Back to basics: the facts behind the flu jab

More than 900 people were admitted to intensive care during last year’s flu season. Around 89% of those people were under the age of 65, and more than 10% of them lost their lives.

These figures are high for a disease that is largely preventable through vaccination. As a comparison, hepatitis B (vaccination against which is largely expected for NHS workers) causes around 60 deaths a year. Flu deaths are also high compared to other infectious diseases – invasive meningococcal disease for example causes around 60-80 deaths per year.

Influenza is a highly transmissible infection – everyone is familiar with the age old ‘coughs and sneezes spread diseases’ and ‘catch it, bin it, kill it’ mantras. The virus is spread in small droplets of fluid coughed or sneezed into the air by an infected person. These droplets can travel a metre or so and infect anyone within range who breathes them in; they hang suspended in the air for a while before landing on surfaces, where the virus can survive for up to 24-hours. Flu can also spread if someone with the virus transfers it on their fingers, or through unwashed hard surfaces like door handles.

The vaccine

The flu vaccine is 50-70% effective depending on the age and health of the person receiving it, and on how well the influenza strains match the composition of the vaccine.

This year, EEAST is using the vaccine Enzira.

Enzira contains three different strains of the influenza virus, all of which are inactive (meaning no live virus is within the vaccine):

• Strain 1: A/California/7/2009 (H1N1) pdm09 - derived strain used: 15 micrograms haemagglutin
• Strain 2: A/Texas/50/2012 (H3N2) like strain used: 15 micrograms haemagglutin
• Strain 3: B/Massachusetts/2/2012 - derived strain used: 15 micrograms haemagglutin

Suitable for adults and children over the age of five, Enzira comes in the form of a 0.5ml pre-filled syringe and is administered in the upper arm.

‘I don’t have the jab because it gives you flu’

It’s time to dispel the age old myth: it’s clinically impossible for the Enzira vaccine to give you flu because it doesn’t contain a live virus. It’s more likely that any flu-like symptoms felt after the jab are the result of other circulating viruses.

As with all medicines in the UK, influenza vaccines require licensing by the Medicines and Healthcare Products Regulatory Agency (MHRA). And like other medical products, passive surveillance is used to identify adverse events. Other countries work to similar systems and data is pooled and reviewed at national and international levels.

Every vaccine has to undergo extensive clinical trials to make sure it’s safe, including at least 50 adults aged 18 – 60 years of age and at least 50 elderly aged 61 years or older. Safety evaluation is performed during the first three days following vaccination.

That said, as with any vaccination there are warnings of some side effects. Adverse reactions to Enzira have been recorded as shown below:

Organ class	Very common > 1/10	Common ≥ 1/100, < 1/10	Uncommon ≥ 1/1,000, < 1/100
Nervous system disorders		Headache*
Skin and subcutaneous tissue   disorders		Sweating*
Musculoskeletal and connective tissue disorders		Myalgia, arthralgia*
General disorders and   administration site conditions		Fever, malaise, shivering,   fatigue. Local reactions: redness,   swelling, pain, ecchymosis, induration*

* These reactions usually disappear within one to two days without treatment.

But the bottom line is the flu vaccine is safe, it doesn’t give you flu, and can prevent a potentially lethal infection.

So why doesn’t everyone get the vaccination?

Good question. The Green Book (Immunisation against infectious disease: the green book) recommends that any healthcare worker involved in patient care is vaccinated annually - something that’s also encouraged by the General Medical Council, the British Medical Association, and EEAST itself as a healthcare organisation.

Despite working at the centre of British healthcare, during last year’s flu season just over half of NHS staff (54.8% to be precise) had the jab. You, as a frontline healthcare worker, are more likely to be exposed to the influenza virus than most people through the very nature of your work - you come into contact with a lot of patients. It’s been estimated that one in four healthcare workers will become infected with flu during a mild season, a much higher incidence than in the general population. If you have a higher chance of being exposed to the virus, you also have a higher chance of passing it on to your patients, family, your colleagues, and basically anyone you come into contact with, even if you’re only mildly or sub-clinically infected. You can carry the virus but be asymptomatic too, so in a lot of cases you might not even know you have it and are passing it on to others.

But staff across the NHS still don’t take the vaccine. A survey last year of healthcare workers in University Hospitals of Leicester and Leicestershire Partnership Trust found that one third of unvaccinated clinicians didn’t get the jab because they thought IPC practices were sufficient protection. One third also said they didn’t take it because they were healthy, had a good diet and/or took vitamins that they felt worked as well as the vaccine.

Although good IPC measures can certainly help control the transmission of infection, and a good diet in encouraged, these actions alone simply won’t prevent the spread of influenza; vaccination is the best option for protecting yourself, your family and vulnerable patients from the virus.

EEAST didn't make you have the vaccine last year, and it won't make you have it this year either – deciding whether to have it all comes down to your individual choice. But you’re more likely to get infected, more likely to carry, and more likely to pass on the flu virus than the general population. You as a clinician have a duty of care to protect your patients (as well as yourself, your colleagues, and your family) against flu.

So this year, please consider getting the vaccination.

Following feedback in last year’s flu season, this time you’ll be able to get your flu jab administered by your DLO or other colleagues at your office or station whenever it suits you, as opposed to having to go to a specific clinic at a specific time. You’ll also still have the opportunity to get your jab done elsewhere (i.e. pharmacy etc.) and claim the money back on expenses.

Vaccines will be delivered to the Trust on 1^st October.