Co-infection by the influenza virus for people with respiratory diseases like asthma and COPD can end badly – vaccines can help.
Before smallpox was eradicated, it was a serious infectious disease caused by an incredibly contagious virus that claimed over 300 million lives in the 20th century alone. Measles, too, was a similarly infectious and potentially dangerous disease in its heyday. However, some 23.2 million deaths due to measles were prevented by vaccination. Vaccinations save up to three million lives each year from vaccine-preventable infections. Vaccines, for decades, have reduced the morbidity and mortality caused by many diseases. As we wrestle with the COVID-19 pandemic, the role of vaccines is more pertinent than ever before.
At this juncture, it is even more critical to underline the need for vaccination to keep other (less intimidating) respiratory infections, such as influenza (commonly called the flu), at bay. The 2020 GOLD Science Committee announced that during the COVID-19 pandemic, “patients should receive their annual influenza vaccination, although the logistics of providing these while maintaining social distancing will be challenging.”
The announcement emphasizes the critical need for individuals to protect themselves from influenza, but also from the COVID-19 disease by extension. The practice of flu vaccination is part of the risk reduction strategy in Chronic Obstructive Pulmonary Disease (COPD) patients, and could be as vital in defending patients suffering from COVID-19 .
The ‘right season’ to get a flu shot
Commonly known as the flu, influenza is caused by the influenza virus. Those infected by it experience symptoms such as high fever, sore throat, joint pain, cough, tiredness and runny nose, which can persist from as little as two days to as much as three weeks. In many cases, the resulting problems can lead to respiratory complications, heart failure and even death.
The effects of influenza, such as respiratory failure, decreased functional capacity and related cardiovascular complications could potentially put millions at risk of COVID-19 , in a population that is already high-risk. India’s Ministry of Health and Family Welfare has used a prioritisation strategy for adults during the COVID-19 pandemic, advising vaccination of all people in risk groups with the flu shot to help prevent “influenza, influenza-related complications, co-infection with SARS-CoV-2”. This will ultimately add up and build herd immunity against COVID-19 , reducing the burden of the pandemic on the already-stressed healthcare system.
Of the three types of seasonal influenza viruses which infect humans (types A, B, and C), the A and B viruses circulate and cause seasonal epidemics of disease. Due to low awareness on the subject, it is observed that people mostly take the vaccine after the outbreak (as in the case of H1N1), which is often too late. The vaccine must be taken at the beginning of the season for lasting immunity through the season. An important thing to note here is that flu viruses are constantly changing. Today, seasonal influenza looks very different from one season to the next, and one geography to the next. In India, it peaks between summer and monsoon, making April an ideal month to get oneself vaccinated. As per government guidelines, those who have received both shots of the COVID-19 vaccine should wait for 14 days before taking a dose of the flu vaccine.
For years, children have been a priority population for vaccination programs. However, adult immunisation needs to be addressed – more so in a country like India, where communicable diseases are still a major health threat.
Adult immunisation is important
In a manner of thinking, immunisation is a lifelong journey. Ageing is linked with many detrimental changes to the immune system, and many people develop inadequate vaccine responses in adulthood as a result of what is called ‘immune ageing’. As the people of the world age, more and more individuals in the population become vulnerable to vaccine-preventable diseases. Although there are recommendations from scientific panels and the Ministry of Health and Family Welfare of India for vaccination against influenza, the implementation policy for adult influenza vaccination is still missing. According to the WHO, vaccination is the key to fight the latest strains of influenza and henceforth, vaccination must be prioritised among pregnant women, children (six months to five years), the elderly, individuals with chronic medical conditions such as diabetes, heart conditions, and healthcare workers.
A panel of Indian experts made a consensus-based recommendation for the flu shot in 2019. They stated the flu shot, specifically for adults over 50 years of age, is cost-effective in India. Significant challenges remain in fighting influenza in India, including the fact that adults – a vulnerable population to the flu – aren’t aware they need the flu vaccine at all.
Strengthening access to vaccines
Vaccines should be readily and easily accessible to the public. Particularly in developing countries such as India, where the primary healthcare system needs to reinvent ways to provide equitable and cost-effective solutions to achieve challenging health targets, it needs to focus on not just treatment, but preventing disease before it happens. This might require strategic measures such as setting up accessible health & wellness centres to provide comprehensive healthcare services for outpatients, and adult vaccination units in hospitals and clinics, which would handle chronic disease management.
There is also an urgent need for digital healthcare information that can help people understand the vaccination process better. This could go a long way in fighting misinformation. Imagine a day when authorities disseminate accessible science information in targeted campaigns to build public trust, where mistrust currently exists. Improving the practice of vaccination in the country, and strengthening the country’s fight against seasonal flu, particularly at a time when we are simultaneously battling a pandemic, is important and necessary. Patients hospitalised with a viral respiratory infection will be prone to secondary bacterial, or fungal infections, too. This is where influenza vaccination becomes even more critical.
For decades, influenza vaccination has effectively helped in preventing influenza-related respiratory infections and severe disease. In decreasing the relative risk of death from these causes, the number of outpatient visits and hospitalisation episodes in patients with COPD are bound to reduce. From economic evaluations to prioritising age groups for vaccination, the time is now to turn a corner in understanding the rationale behind influenza vaccination. After all, preventing the preventable is better than curing the preventable.
What is COPD?
Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory disease that affects the tissues and airways of the lungs. Depending on its severity, it makes the lungs incapable of coping with increased oxygen demand in day-to-day activities, or during respiratory stress or physical activity. Symptoms of COPD include chronic cough, increased phlegm production and shortness of breath.
Do I have COPD?
To get a COPD diagnosis, doctors confirm any symptoms a patient might report using a simple test called spirometry. The test measures how deeply a person can breathe and how fast air can move in and out of the lungs.
Will vaccination help manage COPD better?
Seasonal influenza in patients already suffering from COPD invites a range of complications, along with the risk of hospitalisation. Research indicates the seasonal influenza and the pneumococcal vaccine, given together, could lower the risk of hospitalisation for pneumonia by 63 percent, and slash the risk of death among elderly patients with COPD by a whopping 81 percent.
In other words, the flu vaccine could go a long way in protecting healthy adults, as well as those who have other respiratory illnesses such as COVID-19 and COPD.
The author is a Professor of Internal Medicine at Hacettepe University, Ankara, Turkey