Opinion
With the flu season starting and peaking earlier, there have been several enhancements to influenza vaccines. What are they? And which one should you get?
Influenza is a common respiratory infection. Although most cases are relatively mild, flu can cause more severe illness in young children and older people.
Influenza virtually disappeared from Australia during the first years of the Covid-19 pandemic when public health restrictions reduced contact between people. Since 2022, it has returned to a seasonal pattern, although the flu season has started and peaked a few months earlier than before 2020.
Its difficult to predict the intensity of the flu season at this point in the year, but we can sometimes get clues from the northern hemisphere. There, the season started earlier than usual for the third year running (peaking in early January rather than late February or March), with a similar number of reported cases and hospitalisations to the previous year.
Influenza vaccines are recommended annually, but there are now an increasing number of different vaccine types. Heres what to know about this years shots, available from this month.
Like other vaccines, influenza vaccines work by training the immune system on a harmless component of the influenza virus (known as an antigen), so it can respond appropriately when the body encounters the real virus.
Influenza strains are constantly changing due to genetic mutation, with the pace of genetic change much higher than for Sars-CoV-2 (the virus that causes Covid). The strains that go into the vaccine are reviewed twice each year by the World Health Organization, which selects vaccine strains to match the next seasons predicted circulating strains.
All current influenza vaccines in Australia contain four different strains (known as quadrivalent vaccines). One of the strains appeared to disappear during the Covid pandemic, and the WHO has recently recommended dropping this strain from the vaccine. Its expected trivalent (three strain) vaccines will become available in the near future.
There are eight brands of flu vaccines available in Australia in 2024. These include egg-based vaccines (Vaxigrip Tetra, Fluarix Tetra, Afluria Quad, FluQuadri and Influvac Tetra), cell-based vaccines (Flucelvax Quad), adjuvanted vaccines (Fluad Quad) and high-dose vaccines (Fluzone High-Dose Quad).
Until recently, the process of manufacturing flu vaccines has remained similar. Since the development of the influenza vaccine in the 1940s, influenza viruses were grown in chicken eggs, then extracted, inactivated, purified and processed to make up the egg-based vaccines that are still used widely.
However, there have been several enhancements to influenza vaccines in recent years.
Older peoples immune systems tend not to respond as strongly to vaccines. In some flu vaccines, adjuvants (components that stimulate the immune system) are included with the influenza antigens. For example, an adjuvant is used in the Fluad Quad vaccine, recommended for over 65s. Studies suggest adjuvanted influenza vaccines are slightly better than standard egg-based vaccines without adjuvant in older people.
An alternative approach to improving the immune response is to use higher doses of the vaccine strains. An example is Fluzone High-Dose Quad another option for older adults which contains the equivalent of four doses of a standard influenza vaccine. Studies suggest the high dose vaccine is better than the standard dose vaccine (without an adjuvant) in preventing hospitalisation and complications in older people.
Other manufacturers have updated the manufacturing process. Cell-based vaccines, such as Flucelvax Quad, use cells instead of eggs in the manufacturing process. Other vaccines that are not yet available also use different technologies. In the past, manufacturing issues with egg-based vaccines have reduced their effectiveness. Using an alternative method of production provides some degree of insurance against this in the future.
Given indications this years flu season may be earlier than usual, its probably safest to get your vaccine early. This is particularly important for those at highest risk of severe illness, including older adults (65 years and over), those with chronic medical conditions, young children (six months to five years) and Aboriginal and Torres Strait Islander people. Influenza vaccines are also recommended in pregnancy to protect both the mother and the baby for the first months of life.
Influenza vaccines are widely available, including at GP clinics and pharmacies, while many workplaces have occupational programs. For high-risk groups, four of the vaccines are subsidised by the Australian government through the National Immunisation Program.
In older people, a number of vaccines are now recommended: Covid and influenza, as well as one-off courses of pneumococcal and shingles vaccines. In general, most vaccines can be given in the same visit but talk to your doctor about which ones you need.
All influenza vaccines can cause a sore arm and sometimes more generalised symptoms such as fever and tiredness. These are expected and reflect the immune system reacting appropriately to the vaccine, and are mostly mild and short-term. These side effects are slightly more common in adjuvanted and high dose vaccines.
As with all medications and vaccines, allergic reactions such as anaphylaxis can occur after the flu vaccine. All vaccine providers are trained to recognise and respond to anaphylaxis. People with egg allergies should discuss this with their doctor but in general, studies suggest they can safely receive any (including egg-based) influenza vaccines.
Serious side effects from the influenza vaccine, such as Guillain-Barr syndrome, a neurological complication, are very rare (one case per million people vaccinated). They are thought to be less common after influenza vaccination than after infection with influenza.
Allen Cheng is professor of infectious diseases at Monash University. This article was originally published in the Conversation
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Federal officials are preparing for the possibility of additional human cases of bird flu, testing components to create a vaccine after a Texas dairy worker was infected with the highly virulent virus, even as they stress the United States remains far from needing to activate a full-blown emergency response
Two candidate vaccine viruses essentially the building blocks manufacturers use to produce a vaccine appear well matched to protect against the H5N1 strain circulating among dairy cattle and birds, according to federal health officials. Itd probably be weeks to months before those shots could first be made available if needed, according to a Health and Human Services official who spoke on the condition of anonymity to describe an ongoing investigation.
Top officials at the Centers for Disease Control and Prevention said the agency is well poised to detect if a person has H5N1 through the agencys regular surveillance for seasonal flu at more than 100 public health labs in all states as well as enhanced monitoring put in place in 2022 for anyone who has been exposed to birds infected with that strain.
CDC and the whole U.S. government is taking this situation very seriously, CDC Director Mandy Cohen said in an interview. We had not seen avian flu in cattle prior to last week. That is new. Its a reservoir for virus to circulate and potentially, change.
The development underscores critical questions about whether the country is equipped to handle an influenza outbreak after the coronavirus pandemic, the worst global health crisis in a century, exposed the weaknesses in the nations public health infrastructure and decimated the publics trust in key federal agencies.
More than half a dozen federal officials say their job is to prepare for the worst but said risk to the general public remains low. H5N1 was first identified in geese in China in 1996, but outbreaks in the past havent led to an explosion of cases in humans.
The heightened attention on bird flu comes after the virulent H5N1 strain was recently identified in U.S. dairy cattle for the first time. Federal and state officials announced Monday that a dairy worker in Texas is being treated for bird flu, marking the second-ever human case of this bird flu strain in the United States. The patient who experienced eye inflammation as the only symptom was exposed to cattle presumed to be infected with the virus. Disease trackers are monitoring for additional cases, particularly whether the virus can jump from human to human, which has happened infrequently and would be cause for more alarm.
Why I feel we can say the risk of avian flu remains low to the public is because the virus we are seeing in the cattle and in this one human case is the same genetic virus that we were seeing in poultry, Cohen said, meaning the virus has not yet evolved to spread easily in humans.
Since bird flu isnt a novel virus, some experts believe the country is better prepared to tackle such an outbreak than covid, but cautioned against overconfidence.
Others pointed to the drastic cut in funding for pandemic preparedness.
Federal funding for pandemic influenza has not kept up with the threat, even by the governments own assessments, Tom Daschle, former Senate majority leader and head of the Coalition To Stop Flu, which includes public health organizations and vaccine manufacturers, said in a statement Tuesday.
The government group responsible for defining requirements for medical countermeasures called for $1.15 billion in funding for pandemic influenza for 2025, Daschle said. But the $335 million in Bidens 2025 budget request fell far short. (Congress appropriated $335 million for pandemic influenza preparedness in the most recent appropriations bill.)
Significant cuts to preparedness funding were also made two weeks ago in a bipartisan appropriations package, Daschle said. That funding could have been used to speed vaccine development and manufacturing, improve diagnostics and early warning capabilities, and ensure the public health workforce on the front lines is adequately resourced, he said.
Detecting changes in the viruss pattern starts with surveillance.
When there is a presumptive positive test, state health departments begin an investigation and send specimens to the CDC for confirmatory testing, said Vivien Dugan, who heads the agencys influenza division. The CDC conducts extensive lab testing and analysis to determine the risk to public health; it expects to finish sequencing the sample from the infected dairy worker this week.
Since bird flu outbreaks have become widespread globally in recent years, the CDC and the Agriculture Department have enhanced surveillance closely monitoring anyone who has been exposed to infected birds or poultry infected with H5N1 for 10 days. More than 8,000 people have been monitored in all the 50 states, D.C., New York City, Puerto Rico, Virgin Islands and the Northern Marianas. Until this week, the only positive case was in Colorado in 2022.
If an outbreak in humans occurs, quickly scaling up vaccination would be paramount. The nations 10-year playbook to modernize flu vaccination sets a goal of delivering first doses of a vaccine within 12 weeks of the declaration of an influenza pandemic.
Federal officials point to some good news: Manufacturing a vaccine to match this specific strain of the virus and then mass producing it is vastly easier than the effort to develop a coronavirus vaccine. Thats because there are already vaccines to combat the bird flu. They can be altered, experts say, to better protect against this specific strain.
This scenario would probably only happen if theres fairly widespread human-to-human transmission. But there would be trade-offs. Manufacturers have limited capacity to produce flu vaccine. Manufacturers are now in the midst of producing the estimated 156 million to 170 million doses of the annual seasonal flu vaccine to be given in the fall.
It would be a risky political decision to disrupt that production and switch to making millions of doses of a new shot, public health officials and experts have said.
We have a n of 1, said CDCs Dugan, referring to the single human case.
Its a good news story that we have bulk vaccine in [a government stockpile] but I dont think we should assume that all Americans will get jabs, said another federal health official who spoke on the condition of anonymity because of an ongoing investigation.
Those who do become infected with bird flu could be treated with antiviral drugs the Food and Drug Administration has approved for the flu. Experts and officials said there havent been any signs that the current strain would be resistant to those therapeutics. The nations Strategic National Stockpile has an emergency supply of antivirals that are also available on the commercial market.
In the wake of our experiences with covid-19, it has become increasingly clear that some individuals show a preference for therapeutic interventions post-infection over preventative vaccination, Taylor Sexton, the executive director of the Medical Countermeasures Coalition, wrote in an email. Vaccines and therapeutics are two sides of the same coin when we are fighting a pathogen, and both remain critical.
A few simple interventions boosted flu vaccine uptake for patients waiting at the emergency department [ED], according to the cluster-randomized, controlled PROFLUVAXED trial.
People in ED waiting areas who consented to view a 3-minute video with a scripted message, read a one-page flyer, and have a short discussion with an ED clinician about the flu vaccine had a 30-day follow-up vaccination rate of 41% versus 15% among patients that received no messaging about the vaccine.
Even just asking people in the ED "Would you accept the influenza vaccine in the emergency department today if your doctor asked you to get it?" resulted in a 30-day vaccination rate of 32%, Robert Rodriguez, MD, of the University of California San Francisco, and colleagues reported in NEJM Evidence.
"We fully expected the interventions to improve vaccine uptake but were surprised by how effective they were," Rodriguez told MedPage Today. "The simple question intervention doubled vaccine uptake and the messaging intervention nearly tripled vaccine uptake."
"There is a distinctly underserved population whose primary (and often only) healthcare access occurs in emergency departments," Rodriquez noted. "To decrease disparities, public health interventions, especially vaccine messaging and vaccine administration, can and should be delivered in emergency departments."
To ensure the messages in the video and flyer reached medically underserved populations, researchers created five different versions with the same wording that featured African American, Latinx (English and Spanish versions), multiracial, or white physicians.
The consequences of poor influenza vaccine uptake are particularly stark for members of racial and ethnic minority groups, Zanthia Wiley, MD, and Annelys Roque Gardner, MD, both of Emory University School of Medicine in Atlanta, wrote in an accompanying editorial. Black, Hispanic, and American Indian or Alaska Native adults have age-adjusted influenza hospitalization rates of 1.2 to 1.8 times the rate of non-Hispanic white adults, they noted. Moreover, it is common for people who lack health insurance and access to primary care to visit EDs for non-emergency care, they pointed out.
"Exploring alternative methods of promoting vaccinations in racial and ethnic minority communities and for those individuals who have limited access to routine healthcare is essential for vaccine equity," Wiley and Gardner wrote.
The PROFLUVAXED trial enrolled 767 participants from six emergency departments in San Francisco, Houston, Philadelphia, Seattle, and Durham, North Carolina from October 2022 to February 2023. No participant was critically ill and the majority of ED visits were for conditions that would not preclude offering and administering vaccines. Forty-six percent of participants were female, 36% African American, and 21% Latinx. Sixteen percent had no health insurance, approximately one-third did not have a primary care physician, and 9% were unhoused or marginally housed.
All participants filled out a consent and intake survey and were then randomized to one of three groups. Participants in the first group (Intervention M, n=210) were asked to view the video and flyer and have a discussion with an ED clinician about the flu vaccine. Participants in the second group (Intervention Q, n=244) were asked if they would accept a flu vaccine if offered. The control group (n=313) received no intervention. Researchers used data from electronic health records for a period of 30 days post-intervention to determine if participants received the flu vaccine, or were contacted with a follow-up phone call.
Similar percentages of participants in the intervention groups said they would accept the flu vaccine in the ED (49% in M vs 45% in Q) and similar percentages also received the flu vaccine during their index ED visit (27% and 24%, respectively). However, nearly one-half of participants who said they were willing to receive the vaccine in the ED did not receive it at the index visit. The main reason for participants not receiving the vaccine at the index ED visit were clinicians not ordering or administering the vaccine.
One limitation of the study was that research coordinators delivered the vaccine messages in the intervention groups. These staff are unlikely to be available in most EDs, especially ones with limited resources, the authors pointed out. Also, all the sites participating in the study were urban academic EDs, so the study results may not be generalizable to rural or community EDs, they concluded.
Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.
Disclosures
The study was funded by the National Institute of Allergy and Infectious Diseases.
Rodriguez reported a relationship with the Pfizer Foundation; other study authors reported ties to industry.
Wiley and Gardner reported no ties to industry.
Primary Source
NEJM Evidence
Source Reference: Rodriguez RM, et al "Promotion of influenza vaccination in the emergency department" NEJM Evid 2024; DOI:10.1056/EVIDoa2300197.
Secondary Source
NEJM Evidence
Source Reference: Wiley Z and Gardner AR "Adult influenza vaccination -- seizing every opportunity" NEJM Evid 2024; DOI: 10.1056/EVIDe2400032.
Those who are considering getting an influenza vaccine may now save on costs as the World Health Organization (WHO) and influenza experts have agreed that the B/Yamagata lineage virus may no longer be necessary to be included in the flu shot.
This opens doors for the return of the trivalent influenza vaccine, which could be less expensive, and have more takers.
Why is the B/Yamagata lineage virus being excluded?
The vaccine is manufactured with a live virus, which is then inactivated or attenuated. However, the B/Yamagata lineage virus has not been seen for the past four years, according to experts.
The virus is currently only found in the vaccine labs around globe, and any lapses in handling and containment, could bring it back into circulation, Professor Parvaiz A. Koul, who is former director of Sher-e-Kashmir Institute of Medical Sciences, J&K, told The Wire.
An avid influenza researcher, Koul, further said, It defies logic as to why you should vaccinate for an infection that has not been seen for the past four years.
He strongly advocated for the reintroduction and re-adoption of trivalent flu shots.
Separately, the WHO, in a four-day consultative meeting on Composition of Influenza Virus Vaccines, on 23 February, decided to omit the B/Yamagata lineage virus from the vaccines.
In September, WHO had declared the need to exclude the B/Yamagata strain from the vaccine because it is no longer warranted. Its influenza vaccine composition advisory committee said, [The] inclusion of a B/Yamagata lineage antigen in quadrivalent influenza vaccines is no longer warranted, and every effort should be made to exclude this component as soon as possible.
Influenza vaccines are updated biannually so that they align with circulating strains to match evolving flu viruses. This process ensures effective protection from the virus.
The Yamagata lineage virus
Influenza B/Yamagata is one of the two main lineages of Influenza B viruses that commonly circulate and cause illness in humans, alongside Influenza B/Victoria. Influenza A and Influenza B are two types of viruses that cause the flu. Influenza A, in comparison to Influenza B, is usually responsible for more severe flu outbreaks due to its ability to undergo significant changes, called antigenic shift.
The fresh recommendations mandate the the egg-based flu vaccines must contain an A/Victoria/4897/2022 (H1N1)pdm09-like virus, an A/Thailand/8/2022 (H3N2)-like virus, and a B/Austria/1359417/2021 (B/Victoria lineage)-like virus. Similarly, the cell culture or recombinant-based flu vaccines may contain an A/Wisconsin/67/2022 (H1N1)pdm09-like virus, an A/Massachusetts/18/2022 (H3N2)-like virus, and a B/Austria/1359417/2021 (B/Victoria lineage)-like virus.
These names represent specific strains of flu viruses. The first part refers to the type of flu virus (either influenza A or B), followed by the location where the virus was isolated (such as Victoria, Thailand, or Austria), and then a number and year indicating when the virus was identified or isolated. The egg-based flu vaccines are manufactured by growing the vaccine inside chicken eggs, while cell-culture based ones are grown inside animal eggs.
Days before WHOs consultative meetings, the Lung India,a peer-reviewed medical journal, published a paper titled Influenza vaccination: A case for removal of B/Yamagata from the quadrivalent vaccine. The paper was written by professor Parvaiz A. Koul. The article advocated for the B Yamagata virus to be dropped from the vaccines.
It read: After the onset of the COVID-19 pandemic, there was a virtual elimination of the influenza circulation from the globe (Influenza virus detections reported to FluNet for all viruses), which, however, reappeared in 2021 (mid-year). However, the recent global influenza surveillance has been notable in the virtual absence of the circulation of B/Yamagata lineage.
Given the virtual absence of B/Yamagata from the global circulation, after the onset of the COVID-19 pandemic in 2020, it would be apt to drop B/Yamagata totally from the vaccine and recommend only the trivalent vaccine with B/Victoria lineage, it added.
The two Influenza A lineages are determined by WHO twice every year, based on circulating strains data, Koul said.
Kim Sampson, executive director Asia Pacific Alliance for the Control of Influenza (APACI), and advisor to the Australian Immunisation Coalition, while endorsing the case for exclusion of B/Yamagata, told The Wire that the case was clear. Inclusion of a non-existent virus in a vaccine is unreasonable, to say the least, he said.
He further said, The Lung India recommendations are very succinct and put forward a case for the removal of B/Yamagata from the forthcoming vaccine composition. Soon after the Lung India article publication, the WHO reached the same conclusion, he said.
Kouls article in Lung India said, This (exclusion of B Yamagata) would also prevent inadvertent reintroduction of the vaccine-contained B/Yamagata strain into the community circulation.
Last year, WHO and the UKs Medicines and Healthcare products Regulatory Agency noted in a meeting in London that there was no global circulation of B/Yamagata viruses since 2020, except for those derived from live attenuated vaccines, he said in his article.
On February 28, the New England Journal of Medicine (NEJM) published a paper titled Ending B Yamagata Flu Transmission Shifting from Quadrivalent Vaccines. The paper suggested that discussions may lead to an immediate return to trivalent vaccine formulation, analysing advisory group recommendations, manufacturer practices, regulatory requirements, and virus circulation patterns.
Earlier last week, the US Food and Drug Administration (FDA) issued a statement that called for the revamping of influenza vaccines, and switching to trivalent ones.
In the interest of public health, FDA strongly recommended to influenza vaccine manufacturers the removal of the B/Yamagata lineage virus from seasonal influenza vaccines in the US for the 2024-2025 influenza season. FDA and the manufacturers have been working together so that the move from quadrivalent to trivalent seasonal influenza vaccines occurs for the upcoming influenza season, read the statement.
The seasonal flu is a bi-annual incidence in India. As per estimates, between 2,91,000 and 6,46,000 people die each year from seasonal influenza-associated respiratory illnesses, of which 36% occur in low and middle income countries (LMICs) like India.
According to the WHO, children aged between six months and five years, pregnant women, adults aged 65 years and above, people with chronic medical conditions and healthcare workers constitute the high risk group for influenza.
Despite this, the vaccination coverage in India is poor.
A 2022 study assessing the vaccination coverage in older adults in India found that a miniscule 0.6% had taken the flu shot. Among healthcare workers, a study found that over 71% had been vaccinated at least once. The wide disparity, Koul said, could be due to a variety of reasons. Many hospitals have influenza vaccines at subsidised prices for healthcare workers; healthcare workers have a better education about influenza and vaccines; the threat perception is more, he said.
The cost
In India, the annual influenza vaccine shot costs around Rs 1,500 to Rs 2,000. Many believe that the switch to trivalent would reduce the cost and increase the uptake, especially in countries like India where the vaccine is not covered under any support or insurance system.
Sampson said having a lower price will certainly make people consider an annual flu shot, especially those in the community that have been introduced to the significance of vaccination against influenza. He said that while there certainly was a correlation between price and uptake, it is not the only factor to be considered when thinking about influenza vaccination at a global level.
Government funded programmes will have the most significant impact, but such programmes are limited to countries that can afford them, he said.
Koul said influenza vaccines saved lives. Influenza is a serious threat for many people and has been responsible for so many deaths. These deaths are preventable, he said. Switching to trivalent flu shots could help bring the costs down and probably help in making vaccines more affordable for people, he said.
CSL Seqirus, one of the largest vaccine companies, has announced that the transition from quadrivalent to trivalent influenza vaccines for the US will take place in time for the 2024-25 season. For other countries, we are continuing to consult on the most optimal timing, the company said.
Influenza is a common respiratory infection. Although most cases are relatively mild, flu can cause more severe illness in young children and older people.
Influenza virtually disappeared from Australia during the first years of the COVID-19 pandemic when public health restrictions reduced contact between people. Since 2022, it has returned to a seasonal pattern, although the flu season has started and peaked a few months earlier than before 2020.
Its difficult to predict the intensity of the flu season at this point in the year, but we can sometimes get clues from the northern hemisphere. There, the season started earlier than usual for the third year running (peaking in early January rather than late February/March), with a similar number of reported cases and hospitalisations to the previous year.
Influenza vaccines are recommended annually, but there are now an increasing number of different vaccine types. Heres what to know about this years shots, available from this month.
Like other vaccines, influenza vaccines work by training the immune system on a harmless component of the influenza virus (known as an antigen), so it can respond appropriately when the body encounters the real virus.
Influenza strains are constantly changing due to genetic mutation, with the pace of genetic change much higher than for SARS-CoV-2 (the virus that causes COVID). The strains that go into the vaccine are reviewed twice each year by the World Health Organization (WHO), which selects vaccine strains to match the next seasons predicted circulating strains.
Read more: Flu vaccine won't definitely stop you from getting the flu, but it's more important than you think
All current influenza vaccines in Australia contain four different strains (known as quadrivalent vaccines). One of the strains appeared to disappear during the COVID pandemic, and the WHO has recently recommended dropping this strain from the vaccine. Its expected trivalent (three strain) vaccines will become available in the near future.
There are eight brands of flu vaccines available in Australia in 2024. These include egg-based vaccines (Vaxigrip Tetra, Fluarix Tetra, Afluria Quad, FluQuadri and Influvac Tetra), cell-based vaccines (Flucelvax Quad), adjuvanted vaccines (Fluad Quad) and high-dose vaccines (Fluzone High-Dose Quad).
Until recently, the process of manufacturing flu vaccines has remained similar. Since the development of the influenza vaccine in the 1940s, influenza viruses were grown in chicken eggs, then extracted, inactivated, purified and processed to make up the egg-based vaccines that are still used widely.
However, there have been several enhancements to influenza vaccines in recent years.
Older peoples immune systems tend not to respond as strongly to vaccines. In some flu vaccines, adjuvants (components that stimulate the immune system) are included with the influenza antigens. For example, an adjuvant is used in the Fluad Quad vaccine, recommended for over 65s. Studies suggest adjuvanted influenza vaccines are slightly better than standard egg-based vaccines without adjuvant in older people.
An alternative approach to improving the immune response is to use higher doses of the vaccine strains. An example is Fluzone High-Dose Quad another option for older adults which contains the equivalent of four doses of a standard influenza vaccine. Studies suggest the high dose vaccine is better than the standard dose vaccine (without an adjuvant) in preventing hospitalisation and complications in older people.
Other manufacturers have updated the manufacturing process. Cell-based vaccines, such as Flucelvax Quad, use cells instead of eggs in the manufacturing process. Other vaccines that are not yet available also use different technologies. In the past, manufacturing issues with egg-based vaccines have reduced their effectiveness. Using an alternative method of production provides some degree of insurance against this in the future.
Read more: Should I get the flu shot if I'm pregnant?
Given indications this years flu season may be earlier than usual, its probably safest to get your vaccine early. This is particularly important for those at highest risk of severe illness, including older adults (65 years and over), those with chronic medical conditions, young children (six months to five years) and Aboriginal and Torres Strait Islander people. Influenza vaccines are also recommended in pregnancy to protect both the mother and the baby for the first months of life.
Influenza vaccines are widely available, including at GP clinics and pharmacies, while many workplaces have occupational programs. For high-risk groups, four of the vaccines are subsidised by the Australian government through the National Immunisation Program.
In older people, a number of vaccines are now recommended: COVID and influenza, as well as one-off courses of pneumococcal and shingles vaccines. In general, most vaccines can be given in the same visit, but talk to your doctor about which ones you need.
All influenza vaccines can cause a sore arm and sometimes more generalised symptoms such as fever and tiredness. These are expected and reflect the immune system reacting appropriately to the vaccine, and are mostly mild and short-term. These side effects are slightly more common in adjuvanted and high dose vaccines.
As with all medications and vaccines, allergic reactions such as anaphylaxis can occur after the flu vaccine. All vaccine providers are trained to recognise and respond to anaphylaxis. People with egg allergies should discuss this with their doctor, but in general, studies suggest they can safely receive any (including egg-based) influenza vaccines.
Serious side effects from the influenza vaccine, such as Guillain-Barr syndrome, a neurological complication, are very rare (one case per million people vaccinated). They are thought to be less common after influenza vaccination than after infection with influenza.
April 1, 2024A person in the United States has tested positive for highly pathogenic avian influenza (HPAI) A(H5N1) virus (H5N1 bird flu), as reported by Texas and confirmed by CDC. This person had exposure to dairy cattle in Texas presumed to be infected with HPAI A(H5N1) viruses. The patient reported eye redness (consistent with conjunctivitis), as their only symptom, and is recovering. The patient was told to isolate and is being treated with an antiviral drug for flu. This infection does not change the H5N1 bird flu human health risk assessment for the U.S. general public, which CDC considers to be low. However, people with close or prolonged, unprotected exposures to infected birds or other animals (including livestock), or to environments contaminated by infected birds or other animals, are at greater risk of infection. CDC has interim recommendations for prevention, monitoring, and public health investigations of HPAI A(H5N1) viruses.
CDC is working with state health departments to continue to monitor workers who may have been in contact with infected or potentially infected birds/animals and test those people who develop symptoms. CDC also has recommendations for clinicians on monitoring, testing, and antiviral treatment for patients with suspected or confirmed avian influenza A virus infections.
This is the second person reported to have tested positive for influenza A(H5N1) viruses in the United States. A previous human case occurred in 2022 in Colorado. Human infections with avian influenza A viruses, including A(H5N1) viruses, are uncommon but have occurred sporadically worldwide. CDC has been monitoring for illness among people exposed to H5 virus-infected birds since outbreaks were first detected in U.S. wild birds and poultry in late 2021. Human illnesses with H5N1 bird flu have ranged from mild (e.g., eye infection, upper respiratory symptoms) to severe illness (e.g., pneumonia) that have resulted in death in other countries.
H5 bird flu is widespread among wild birds in the U.S. and globally. These viruses also have caused outbreaks in commercial and backyard poultry flocks, and sporadic infections in mammals. HPAI in dairy cows was first reported in Texas and Kansas by the U.S. Department of Agriculture (USDA) on March 25, 2024. Unpasteurized milk from sick cattle collected from two dairy farms in Kansas and one in Texas, as well as a throat swab from a cow in another dairy in Texas, tested positive for HPAI A(H5) viruses of the genetic clade 2.3.4.4b, which is the same clade that is widespread among birds globally. On March 29, 2024, USDAs National Veterinary Services Laboratories (NVSL) confirmed HPAI in a Michigan dairy herd that had recently received cows from Texas. The USDA Animal and Plant Health Inspection Service (APHIS) is providing regular updates on detections in dairy herds, as well as information on epidemiological findings and biosecurity guidance for farmers and veterinarians. Preliminary analysis of A(H5N1) viruses has not found changes that would make these viruses resistant to current FDA-approved flu antiviral medications, so these are believed to be effective against these viruses. Candidate vaccine viruses (CVVs) developed against related clade 2.3.4.4b viruses are available for vaccine manufacturing if necessaryand preliminary analysis indicates that they may provide reasonable protection against H5N1 influenza viruses. Seasonal flu vaccines do not provide protection against these viruses. Analysis of virus samples is ongoing.
CDC is working closely with state and federal agencies, including USDA, the Food and Drug Administration (FDA), and local health authorities to further investigate and closely monitor this situation.
Prevention Measures
According to CDCs interim recommendations, people should avoid unprotected exposures to sick or dead animals including wild birds, poultry, other domesticated birds, and other wild or domesticated animals (including cattle), as well as with animal carcasses, raw milk, feces (poop), litter, or materials contaminated by birds or other animals with confirmed or suspected HPAI A(H5N1)-virus infection. People should not prepare or eat uncooked or undercooked food or related uncooked food products, such as unpasteurized (raw) milk, or products made from raw milk such as cheeses, from animals with confirmed or suspected HPAI A(H5N1)-virus infection (avian influenza or bird flu). Specific recommendations for farmers; poultry, backyard flock, and livestock owners; and worker protection are also available.
People exposed to birds or other animals with confirmed or suspected HPAI A(H5N1) virus infectionshould be monitored for any signs and symptoms of illness for 10 days after the last known exposure, including people wearing recommended personal protective equipment (PPE). Additional information onprotective actions around birds, includingwhat to doif you find a dead bird, is available on CDCs website.
According to FDA and USDA, there are not concerns with the safety of the commercial milk supply at this time because products are pasteurized before entering the market. Dairies are required to send only milk from healthy animals into processing for human consumption; milk from impacted animals is being diverted or destroyed so that it does not enter the human food supply. In addition, pasteurization has continually proven to inactivate bacteria and viruses, like influenza, in milk. Pasteurization is required for any milk entering interstate commerce for human consumption. FDAs longstanding position is that unpasteurized, raw milk can harbor dangerous microorganisms that can pose serious health risks to consumers, and FDA is reminding consumers of the risks associated with raw milk consumption in light of the HPAI detections.
CDC continues to work with USDA, FDA, and state health departments to monitor people exposed to animals infected with HPAI A(H5N1) viruses. Because influenza viruses constantly change, continued surveillance and preparedness efforts are critical, and CDC is taking measures in case the public health risk assessment changes. This is a developing situation, and CDC will share additional updates as new relevant information becomes available.
Atlanta (Precision Vaccinations News)
Although avianinfluenza (bird flu) viruses usually do not infect people, there have been some rare cases of human infection.
Human infections with bird flu viruses can happen when the virus gets into a person's eyes, nose, or mouth or is inhaled.
To clarify recent reports, the U.S. Centers for Disease Control and Prevention (CDC) today publisheda technical summary of an analysis conducted on the genomic sequences of viruses linked to an outbreak of highly pathogenic avian influenza (HPAI) A(H5N1) viruses in Texas.
HPAI A(H5N1) clade 2.3.4.4b viruses have been circulating globally in wild birds in the United Statessince late 2021. These HAPI viruses have caused commercial and backyard poultry outbreaks, with spillover resulting in sporadic infections in mammals.
As of April 2, 2024, the analysis results confirm that the risk to the general public associated with the ongoing HPAI A(H5N1) outbreak remains low.
The CDC stated while minor changes were identified in the virus sequence from the patient specimen compared to the viral sequences from cattle, both cattle and human sequences maintain primarily avian genetic characteristics and, for the most part, lack changes that would make them better adapted to infect mammals.
Avian influenza viruses can undergo changes in a host as they replicate after infection.
The genome for the human isolate from Texas had one change (PB2 E627K) that is known to be associated with viral adaptation to mammalian hosts and which has been detected before in people and other mammals infected with HPAI A(H5N1) virus and other avian influenza subtypes (e.g., H7N9).
But there isno evidence of bird flu virusesspreading among people.
In addition to dairy cows, several mammals, such as Bears, cats, dogs, and seals,have recently been infectedwith this type of bird flu.
Furthermore, there are no markers known to be associated with influenza antiviral resistance found in the virus sequences from the patient's specimen, and the virus is very closely related to two existing HPAI A(H5N1) candidate vaccine viruses that are already available to manufacturers, and which could be used to make vaccine if needed.
TheU.S. Food and Drug Administration authorized theAudenz(Influenza A(H5N1) Monovalent Vaccine, Adjuvanted) cell-based vaccineon January 31, 2020.
Overall, the genetic analysis of HPAI A(H5N1) viruses in Texas supports the CDC's conclusion that the human health risk currently remains low.
More details are available in this CDC technical summary, linked here.
On April 28, 2022, the state ofColoradoreported aninfluenza A (H5) virus infectionin a man. The CDC confirmed that this'Montrose County, Colorado patient is the first human detection of any influenza A(H5) virus in the U.S.since2016.
The World Health Organization (WHO) says available epidemiological and virological evidence currently suggests that influenza A(H5) viruses have not acquired the ability to sustain transmission among humans.
The WHO posted the cumulative worldwide number of confirmed human cases of avian influenza A(H5N1) reported (2003-2022).
From this week, free influenza vaccination will be available to some New Zealanders (those over 65, with long-term conditions, pregnant or with specific mental health conditions), but Pharmac recently announced it will no longer be free for children under 12 and Mori and Pacific people aged between 55 and 64.
This is the most recent example of a missed opportunity for New Zealands health system to improve outcomes and close equity gaps.
We know that free flu vaccination for children is a crucial component of achieving health equity.
Not only is the burden of influenza high in children compared with other groups in the population, but children are also a major pathway for the virus to spread within their whnau and wider communities.
We also know poor-quality housing contributes to worse health outcomes, especially for Indigenous peoples, ethnic minorities and people with low incomes.
Children living in cold, damp houses, and Mori and Pacific children, are more likely to be hospitalised for acute respiratory conditions such as asthma, which are exacerbated by the flu.
Read more: How do you make a universal flu vaccine? A microbiologist explains the challenges, and how mRNA could offer a promising solution
Mori and Pacific adults have a higher risk of dying from the flu and lower rates of flu vaccination than other groups in the population. A significant life expectancy gap persists between Mori and non-Mori New Zealanders (7.5 years for men, 7.3 years for women).
Even Pharmacs own clinical advisors noted that wider criteria for free flu vaccination reduce access barriers for people at higher risk from this disease. The Whakamaua Mori Health Action Plan 2020-2025 states that:
achieving equitable Mori health outcomes requires initiatives to respond earlier to Mori health need.
Given the disproportionate burden of influenza on Mori and Pacific people, lower vaccination rates, greater exposure to risk factors for respiratory illness and persistent inequities in life expectancy, a lower age for free flu vaccination for Mori and Pacific adults is essential for achieving equity.
So why are we not funding free flu vaccinations for children under 12 and Mori and Pacific adults aged 5564?
One reason is money. Pharmac receives a fixed budget from the government and has to make tough decisions about how to allocate its funding across a range of competing health priorities. In 2022 and 2023, Pharmac widened access to free flu vaccination with funding made available as part of the former governments response to COVID, but says this funding has now ended.
The second reason is political will. The hard part about achieving equity is that it can mean doing things differently for different groups. This is what makes equity fundamentally different from equality. Sometimes we have to treat people differently to achieve equity.
Despite its apparent commitment to equity for all New Zealanders, our health system and political leaders often focus on one-size-fits-all approaches rather than recognising differences in need and access.
Read more: Racism and democracy: why claims of division by race in the NZ election and Voice referendum need challenging
We dont need to look far for examples of other missed opportunities to promote health equity.
When deciding whom to prioritise for COVID vaccination, the cabinet refused to include Mori in the high-risk group at 50 or 55 rather than 65, even though Mori were at greater risk of hospitalisation and have a lower life expectancy. Critics argued that inequity was hard baked into the vaccine rollout.
The National Bowel Cancer Screening Programme was initially criticised for adopting a blanket 6074 age range, when at least half of Mori bowel cancer is diagnosed before age 60 (compared with 30% for non-Mori). Although the age range for this program has since been lowered to 50 for Mori and Pacific people, this has been rolled out in only three districts (Waikato, Tairwhiti and MidCentral) with no clear commitment to do the same in the rest of the country.
In 2023, Shane Reti, who is now the health minister, described the introduction of an equity adjuster into prioritisation tools for planned surgery as offensive. David Seymour, now an associate health minister, described it as racial discrimination. Despite clear evidence that Mori have longer wait times for elective surgery than non-Mori, these criticisms claim that adjusting for ethnicity (among other factors) would give Mori an unfair advantage.
These examples show how difficult it is to introduce much-needed measures to achieve equity when they require a tailored approach for some groups not to create an unfair advantage but to rectify an unfair disadvantage. Such measures depend on political courage and an appropriate budget.
But adjusting inclusion criteria for flu vaccination or bowel cancer screening are fairly cheap and simple interventions that can start saving lives immediately. What are we waiting for?
(Precision Vaccinations News)
Longhorn Vaccines and Diagnostics today announced itis presenting a poster at the World Vaccine Congress on a mice study that examined LHNVD-110, a novel, unconjugated single peptide vaccine candidate comprised of multiple epitopes to broadly target human and influenza viruses.
According to the Company's press release on April 2, 2024, results from the poster show that LHNVD-110 generated broadly reactive antibodies to human and highly pathogenic avian influenza (HAPI) viruses while neutralizing seasonal and pandemic influenza strains.
The Company says using a single peptide provides a more cost-effective and easily scalable approach to such a universal influenza vaccine.
In this study, Longhorn examined mice that were immunized intramuscularly with a low dose (2 g) and high dose (20 or 40 g) of LHNVD-110, an unconjugated composite influenza peptide vaccine with multiple highly conserved epitopes of HA, NA, and matrix (M1/M2/M2e), including a universal T cell epitope.
Two booster immunizations were given on days 21 and 35. Isotype specific IgG titers to composite peptides, individual epitopes, and multiple strains of influenza A (H1N1, H3N2, H5N1), and B (Yamagata, Victoria) were analyzed by an enzyme-linked immunosorbent assay, known as ELISA.
This data mirrors previous studies with LHNVD-105, a dual peptide vaccine containing the same epitopes.
"We are studying a single peptide universal influenza vaccine because we believe it could deliver a cost-effective strategy towards formulation and manufacturing and provide immunity against human and avian influenzas," said Longhorn Vaccines and Diagnostics CEO Gerald W. Fischer, MD, in a press release.
"We are expediting IND-enabling studies of LHNVD-110 to prepare for human clinical trials."
The Company wrote, 'While traditional influenza vaccines protect against specific strains predicted for circulation during the upcoming flu season, this often leads to mismatches and variable effectiveness. That is why peptide-based vaccines with broad strain coverage may offer useful strategies for preventing influenza, no matter the strain.'
LHNVD-110 is also formulated with the AddaVax adjuvant from InvivoGen.
Austin (Precision Vaccinations News)
Recent reports indicate that the multi-year, global outbreak of the highly pathogenic avian influenza (HPAI) virushas reached the stateof Texas.
In late March 2024, the Texas Animal Health Commission announced that dairy cattle in the Texas Panhandle had tested positive for avian influenza A(H5N1).
Subsequently, on April 1, 2024, the Texas Department of State Health Services (DSHS) reported one confirmed human case of avian influenza A(H5N1) virus in Texas. The affected person had direct exposure to dairy cattle suspected of being infected with avian influenza.
The patient is being treated with anantiviral drug.
Additionally, the U.S. Department of Agriculture (USDA) Animal and Plant Health Inspection Service has confirmed the detection of HPAIin fiveadditional dairy herds in Texas.
The USDA reported that the HAPI strain foundis similar to the strain confirmed initially in cattle in Texas and Kansas.
This strainappears to have been introduced by wild birds (H5N1, Eurasian lineage goose/Guangdong clade 2.3.4.4b), which indicates the virusjumped from birds to cows.
Furthermore, these HAPIcases donot change the risk for the general public, which remains low.
However,the DSHS says in today'spress release that this 'bird flu' case is concerning and warrants close monitoring of the situation.
In response, DSHS issued a Health Alertasking healthcare providers around affected dairies to be vigilant for possible human cases and is providing testing and treatment recommendations.
According to TexasFarmbureau.org,Texas's 2023 dairy cattle population includedover 4 million beef cows, 635,000 milk cows, and 4.25 million calves.
Providers should consider the possibility of avian influenza A(H5N1) virus infection in those with influenza symptoms and relevant exposure history.
This includes people who have had close contact with a person with suspected or confirmed avian influenza A(H5N1) infection, affected animals, or unpasteurized milk from dairy farms with suspected avian influenza A(H5N1) infection.
A close contact is defined as a person who has been within 6 feet of a confirmed or probable avian influenza A(H5N1) case for a prolonged period or has had direct contact with infectious secretions. In contrast, the case was likely to be contagious, beginning one day before illness onset and continuing until the resolution of illness.
From a prevention perspective, bird flu vaccines have been approved and produced as of April 2024.
According to the U.S. Centers for Disease Control and Prevention,about 20 millionH5N1 and12 millionH7N9 vaccines were availablein theNational Strategic Stockpile in 2023.
One vaccine, CSL Seqirus Inc.Audenz monovalent, adjuvanted,cell-basedinactivatedsubunit vaccine, received its initial U.S. Food and Drug AdministrationApproval inJanuary 2020.
These bird flu vaccines are not commercially available in the United States. Moreover, the CDC says annual flu shots do not offer protection against this type of influenza virus.
