Research among over 1,000 GPs conducted by medeConnect has found that many GPs are unaware of the recent findings by Public Health England (PHE) on the poor performance of existing flu vaccines in the most recent 2016/17 flu season in adults aged 65 years and over.
Nearly nine-tenths of GPs interviewed had “no concerns around the current influenza vaccines used in patients aged 65 and over”, despite a statement made by Public Health England in August 2017 reporting that in the 2016-17 flu season existing flu vaccines showed little efficacy in protecting elderly patients against flu.
The Joint Committee on Vaccination and Immunisation (JCVI) – which advises UK health departments on vaccination policies - stated in their October 2017 Meeting Minute that an analysis of influenza data spanning 2005-17 showed that, over a decade of flu seasons dominated by A(H3N2) strains, existing non-adjuvanted influenza vaccines demonstrated little or no efficacy in the 75+ age-group, and only limited efficacy in the 65-74 years age group.
It has been estimated that between 7,000 and 25,000 deaths were associated with influenza in the winter periods 1999-2009, with the mortality burden highest among the over 75 age group.
Nearly two-thirds of the GPs surveyed felt it was important for their elderly patients to be protected against flu, clearly demonstrating GPs’ concern about the risks of flu infection in this age-group; But only 1 out of 10 GPs expressed any specific concerns about the existing flu vaccines currently used in patients aged 65 years and over. Of those GPs who expressed concerns, the great majority were worried about efficacy – correctly, as PHE analyses have shown this to be poor.
The survey showed that there was a low awareness amongst GPs regarding the availability of a new adjuvanted flu vaccine, which the JCVI states has been shown to be work better than nonadjuvanted vaccines in the 65+ population, and which is available to order for use in the 2018-19 flu season. This new vaccine, called Fluad, aims to address the disappointingly low efficacy issues seen with current flu vaccines in these older patients. The JCVI has said that the use of this adjuvanted vaccine in those aged 65 years and over “would be both more effective than the non adjuvanted vaccines currently in use, and also cost-effective.”
Public Health England and the Welsh Chief Medical Officer (CMO) have responded rapidly to the JCVI guidance, in the former case by revising the Green Book chapter on influenza, and in the latter case issuing a Welsh Health Circular on the 29th of November to all GPs in Wales. The Circular states that the “adjuvanted trivalent vaccine is cost effective when administered to those aged 65 to 74 years” and that “the adjuvanted trivalent vaccine [aTIV] is the only clinically effective and cost effective option for those aged over 75 years.”
The revised Green Book entry on influenza vaccines states: “Given the low influenza vaccine effectiveness seen in the over 65 year olds in seasons dominated by A(H3N2), the Committee agreed that use of aTIV in those aged 65 years and over would be both more effective and cost-effective than the non adjuvanted vaccines currently in use. JCVI also agreed that the priority for adjuvanted vaccine should be for those aged 75 years and above as this age group appear to derive little benefit from the non-adjuvanted vaccine (JCVI, October 2017).”
Dr George Kassianos, GP and immunisation expert, said: “Public Health England’s findings, the JCVI’sguidance, and these survey results are all unsurprising to me. The current, but historically anomalous, approach to influenza vaccination places an unfair and unnecessary burden on GPs, forcing them to proactively follow all issues relating to flu vaccines. I welcome the fact that the JCVI has provided strong guidance for GPs on which HPV or MMR vaccine to use. Nonetheless, in view of the enormous workload pressures currently upon GPs and their practices, GPs are expected to keep on top of all the flu vaccine effectiveness data and make their own judgements on flu vaccines.
"Given the myriad of other responsibilities faced by GPs, this is unreasonable. While the guidance in the revised Green Book is welcome, we would like to see the health authorities in England follow the Welsh CMO’s example and give direct guidance to GP practices and pharmacists as to the specific vaccines recommended by the JCVI for specific ages for the next influenza season.”
Dr Jonathan Liu, Medical Director, Seqirus UK, said: “Evidently, there is a clear need to provide better protection for patients aged 65 years and over against influenza infection, which can in too many cases be deadly. In England, normally national guidance to GPs is only issued in the Spring prior to the forthcoming flu season via an annual “Flu Letter”, but unfortunately, this is actually several months after most GPs have already placed their orders. While we welcome the JCVI guidance and the newly updated Green Book Chapter 19, GPs urgently need further support from health authorities to make a fully-informed choice about which vaccine actually is the best option for their patients. Our older patients really do need better protection from influenza, and any step working towards that, such as the clear advice issued directly to all GPs in Wales by the Welsh CMO, would be extremely welcome for the rest of the nations of the UK.”