Influenza remains at record low levels to start 2021

Influenza is currently at historically low levels in Australia.
 
In its latest weekly report, the Flutracking surveillance system recorded no cases of the flu among its more than 52,000 participants, while in the nearly 16 weeks to 21 April there have only been 214 laboratory-confirmed cases nationwide.
 
By the same time last year, there were 20,366 recorded cases, and in 2019 the figure topped more than 43,000.
 
The current 2021 numbers represent a continuation of a trend that saw laboratory-confirmed influenza cases drop by more than 99% following the introduction of coronavirus restrictions at the end of March last year, and the Department of Health (DoH) has said cases remain at historically low levels.
 
As such, prioritising a flu vaccination could easily get buried among the flurry of the COVID-19 vaccine rollout, but RACGP President Dr Karen Price has urged GPs to stay on top of flu shots, despite the logistical challenges they may face in administering both vaccines.
  
‘We are dealing with the twin threats of influenza and COVID-19, for which two national vaccination programs will be rolling out at the same time – it’s a lot for our health system to manage, and it’s a lot for patients,’ she said.

‘[But] I have every confidence that general practice is up to the task. Vaccines are business as usual for GPs.’
 
In line with current advice from the Australian Technical Advisory Group on Immunisation (ATAGI), the RACGP has asked patients in later phases of the COVID-19 vaccine rollout plan to get their flu shot as soon as possible, followed by the COVID-19 vaccine when it becomes available later in the year.
 
The reason for the delay is that ATAGI recommends administration of an influenza vaccine and a COVID-19 vaccine should be a minimum of 14 days apart.
 
Dr Kerry Hancock, Chair of RACGP Specific Interests Respiratory Medicine, told newsGP the competing vaccine programs and need for a two-week break has forced her to assess what the best timing is for her patients.
 
‘GPs should be discussing with their patients which is the most appropriate one to have first,’ she said.
 
‘With my patients, I would advocate that if they are in the right [prioritised] group, they get the COVID vaccine first, then their second shot 12 weeks later. Then wait a couple of weeks and have their flu vaccine.’
 
And even though the trend of low case numbers appears to be continuing, the DoH notes there is currently no indication of the potential severity of the 2021 flu season, so preventive measures such as vaccination should still be taken.
 
According to ATAGI, people should ideally receive their annual influenza vaccination before the start of the flu season – typically June to September in most parts of Australia.
 
Professor Paul Effler, Senior Medical Advisor and Communicable Disease Control Directorate at Western Australia Department of Health, spoke in a recent podcast about the importance of timing vaccines.
 
‘There is no reason to believe there to be any interference of one of these vaccines [Pfizer and AstraZeneca] against the other, as they’re both inactivated vaccines,’ he said.
 
‘The major issue is if there is an adverse event, but we will know which vaccine caused it.’
 
This advice is timely given recent adverse reactions linked to the COVID vaccine and major adjustments to the timing of the national vaccine rollout due to the Federal Government unsuccessfully reaching its initial targets.
 
ATAGI advice states that vaccine administration separated by reasonable intervals ‘may reduce the likelihood of overlapping periods of systemic adverse events following immunisation, and will assist in attributing any adverse event following immunisation to a particular vaccine’.
 
If flu cases begin to soar, ATAGI suggests that co-administration or close administration of less than the current 14-day recommendation of an influenza vaccine with a COVID-19 vaccine ‘may be considered in certain circumstances’, but that more research is needed.
 
‘Co-administration may make the attribution of potential adverse events following immunisation more challenging. It is plausible that co-administration or near administration [eg within days] with an influenza vaccine may increase the likelihood of some of these reactions, though there is no evidence yet to suggest that this will be the case,’ ATAGI guidelines state.
 
In the interim, Dr Hancock has been sticking to the two-week rule.
 
‘If ATAGI deems that it is appropriate to have a shorter interval between the two, then I think GPs can follow that directive. But until we definitely know, we should stick with [the current advice] of two-week intervals,’ she said.
 
‘Because of some concerns patients have around adverse effects of the COVID vaccine, then it is best to go by the guidelines we currently have.
 
‘But there’s obviously things that can influence that – around people’s geographical locations and how difficult it is for them to access the vaccine, and some other confounding factors.’
 
If a flu vaccine has been inadvertently co-administered or given within a shorter interval than the recommended 14 days with a COVID-19 vaccine, revaccination with either vaccine is not considered necessary, ATAGI advises.
 
There is also no particular requirement regarding the order of receiving a dose of flu vaccine and either the first or second dose of a COVID-19 vaccine.
 
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