Influenza activity is currently at low levels and whilst last year’s flu season was less severe than some we’ve seen, we must remember the unpredictable nature of the virus.
It’s impossible to predict the impact that the disease will have this winter. And we cannot be sure of how many serious cases there might be as new strains have the possibility to circulate each year with varying intensity.
This reinforces the need for annual flu vaccination among key groups – including people of all ages with a long term health condition, pregnant women, children aged 2 to 4 and those aged 65 and over.
Immunisation uptake in eligible people under the age of 65 has remained static for some years and in a bid to drive change this year, our marketing approach for the campaign was six months in development.
During this time, research was carried out with people in risk groups with lowest uptake, followed-up by testing of various creative approaches.
Our research found that many people are often accepting of the flu vaccine or at least willing to consider it, but simply don’t think of it, or get around to getting it.
This insight guided us towards a ‘behaviour first’ approach, targeting those who accept they should get vaccinated but need a timely nudge to encourage them to act. Hence the ‘don’t put if off’ message used in the campaign press and radio advertisements.
It’s early days, but the good news is that first indications suggest that vaccine uptake is currently higher amongst people with health conditions, pregnant women and people aged 65 and over, when compared to this time last year.
But we must interpret these early figures cautiously and continue in our efforts to drive uptake much further throughout the season. A full evaluation of our campaign, to be completed later in the year, will inform our approach in future years.
As healthcare workers we must also remember our professional duty to be immunised against common serious communicable diseases. Good infection control measures, although important in reducing the risk of influenza infection, are not sufficient alone in preventing the spread of flu, which can have a fatal impact on frail and vulnerable patients, and cause severe disruption in hospitals, care homes and communities.
NHS Employers’ Flu Fighter campaign is well underway and PHE will publish the first vaccine uptake figures for healthcare workers in mid-November.
Antivirals – the evidence
Each winter hundreds of thousands of people see their GP and tens of thousands are hospitalised because of flu. Last winter, PHE received reports of 904 people admitted to intensive care or high dependency units with laboratory confirmed flu and, of them, 11% (98 people) died. This does not account for the many deaths where flu is not recognised or reported - estimates of the annual number of deaths attributable to flu range from 4-14,000 per year, with an average of around 8,000 per year.
The impact that flu can have on the health of people at risk in our communities and on our health services is unquestionable. It has been of great concern that reporting this year around the Cochrane Review 2014 publication suggested that antivirals are not effective for influenza, which could impact the prescribing of these important drugs.
So let’s be clear on the evidence. The findings of the 2014 Cochrane Review were not substantially different to the previous (2010 and 2012) reviews, and there is no evidence to support a change to the recommended use of antiviral drugs.
Today, PHE is publishing further guidance for healthcare professionals on the use of antivirals to treat and reduced the spread of flu. Whilst we know that antivirals are not a ‘magic bullet’ to prevent or treat flu in otherwise healthy individuals, there is evidence that antivirals can reduce the risk of death in patients hospitalised with flu.
A recent study of patients hospitalised with flu showed that among adults, treatment with antivirals was associated with a 25% reduction in the likelihood of death compared with no antiviral treatment. Early treatment within 48 hours of onset of symptoms halved the risk of death compared with no antiviral treatment. This supports the view that the benefit of antiviral treatment is greatest when started within two days of onset of illness.
We therefore continue to support the early use of antivirals for patients with proven or suspected seasonal influenza who are in high risk groups or who are considerably unwell (even if not in a high risk group).
It is essential that doctors treating severely unwell patients are not deterred from prescribing what may be lifesaving drugs as a result of confusion over whether they work; this is especially true for patients hospitalised with proven or suspected influenza.
This position is consistent with that taken by the World Health Organisation (WHO) and other national public health organisations such as the USA’s Centers for Disease Control and Prevention (CDC).