How the flu jab is changing this winter

In recent winters the flu vaccine hasn't been as effective as hoped, especially for the over-65s, but a new type means things will change this winter, says Lucy Trevallion.

A woman suffering with flu

It’s autumn, and that means fireworks in the sky, and… flu jabs in the calendar. If you have an underlying health problem this is a seasonal ritual you shouldn’t miss out on, as you have a greater risk of getting flu, and of complications from flu.

There is evidence that heart attacks happen more often during or immediately after an infection such as flu

Viral infections like flu put added stress on your body, which could affect your blood pressure, heart rate and overall heart function.

There is also evidence that heart attacks happen more often during or immediately after an infection such as flu. A Canadian study published in the New England Journal of Medicine found that older people’s risk of a heart attack was six times higher the week after having severe flu.

Flu symptoms can also affect people with heart problems differently; for example, if you take warfarin, flu symptoms can affect your blood clotting rate (INR). And if you have certain heart or circulatory conditions, you may not be able to take some flu treatments. All these are reasons why it’s vital to be protected against flu.

Changes in the flu vaccine this year

As we get older, our immune system works less efficiently, so the flu jab doesn’t generate the same immune response as in younger people. In winter 2017-18 the flu jab was found to be just 10 per cent effective in those aged 65 and over, compared to 27 per cent in children aged 2 to 17. The relatively low figures are partly because the vaccine turned out not to be the best match for the strains of flu that were circulating. In the previous winter it was found to be "ineffective" in the over-65s.

This year, the flu jab will be different for anyone aged over 65 in England, Wales and Northern Ireland (because of limited supplies Scotland will only be offering the new flu jab to over-75s.) The Westminster government has asked GPs and pharmacists to provide an adjuvanted trivalent vaccine. ‘Adjuvanted’ means it contains an extra ingredient to improve immune response, while trivalent means it protects against three strains of flu.

This year the NHS is recommending a quadrivalent vaccine, protecting against four strains of flu

It will still be free and safe, and has been used elsewhere in Europe, Canada and the United States for years.

In a letter to GPs and pharmacists, NHS England said: “Use of these more effective vaccines in the 2018–19 season is clearly in the best interests of patients, particularly given the association of flu with increased mortality.”

Younger people who are eligible may also get a better vaccine than previously. This year the NHS is recommending a quadrivalent vaccine, protecting against four strains of flu.

Last year some GP surgeries used a cheaper vaccine that protected against three strains. Children were already receiving the quadrivalent vaccine, as they’re more likely to catch the extra strain covered in this vaccine.

How is the flu vaccine created?

Designing the flu vaccine involves an element of educated guessing. Professor Peter Openshaw, President of the British Society for Immunology, explains: “The way influenza survives every winter is by mutating into a new form that is different from before.”

World Health Organization experts meet twice annually to work out what to include in the flu vaccine. They’ll look at maps of different flu viruses and try to predict which types will hit which areas, as the virus needs to develop new mutations to survive.

Some protection is so much better than nothing. Flu vaccines are worth taking.

Professor Peter Openshaw

For the northern hemisphere vaccine we have in the UK, manufacturers grow the virus in fertilised chicken eggs – a 70-year-old method. “It sounds a bit old fashioned,” says Professor Openshaw. “But if you added up all the flu viruses in the world, most of them are in birds.”

Manufacturers buy hens eggs, make a nick in the shell, and add some influenza virus. After two days, they take out the fluid in the egg to use for the vaccine.

Professor Openshaw says: “The overwhelming message is that flu vaccines could be better, but there are limited possibilities to do this, and some protection is so much better than nothing. Flu vaccines are worth taking.”

Worried about delays to the flu vaccine?

If you have a long-term health condition or are over 65, you can get the jab free from your GP surgery or a community pharmacy. You should receive a letter from your GP practice inviting you to have one, or you can ask any pharmacy about it.

The adjuvanted vaccine is for people aged 65 or over, or for those in Scotland aged 75 or over. Only one company is making this new adjuvanted flu jab and both pharmacies and GP surgeries are receiving the jabs in batches, with deliveries still coming in in October and November 2018. There is enough stock of the adjuvanted vaccine available across the country, but you may have to wait until your GP surgery or pharmacy receives their stocks of the vaccine, which could mean having your jab later than you would usually.

NHS England and Public Health England recommend that it is better to wait to have the flu jab that is most effective for your age group, even if that means having your jab slightly later in the year. In Northern Ireland, over-75s are being prioritised for the first deliveries of the adjuvanted vaccine, and its Public Health Agency also advises that people aged 65-74 should wait to have this vaccine, rather than having a different flu jab. Flu usually starts from December onwards, so if you are vaccinated in November you should benefit from its protective effect. Remember, having the jab is important - so if it's not available the first time you go to your GP or pharmacy, don't let that put you off going back.

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