The NHS should prepare for the UK to be hit with a heavy burden of influenza cases this winter, as Australia and New Zealand have just experienced their worst flu season in years, NHS England chief executive Simon Stevens has warned.
Reports suggest that Australia and New Zealand were hit with almost double the number of cases in July and August — the countries’ core winter months — than the average number over the previous five winters, and that many hospitals struggled to cope.
Previous experience suggests the UK could be hit by the same H3 strain that has just affected the southern hemisphere. Stevens said this should act as a warning to the NHS and underlined the need to get as many people as possible vaccinated.
“For the next three, four, five months, the top priority for every NHS leader, every part of the NHS, is ensuring that the NHS goes into winter in as strong a position as possible,” he told the Health and Care Innovation Expo conference in Manchester on 12 September.
Paul Cosford, medical director of Public Health England (PHE), said: “The strains of flu circulating in Australia this past winter have led to a significant increase in cases, but it is too early to know which will be the dominant strains of flu to circulate in England.”
Each year the World Health Organization (WHO) reviews the circulating strains of flu and recommends which flu strains should go in the vaccine, Cosford added. He stressed the importance of as many eligible people as possible getting vaccinated.
Last winter, 10 million flu vaccinations were given to patients in England, and more than 950,765 of them were administered by community pharmacists. This was almost 60% more vaccines than the 595,467 administered by community pharmacies in 2015–2016, with almost three-quarters of community pharmacies (8,451) in England delivering the national NHS Flu Vaccination Service in 2016–2017 — 1,256 more than the previous year.
However, provisional estimates by PHE show that for all age groups combined, the vaccine effectiveness against influenza A and B was 39.8% (85% confidence interval [CI]: 23.1 to 52.8). But for the over-65s, the principal target of the campaign, effectiveness was -6.3% (CI: -95.5 to 42.0).
A spokeswoman for PHE said although the effectiveness last winter was lower than hoped for, effectiveness varies each year and flu vaccination remains the best protection against the influenza virus.
For this winter, WHO has recommended that the trivalent vaccine contains two influenza A strains and one influenza B, and the quadrivalent vaccine an additional B strain. In 2015, 92% of documented B strain-related cases of influenza reported in Europe were caused by a B strain that was not included in the available trivalent vaccines during that season
Trivalent vaccines are used for the majority of patients, but quadrivalent vaccines are given to children, with GPs having the option to buy them to give to older adults, the spokeswoman for PHE explained. Quadrivalent vaccines give added protection against influenza B, which is less common in older adults and more common in children, she added.
On 12 September, Sanofi Pasteur, the vaccine development division of the French drugs giant Sanofi-Aventis, announced that its quadrivalent influenza vaccine will be available in the UK for the first time this winter, although not elsewhere in Europe.
Dr Ian Gray, medical head, Sanofi Pasteur UK & Ireland, said: “The UK authorities are leading the way in Europe by encouraging those in at-risk groups to get vaccinated against flu. Sanofi Pasteur fully supports such immunisation policies by developing innovative vaccines that fit with the influenza epidemiology, providing the option for broad protection for those aged three years and older.”
 ECDC. Seasonal influenza vaccination and antiviral use in Europe — Overview of vaccination recommendations and coverage rates in the EU Member States for the 2013–14 and 2014–15 influenza seasons. Stockholm: ECDC; 2016.