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10 Oct 2017

BY AMA VICE PRESIDENT DR TONY BARTONE

You would have to be living under a rock to have missed the scale of this year’s influenza activity. So much so that the AMA was mentioned and quoted in a recent edition of the New York Times. The reporting was accurate and well written and, while that is great for our organisation, the topic of the article should be raising a few questions for us in this country.

Titled Why Australia Wasn’t Ready for a Dangerous Flu Season, the piece describes “Australia’s carefree attitude towards preventive medicine” and says such an attitude “may have met its match” in this season’s flu. It highlights the historically high number of cases being reported in some States, and associated number of deaths (including some tragic stories which have attracted media attention in the past few weeks). However the NYT article says alarm bells are ringing across the nation. The same alarm has also crept into a number of the daily media reports and headlines.

These are some of the facts.

So far this year (late September), more than 175,000 influenza cases have been reported in Australia. The number is likely to be revised higher once the backlog of notifications from certain jurisdictions is entered. That is a huge hike from the 91,000 cases reported last year and it more than doubles the average annual number of cases reported in the last five years.

There are a large number of “A untyped”. These are almost certainly H3N2 – the predominant virus this year which seems to have undergone some genetic change. It is hard to know how significant the genetic changes in the virus are and what that means and we await the findings of the World Health Organization team at the Doherty Institute. There remains little doubt that this has been a factor this year. 

Of concern is the high number of (mainly H3N2) cases in vaccinated people over 65. Vaccine effectiveness in the elderly is traditionally poorer than the young. However this year it seems to be even worse.

The community has had a misconception about what influenza is. It is not the common cold.  Combine that with the “she’ll be right” attitude, and a culture in this country that doesn’t really respect having time off work because of the flu, and you have some of the other drivers behind this year’s numbers. The Australian character does not give this dangerous virus its due respect.

The AMA is on the record declaring this country to have been “woefully unprepared” for our flu outbreak. We have placed a lot of the blame on the low rate at which Australians have flu shots.

Fewer than ten per cent of Australian children receive flu vaccinations, while in the United States it is almost 40 per cent.

According to data released by the Royal Children’s Hospital in Melbourne, less than a third of Australian parents planned to have their children immunised against the flu this season. A whopping 88 percent of them said they were unsure about the safety of the flu shot.

This is most alarming. Past adverse reactions to a certain brand of vaccine in young children are still lingering no doubt but we must inform, educate and encourage everyone we can.

The Health Department here does a good job at raising awareness about the need for influenza vaccinations – and high risk groups get their shots for free.

But perhaps the messaging should be clearer and not just targeting the very old and the very young.

The only way you can prevent complications from influenza is vaccination. It can show no respect for age or health.

In recent days there has been a call from certain quarters and media commentary around expanding the NIP vaccine to other age groups. We await the appropriate study and research and cost benefit analysis and ultimately the advice of the CMO. Despite this call we know that WA provides free vaccine to the under 5s and we provide it to Indigenous children under 5 in the NIP. Take up is about 10 per cent in both these groups.

The question to be asked, is whether expanding the NIP to provide vaccine to other age groups will get significantly increased take up.

The Commonwealth has also confirmed it is examining ways to provide a more potent vaccine for the elderly, in whom there is evidence this year of a significant number of cases in people who have been vaccinated.

Anti-vaccination campaigns have created misinformation and confusion in the Australian public.

We as doctors must do all we can to counter those campaigns and keep our patients fully aware of the consequences of ignoring the need for immunization.

The Commonwealth will be currently under tight timelines to make decisions about the formulation and production of next year’s vaccine. The question of a high dose or adjuvanted vaccine for the elderly for next season will certainly be part of that discussion.

We don’t want to see is another New York Times article next year pointing out that this year’s horrendous flu season provided no lessons for Australia. More importantly, we want to avoid preventable unnecessary suffering and misery of a hostile flu season.

 


Published: 10 Oct 2017