Annual Flu Vaccinations
Flu is the shortening of the word influenza and each autumn there are scare stories in the press about bird flu re-emerging and how to protect yourself from various types of flu – this article examines some of the issues surrounding the vaccination against flu in all its forms.
Do not confuse the annual flu vaccination with the pneumococcal vaccination or prevention of bird flu. For information on the pneumococcal vaccination recommended for the elderly or welders click here.
The Science of Flu
Influenza is an acute viral infection of the respiratory tract. Influenza is highly infectious with a usual incubation period of one to three days. The disease starts with the sudden onset of fever, chills, headache, aching muscles and extreme tiredness. Other common symptoms include a dry cough, sore throat, and stuffy nose.
For otherwise healthy people, influenza is an unpleasant but usually self-limiting disease with recovery usually within two to seven days. The illness may be made worse or be first seen as a severe chest infection or, in children, an ear infection or an earache. Influenza can rarely cause meningitis.
The risk of serious illness from influenza is higher among children under six months of age; older people and those with underlying health conditions in those with chest and heart conditions, long-term health conditions such as multiple sclerosis or paralysis, those receiving treatments for cancers (immunosuppression) and pregnant women. Blood tests taken in healthcare professionals have shown that about 30 to 50% of those tested did not know they were carriers of influenza, although this varied depending on the strain.
For more information on the science of Flu Vaccinations go to The Green Book on Vaccinations
Annual Flu Vaccination – What it is?
In February each year, the World Health Organization (WHO) assesses the strains of flu virus that are most likely to be circulating during the following winter in the northern hemisphere. Based on this assessment, the WHO recommends which three flu strains the vaccines should contain for the forthcoming winter. Vaccine manufacturers then produce flu vaccines based on the WHO’s recommendations. These flu jabs are used in all the countries in the northern hemisphere, not just the UK. Production of the vaccine starts in March each year after the WHO’s announcement. The vaccine is usually available in the UK from September with GP practices and NHS Occupational Health services calling up those who need the vaccination
Types of flu virus
There are three types of flu viruses. They are:
- A flu virus is usually the more serious type. The virus is most likely to mutate into a new version that people are not resistant to. The H1N1 (swine flu) strain is a type A virus. Pandemics in the past were typed A viruses.
- B flu virus causes a less severe illness and is responsible for smaller outbreaks. Type B mainly affects young children.
- C flu virus usually causes a mild illness similar to the common cold.
Most years, one or two strains of type A Flu circulate as well as type B.
Making the Flu Vaccination
The injectable flu vaccine has three different types of flu virus (usually two A types and one B-type). For most vaccines, the three strains of the viruses are grown in hens’ eggs. The viruses are then killed (deactivated) and purified before being made into the vaccine. You cannot get Flu from the vaccination as some people claim because it is a dead virus.
Flu vaccination ingredients
As there are lots of different flu vaccines produced each year, for more detailed information on ingredients ask to see the Patient Information Leaflet for the particular vaccine being offered. However, before having the vaccination, you will be asked about any allergies to known components of the vaccine by the nurse or Doctor such as, do you have any allergy to eggs?
How the Flu Vaccination protects you
The vaccine stimulates your body’s immune system to make antibodies attack the flu virus.
Antibodies are proteins that recognise and fight off germs, such as viruses, that have invaded your blood. If you catch the flu virus after you’ve had the vaccination, your immune system will recognise it and immediately produce antibodies to fight it. It may take 10-14 days for your immunity to build up after you have had the flu shot. The antibodies that protect you from the flu will then gradually decrease over time. The flu strains can also change from year to year. Therefore, you need to have a flu jab every year to ensure that you have the best protection against the latest strain of the virus.
The flu strains can also change from year to year. Therefore, you need to have a flu jab every year to ensure that you have the best protection against the latest strain of the virus.
Experts argue that having the Flu jab cuts down the amount of virus in the general population and thus lessens the chance of a mutation of genes to something like bird flu.
Also, watch this interesting video on the principles of herd immunity and how that protects even those who do not have the vaccination.
Who should be Vaccinated?
The UK government and health agencies recommend that the over-65s, patients with diabetes, heart disease and asthma (plus other groups which change each year) are first in line for the flu jab, and this is important when there isn’t enough vaccination to go round.
Other people who want to be vaccinated can pay for the vaccine at a pharmacy – such as, Boots or the larger supermarkets such as Tesco and Asda for about £12.
Alongside flu vaccinations, there are other ways of protecting against pandemic and epidemic influenza. The UK has a stockpile of specialist medications (neuraminidase inhibitors) to guard against any sudden outbreak of bird influenza H5N1 and H7N9, which are recognised as continued threats by the World Health Organisation (WHO) in countries such as Egypt, where cases of bird flu are quickly treated with the neuraminidase inhibitors. These drugs can reduce mortality by 50%.
Should we ‘catch it, bin it, kill it’ or are there other measures we can take?
Along with medicine there are other, simpler interventions, such as good hygiene, social distancing and cough and sneeze etiquette. Recent community experiments have shown the importance of hygiene and disinfection to kill influenza on surfaces and hands, and how simple masks can help. The masks are worn by an infected person to prevent spread onwards and not the other way round. And a 2m gap is the smallest safe distance to avoid virus-containing droplets from coughs and sneezes.
A cough and sneeze etiquette from the US Centres for Disease Control is very helpful, including the recommendation to sneeze into the inner elbow rather than the hand.
The media quickly pick up on early warnings of influenza in the community, alongside social networking and blog sites. But in the absence of an influenza outbreak, GP’s have a tough task sorting out whether it is flu or not given the different types of cold and respiratory viruses – especially outside the winter. Even the official definition of influenza-like illness as temperature, cough and malaise is not foolproof.
Most of us will have a cold this autumn or winter, and some of us will have flu. Here’s how to look after yourself if these viruses affect you.
Viruses cause colds and flu. There are more than 200 common cold viruses and three types of flu virus with many different strains, so they’re hard to avoid. These viruses are spread through coughing or sneezing if you are infected. The viruses can also be transferred on a person’s fingers. For example, if you have a cold, and touch your nose or eyes and then touch someone else, you may pass the virus on to them.
The main symptoms of winter cold and flu bugs are:
- blocked nose
- sore throat
- a slight temperature
If these are the only symptoms you have, it’s unlikely that your GP will be able to do anything. You may want to visit your local pharmacy, where you can get advice on how to manage the symptoms and buy over-the-counter medicine.
It’s really important not to pass it on to anyone who may be likely to have a serious health problem already.
CATCH IT Germs spread easily. Always carry tissues and use them to catch your cough or sneeze. BIN IT Germs can live for several hours on tissues. Dispose of your tissue as soon as possible. KILL IT Hands can transfer germs to every surface you touch. Clean your hands as soon as you can.
Get rest and eat well
Try to rest, eat well, avoid stress and drink lots. If you have a fever, you may need extra fluids. You could also take paracetamol to treat fever and pain or inhale steam with a decongestant in it to help clear a blocked nose. But don’t give aspirin to children under 16 years of age.
Pharmacists say cold and flu medicines are among their top sellers in the winter and in most cases, antibiotics aren’t necessary.
When to see a doctor
While most bugs will run their course without doing any real harm, there are certain cases when adults should see a GP. This includes the following symptoms:
- a chronic condition such as asthma, diabetes or heart disease
- high temperature and feel ill, for example, if you also have an unusually severe headache or abdominal pain
Babies and older and frailer people should get help if they’re unwell. All babies under three months with a temperature of more than 38°C (100.4°F) should be urgently assessed by a doctor, as should babies aged three to six months with a temperature higher than 39°C (102.2°F).
Who are likely to have a dangerous reaction to flu?
The at-risk groups – under-fives, over-65s, and patients with asthma, diabetes, and chronic heart disease – are prime targets for extra medical attention from GPs. The first sign of trouble is when the common flu symptoms of a cough, tiredness, and high temperature fail to go after three to four days. At this stage, the GP will need to intervene with a course of antibiotics.
There is also a new group of at-risk people is those with obesity, who do not respond so well to the influenza vaccine.
Are we likely to have the swine flu Pandemic again?
WHO revised its pandemic planning advice to governments, including the current UK Government.
There are four phase stages, called inter-pandemic, alert, pandemic and transition.
The new plan, resulting from the information gained in 2009, fits more easily into the current UK national plans (Emergency Risk Management for Health, ERMH) and breaks global phases from decisions and actions at national level. The UK could delay a pandemic declaration even if the outbreak started in the southern hemisphere.
If there is a pandemic (within five years) – there will be less focus on the tablet regime from the swine flu outbreak and more concentration from GPs on special risk groups, using newer drugs alongside more attention to hygiene in the home.
Should Flu Vaccination be compulsory for healthcare workers?
There is no doubt that there is a low uptake of vaccines among healthcare workers in the UK. We know that influenza can be carried into and out of hospitals by doctors and nurses. When advising patients, we know that a word of encouragement from a nurse and doctor for vaccination makes all the difference to an undecided and possibly vulnerable patient – and patients do ask the healthcare workers whether they are vaccinated. The current flu vaccination figures, which hover around 35%, among healthcare workers, should aim for 75% coverage.
Ethical Issues with Flu Vaccinations
As the number of businesses adopting influenza vaccination policies, so do questions about employee rights, freedom of choice, and exemptions for religious and other reasons. Occasionally I come across an occupational health professional who refuses to give the vaccination because it is unnecessary.
Rarely some individuals will have a reaction to one of the components of the Flu vaccination whether this might be an inflamed site of injection or even more rarely anaphylactic shock. More information on anaphylactic shock
The UK provides free health care for all. However, there is a three-line whip that all frontline healthcare staff take up the flu vaccination offer.
Suggestions of Ways to Improve Uptake of Flu Vaccinations in the NHS
There are some creative ways of improving the uptake of flu vaccinations in the NHS that I have come across and these include:
- Taking the flu vaccination to the wards and not waiting for staff to come to Occupational Health
- Offering money back on having flu jabs at local supermarkets
- Items on websites and local newsletters
- Poster campaigns
- Nurses to be local flu vaccinators under PGD instructions
If you have any more good ideas why not share them here? It will be interesting to see how much farther the vaccination compliance dial moves after this flu season. To be on the safe side, be sure to frequently wash your hands. That’s one of the best and easiest ways to avoid getting and spreading the flu.
- Here is the list of the vaccination programmes in the UK:
- Guidance for healthcare professionals on giving the Influenza Vaccination
- Ten common myths about Flu – how many do you believe?
- BMJ discusses whether health care professionals should have the flu vaccination
See also this video on YouTube on how the virus works
Are you entitled to a free flu vaccination click here to find out
Do you have an effective way of interesting people in having a flu jab – let me know in the reply and I can add it to this article.