The Flu season is upon us


This year’s Flu season is here and thousands of people have already had it – if you can believe the media-hype (that conveniently had no reference for the dreadful statistic but very well may be true).

An then there is this:

If you find that you are time poor, and you can’t go to your doctor’s surgery to get your flu shot, go to your local pharmacy and get your flu shot as soon as possible before the winter season,” said Rich Samimi, the NSW Branch President of the Pharmacy Guild of Australia” – adding up to an expected additional 2 million Australians being vaccinated this year – not a bad little money spinner if you take into account that every one of these injections at the Pharmacy is being paid for by their Customer with costs varying between $10-20 a shot.

The pessimist in me cannot but help wonder how much of a commercial influence there is with the changes in 2017 where Pharmacies all over the country  can now administer vaccines. At a price of course.

Administered by a “qualified health professional” – with no further detail on most of the websites provided so one must assume they either employ Nurses or the Pharmacist did a quick course on how to inject a patient.

The ads are there to sell a service and make a profit and it is fascinating to see how people are being manipulated. Some make sure that they are making their clients aware that they are providing a four strain vaccine that is better than the three strain vaccine. This is off course true – just somewhat irrelevant in 2017 when all the available vaccines have four strains in them.

Some offer a vaccine against the quadrivalent strain  (whatever this frightful beast may be) while others advocate every single person over the age of six months getting a flushot.

And before anyone accuse me of beating-up on the poor Pharmacies. Many others such as Nurse Practitioner Clinics and a variety of other Corporate type services are jumping on the bandwagon – some even offer free lollipops to their Customers.

All of the above sounds very reasonable and often results in visceral responses from the operators involved about doctors, especially GPs, engaging in a turf war about this issue.

The question thus emerges – what is the risk for the average healthy individual of contracting influenza ?

Unvaccinated – 3%. Yep. That low. And when you vaccinate it drops to 1%

This is nicely explained by Dr Dan (and yes, I would be the first one in the line if that man-flu shot was discovered).

Sadly the evidence that the severity of a Flu attack is less if vaccinated is also not very overwhelming.

So am I against giving the flu-shot ?

No, I am not, but believe that the evidence to support giving it to everyone above the age of six months, regardless of presence or absence of risk factors, is lacking.

There is however a group of high risk individuals that has the greatest risk of becoming severely ill from the flu – this group of people can get their vaccines for free from their General Practitioners and do not need to waste their limited resources on purchasing it elsewhere.

So who is this high risk group who qualify for the free vaccine?

  • pregnant women – the flu vaccine can be safely given during any stage of pregnancy
  • Aboriginal and Torres Strait Islander people of certain ages (children from 6 months of age up to their 5th birthday and those aged 15 years and over)
  • people aged 65 and over
  • people with certain medical conditions (see table 3)
  • cardiac disease
  • chronic respiratory conditions (including asthma that requires frequent hospitalisation)
  • chronic neurological conditions
  • conditions that reduce the function of your immune system
  • diabetes and other metabolic disorders
  • renal disease
  • haematological disorders (blood disorders)
  • children aged from 6 months to 10 years of age on long-term aspirin therapy.

If you fall in this group I would suggest that you wait until your GP receive the supply of free Government vaccines (mid-April) and then have the injection. The vast majority of GP clinics do not charge if the visit is purely for the purpose of administering a flu shot and many of us would hold special vaccination clinics to get our Patients vaccinated. This may also be an opportunity to review the vaccination status of vulnerable patients in regards to pneumonia, tetanus, whooping cough, etc.

Vaccinations such as these are best performed by the staff at your usual GP Clinic where there is proper facilities and access to your full medical record.

Influenza vaccination is also strongly recommended, but not funded, for other groups who are at increased risk of influenza and its complications:

  • Aboriginal and/or Torres Strait Islander children aged 5 years to <15 years;
  • persons with Down syndrome;
  • persons with class III obesity (body mass index ≥40 kg/m2);
  • persons with chronic liver disease;
  • children aged 6 months to <5 years;
  • residents of aged care and long-term residential care facilities (, 65y);
  • persons who may transmit influenza to children or adults at increased risk of influenza complications (e.g. healthcare workers);
  • homeless people;
  • persons involved in the commercial poultry or pork industry, or in culling poultry or pigs during periods of confirmed avian or swine influenza activity;
  • persons providing essential services;
  • persons travelling during the influenza season, especially if it is known before travel that influenza is circulating in the destination region.

Our advice to our Patients in this group is to call us for a script,

that we will provide free of charge at our clinic,

and book an appointment with us to administer the vaccine to our Patient

(free of charge if that is the only reason for the visit).

Patients may elect to attend a Pharmacy who would administer the vaccine to their Customers but we would not consider this an ideal management.

So how do I know if I have a cold or the flu ?

It can be surprisingly difficult in immune suppressed patients but in mots other patients it is fairly straightforward:

ColdFluSymptoms

 Influenza can cause severe illness or death, particularly in high risk populations.

 Mortality is higher among individuals with complicated influenza (illness necessitating hospital admission, or an exacerbation of an underlying chronic illness) across all age groups, but is highest in infants aged 6 months or younger.

Influenza is usually self limiting in healthy individuals

Sadly when complications do occur they can be severe:

F1.large

(http://www.bmj.com/content/355/bmj.i6258)

So when should I have my flu-shot ?

If we can believe the commercially driven hype everyone should already have had their flu-shots by now.

The problem with this approach is:

  • Evidence suggests that the flu-vaccine’s effectiveness starts to wane after about 4 months and
  • the peak flu season in Australia usually falls around August

This means that there is a very high likelihood that all the people who have rushed in to have their Flu-shots at their local Pharmacy in February or March will start to lose their protective status right at the peak of the season.

This issue is the reason why the free Government supply of Flu-shots will only be released mid-April. Receiving the shot in late April to early May would result in an immune response within two to three weeks of being immunised and this should last well beyond the peak of the influenza season.

A classical case of being penny wise and pound foolish.

A much smarter approach is to wait until when the Infectious disease experts advised us to vaccinate (late April onwards) and in the meantime take sensible precautions:

prevent-flu

Lastly I should point out that I am not entire pro – vac.

There is one very specific situation where I am distinctly anti-vac.

Make of that what you want    download (1)

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