Johannesburg, 13 April 2022: Each year influenza (flu) causes up to 650 000 deaths globally, the highest numbers being in sub-Saharan Africa. Over 11 000 deaths related to flu occur in South Africa (SA) each year, and almost 50% of those in SA who catch severe flu, need hospitalisation.
Flu viruses circulate worldwide at different times of the year, and SA’s seasonal flu usually has the highest number of recorded cases between May and September. Flu spreads quickly and can affect anyone, regardless of their state of health or their age.
A recent study in SA found that there was a high occurrence of flu in both rural and urban settings, and also showed that people with no symptoms – particularly children – are able to transmit flu. In this study, around half of the people with flu had no symptoms – but they transmitted flu to 6% of their household contacts.
Young children had the most cases of symptomatic flu illness and were more likely to spread the flu to people in their household. Among children older than 5 years, 74% had flu symptoms, compared to 39% of adults aged 19-44 years.
While all age groups can be infected with both the COVID-19 virus and flu virus, the following people are at higher risk for severe disease and death from both COVID-19 and flu: elderly adults over 65; people of any age with chronic medical conditions (such as chronic heart or lung disease); people with immunosuppressive conditions (such as HIV/AIDS) and pregnant women.
Says Dr Thinus Marais, Medical Head: Africa Zone, Sanofi Pasteur: “Targeting vaccination towards children not only has the potential to reduce symptomatic disease in this at-risk group, but also of reducing transmission in the community.”
He adds: “Flu vaccination is even more important now, given that simultaneous infection with flu and COVID-19 canresult in severe disease. In the UK, a study from January to April 2020 showed that co-infection with flu and COVID-19 was associated with a two times higher risk of death and intensive care unit admission, compared with COVID-19 infection alone.”
“Flu vaccination is critical, considering the possible co-circulation of both the flu and SARS-Cov-2 viruses in the absence of a hard lockdown. It is important to remember that the flu vaccine will not prevent COVID-19 and vice versa; therefore, it is important to ensure that you are vaccinated against both,” says Dr Marais.
Since their introduction in the 1940s, seasonal flu vaccines have saved countless lives and limited pandemic spread.8 According to the US Centers for Disease Control, during the 2019-2020 season, flu vaccination averted 7.5 million cases of flu, 3.7 million medical visits, 105 000 flu-associated hospitalisations, and 6 300 deaths.
“It is important to note that due to non-pharmaceutical interventions such as mask wearing and social distancing, the numbers of flu cases reported in 2020 and 2021 were reduced. The flu virus remains unpredictable, and experts expect a resurgence of cases as population movements and habits return to normal.” says Dr Marais.
Guidance regarding having flu and COVID-19 vaccination at the same time is constantly being updated. At the time of publication, the Department of Health advises that while the flu vaccine can be given concurrently with other injectable, non-flu vaccines (but must be administered at different injection sites), it should not be co-administered with COVID-19 vaccines.6 As per the National Institute for Communicable Diseases (NICD), the COVID-19 vaccine should be administered with at least a 14-day interval between it and any other vaccine.
Recent studies have found that COVID-19 has caused people to have a higher risk of heart complications – which further expands the pool of high-risk people. Evidence has also shown that flu may predispose people to heart problems.
“In SA, annual flu recommendations encourage individuals at high risk of severe outcomes to get vaccinated. Remember that even healthy individuals who wish to protect themselves and those around them from getting the flu can consider vaccination annually” says Dr Marais.
Ask your doctor, pharmacist, or healthcare provider for more information about flu vaccination.
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References
1. World Health Organization. Flu (Seasonal). Available from: https://www.who.int/newsroom/ fact-sheets/detail/flu-(seasonal). Accessed October 2019.
2. Wits Communications. (2021, 19 May). Who catches and transmits flu in SA and the implications for vaccination. Available from: https://www.wits.ac.za/news/latest-news/research-news/2021/2021-05/who-catches-and-transmits-flu-in-sa-and-the-implications-for-vaccination.html. Accessed 20 October 2021.
3. Blumberg L, Cohen C, Dawood H, et al. (2018). Flu NICD Recommendations for the diagnosis, prevention, management and public health response. Available from: http://www.nicd.ac.za/wp-content/uploads/2017/03/Flu-guidelines-rev_-23-April-2018.pdf. Accessed October 2019.
4. CDC. Key facts about influenza. Available from: https://www.cdc.gov.flu/about/keyfacts.htm. Accessed 25 October 2021.
5. Cohen, C, et al. Asymptomatic transmission and high community burden of seasonal influenza in an urban and a rural community in South Africa, 2017–18 (PHIRST): A population cohort study.
Wits. The Lancet Global Health 2021;9(6,):E863-874.
6. Department of Health. Influenza Vaccination Guide 2021.
7. Stowe J, et al. Interactions between SARS-CoV-2 and influenza, and the impact of coinfection on disease severity: a test-negative design. International Journal of Epidemiology 2021; 1-10; doi: 10.1093/ije/dyab081
8. Wei, CJ, et al. Next-generation influenza vaccines: opportunities and challenges. Nature Reviews Drug Discovery 2020; 19, 4, 239-252.
9. CDC. Vaccine effectiveness: How well do the flu vaccines work? Available from: https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm. Accessed 15 July 2021.
10. World Health Organization. WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic. Available from: https://www.who.int/immunization/policy/position_papers/Interim_SAGE_influenza_vaccination_recommendations.pdf?ua=1. Accessed November 2020.
11. Pesheva E. Coronavirus and the heart. The Harvard Gazette. Available from: https://news.harvard.edu/gazette/story/2020/04/ Accessed 22 October 2021.
12. Warren-Gash C, Blackburn R, Whitaker H, et al. Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland. European Respiratory Journal. 2018;51(3):1-9.
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