Flu jabs for the elderly or not?

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Flu is a winter regular – and as always there’s a particular debate about the benefits of flu jabs for the elderly.  Are flu jabs worth it?

Vaccination is recommended for high-risk groups (listed below) which includes the frail and elderly even though it is not fully effective. Minimising the risk as much as possible – even if not by very much –is recommended because flu is highly debilitating and each year kills about 8,000 people in the UK. Global epidemics can account for in a single year up to five million severe cases and half-a-million deaths.

There are other little known, life-saving arguments (also explained below) for influenza vaccination.

‘Real flu’ v ‘phoney flu’

It is important to distinguish between ‘real flu’ and the many bugs that deceive people into thinking that the country is in the grip of a flu epidemic once autumn gives way to the chilly blast of winter. These bugs can also be very nasty, but many of them are nothing more than bad colds or respiratory infections. People claiming to have struggled into work with flu are almost certainly deceiving themselves (and lets not even talk about ‘Man Flu’). Genuine flu delivers a bed-confining, knock-out blow.

High alert

NHS chief executive Simon Stevens has put Britain on flu alert because Australia and New Zealand have just had their worst flu season for many years. It does not follow automatically that what happens in the southern hemisphere will happen here, but it is something that a little known group, the world’s flu forecasters, take particular note of.

Throughout the year 142 national influenza centres in 113 different countries collect data on prevailing flu viruses for the forecasters. Based in five World Heath Organisation reference centres, they meet in February each year to decide the composition of the yearly flu vaccine for the northern hemisphere.

Just like weather forecasters they don’t always get it right, sometimes because circulating influenza strains change between February and September when the vaccines are first administered.

Vaccines 

Most injected flu vaccines protect against three types of flu virus:

  • A/H1N1 – the strain responsible for the swine flu pandemic in 2009.
  • A/H3N2 – a strain mainly affecting the elderly and those with long term health condition. The 2017/18 vaccine contain an A/Hong Kong/4801/2014 H3N2-like virus
  • Influenza B – a strain that particularly affects children. The 2017/18 vaccine  contains B/Brisbane/60/2008-like virus.
The Australian alert

The Australian Department of Health reported that the number of laboratory-confirmed flu cases reached a record high of 215,280 by mid-October, far exceeding the 59,022 reported during the 2009 influenza pandemic.

highalertInfluenza A (H3N2) viruses predominated and the preliminary estimate of the vaccine’s effectiveness against H3N2 was only 10 per cent. This might seem alarmingly low, but NHS England still insists that vaccination provides the best available protection, especially for high-risk groups such as:

  • The over 65s.
  • Patients with certain chronic medical condition such as asthma or diabetes.
  • Residents in long-stay care homes.
  • Carers.
  • Healthcare workers.
Life saver

A report in The New England Journal of Medicine states that despite its limitations, flu vaccination prevented 40,000 deaths in the US between the 2005-2006 and 2013-2014 flu seasons. This massive saving of life occurred even though in years when vaccines are well matched to circulating viruses, they are only between 40 to 60 per cent effective.

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The heart of the matter

Flu jabs offer over potential benefits. A study published in the Journal of the American Medical Association (JAMA) concluded that they may lower the risk by about a third for a year of an individual having a heart attack, stroke or heart failure.

This may seem astonishing, but the body responds to flu by generating an immune response, resulting in inflammation which can affect fatty plaque in blood vessels – in turn this may trigger a heart attack or stroke. The flu virus may also damage heart muscle and compromise the lungs, lowering blood oxygen levels, meaning that the heart has to work harder.

stayhydratedwhenelderlyThe JAMA study pooled the results from six clinical trials involving more than 6,700 people with an average age of 67, one third of whom had heart disease. The researchers found that overall those who had been vaccinated had a 36 per cent lower risk of a major cardiac event.

Such a large study might sound conclusive but the researchers want  to confirm the results with a further large trial.

Case for vaccination

On the basis of scientific evidence so far, the case for having a flu jab is compelling for three reasons.

  • It may help to protect you against flu. Reducing the risk by ten per cent is better than not reducing it at all.
  • It may prevent a heart attack or a stroke.
  • It will help to promote so-called ‘herd immunity’. The more people who are vaccinated, the less chance there is that an unvaccinated individual will be exposed to infection.

NHS England is trying to increase herd immunity by appealing to parents to book in their children for a free nasal spray vaccination. This could protect youngsters and stop them infecting vulnerable relatives, such as older grandparents with heart or lung conditions.

The Australian alertBut the biggest threat of all to herd immunity may be the many millions of people who are the most vulnerable – the ‘high risk’ groups who have yet to roll up their sleeves. Last winter only 70.5 per cent of the UK’s ten million over 65s had been immunised by the end of January.

And yet, of all potentially life-saving initiatives, are there any more simple than the flu jab? It takes just a few seconds and is a lot less demanding than other health-promoting regimes such as regular exercise and prudent eating. A simple prick – and that’s it.

Consult your GP or go to NHS Choices for more information on flu jabs.