Esther Alonso Vaquerizo
Winter begins and, with it, the circulation of respiratory viruses and the start of vaccination campaigns against influenza to protect the population. This year 2021 is presented as atypical, after the low circulation of the flu virus last season and the coincidence of the flu vaccination and booster against COVID-19 in people over 65 and other risk groups. To help answer the population’s questions about influenza vaccination, Prensa Ibérica has organized a panel of experts, with the support of Sanofi, in which three renowned professionals have participated: Jose Maria Eiros Bouza, head of the Microbiology Service of the “Río Hortega” University Hospital and director of the National Flu Center of Valladolid; Pepe Gutierrez Rodriguez, care coordinator of the Geriatrics Clinical Management Area of the Monte Naranco Hospital in Oviedo and coordinator of the Infections and Vaccines Working Group of the Spanish Geriatrics and Gerontology Society; and Isabel Jimeno Sanz, Head of the Vaccine Group of the Spanish Society of General and Family Physicians (SEMG).
The flu may be stronger this year
Due to the low levels of transmission of the influenza virus recorded last season, the fact that there are no longer lockdowns and that the prevention measures in place during the maximum peak of the coronavirus pandemic have been relaxed, may make the season flu is especially hard this year. As explained Jose Maria Eiros Bouza, “Although the onset, duration and intensity of the flu is unpredictable, according to previous monitoring carried out in Castilla y León, it can be observed that seasons that have registered little flu activity are followed by other seasons with greater intensity, where the flu it starts earlier, lasts longer and also affects a greater number of people ”.
In this same line, Pepe Gutierrez Rodriguez, underlines that, “although the little extension of the influenza infection in the past season may make us think that the infection is going to be a minor problem this year, precisely that little exposure of the population to the virus can increase the infection. It is a probability and, therefore, we should not relax in the goal of vaccination. In the 2020 campaign, despite the alarm that was generated against the coronavirus and despite the increase in vaccination rates, only 8 autonomous communities increased the rate above 70% in those over 65 years of age. As a clinician and as a person who lives in this society, I would like to emphasize that we must try to continue looking for rates higher than 75% in those over 65 years of age ”.
We must not fall into the comparison between the flu and Covid-19, underestimating the first of these viruses. The flu is much more than an infection that leaves you in bed for a few days, it can have severe cardiovascular consequences. Regarding this issue, Isabel Jimeno Sanz, points out the importance of relating flu and cardiovascular events: “When we have a flu, the possibility of having a cardiovascular event such as a heart attack, arrhythmia or stroke increases. It should be remembered that this type of event can occur in people without a previous history of pathology or patients with heart disease that we must protect, the best mechanism being vaccination ”. This issue is especially important in the group of older adults, in whom influenza infection can cause decompensation of different respiratory or cardiovascular pathologies, causing hospital admission: “It is important to remember that the hospital is a source of fragility in people elderly: two out of every three patients over 75 years of age who are hospitalized have a new functional disability in any of the personal care activities during hospitalization and, in one of every three that disability persists one month after discharge. If we vaccinate this age group against the flu, we will avoid that burden of over-added disability caused by hospitalization ”, he says. the geriatric specialist consulted.
Regarding the economic and social cost of the flu, the director of the National Flu Center of Valladolid added: “According to the figures published annually by the Carlos III Health Institute, 34% of severe flu cases that are hospitalized require assistance in a critical care unit and 12% of them die. Regarding the economic cost caused by this disease, we estimate that a flu season with maximum activity can cause a cost of about € 56 million per million inhabitants. EU studies from a decade ago estimate that each flu season represents approximately € 11 billion in the context of countries ”.
Pregnancy, Covid-19 and flu vaccination
The members of the table agreed to affirm the importance of influenza vaccination in pregnant women. “Vaccines are indicated in pregnant women and contribute to reduce the effects of the disease on itself and on the future baby,” he declared. Gutierrez Rodriguez. As pointed out Jose Maria Eiros Bouza “The available studies indicate that the vaccine effectiveness in pregnant women is not very high in the influenza vaccine. However, it is proven effective in preventing the flu in newborns. The importance of vaccinating the environment of pregnant women was also discussed at the event: “When there are premature children, for example, it is important that parents, grandparents, caregivers, etc. are vaccinated. That is why gynecologists, obstetricians, primary care physicians, primary care personnel, etc. We should lose our fear of advising pregnant women to be vaccinated ”, says the specialist present at the table.
When asked if it is possible to simultaneously vaccinate against Covid-19 and influenza, the experts present also agreed: “When vaccination against Covid-19 began, it was said that it had to be separated from others because we were beginning to administer a vaccine that we knew very little about and the precautionary measures were greater. But the studies that exist right now already clearly show that there is no problem in giving the two vaccines at the same time ”, affirmed the Head of the Vaccine Group of the Spanish Society of General and Family Physicians (SEMG). “It is very important to convey to society that the two vaccines can be administered at the same time, you just have to have the appreciation that they must be administered in different anatomical sites,” he said. Pepe Gutierrez Rodriguez.
Regarding the possibility that the vaccine against Covid-19 protects against the flu and vice versa, the specialists consulted agreed in admitting that a single vaccine does not cover both pathologies. However, they did point out that the administration of continuous vaccines can contribute to improving the response of the immune system in older adults. In the words of the coordinator of the Infections and Vaccines Working Group of the Spanish Society of Geriatrics and Gerontology “Older people have a depressed immune system. This is why your response to the vaccine may be less intense than that of a young adult. Now, if we are systematically giving all the elderly people all the vaccines that are indicated, this continuous stimulus can improve the immune system as a whole ”.
The duration of the immunity of the vaccine against influenza was also commented on by the experts. The changing nature of the virus makes it difficult to determine the protection capacity for a specific strain of influenza, although it appears that consecutive annual vaccination improves immunity to better respond the following year. “It is important to know that the positive fact that being vaccinated represents for a human being can induce some improvements in the immune response – part known and much unknown – against other viruses”, explained José María Eiros Bouza.
The importance of annual vaccination
As noted at the panel of experts, vaccines are one of the public health tools that have most contributed to increasing human life expectancy. “Getting vaccinated for the flu reduces the severity of the infection, the risk of hospitalization and the risk of death.
For this reason, any population susceptible to being vaccinated (we are not only talking about elderly people, but also people with other chronic diseases such as diabetes, COPD and heart disease), should be vaccinated against the flu “he pointed out. Pepe Gutierrez Rodriguez. For its part, Isabel Jimeno Sanz emphasized the importance of annual vaccination, fundamental in vulnerable groups and, also, for their environment: “The flu vaccine protects vulnerable people from worsening their underlying diseases and entering the hospital (with all the problems that this brings later), it reduces the risk of cardiovascular events with very important sequelae and, of course, the risk of death. It is important that the environment of these people is vaccinated to protect them. It is true that we would like the effectiveness of the flu vaccine to be better, but it is quite effective as it is, that is why our goal is to vaccinate all our patients who are likely to receive the flu vaccine ”.
In his last speech, Jose Maria Eiros Bouza He highlighted the benefits of vaccination: “We live in a country where vaccines are available, where the health system is accessible. The vaccine has so many benefits that it is difficult to understand that there are people who do not consider it necessary to be vaccinated and not only for individual protection, but to protect the people around you and to protect society as a whole ”, he concluded.