Johannesburg, 12 May 2023: The cooler months usually bring about a surge in cases of influenza or ‘flu’. Flu is an acute infection of the respiratory tract caused by type A, B or C influenza viruses, which circulate worldwide at different times of the year.1 South Africa’s seasonal flu usually has the highest number of recorded cases between May and September each year.1 It is therefore important for people not to delay in getting an annual flu shot, especially those with chronic conditions who are at greater risk of contracting flu and developing more serious complications.
Flu can spread quickly between people when an infected person coughs or sneezes, dispersing droplets of the virus into the air. It can also be spread by hands contaminated by the virus.2 The flu causes up to 650 000 deaths globally each year, and the highest numbers are in sub-Saharan Africa.1 Over 11 000 deaths related to flu occur in South Africa each year, and almost 50% of people in South Africa who catch severe flu, need to be hospitalised.1
What are the symptoms of flu and who is at risk of contracting it?
Seasonal flu is characterised by a sudden onset of fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and a runny nose. The cough can be severe and can last two or more weeks.3
Most people recover from the fever and other symptoms within a week, without requiring medical attention. However, among high-risk groups, flu can cause severe illness or death.3
According to the National Institute for Communicable Diseases (NICD), the people most at risk for severe/complicated influenza include:1
- Pregnant women and women up to 2 weeks after giving birth
- Young children (particularly those under 2 years of age)
- Persons over the age of 65 years
- Individuals who are morbidly obese (e.g. body mass index (BMI) of ≥40)
- HIV-infected individuals
- Individuals with tuberculosis
- Persons of any age with chronic diseases:
- lung diseases (e.g. asthma, chronic obstructive pulmonary disease)
- immunosuppression (e.g. those on immunosuppressive medication, or who have cancer)
- heart diseases (e.g. congestive cardiac failure), except for hypertension
- metabolic disorders (e.g. diabetes)
- kidney or liver disease
- neurological and neurodevelopmental conditions
- abnormal production or structure of haemoglobin (e.g. sickle cell disease)
- Those under 18 years receiving chronic aspirin therapy
Dr Lourens Terblanche, Medical Head: South Africa, Sanofi Vaccines, says: “Influenza viruses evolve constantly, so twice a year the World Health Organisation (WHO) makes recommendations to update vaccine compositions. Patients that are known to be at high risk for developing severe or complicated illness as a result of contracting the flu should prioritise immunisation against the flu every year as recommended by the NICD.”
Dr Terblanche says that people should ideally get vaccinated before the flu season begins for the most effective coverage, although getting vaccinated at any time during the flu season can still help protect against flu infections.
Adds Dr Terblanche: “Lower levels of circulating influenza virus over the last two or three flu seasons may have led to lower levels of herd immunity than usual, which may mean a build-up of susceptible individuals in the coming season. In addition, the fact that a large number of infants and young children have never been exposed to flu may result in higher infection levels in these younger age groups. They in turn can infect other members of the household.”
How vaccination could protect beyond flu
Flu can impact many major organ systems in the body, so flu vaccination can provide protection where these systems would have been affected. Complications of flu include a 10x higher risk of having a heart attack,5 an 8x higher risk of stroke,5 and an 8x greater risk of pneumonia in children under the age of 14,6 while people with diabetes may experience a 75% increase in abnormal blood sugar levels.7
A 2021 study by the US Centers for Disease Control (CDC) showed that among adults hospitalised with flu, vaccinated patients had a 26% lower risk of having to go to the intensive care unit (ICU) and a 31% lower risk of death from flu, compared with those who were unvaccinated.8
“Flu vaccination is also essential considering the possible co-circulation of both the flu and SARS-Cov-2 viruses or other respiratory pathogens this winter season. However, it is important to remember that the flu vaccine will not prevent COVID-19 and vice versa; therefore, it is important to ensure that you are vaccinated against both. Simultaneous infection with flu and COVID-19 can result in severe disease,9” says Dr Terblanche.
Current guidance from the Department of Health regarding having flu and COVID-19 vaccinations at the same time is that they may be given on the same day, if they are given in different arms.10
“In South Africa, annual flu recommendations encourage individuals at high risk of severe complications to get vaccinated. Remember that even healthy individuals above the age of 6 months who wish to protect themselves and those around them from getting the flu should also consider vaccination annually,” says Dr Terblanche.
Ask your doctor, pharmacist, or healthcare provider for more information about flu vaccination.
Myths about the flu vaccine
The WHO reports that there are a number of myths about the flu vaccine,11 including the myth that ‘Flu is not serious, so I don’t need the vaccine’. The WHO responds as follows: “As many as 650 000 people a year can die of the flu. This only represents respiratory deaths, so the likely impact is even higher. Even healthy people can get the flu, but especially people whose immune systems are vulnerable. Most people will recover within a few weeks, but some can develop complications including sinus and ear infections, pneumonia, heart or brain inflammation.”11
Another myth is that the flu vaccine can give you the flu, to which the WHO responds: “The injected flu vaccine contains an inactivated virus that cannot give you influenza. If you feel achy or slightly feverish, it is a normal reaction of the immune system to the vaccine, and generally lasts only a day or two.”11
- Ends –
References
- Blumberg L, et al. National Institute of Communicable Diseases. Influenza: NICD recommendations for the diagnosis, management, prevention and public health response. April 2022.
- World Health Organization. How to stop the spread of flu. Available from: https://www.who.int/news-room/questions-and-answers/item/how-can-i-avoid-getting-the-flu Accessed 7 March 2023.
- World Health Organization. What is seasonal influenza? Available from: https://www.who.int/news-room/questions-and-answers/item/how-can-i-avoid-getting-the-flu Accessed 7 March 2023.
- Wits Communications. (2021, 19 May). Who catches and transmits flu in SA and the implications for vaccination. Available from: https://www.wits.ac.za/news/latest-news/research-news/2021/2021-05/who-catches-and-transmits-flu-in-sa-and-the-implications-for-vaccination.html. Accessed 20 October 2021.
- Warren-Gash C, et al. Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland. Eur Respir J. 2018; DOI: 10.1183/13993003.01794-2017
- Kubale J, et al. Individual-level Association of Influenza Infection With Subsequent Pneumonia: A Case-control and Prospective Cohort Study. Clin Inf Dis. 2021; 73(11): e4288–e4295.
- Samson SI, et al. Quantifying the Impact of Influenza Among Persons With Type 2 Diabetes Mellitus: A New Approach to Determine Medical and Physical Activity Impact. J Diabetes Sci Technol. 2019; 15(1):44-52.
- CDC. Vaccine effectiveness: How well do the flu vaccines work? Available from: https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm. Accessed 14 March 2023.
- Stowe J, et al. Interactions between SARS-CoV-2 and influenza, and the impact of coinfection on disease severity: a test-negative design. International Journal of Epidemiology 2021;1-10. doi: 10.1093/ije/dyab081.
- Turner KJ. Flu shot and Covid-19 vaccine double jab encouraged during winter season. IOL News. 2022; Jun 9.
- World Health Organization. 5 myths about the flu vaccine. Available from: https://www.who.int/news-room/spotlight/influenza-are-we-ready/5-myths-about-the-flu-vaccine. Accessed 8 March 2023.
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