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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Pragmatic Approach to Treating Inflamed Nasal Passages and Sinuses

Alberta countryside. (Dr. Noorali Bharwani)
Alberta countryside. (Dr. Noorali Bharwani)

Sinusitis refers to inflammation of a sinus, while rhinitis is inflammation of the nasal passage. Anatomical closeness of the sinus cavities and the nasal passages lead to frequent simultaneous involvement of both structures. When both structures are involved the diagnosis is rhinosinusitis. The inflammation may be due to a virus or bacteria. The disease can be acute or chronic.

Rhinosinusitis is a frequently occurring disease. It has a big impact on the quality of life and health care spending. This also affects absenteeism and productivity. It is estimated that approximately six billion dollars is spent on 25 million individuals in the United States annually on therapy for rhinosinusitis. Rhinosinusitis probably affects more than 25 million Americans and 2.5 million Canadians.

As we know the quality of life of patients with chronic or recurrent sinusitis can be unpleasant. Antibiotics are prescribed for nearly all patients with sinusitis, but they are not always effective and increase the risk of antibiotic resistance.

A study published in the Canadian Medical Association Journal (CMAJ September 2, 2016) looks at the pragmatic approach to treating rhinosinusitis. The study involved adults age 18 to 65 years old with a history of chronic or recurrent sinusitis from 72 primary care practices in the United Kingdom. These individuals reported that the illness impacted their quality of life. They were randomly assigned to one of four strategies: usual care, daily nasal saline irrigation, daily steam inhalation, or combined treatment with both interventions. They were followed for three to six months.

The study concluded:

  1. Nasal irrigation: Nasal irrigation for chronic or recurrent symptoms was less effective than prior evidence suggested, but it resulted in reduced overall symptom burden, headache, use of over-the-counter medications and the perceived need to consult primary care physicians in future episodes.
  2. Steam inhalation: Steam inhalation had no consistent benefits. On a personal note – I have found steam inhalation done twice a day does provide temporary symptomatic relief by unblocking the nasal passages. You can try it. It may help but it will not hurt.

The common cold can lead to rhinosinusitis. Common cold is caused by a virus (rhinovirus), and in most cases the severity of symptoms peak by day three. However, the same virus can activate an inflammatory process leading to bronchitis, pharyngitis, and rhinosinusitis.

Rhinosinusitis caused by bacteria usually gets better in less than four weeks. Within this 4-week period, symptoms resolve either spontaneously or with appropriate treatment. There may be up to three episodes per year and full recovery in between episodes.

Harvard researchers found that sinusitis sufferers reported the highest levels of pain and the lowest levels of social functioning, as well as significant problems with work, energy, and mental health.

Mayo Clinic website says, “One of the simplest, cheapest, and most effective ways to prevent and treat sinus problems is nasal irrigation. Using a homemade solution, you can often relieve sinusitis symptoms, reduce reliance on nasal sprays and antibiotics, and improve your quality of life.”

Hope this information helps. Flu season is coming. Do not forget your flu shot!

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Common Cold has a Large Impact on Society and Health Care System

A goose family heading home for supper at Echo Dale Provincial Park recently. (Dr. Noorali Bharwani)
A goose family heading home for supper at Echo Dale Provincial Park recently. (Dr. Noorali Bharwani)

A doctor finished examining a man in his office.

“It’s just a common cold,” he announced, “There is no cure, and you’ll just have to live with it until it goes away.”

“But, Doctor,” the patient complained, “it’s making me so miserable.”

The doctor rolled his eyes toward the ceiling. Then he said, “Look, go home and take a hot bath. Then put a bathing suit on and run around the block four times.”

“What!” the patient exclaimed, “I’ll get pneumonia!”

“Exactly,” the doctor replied, “We have a cure for pneumonia.”

This joke is from Ryan Murphy found on the Internet.

In 1931, an article in the Canadian Medical Association Journal (CMAJ) on the common cold said, “The common cold is so common that we are apt to pass it by with a contemptuous gesture, unless, of course, we are the sufferers ourselves.”

The illness is very costly in terms of direct medical costs and indirect costs owing to missed work because of illness or caring for an ill child.

The common cold is an acute, self-limiting viral infection of the upper respiratory tract involving the nose, sinuses, pharynx and larynx.

The virus is spread by hand contact with secretions from an infected person or aerosol of the secretions and virus. The incubation period varies but is just under two days for rhinovirus.

Symptoms typically peak at one to three days and last seven to 10 days, although they occasionally persist for three weeks. Symptoms can be mild to severe.

The incidence of the common cold declines with age. Children under two years have about six infections a year, adults two to three and older people about one per year.

Stress and poor sleep may increase the risk of the common cold among adults, whereas attendance at a daycare center increases the risk among preschool children.

The symptoms and signs of the common cold overlap with those of other conditions like allergic rhinitis, sore throat, sinusitis, ear infection and influenza. If you have these symptoms then you should see your doctor.

How can we prevent common cold? A Cochrane systematic review of 67 studies of various types was looked at. The majority of results suggested that physical preventive measures such as hand washing reduced the risk of getting or spreading upper respiratory tract infections.

When I have a cold, I lie on the sofa for three days and sleep a lot. On the fourth day I feel better. I am ready to go to work. It’s like magic.

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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.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!