Flu boosters unnecessary as influenza all but vanishes

Doug Hendrie

18/08/2020 4:36:08 PM

Looking for a silver lining in the pandemic year? Flu booster shots are not needed.

Hand washing
Social distancing and better hand-hygiene practices to combat the coronavirus have led to dramatic falls in in flu numbers in 2020.

But experts say people who have not had the flu shot this year should still get their jab – and those with flu-like symptoms should get a COVID swab.
Rates of influenza have plummeted due to Australia’s move to social distancing and better hygiene practices to combat the coronavirus, coupled with the effective closing of international borders.  
The flu is now so uncommon that Victorian and NSW authorities are calling on anyone with fever, cough and aches and pains to get a COVID test, as it is now more likely to be the novel coronavirus than influenza.
Influenza booster shots are not routinely recommended in the same year, according to Dr Penny Burns, who is the RACGP’s representative on the National Immunisation Committee.
Booster shots are even less justifiable this year, according to Professor Ian Barr, Deputy Director of the World Health Organization (WHO) Collaborating Centre for Reference and Research on Influenza at the Doherty Institute.
‘There is no clear evidence or rationale for giving an influenza vaccine booster in the same season to normal healthy people,’ he told newsGP.
‘This year it’s probably less justifiable because of the very low levels of influenza virus circulating at this time when normally at this time it is the peak of the influenza season.’
Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP that there is an overall lack of evidence to support flu booster shots.
‘In a year with much less influenza circulating, that information would be even more relevant,’ he said.
‘There’s a difference between how long antibodies survive in experimental testing versus whether it reduces significant numbers of flu-like illnesses, which is what we’re interested in.’
Many Australians rushed for flu vaccinations early in the pandemic, in a bid to prevent undue strain on the healthcare system from influenza.
The ABC reports that around two million more flu vaccines were administered this year compared to last year – 8.8 million in total from March to mid-July.
These factors are likely to have caused the 99% drop in laboratory-confirmed influenza between last April and April this year, falling from 18,692 cases to just 308.
That trend has continued, with data from the National Notifiable Diseases Surveillance System showing flu cases have continued to fall, down to just 192 cases in July.
That represents a 99.997% fall from the 70071 cases reported in July 2019.
Interestingly, the falls seem broadly consistent, remaining at ‘historic lows’ across all states and territories – even those that have moved out of lockdown, according to the FluTracking report for the week of 16 August. 
Flu has been confirmed in only one person a week over the last four weeks out of the roughly 70,000 Australians who report their flu-like symptoms to FluTracking. Several who had fever and cough tested instead positive for COVID-19.
But Australians who have not yet had their flu shot are still encouraged to do so. 
Vaccine safety expert Associate Professor Nigel Crawford told newsGP he would not recommend skipping the initial flu vaccine this year, even with the low prevalence of the virus.
‘[Influenza] is one of the few infections we can modify and if you do get an influenza-like virus, you will need a COVID swab and isolate till you get the result,’ he said.
‘It is also uncertain what role lockdown in Melbourne [and] increased mobilisation in other states will have, noting the influenza season is not always easy to predict in a big country like Australia.’
The Murdoch Children’s Research Institute researcher said influenza may become a ‘more pressing topic’ next year in Australia and other southern hemisphere nations. 
By contrast, COVID-stricken nations such as the US are bracing for a ‘twindemic’ in the northern hemisphere winter, where flu outbreaks alongside the coronavirus cause even greater strain on health systems, according to the New York Times
Professor Barr previously told newsGP that while flu is ‘very unpredictable’ and the severity of seasons depends on many factors, similar rebounds have been seen previously in Australia.
‘[C]ertainly you would expect, logically, that if we have fewer people infected this year that we’ll have less herd immunity going forward, unless the vaccine can pick up some of that slack,’ he said.
Australian deaths from influenza have plunged, according to the ABC, falling from 486 to 36 when comparing the January–August period between 2019 and 2020.

With the flu banished, rhinovirus has become the most common respiratory virus reported by GPs who are part of the Australian Sentinel Practices Research Network (ASPREN), accounting for 30% of all tests.
That data is from the Department of Health’s latest Australian Influenza Surveillance Report for the two weeks ending 9 August.
Dr Evan Ackermann, past Chair of the REC–QC, previously told newsGP the drop in influenza showed the importance of good hygiene.
‘People in public places are not only washing their hands, but they’re quarantining when sick, and many are using a face mask when in public,’ he said. ‘It really is something that I hope is going to lead to some long-term behavioural change.
‘The [influenza] vaccine doesn’t last that long – it produces an immunological response but that wanes over time. What these figures suggest is that these non-drug interventions do work.’
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