Should you sign up for the new 4-in-1 FLU JAB?

After last year’s vaccine failed to give full protection, there’s a new range of advanced injections on offer. So...

With memories of last winter’s flu-mageddon — when the virulent ‘Aussie’ flu nearly doubled the UK’s annual death toll — many might be understandably nervous about the approaching flu season. Experts have long warned that it’s a question of when, not if, another flu pandemic hits. the last one, in 1918, led to the deaths of between 50-100 million people and has been described as one of the deadliest human disasters ever.

Flu is one of the world’s most dangerous viruses — thanks to its ability to mutate — and every winter poses a serious threat to the nation’s wellbeing and the health service’s ability to cope.

the flu virus circulates all year round but rates spike from early December through to February or March when we spend more time indoors and in close proximity to each other — allowing it to spread more easily. in anticipation of this year’s flu season, over the next six weeks up to 26 million people across the UK will be offered a free vaccine on the NhS.

this programme targets at-risk groups which include the over-65s, young children, pregnant women and anyone with severe chronic illness such as asthma, heart failure or diabetes.

this huge public health exercise marks the beginning of an annual battle which starts in February, when the World health Organisation (WhO) predicts which strains will present the greatest threat over the coming 12 months.

however, vaccine production takes six months or so, during which time the chosen strains can mutate, or new ones can emerge. hence, the best hope for any jab is that it protects around 60 per cent of the population.

Choosing which strains to include is a guessing game and although the WhO gets it right roughly eight out of ten times, in some years the jab is much less effective.

Which is what happened in the UK last winter. the vaccine given to millions of NhS patients had little or no effect because one of the strains it targeted, h3N2 (dubbed Aussie flu because it had already triggered the worst flu outbreak there in a decade) had mutated.

this year the NhS is introducing two new forms of flu jab — a ‘turbo’ jab for the over-65s and a four-strain ‘super’ jab for younger adults.

But how well will any of the jabs available safeguard you and your loved ones? We spoke to the experts to find out.

A ‘TURBO’ JAB FOR THE OVER-65S

LASt winter’s jab worked for fewer than one in three of the over-65s given it — and many of the 15,000 flu deaths in the UK were older patients. the problem is our immune systems enter a process of age-related decline — this can happen in some people from as early as middle age onwards, some experts believe.

it’s this irreversible decline, known as immunosenescence, which explains why flu jabs often fail to generate the desired reaction in the elderly.

As a result of immunosenescence, vaccines that would fire up a 30-year-old’s immune system to defend against invading viruses have a much weaker effect on someone in their 60s or 70s.

‘the truth is we don’t really know at what point immunosenescence begins,’ says Professor John Oxford, a virologist at Queen Mary University of London.

‘But it’s possible for some people it’s as early as their 40s, when other visible age-related changes such as greying hair or wrinkles also start to appear.’

this year, the Department of health is introducing a new turbo-charged flu jab specifically designed to boost the immune response in the elderly to make the jab more effective.

Called Fluad, the vaccine targets three flu strains that have been identified as those most likely to be a threat to older people. Unlike the vaccine for younger adults, it contains a new ingredient known as an adjuvant.

these are molecules added to vaccines to boost the immune system’s response, so that greater numbers of antibodies (the virusbusting cells in the body) are released into the bloodstream.

Fluad uses an adjuvant called MF59 — during tests, it reduced hospital admissions due to flu among the elderly by a quarter compared to vaccines that did not use an adjuvant (but it’s not clear if it cuts rates of infection).

Public health experts predict that the new vaccine will save 30,000 GP consultations and prevent 700 flu-related deaths — but there are drawbacks.

‘Adjuvants can increase the immediate side-effects, such as local pain and swelling at the injection site, because they work by attracting more immune system cells to the area — and it’s the immune system response that triggers the side-effects,’ says Peter Openshaw, an immunologist and a professor of experimental medicine at imperial College London.

‘All elderly patients should be informed of this because it may cause more of a reaction than vaccines in previous years.’ One in four patients suffers injection site pain and 13 per cent get a headache, says the maker Seqirus.

Fluad has been available in France and italy for more than 20 years but was only licensed for use in the UK last year. (A four-strain version of the adjuvant vaccine is also being developed.)

. . . BUT YOU MAY STRUGGLE TO GET IT

iN SEPtEMBEr the NhS wrote to GPs warning that supplies of Fluad would arrive in batches — with 40 per cent delivered in September, 20 per cent in October and the remaining 40 per cent in November — potentially leaving some surgeries with just days to immunise many elderly patients before flu rates spike (and it can then take up to three weeks for the jab to work).

the situation is more critical in Scotland, where an estimated half a million 65-to-74-year-olds are set to miss out on the new jab because the NhS north of the Border left it too late to order enough, it’s been suggested.

NhS guidance says that if stock does turn out to be limited then ‘those aged 75 and over and those aged 65 to 74 with an underlying clinical risk factor should be prioritised’.

if Fluad supplies run out completely, doctors can give elderly patients the quadrivalent jab meant for younger adults, says NhS England.

NEW SPRAY FOR TWO TO 18 YEAR OLDS

ALthOUGh we tend to associate flu with the elderly, it’s the underfives who are more likely to be admitted to hospital with complications from flu than any other age group.

A children’s vaccine, called Fluenz tetra, which comes in the form of a nasal spray (given as one squirt in each nostril), is offered annually to all aged two to ten, as well as those under 18 with chronic health conditions, such as diabetes, that increase the risk of serious complications from infection.

the nasal spray has been found to trigger higher levels of virus-

fighting antibody cells in children than the vaccine given by injection. But vaccinating children is not done solely to protect them — it also protects adults as children are known as ‘super spreaders’.

‘Children spread flu because they generally don’t use tissues properly or have good hand hygiene,’ says Professor Oxford.

‘But vaccinating them also benefits grandparents who may be living with or near them by reducing their exposure to the virus.’

This year’s spray protects against four strains — two types of influenza A (the most dangerous type of flu virus) and two types of influenza B (which generally causes milder illness), the same as the adult version.

Common side-effects of the spray include a runny nose, sneezing or loss of appetite. How effective it will be remains to be seen.

Public health experts say that last year the trivalent nasal vaccine protected up to 90 per cent of children against one type of flu virus but was powerless to stop them contracting another of its strains — H3N2, or Aussie flu.

If your child falls outside the NHS vaccination programme, you can get them vaccinated with the spray at some chemists, such as Boots, from the age of ten (see Dr Scurr’s commentary, above).

THE SUPERJAB FOR ADULTS

IN PrevIOuS years, flu jabs for adults have targeted three commonly circulating virus strains.

This year, for the first time, the NHS is using a quadrivalent version — targeting four strains.

It was introduced after the Joint Committee on vaccination and Immunisation — the expert body that decides who gets what vaccines — did a cost effectiveness study last year which found that it would prevent more cases than a three strain vaccine.

The injectable vaccine is free on the NHS to all healthcare workers, plus anyone aged 18 to 65 who is pregnant, or has existing medical conditions that may weaken their resistance to flu infection and increase the risk to their lives from complications such as pneumonia. These include asthma, diabetes, heart and liver disease.

So why won’t adults be given a supercharged vaccine like that for the over 65s this year? Professor Openshaw says the case for using adjuvants in vaccines for younger patients is less convincing.

‘The fact they are unlikely to trigger such a significant improvement in immune response in children or younger adults as seen in the elderly — coupled with increased risk of side-effects — means they are probably unnecessary.’

I’M HEALTHY, DO I NEED IT?

HeALTHY people aged 18 to 65 do not qualify for a free NHS vaccine —unless they work in healthcare.

But jabs are available, either on a private prescription from your GP or at High Street pharmacies and supermarkets, with prices starting from £7 at Asda. The only option is the quadrivalent jab the NHS uses (Fluad jabs are only for over-65s).

But is a vaccine really necessary for an otherwise healthy adult?

This year’s Australian flu season — which runs approximately from May to August and partly dictates what strains affect the uK — was much less traumatic, with infections down around 90 per cent.

Better still, most of those affected had a strain that matched the vaccine well; the virulent H3N2 strain that did so much damage last winter accounted for fewer than one in four cases.

However, what happens in Australia does not necessarily translate to the uK. ‘I would advise everyone to get vaccinated,’ says Professor Andrew easton, a specialist in viral infections from the university of Warwick.

‘As well as protecting themselves, they are helping to protect their nearest and dearest by preventing spread of the virus.’

Previous research had raised concerns that having the vaccine weakened the body’s natural ability to protect itself from the disease. But in a study published in 2017 in The Journal of Infectious Diseases, Norwegian researchers found it did not. Indeed those who had the vaccine annually appeared to have a better immune response than those vaccinated only once.

So should the NHS just offer everybody the flu vaccine to try to improve prevention of outbreaks?

‘It’s heading that way and it would be a good thing,’ says Professor Oxford. ‘It could happen within the next few years.’

WHO SHOULDN’T HAVE IT

THe viruses in all flu jabs are grown in hens’ eggs, so for someone allergic to eggs this is potentially lethal. Around 60,000 children in the uK have egg allergies — far fewer adults are affected.

The Joint Committee on vaccination and Immunisation has advised doctors that most children with an egg allergy can still be safely immunised with the nasal flu spray, since the content of ovalbumin (egg protein) is very low.

The exception is children who’ve previously needed treatment in intensive care due to egg exposure. It would also be inappropriate for children with an allergy to any of the other ingredients, such as an antibiotic called neomycin.

The NHS advises patients to ask their GP if an egg-free vaccine is available (some have come on the market in recent years) — or if one with very low egg content is available. However public health officials say there is no ovalbumin-free vaccine for 2018/19.

Those with the severest allergy may be referred to a specialist to have the jab in hospital.