Flu and flu vaccines: Expert interview

You may have seen media coverage in recent days about so called ‘Aussie’ flu. In response to this, our Medical Director Paul Cosford has answered some key questions about flu and flu vaccination.
What is ‘Aussie flu’?
So called ‘Aussie flu’ is actually a bit of a misnomer. This strain of flu is one of many and is officially named H3N2. It is a strain that we have seen in previous seasons in the UK, in fact we saw it circulating last season. The good news is that all vaccines offered to children and adults include coverage against this strain of flu.
Do we know how many cases of so called ‘Aussie flu’ we have seen?
We don’t test everyone who sees their healthcare professional with flu to determine the type, however the sampling we have suggests that both the influenza A and B types are co-circulating in roughly equal numbers. The samples we have examined of flu A(H3N2) and  flu A(H1N1)pdm viruses so far are similar to the components in the vaccines being offered.
Are increased hospital admissions due to Aussie flu?
In the last week, hospital admissions have increased due to a combination of influenza A and B and no strain is currently dominating. Find out more in our weekly flu report.
Why is flu a problem?
In most people, flu is a fairly mild, self-limiting illness. However for some people, particularly those in what we call ‘at-risk’ groups (for example older people and those with weakened immune systems), all types of flu can be very serious. The vaccine is the best defence we have against the spread of flu and it isn’t too late to get vaccinated.
Who is at risk?
There are certain groups who are at higher risk from flu; these include pregnant women, those over the age of 65 and those with serious long-term health conditions. We offer the flu vaccine to all of these groups, as well as children, to help protect them from catching flu. People over the age of 65 are slightly more likely to catch H3N2 – that’s why it’s important to take up the offer of the vaccine, all vaccines offered to adults cover against this strain.
Eligible people can have their flu vaccine at their GP surgery or a local pharmacy offering the service. Some midwifery services can offer the vaccine to pregnant women.
What is the flu vaccine programme?
The flu vaccine programme aims to reduce the impact of flu on the population. Individuals at risk of severe consequences of flu infection are recommended to receive the flu vaccine, as are health workers to both protect themselves and the patients they care for. In recent seasons, the UK has been incrementally introducing a childhood flu vaccine programme, which will ultimately target all children 2-11 years of age. Two types of vaccine are available for use – the trivalent and quadrivalent.
Quadrivalent vaccines offer protection against two types of flu A and two types of B. Trivalent vaccines provide protection against one type of flu B and two types of flu A. The WHO recommend that either vaccine can be used. Children in eligible groups receive the quadrivalent vaccine, as this group are most likely to be affected by flu B and this will also provide some indirect protection to other parts of the population as children often pass on flu to other members of their family.
There are some reports that suggest not everyone is being protected against all strains of flu, what can you tell us about that?
Adults are offered either the “trivalent” or “quadrivalent” vaccine which include the strains recommended by the World Health Organisation. The trivalent vaccine includes two types of flu A strain and one of flu B, while the quadrivalent includes two types of A and two B strains.
Early indications are that what’s called the “influenza B/Yamagata lineage” is circulating which is contained in the quadrivalent but not in the trivalent 2017/18 vaccine.
The components of the vaccine are determined 12-18 months before the season, following World Health Organization WHO recommendations. Flu is unpredictable and it is impossible to know which strains will circulate each season and so we have to use our best judgement about which vaccines to offer.
The nasal spray vaccine, given to children who are the group most likely to be affected by flu B, does protect against both B strains and will also provide the indirect protection to other parts of the population.
The good news is that all vaccines offered cover the flu A(H3N2) and flu A(H1N1)pdm strains. The vaccine remains the best defence against the virus.
Should we make healthcare worker vaccination mandatory?
For some, flu can be a particularly serious illness and healthcare workers have an important role to play in protecting the health of the public – particularly at a time of year when there is increased pressure on the health service. Around 30% of people who have flu will not have any symptoms and so relying on staff not to work only when they are displaying signs of flu is not enough to protect the population.
It is important to make it really easy for healthcare workers to be vaccinated as that is what will help us to achieve really high rates of uptake. The vaccine is the best form of protection against flu, keeping staff healthy, protecting their patients and doesn’t cause harm, so why would you not take up the offer and get vaccinated?  We need to see where we get to this season with healthcare worker vaccination and then talk to the professions about what measures are needed to best protect our patients.
How are flu vaccinations made?
The World Health Organization (WHO) monitors influenza globally and each year convenes a vaccine composition group that recommends the strains of flu virus that should be included in the flu vaccine for the next flu season. As the vaccine is an organic product that has to be grown it takes from February through to August or even September for vaccine manufacturers to produce sufficient quantities of the flu vaccine for the annual campaign.
If a change in the virus is detected once production has started there isn’t time to change it. PHE provides advice on the efficacy of the vaccines but does not manufacture them.
Do outbreaks suggest people have not received the right vaccination?
It is usual for us to see outbreaks of flu at this time of year and it is an issue we prepare for each winter. All eligible children have been offered the quadrivalent nasal spray vaccine which includes two strains of flu A and two of flu B which they are more likely to be affected by.
We are seeing low numbers of children being hospitalised to intensive care/high dependency units due to flu and a low number of school-based outbreaks. The vaccine is the best defence we have against the spread of flu and it isn’t too late to get vaccinated.
What should people look out for?
Flu is usually characterised by a fever, chills, headache, aching muscles and joint pain and fatigue. For many healthy people, flu symptoms can make you feel so exhausted and unwell that you have to stay in bed and rest until you get better.
The best remedy is to rest at home, keep warm and drink plenty of water to avoid dehydration. You can take paracetamol or ibuprofen to lower a high temperature and relieve aches if necessary.  If you feel no better after about a week, it’s a good idea to ring NHS 111 or visit your local pharmacist.
If you're otherwise fit and healthy, there's usually no need to see a doctor if you have flu-like symptoms.  However, you should consider seeing or contacting your GP or NHS on 111 if you are in a group at higher risk of severe disease such as over 65 years of age; pregnant or with an underlying health condition; or if your symptoms are getting worse.
A GP can assess you and may prescribe you antivirals, which can reduce your symptoms and shorten the length of your illness.


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