Impact of flu vaccine opt-out is being seen as A(H1N1) returns to Europe

As the UK and a number of European countries are now experiencing epidemics of influenza, including A(H1N1) which was the 2009 pandemic virus, the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) warns that the consequences of non-vaccination could emerge as a new flu emergency and are calling for greater efforts to encourage vaccination, not only for at risk groups but also health care workers.

The UK has been experiencing a surge in both mild and very severe cases of influenza primarily associated with A(H1N1), which according to the World Health Organization (WHO) has not yet peaked. With the return to schools and work after the Christmas holidays, numbers are expected to stay high for some time. To date, those severely affected are young adults (notably including pregnant women), some without any underlying chronic illness. And most of the very severe cases and identified deaths associated with A(H1N1), as well as other influenza viruses, have been under the age of 65 and largely unvaccinated.

There are concerns that what is happening in the UK could be mirrored in other parts of Europe with France, the Russian Federation and Ukraine already reporting influenza rates above their usual thresholds.

“Whilst the 2009 pandemic may not have had the catastrophic outcomes that many first feared, what we are seeing in the 2010 seasonal flu period is a return of A(H1N1) with vengeance to parts of Europe, and now in combination with other respiratory viruses including influenza B”, said Professor Giuseppe Cornaglia, President of ESCMID. “Influenza viruses are unpredictable and we are currently witnessing A(H1N1) affecting groups not usually hit by the old (pre 2009) seasonal influenza, such as young adults and those without underlying health risks, many of whom are not vaccinated.”

The return of A(H1N1) influenza is the focus of an editorial in the Clinical Microbiology and Infection (CMI) journal authored by the ESCMID President, Professor Cornaglia, and the CMI Editor-in-Chief, Professor Didier Raoult.

“We know that the flu vaccine works and is very safe, yet uptake in many European countries is much lower than desired. Whether this is a result of general vaccine scepticism, doubts about the safety of a new vaccine or the perception that A(H1N1) is not a threat, the risks of opting out of the vaccine have to be made clear,” said Professor Cornaglia. “Much better public health communication is imperative to increase vaccination rates and there is simply no reason for those at risk or who are being offered it not to get vaccinated.”

The increased cases of severe influenza are also putting pressure on some intensive care units, for example in the UK with such patients occupying more than 20% of intensive care space. In countries with limited capacity for higher level care, such additional strain on health systems struggling in the middle of winter carries real public health risks.  

ESCMID, a scientific society that reaches out to more than 33,000 microbiologists and infectious diseases specialists in Europe and around the world, is organising a conference on the Impact of Vaccines on Public Health in April in Prague bringing together experts to look at a range of issues including influenza, vaccine safety and anti-vaccine opposition.

Further information on influenza in Europe this year can be obtained from the Influenza Spotlight of the European Centre for Disease Prevention and Control (ECDC) and the ECDC Director has also issued a statement on immunisation.

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