Use of high-dose influenza vaccine for seniors.

Sunrise in San Francisco. (Dr. Noorali Bharwani)
Sunrise in San Francisco. (Dr. Noorali Bharwani)

Our immune system changes as we get older. And flu season takes its toll. Use of high-dose influenza vaccine for people 65-years of age and older can have some benefits.

Canada’s flu season typically starts in October, when temperatures drop and people are in closer contact with each other indoors. The time to get a flu shot is between now and November, before the virus is circulating widely, says the Public Health Agency of Canada (PHAC) on its website.

As Canada braces for another flu season alongside COVID-19, experts say it’s difficult to predict the severity of the virus and the effectiveness of the flu shot this year.

How many Canadians are affected by the flu each year?

An estimated 3,500 Canadians die of the flu each year and 12,200 are hospitalized, making it one of the 10 leading causes of death in this country, says PHAC.

According to the national Influenza Vaccine Coverage Survey, we know that only 42 per cent of Canadian adults reported getting the flu shot last season, though it’s up from 38 per cent in the 2017-18 season and 36 per cent in 2016-17.

“Despite the fact that the influenza vaccine is much better than nothing… a lot of people still think that they don’t want to get it because it’s not good enough,” says Dr. Allison McGeer, a physician and infectious diseases specialist at Mount Sinai Hospital in Toronto (Second Opinion CBC Oct 12, 2019).

“Influenza vaccines are about 50 or 60 per cent effective in protecting you from hospitalization due to influenza. How good are seat belts at protecting you from dying in a car accident? About 50 per cent. How good are smoke detectors at reducing your risk of death in a house fire? About 35 per cent. So, we have this weird double standard that goes on with vaccines,” says Dr. McGeer.

There are two types of flu vaccines. The high-dose vaccines contain four times as much flu virus antigen – the part of the vaccine that stimulates the immune system – as regular Fluzone and other standard flu vaccines.

High-dose vaccines are meant for seniors. This can give older people a higher immune system response against the flu. Fluzone High-Dose is approved for use in Canada for adults 65 years of age and older. It costs about $75 and needs to be ordered in advance compared to regular Fluzone vaccine. There is no charge for the regular vaccine.

Fluzone High-Dose is given by injection. Like other flu vaccines, Fluzone High-Dose is made up of the three flu strains most likely to cause the flu during the upcoming flu season. A new vaccine called Fluzone High-Dose Quadrivalent that is made up of four flu strains has also been approved for people age 65 and older.

People age 65 and older have the highest risks of flu complications. Protecting this group from the flu is especially important.

Some older adults may have weaker immune systems, which can lead them to be less protected after a regular flu vaccine. In response to a regular flu shot, older people produce 50 per cent to 75 per cent fewer antibodies, which protect against the vaccine antigens, than do younger adults.

Studies have found higher antibody levels in older adults who received high-dose flu vaccines than in those who received standard flu vaccines.

In addition, one study found almost 25 per cent fewer cases of influenza in adults age 65 and older who took the high-dose vaccine compared with those who took the standard-dose vaccine.

In a large study comparing high-dose and standard-dose flu vaccines, those who received the high-dose vaccine were more likely to develop side effects during the week after getting the vaccine. Side effects included a fever and soreness at the injection site.

Canada’s National Advisory Committee on Immunization (NACI) concluded that Fluzone High-Dose vaccine for older adults should provide superior protection compared with our standard dose vaccine. It is 24.2 per cent more effective than regular Fluzone vaccine.

We are going to face many challenges this winter. So, make sure you get your flu shot as soon as it is available. Take care. Be safe. Protect yourself and protect others.

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Swine Flu Causes Anxiety in the General Population

A careful walk in the snow certainly helps to stay healthy. (Dr. Noorali Bharwani)
A careful walk in the snow certainly helps to stay healthy. (Dr. Noorali Bharwani)

The Canadian Lung Association has a logo on their website, “When you can’t breathe, nothing else matters.” That is a pretty serious situation. And that is what swine flu is doing in some parts of Canada.

The media report, as of few days ago, says the virus has claimed the lives of six people in Saskatchewan and 10 people in Alberta. It is also making its presence felt in southwestern B.C. By the time you read this the numbers may have changed.

Getting the flu vaccine is your best protection against H1N1 flu virus. The virus is contagious and infects the breathing tubes in your nose, throat, and lungs. It causes swine flu. Swine or pig flu is a form of influenza that affects pigs, or a form of human influenza that is caused by a related virus. You cannot get H1N1 from properly handled and cooked pork or pork products. People with regular exposure to pigs are at increased risk of swine flu infection.

Symptoms of H1N1 are similar to seasonal flu symptoms. Chills, fever, sore throat, muscle pains, severe headache, coughing, weakness and general discomfort. These symptoms usually come on quickly. If it’s difficult to breathe, then get emergency help right away.

If you have mild or moderate symptoms, stay home for seven to 10 days unless you need to see your doctor or go to emergency. Sleep a lot, drink lots of fluids and stay away from other people. Your doctor will decide if antivirals are right for you. It’s best to start antiviral medicines within the first two days of symptoms.

If your symptoms are getting worse then go straight to hospital emergency. The best way to prevent the H1N1 flu is to get the seasonal flu vaccine. And I hope you have done that.

That is all for today. Sleep well, listen to music, dance and eat healthy. “Human happiness and human satisfaction must come from within oneself. It is wrong to expect some final satisfaction to come from money or computer,” says Dalai Lama.

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Annual Flu Shot

“Yes, it’s time again, it‘s time for your annual flu shot,” said a friend in an e-mail. So I made an appointment to see my family doctor and got my flu shot last week. And my family has been through the same process.

This annual ritual is very important. As a health care provider I get my flu shot free. The same privilege is granted to adults and children with serious health problems. People who live them also get free vaccination. Those who are 65 and over are vaccinated without any charge as well. And children six months to 23 months and their families are vaccinated free.

As you may know, there is a reason why these groups of people are vaccinated free of charge. They live or work in an environment where people are sick, are vulnerable to the flu virus and their capacity to fight the virus is not great. They need to be protected. So if you are in one of these four groups or if you know somebody who is in one of these four groups but hasn’t had a flu shot then encourage them to do so. You will be performing a big service.

It is very important to prevent influenza, which is a major cause of outpatient visits, antibiotic use, hospitalization and death, particularly among those older than 65.

Studies have shown that elderly people residing in nursing homes, influenza vaccination can be 50 to 60 per cent effective in preventing admission to hospital and preventing pneumonia and 80 per cent effective in preventing death. Canada’s National Advisory Committee on Immunization (NACI) recommends that both staff and residents of long-term care facilities be vaccinated against influenza.

Among healthy adults, such as the staff of long-term care facilities, vaccination may be 70 to 90 per cent effective in preventing influenza, and it reduces absenteeism from work. Furthermore, the studies say, vaccination of staff reduces the mortality rate among residents of long-term care facilities. No wonder annual influenza vaccination is recommended for both staff and residents of long-term care facilities.

More than 20,000 residents of Palliser Health Region were vaccinated last year. That is a good number but we have a population of around 100,000. What about the rest of the population? What sort of barriers do they face? Is cost of the vaccine a barrier?

In Canada, the publicly funded vaccination programs to prevent influenza are risk-based rather than based on universal immunization. Alberta, the richest province in Canada, should be able to fund universal vaccination programs for all Albertans. But the government’s priorities are some where else. Only Ontario and Yukon fund universal influenza vaccination programs. This allows physicians to recommend vaccination for all their patients. This is important because the effectiveness of influenza vaccine is strongest in healthy people, among whom cases of influenza are reduced by up to 70 per cent.

Studies have shown that the universal influenza immunization program in Ontario has been associated with higher coverage for people with high-risk chronic conditions than has occurred in other provinces. This suggests that universal immunization may increase vaccine delivery to high-risk groups. So universal immunization programs appear to be good for healthy individuals as well as for people with high-risk chronic conditions. A win-win situation. Hopefully, one day Albertans will be in the same win-win situation.

In the mean time, make sure you get your flu vaccine today! I have had mine. Make sure you have yours.

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Influenza (Flu)

Flu and pneumonia can be serious illnesses.

“Influenza (flu) is a highly contagious acute respiratory disease of global importance,” says an editorial in the New England Journal of Medicine.

The editorial says that vaccination is currently the most effective measure to reduce the impact of influenza. But it is not easy to formulate a vaccine for a constantly changing virus. For the last 50 years, World Health Organization has monitored the appearance and spread of new variants of the virus worldwide that may cause the next epidemic. This usually results in producing well-matched vaccines.

How does the vaccination work?

It works by exposing an individual to modified form of influenza virus in order to generate an immune response.

For many years, attempt has been made to prevent and control influenza by vaccinating people over 65, those with chronic medical conditions (heart disease, lung problems, diabetes, kidney disease etc.), medical care providers and others who might transmit the virus to those at risk.

This effort has considerably reduced deaths from this disease. The flu epidemic of 1918 killed 21 million people worldwide. The epidemics come every two years but we have better tools now to save lives.

There is also some comfort in the news that research has produced new ways of dealing with this challenging problem – by way of producing oral antiviral agents. There are few in the market and the newest one – Relenza – has been approved by Health Canada and should be in the drug stores soon.

This takes us to another related disease – pneumonia.

“Invasive pneumococcal disease can be deadly,” says Dr. Ross Pennie, Professor in the Faculty of Health Sciences at McMaster University in Hamilton, Ontario. In an editorial in the Canadian Family Physician, Dr. Pennie says that fewer than 5 percent of the population at increased risk of pneumonia has received the pneumococcal vaccine.

Alberta Health says that the pneumococcal vaccine is now available – free of charge – to all Albertans over the age of 65 through community health clinics and physicians’ offices. The vaccine can prevent serious infections caused by the bacteria Streptococcus pneumoniae.

The organism can cause pneumonia, meningitis, and sinusitis. About 400 people die each year in Alberta from pneumococcal infection.

Among those at greatest risk for the disease are seniors, people living in a nursing home or other long term care facility, or those over two years of age who have medical conditions that may affect their body’s ability to fight diseases, says Alberta Health.

These conditions are: people who have had their spleen removed, who have diabetes, lymphoma, chronic diseases of the heart, lungs, liver, and kidneys. The current vaccine is ineffective for children younger than 2 years.

“In most cases, one pneumococcal vaccination is all a person will ever need,” says Dr. Karen Grimsrud, deputy provincial health officer.

Over the years, flu and pneumonia has taken many lives in nursing homes and seniors living at home. Remember, help is here. It is free. So, if you are not sure whether you need to take these vaccines then speak to your doctor or a public health nurse. Do it soon.

Have a healthy winter!

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