Can GPs help the UK avoid a serious flu crisis this winter?

GPs have been told to expect a bad flu season this winter after Australia faced one of its most deadly on record - but is the UK NHS any better prepared?

Flu vaccination clinic (Photo: Dr P Marazzi/Science Photo Library)

NHS England chief executive Simon Stevens said in September that the NHS should brace itself for ‘real pressures’ over the upcoming flu season.

The warning came as Australia reels from one its worst flu seasons on record – a government surveillance report found there were two and a half times more laboratory-confirmed cases of the disease during this year’s season compared to the preceding year.

Government data showed that the peak of the Australian flu season was not only more severe, but also persisted for a longer, more sustained period than in previous years.

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The dominant strain, influenza A(H3N2), was also the most deadly, accounting for four out of five flu-related deaths in the country. So far in 2017, some 600 flu-related deaths have been reported in Australia, with the majority of these among the elderly.

The Australian flu problem was compounded because there was considerable drift in the strains of influenza A(H3N2) in circulation compared to those that were in the vaccine.

That same vaccine – which was mismatched to the most deadly strain in Australia – is the one currently being offered in the UK, which has been cause for some concern.

And the UK vaccine has been deemed ‘ineffective’ due to drift before. Public Health England (PHE) declared just last year that the vaccine used in over 65s likely provided no significant protection.

Patients hospitalised

The latest UK reports suggest the virus is already having a devastating effect on some patients early on in this season.

The UK government’s latest report on flu shows that seven people were admitted to intensive care units with confirmed influenza in the last week, and a further 11 were hospitalised.

But even if we see the same drifting in the northern hemisphere, experts have suggested that the UK should be better prepared to face this than the healthcare system in Australia – in part because we have a much higher vaccination rate.

‘If the drift was to happen, the UK is in a much better condition to face it than Australia,’ RCGP national immunisation lead Dr George Kassianos told GPonline.

‘Australia recommends vaccination of children, but does not provide the vaccine free and does not have a national campaign to vaccinate children in primary care and schools. The UK does.

Vaccine effectiveness

‘The UK uses the very successful in the UK quadrivalent live attenuated influenza vaccine (intranasal), which consistently shows better effectiveness against A(H3N2) than our injectable vaccines and is able to cover drifts to a degree.’

Dr Kassianos said GPs’ best line of defence against the virus was to go all-out on vaccination, especially vaccinating as many eligible children as possible.

He said: ‘Not only do they get great protection themselves from vaccination but this action has been shown to produce a statistically significant reduction in GP visits with influenza-like illness for adults and the elderly.

‘We must not accept a vaccination rate of 35-40% of children aged two and three years as a good achievement in primary care. Every effort should be made to double our last year’s vaccination rate.’

He added that efforts should be made to ‘double’ last year’s vaccination rate of 45% for adult patients in at-risk groups and 50% in pregnant women.

Increased uptake

And vaccination uptake of elderly patients should be increased to 80% ‘if possible’, he said, up from 73% it was among over 65s last year.

The UK’s figures compare favourably to those in Australia. In 2016, 56% of over 65s were vaccinated – and the latest data from 2010-14 suggests just 7% of under-fives received the vaccine in this period.

Dr Kassianos added: ‘And of course, we, healthcare and social care professionals, must be vaccinated against influenza, unless otherwise contraindicated.’

But even if the UK is better prepared, GPC clinical and prescribing policy lead Dr Andrew Green warned that any ill effects from a bad season could be devastating for the NHS.

He said: ‘The protection offered by the influenza vaccine does change from year to year, and we can never rely on complete protection.

‘The worrying fact is that there is now no slack anywhere in health or social care systems to accommodate the inevitable increased activity that the flu season will bring.’

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