New research has demonstrated that flu jabs the over-50s reduce death by heart attacks by half (1). This is huge news because heart attacks are kill over 159,000 people every year in the UK (2).
Flu jabs 'protect from' heart attacks The association between influenza and cardiovascular disease comes as no surprise to those working in this field because we have long known that flu and other viral illnesses causes the blood to become sticky and to be more likely to clot and when we see a calcified plaque on coronary CT scanning in an otherwise low-risk individual we speculate that it is likely to be related to a previous influenza or flu-like illness.
It is frustrating that the study did not show a correlation between flu and heart attacks, only between flu jabs and a reduction in fatal heart attacks. That logically does not close the door to the possibility that flu vaccination protects in some other but that appears to be unlikely. Urgent research is needed to clarify this. Fortunately it can be carried out in a single flu season because fatal heart attacks are sufficiently common that the data can be collected in a relatively short period of time.
The immediate recommendation arising is that the age for free NHS flu jabs should be reduced to 50. However, in our view that is a knee-jerk reaction that misses the point. The thinking is that not many people of under 50 die of heart attacks and therefore the maximal measurable benefit will be in older patients. However, that doesn’t answer the question of whether those under 50 want to hit the magic age with the battle scars of old subclinical cardiac events in their coronary arteries.
As healthcare progressively moves into the field of pro-actively prolonging life and quality thereof, personal self-care increasingly involves minimising wear and tear throughout life. It is increasingly apparent that flu vaccination plays a vital role. The workplace is the obvious place to offer flu vaccination. There is limited Government funding for pro-active healthcare (which by prolonging life expectancy can clearly not be offset by any hope of a reduction in the burden on the state in the long run). The burden is increasingly for the individual or the employer.
Since there is evidence that flu vaccination in the corporate setting is self-funding because the reduction in sickness absence is greater than the cost (3), this is a great example of how the employer can offer a benefit to staff and help themselves at the same time.
People often ask whether flu vaccinations give protection against pandemic flu. Pandemics are caused by flu viruses that are completely new. Whereas in most infections you are exposed to, your immune system is immediately suspicious that this new thing is an enemy and doesn't take long to produce antibodies, if you are exposed to a completely new type of virus that doesn't appear suspicious, then your immune system is not primed and is much slower to respond. By the time it does, you are very ill indeed. Pandemics were caused amongst the indigenous Americans by our normal viruses when Europeans first visited the Americas because they had not been exposed to them before. In 1918 a new virus appeared to arrive from nowhere and killed more people than the First World War; we still do not know its origin.
Do flu vaccinations work and what are the risks?
The greatest risk is animal viruses as they will not be recognised by our immune systems. For this reason, bird or avian flu kills a up to half the people who contract it and it is mutating all the time and will be able to spread from human to human before long; indeed the first human-to-human case has recently occurred in China. In both the above examples, poverty and the absence of modern treatments made them worse than they would be now. We can also take some comfort in the reduced virulence of mutated viruses. However, there can be no doubt that an avian flu pandemic would kill many thousand people in this country and it is worse amongst the young. It is agreed that it is a matter of when not of whether an avian flu pandemic strikes. Seasonal flu vaccination is a self-funding programme as the reduction in sickness absence that comes with flu vaccination has been shown to more than pay for the vaccination programme. Does it also prime your immune system against pandemic influenza? We do not yet know which strain will cause a pandemic so this is hard to answer. However, seasonal flu vaccine includes H1N1 which is one of the strains we are worried about. We also know that people who have been exposed to more strains have had better-primed immune systems in past outbreaks. Therefore there is good reason to believe that seasonal flu vaccination is likely to help. Large companies have business continuity plans to try and keep the company going during a pandemic. The Government also has contingency plans in place with business continuity planning for the emergency services and with reactive support for the general population. Doctorcall are experts in influenza in relation to business continuity planning both in relation to seasonal influenza and pandemic flu. The Doctorcall on-site flu vaccination programme is the main occupational health flu programme in the UK. Doctorcall was the first OH provider to offer mass flu vaccination in the work place and is also a recognised expert in pandemic planning.