Flu return ‘inevitable’ in 2022

Jolyon Attwooll

4/02/2022 4:19:00 PM

After a succession of record lows, newsGP looks at what the traditional flu season might bring this year and the risks of community complacency.

An elderly woman, sick and in bed.
Australia has had record low flu numbers during the COVID-19 pandemic so far, but the number of influenza cases is expected to increase this winter.

Last year was a year like no other for influenza.
As previously reported in newsGP, by August 2021 more than a year had passed without a single laboratory-confirmed influenza death being recorded in Australia.
The following months continued in the same vein, with 598 laboratory-confirmed cases registered until early November in the National Notifiable Disease Surveillance System (NNDSS).
For context that is just 3% of the total recorded in 2020, which itself was around eight times lower than the five-year average of 163,015.
Nobody died from influenza in 2021 at all, and there was just one hospital admission recorded since April.
There is a currently a blank for the final weeks of the year, with the NNDSS statistics going until 7 November, and the system now being decommissioned and replaced. But all the data points towards 2021 being the lowest on record for influenza since it became a notifiable disease – and by a huge margin.
Worldwide, the number of influenza cases has fallen too.
However, borders, both internal and external, are now much more open than they were for most of 2021. Dr Kerry Hancock, Chair of RACGP Specific Interests Respiratory Medicine, told newsGP she is feeling ‘uncertainty and anxiousness’ about what the traditional flu season will bring as more people come into the country.
So what are the early signs for this year? According to Professor Ian Barr, the Deputy Director of the World Health Organization Collaborating Centre for Reference and Research on Influenza at the Doherty Institute, there has been little change so far.
He cites the Howard Springs quarantine unit as the main source of the influenza cases since the arrival of the pandemic. But, he believes, it is just a question of time.
‘With increased travel and more porous borders, and lack of quarantine, and no testing for influenza at border sites, then it’s inevitable it’ll get back in this year,’ Professor Barr told newsGP.
While his instinct is that cases are likely to remain low this year, he describes any assessment as ‘crystal-balling’.
Professor Barr says it is even harder than usual to know what to expect given the unique situation, and cites recent outbreaks in South Africa and Brazil outside of their normal season as examples of the disease’s unpredictability.
‘Things are a little unusual with influenza, so you can’t be certain,’ he said.
‘We might have a moderate season, but it’s probably unlikely we’re going to have a big season unless something dramatic happens overseas and we get exposed to those viruses.
‘It takes a while to build up the numbers, so even if we do have a moderate season [it] might not come until later than normal.’
Are people ‘vaxxed out’?
A concern that Dr Hancock and Professor Barr share is that the perception of low flu rates could foster community complacency when it comes to vaccination – a pattern with serious implications if cases return in any numbers.
Dr Hancock refers to it as the community being ‘vaxxed out’ in the wake of the intense drive to inoculate the population against the spread of COVID-19.
Professor Barr also thinks the push to vaccinate against COVID-19, with multiple vaccine doses required, may cause people to drag their heels.
‘There will still be an issue, convincing people, especially young people and people with children to get their kids vaccinated again for something else,’ he said.
On a more positive note, Professor Barr says the vaccination rate in the elderly ‘stood up pretty well’, even in the latest year of the pandemic when the presence of flu was so low.
‘Normally [the elderly] are very well vaccinated and that was the case last year. That’s pretty good,’ he said.
‘But there’s all the rest of the population and at-risk groups who may think twice about being vaccinated.’
Dr Hancock hopes government communications campaigns, as well as support for GPs to vaccinate, will kick in if needed.
In the past few weeks, Chief Medical Officer Professor Paul Kelly has been warning about the likelihood of flu’s return and has flagged that a widespread influenza vaccination program will be taking place as usual.
‘I think we need to start getting ready for a winter with COVID and influenza,’ he told Sky News.
‘With open borders and with a relatively open society, we expect COVID will continue to be circulating, and flu almost certainly will be here in winter as it normally is.
‘We have all of our plans that we always have … including very large numbers of pre-purchased vaccines for the flu season.’
While talk of a flu and COVID-19 together in this context may have concerning clinical overtones, one upshot of the pandemic has been increased focus on a potential combination flu/COVID-19 vaccine – with Novavax one of the companies currently running tests.
But for Professor Barr, the prospect of a combination vaccine is unlikely to offer much help in the short term.
‘If [a combination vaccine] was here by 2024 I would be amazed,’ he said. ‘I think for the next two seasons, we have to wing it with what we’ve got.’
He does, however, hope that greater community awareness of rapid antigen testing created by the pandemic will encourage people to screen for flu in greater numbers in the future. He also stresses the ready availability of antivirals such as Tamiflu to combat the flu, a situation he contrasts with the embryonic status of COVID-19 oral medication.
‘At least there are options there and they’re easily accessible,’ Professor Barr said.
He is also keen to emphasise just how much of an outlier influenza has been among respiratory diseases in the last two years.
‘This is not a hiatus for all respiratory viruses,’ Professor Barr said.
‘The seasonality and the impact may have changed, but they all circulated with the exception of influenza. Every other virus has had a run since the pandemic began.
‘No matter what the conditions you put in place – masks, social distancing, working from home – if these viruses get in and get a run, they will go.
‘Influenza is absolutely no different. If it gets in it will go.’
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