How could an adjuvanted vaccine help GPs tackle flu?

UK GPs will be able to order an adjuvanted flu vaccine for the first time from next year, which experts have backed as a more effective line of defence against drifting strains of the virus.

Flu virus samples (Photo: James King-Holmes/Science Photo Library)
Flu virus samples (Photo: James King-Holmes/Science Photo Library)

With the NHS poised to faced one of the worst flu seasons in recent years, experts have raised concerns that the elderly in particular could fare poorly.

RCGP immunisation lead Dr George Kassianos said: ‘Our elderly fare worse because of immunosenescence, vaccine drift but also loss of antibody after vaccination.’

He has championed use of an adjuvanted vaccine, which will not be available for UK GPs to order until the 2018/19 season onwards.

Dr Kassianos said it was ‘a shame’ that the vaccine was not licensed for use in the UK until next year, and urged practices to order it for next year.

What effect could the adjuvanted vaccine have?

Data presented at the European Scientific Working group on Influenza (ESWI) in September found that switching to an adjuvanted vaccine could help prevent 175,000 cases of influenza.

This is turn could slash GP visits from elderly patients by 21,800 a year and help prevent 1,700 deaths, the researchers added.

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Why is it more effective in the elderly?

Modelling suggests the adjuvanted vaccine is more effective in the elderly compared to traditional flu vaccines, especially during years where there is a mismatch between the flu strains in the vaccine and those circulating in the real world.

It uses an adjuvant which helps the body’s immune system develop a strong response to flu, and has been specifically designed for people over 65 whose immune systems are weakening through immunosenescence.

Elderly patients’ weakened immune systems mean normal vaccines do not always produce an optimal immune response causing them to lose antibodies after vaccination.

Dr Kassianos told GPonline: 'The only thing we can do as GPs is order the adjuvanted vaccine for next year. It is really the best we have at the moment for the elderly, it covers much better than the conventional vaccine, but we haven't got it this year - I wish we did.

'It has also been shown to work on the drifting H3N2 strain and the antibodies last for longer and at a much higher level. We are heading towards reducing GP consultations and respiratory attendance to emergency departments.'

Is the current vaccine up to scratch?

There has been growing concern over the current vaccination programme’s effectiveness in recent years.

Data from PHE has revealed that the flu vaccine had ‘no significant effectiveness’ in patients over 65 in the last flu season.

The Joint Committee for Vaccinations and Immunisations (JCVI), which advises the government on vaccinations, described the results as ‘disappointing’, warning that it appears to be the latest in an emerging trend for lower effectiveness against the H3N2 flu strain in this age group.

H3N2 has dominated recent seasons, and the committee has decided that ‘proper consideration’ on the benefits of the over-65s programme should take place.

It has brought forward plans on ‘reviewing the entire programme’, which were initially set to take place in 2020, once the paediatric programme had been fully rolled out in primary schools.

This will also allow it to consider the new influenza vaccines, including the adjuvanted vaccine, which are incoming to the UK market, it said.

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