Do we need to reassess the flu vaccine?

Evan Ackermann

15/06/2018 11:12:45 AM

Dr Evan Ackermann looks at recent research on the use of the flu vaccine in Australia.

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Dr Evan Ackermann wants to remain clear the RACGP still firmly supports the National Immunisation Program targeting people in high-risk groups who are vulnerable to influenza. (Image: Sam Mooy)

The RACGP has traditionally supported the widest possible use of the flu vaccine, in a bid to reduce the impact of a dangerous virus.
A challenge to this approach came from new evidence in the form of three Cochrane reviews on the effectiveness of influenza vaccination in various patient groups.
Does the Cochrane evidence mean our recommendations for influenza vaccination will change?
First, we need to be clear: the RACGP still firmly supports the National Immunisation Program (NIP) targeting people in high-risk groups who are vulnerable to influenza.
The influenza vaccine will remain an essential annual medical intervention in high-risk groups, such as children under five, older people and people with conditions (eg chronic respiratory conditions or cardiac disease). Patients in these groups are more likely to contract influenza and experience more serious consequences as a result.
Tragically, many of the people who passed away last year due to influenza were in high-risk groups and, often, didn’t receive the vaccine. This was further compounded by the fact the vaccine proved less effective than anticipated against the strains experienced.
To safeguard these groups we need to be continually vigilant with vaccination technology, influenza vaccination, streptococcal vaccination (where indicated) and personal hygiene.
The controversial issue, as I see it, is deciding what to recommend for low-risk groups, namely the healthy population.
One of the Cochrane reviews found that influenza vaccination in healthy adults produces very little public health benefit, a drop of influenza rate from approximately 2% to 1% a year. That means that out of 70 healthy adults who get the vaccine, 69 will get no benefit against laboratory confirmed influenza. The illness experienced in this group is often (but not always) minor.
Last week, Bond University Professor Chris Del Mar publically questioned Australia’s drive to roll out the influenza vaccine to low-risk groups in the wake of widespread shortages following last year’s horror flu season.
‘[T]he amount of benefit for influenza vaccine is weak and it makes me think that this is not a great use of our effort in trying to immunise large swathes of the population when there are other opportunities that may be more effective,’ he told AAP.
I believe that Professor Del Mar is broadly correct: if you have a mass flu vaccination program for low-risk populations, the recent evidence casts doubt on its impact. The evidence also suggests promoting other measures may be more beneficial.
That means that for the majority of the population, improved personal hygiene options are more likely to be effective, such as handwashing and quarantining yourself when sick, and using a face mask when in public. This has important implications in how we advise and educate our patients.
The RACGP believes in evidence-based medicine, and this is how evidence-based medicine should work. Now that the evidence has evolved we need to confront that reality. When new evidence challenges the status quo, we may need to come up with a better approach.
The editorial committee for the RACGP’s Guidelines for preventive activities in general practice (Red Book) will be discussing whether we as a college should still be recommending that low-risk population should have the influenza vaccine, or whether this should be left to personal choice. This will entail a critical review of the evidence and consultation with key stakeholders.
In the meantime, GPs should ensure all NIP eligible patients are vaccinated, advise all patients regarding personal hygiene and have a talk regarding staying at home when unwell.

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