability to replicate.

This enormous expansion of T and B cell numbers in response to infection results in swelling of the lymph nodes, which you can feel under your armpits or chin, and which can become sore.

Flu-specific T cells are also a source of the inflammatory molecule TNF-alpha and help fight influenza infection by killing off virus-infected cells. Both actions can contribute to the flu symptoms.

Why can flu become a serious problem?

Our ability to see off a flu infection requires a coordinated response from both our innate and adaptive immune responses.

If our immune system function is diminished for some reason, then it can prolong infection, lead to more extensive damage to the lung and extended symptoms. This can then result in secondary bacterial infections, leading to pneumonia, hospitalisation and eventually death.

Then there are people whose immune system doesn’t work work so efficiently who are particularly susceptible to the flu and its complications. These include:

the very young, whose immune system is still yet to mature
the elderly, whose immune system function wanes with age
people with other conditions where immune function might be compromised, or be taking medication that might suppress the immune system.

Preventing the flu

Washing your hands and covering your mouth when coughing and sneezing are simple things we can all do to reduce the chance of catching the flu in the first place.

And getting the flu vaccine activates your adaptive immune response to induce the sort of immunity efficient at protecting us from infection.

With the flu season well under way, prevention is our best bet that you won’t be saying “Remember the time I got the flu”.

Stephen Turner, Professor, viral immunology, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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