• Flu (influenza) is a respiratory infection caused by the influenza virus
• It is transmitted by droplets of respiratory secretions from person to person and there is a period of two to three days before the disease is apparent
• The symptoms include fever, headache, cough, sore throat and aching muscles and joints. For most people the infection causes several days of acute illness followed by a complete recovery
• However, for some patients with underlying medical conditions, those who are less able to cope because of their age, or even young and healthy individuals flu can be followed by serious complications such as pneumonia, which can be fatal.

There are two major types of flu virus: influenza A, generally the cause of more serious illness, and influenza B.
The difficulty in combating flu occurs because the viruses can change their identity.
This may be a slight change (a drift) meaning that individuals no longer have immunity to the virus, resulting in outbreaks of illness. Alternatively, the viruses can change their identity very significantly (a shift) which may result in a worldwide epidemic of flu - a pandemic.

• Deaths as a direct result of flu infection are often under-reported² because flu is not documented as the cause of death on the death certificate. Instead, the death may be attributed to myocardial infarction (heart attack) or pneumonia.
• Even in non-epidemic years as many as 3,000 to 4,000 excess deaths are attributable to flu in the UK.³ During epidemics this level is much higher - for example during the epidemic of 1989-90 there were almost 30,000 excess deaths in Great Britain attributable to flu⁴
• The UK experienced the seventh consecutive year of low levels of influenza activity during the 2006/07 season with a peak of 44.8 cases per 100,000 reported in mid-February.⁵ The highest rates in recent times were in the winter of 1989/90 when a peak of 583 cases per 100,000 population was seen.³

FLU VACCINATION

• Each year the World Health Organisation (WHO) announces the strains of flu virus which their reference laboratories have identified throughout the world as the likely cause of outbreaks during the following winter. To date, the WHO recommendations have shown a good match between the forecast strains and the actual strains which cause the outbreaks.
• The flu vaccines which are currently available are clinically effective and give 70-80% protection against infection with strains related to those contained in the vaccine³.
• Repeat annual vaccination is necessary due to the changing strains³.
• Vaccination reduces the possibility of death as a result of flu infection by as much as 69%⁶ and prevent 43-65% of deaths from influenza associated respiratory illness⁷.
• Generally the risks of serious complications and death associated with influenza can be avoided through repeated annual flu vaccination.³

 

Since the 2006/07 season the national policy has been extended to include patients with diabetes who control their diabetes with diet alone, along with individuals with chronic neurological disease, multiple sclerosis and related conditions and hereditary and degenerative disease of the central nervous system (see below).⁸ According to the influenza immunisation program 2007/08, influenza vaccination should be offered to⁸:

1. All those aged 65 and over
2. All those aged 6 months and over in a clinical risk group*
3. Those living in long-stay residential care homes or other long-stay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality(this does not include prisons, young offender institutions, university halls of residence etc)
4. Those who are in receipt of a carer’s allowance or those who are the main carer for an elderly or disabled person whose welfare may be at risk if the carer falls ill. This should be given on an individual basis at the GP’s discretion in the context of other clinical risk groups in their practice
   
   

*clinical risk groups are defined as those with:

• Chronic respiratory disease, including asthma
• Chronic heart disease
• Chronic renal disease
• Chronic liver disease
• Chronic neurological disease, including stroke and transient ischaemic attack (TIA)
• Diabetes, type 1 and type 2 requiring insulin or oral hypoglycaemic drugs and diet controlled diabetes
• Immunosuppression due to disease or treatment

As well as offering flu vaccine to people in the groups above, GPs should take into consideration the risk of influenza infection exacerbating any underlying disease that a patient may have, as well as the risk of serious illness from influenza itself. GPs should also assess, for example, the clinical needs of individuals with multiple sclerosis and related diseases, or hereditary and degenerative diseases of the Central Nervous System.

Note: Target groups are generally consistent throughout the UK, however, there is some variation in implementing strategies across the four nations.

 

 

Over 350,000 more older people were immunised against fluin the winter of 2003/04 compared to the winter of 2002/03.  This means that last winter, GPs gave protection against flu to 5.5 million people aged 65 and over in England.  There were a total of around 13 million doses of vaccine available in 2003/04, about 1 million more than the previous year⁷.

In the 2006/07 flu season over 15 million doses of vaccine were distributed throughout the UK,⁹ 900,000 more than in 2005/06.⁸

For the fourth consecutive year, flu vaccine uptake amongst the over 65s has surpassed the Government target of 70%¹⁰, reaching 74% in 2006/07⁸. Indeed, more than 90% of the UK’s Primary Care Trusts achieved target uptakes or better¹¹. This means that last winter, GPs gave protection against flu to 6.2 million people aged 65 and over in England.¹²

The target for the forthcoming season is to achieve 70% uptake in those aged 65 and over in all PCTs and Health Authorities. In addition, the Department of Health (DoH) aim to improve uptake among those people under 65 years of age who are in the risk groups recommended for vaccination.¹⁰

Many people do not realise that they are at risk from flu and there is much that the medical progression and the media could do to inform and educate on the methods which may be utilized to increase vaccine uptake.  An increase in flu vaccine uptake would mean that the complications of this vaccine preventable disease could be avoided and many lives could be saved every year.

 

 

1. Department of Health (DoH), Getting Ahead Of The Curve - A strategy for infectious diseases (including other aspects of health protection). A report by the CMO. http://www.dh.gov.uk/prod_consum_dh/idcplg?IdcService=GET_FILE&dID=5710&Rendition=Web
    
2. Majid et al. Influenza Epidemics and Acute Respiratory Disease Activity are Associated with a Surge in Autopsy-Confirmed CHD Death Eur Heart J 2007; Apr 17 epub
    
3. Salisbury DM & Begg NT (Eds.). 1996 Immunisation Against Infectious Disease. HMSO, chapter 19 - Influenza, updated December 2006
    
4. Ashley J, Smith T, Dunnell K. Deaths in Great Britain associated with the influenza epidemic of 1989-90. Population Trends 1991; 65: 16-20.
    
5. HPA National Influenza Season Reports 2006/2007 http://www.hpa.org.uk/infections/topics_az/influenza/seasonal/activity0607/reports/report14_week08.pdf
    
6. NHS Centre fo Reviews and Dissemination, University of York, Influenza Vaccination and Older People. Effectiveness Matters 1996; 2: Issue 1 www.york.ac.uk/inst/crd/pdf/em21.pdf
    
7. Fedson et al. Clinical Effectiveness of Influenza Vaccination in Manitoba. JAMA 1993; 270(16):1956-1961.
    
8. Donaldson, Sir Liam. Beasley, Prof Christine, Ridge, Dr Keith. The Influenza Immunisation Programme 2007/2008. From the Chief Medical Officer, the Chief Nursing Officer and the Chief Pharmaceutical Officer, 30 March 2007 http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Professionalletters...
    
9. Hansard Archives November 2006 http://www.publications.parliament.uk/pa/cm200506/cmhansrd...
    
10. Flu Watch Department of Health http://www.dh.gov.uk/en/Aboutus/MinistersandDepartmentLeaders/ChiefMedicalOfficer/Features/DH_4103271
     
11. Influenza Vaccine Uptake in Patients Aged 65 Years and Over, NHS Immunisation Information http://www.immunisation.nhs.uk/files/Influenza_vaccine_uptake200607_over65.pdf
     
12. NHS Immunisation Information http://www.immunisation.nhs.uk/files/Influenza_vaccine_uptake200607_over65.pdf