The flu shot has provided a false sense of security for many seniors this season and reminded us all about the importance of hand hygiene.
The US Centers for Disease Control and Prevention (CDC) via its Morbidity and Mortality Weekly Report (MMWR) just issued its interim adjusted estimates of seasonal influenza vaccine effectiveness for the US. These results combined with reports from Canada and Europe show that the quadrivalent vaccine widely utilized, has failed to protect seniors (≥65 years).
The CDC report states that for seniors the 2012-2013 flu vaccine was only 9% effective for the most common and virulent strain of influenza virus. The senior population let down by this news in North America and Europe, even if they didn’t receive the flu shot, is over 120 million people. For many, just knowing that a flu vaccine is out there, provides them with a mental security blanket, even if they choose to put getting a vaccination off. As reported in last week’s blog, wintertime brings a host of respiratory infections including Influenza, and is responsible for a significant number of cases of viral pneumonia.
Influenza epidemics of the western world have been well documented since the “grande influenza” in 1357 with at least 31 influenza pandemics recorded since that time. Today, we know that influenza spreads around the world in yearly seasonal epidemics resulting in 3 to 5 million cases and 250,000 to 500,000 deaths rising to millions and tens of millions in pandemic years.
Flu symptoms while not life-threatening by themselves, weakens the immune system, making the body vulnerable to more serious infections, such as pneumonia. Primary influenza pneumonia causing lower respiratory tract infections is bad enough, but secondary bacterial pneumonia may occur within a few days of onset of symptoms and carry a high mortality, especially in the senior populations. More than 90% of influenza-related deaths are in people age 65 years or older. This is why early diagnosis and antiviral treatment are essential to improve infection outcomes for persons over 65.
All age groups are susceptible to flu infection. Seniors make up the largest number of fatalities in epidemics because they usually having a collection underlying tenuous health conditions that accumulate with age. Influenza infections can usually be prevented by a yearly influenza vaccination and in all other age groups excepting seniors, this year’s vaccine worked pretty much as expected (reported as moderately effective) and prevented countless influenza infections. The CDC reckons that vaccine reduced the risk of outpatient medical visits resulting from influenza by one half to two thirds for most persons recieving the vaccine.
What Next for Seniors?
When technology fails us sometimes we need to take things into our own hands. Despite a highly intensive program of vaccination development, and assurance that Influenza vaccines remain (sometimes, but not always) one of the best preventive tool available we are going to have to rely on what the CDC calls the single-most effective means of preventing the transmission of infectious diseases, hand hygiene. Seniors of all stripes in and out of the work force, must now fend for themselves, roll up their sleeves and commit to improved hand, surface and respiratory hygiene if they want to make it through flu season unscathed.
Aerosolized virus remains transmissible for around an hour and crowded groups are responsible for an estimated 50% of all flu infections. Respiratory hygiene recommendations include: encouraging all persons to cover the nose and mouth when coughing or sneezing. Seniors especially vulnerable to infection should consider wearing surgical masks when in public places, healthcare waiting areas or visits to congregate settings such as nursing homes and adult day care centers. Avoid touching communal surfaces and touching your own eyes nose or mouth without first practicing hand hygiene.
Remember from last week’s blog that Influenza virus like the coronavirus causing SARS is a member of a group of viruses that have as part of its outer structure, a lipid envelope. This makes them very sensitive to the destructive effects soaps and alcoholic hand sanitizers. Using alcohol-based hand sanitizers often for hand hygiene when hand washing with soap and water is inconvenient or unavailable.
What Next for the Rest of Us?
This should be a wake up call for all age groups. Predictive vaccine strain choices by public health authorities is a science riddled with variability and uncertainty. Every year, experts from the the World Health Organization (WHO) and the CDC, consult with their counterparts in the UK, Australia, Japan and China and 100 national influenza centers around the world to decide which influenza strains to use in vaccines for the upcoming flu season. In some years our experts make better preictions than others, and this was not a good year for seniors. On any given year, any or all age groups could suffer a similar fate, and thus good quality hand hygiene must always be our primary defense.
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