Never has a play on words better illustrated what happened in this wave of flu: “Vaccination has punctured”. As pointed out by the spokesperson for the Spanish Society of General and Family Physicians (SEMG) Lorenzo ArmenterosEven without official data at the national level, the provisional figures for some autonomous communities show that the flu vaccination objectives (for children or adults) have not been achieved. And that “has been key in this epidemic, which has coincided with Christmas.”
The doctor focuses on the failure of childhood vaccination in the context of this wave of flu. “We must not forget that the flu virus (influenza) It spreads especially among children and, from children, to family units. There has not been “vaccine coverage” among children in all communities. Of course, it’s not their fault. To this, Armenteros adds the limited use of masks among people with symptoms, although this did not happen before the coronavirus pandemic either.
The World Health Organization (WHO) and the Ministry of Health propose that at least the 75% of the elderly of 60 or 65 years You should get a flu shot every season. But the early epidemic of 2023-24 has caught this population with figures below 60% in several autonomies. According to data managed by the Spanish Association of Pediatrics, this figure remains at 30% among children under 5 years of age, with disparity between communities that provided figures in December: around 40% in Murcia or Galicia and staying at 9% in Madrid or the Balearic Islands.
From the Spanish Society of Epidemiology, the doctor and professor at the UB Angela Dominguez highlights that this has been the first flu season more similar to those before the pandemic of coronavirus, which disrupted the behavior of seasonal viruses (last year there were two unusual waves of influenza A and B). However, he highlights that “the flu “It’s always unpredictable.”, even though the cases that reach primary school have begun to decrease. This year, the wave of seasonal flu began early and “had its peak during the last two weeks of the year, with high social activity” and with children at home. “It is a little before the most common start –before the pandemic–, which used to occur just in these weeks of January.”
For two consecutive winters, exposure to the influenza virus has been low and its spread very limited, “probably due to the use of masks and other measures,” says Armenteros; the natural immunization has also been lower, because the key there is immunization by vaccine, “which is desirable, to prevent cases from reaching hospitals.”
“Perhaps there are parents who have not sufficiently valued the convenience of this vaccine, which has no notable adverse effects and the benefit is clear.”
Domínguez remembers that this has been the first season in which flu vaccination was indicated for children (intramuscular or nasal) between 6 and 59 months even if it was not at risk. “I think this systematic introduction into the vaccination schedule was very positive, not only because they can also get seriously ill,” explains the expert. Part of the transmission can also be contained thanks to the vaccine, in a population that acts as a ‘vector’. “Perhaps there are parents who have not yet sufficiently valued the convenience of this vaccine, which has no notable adverse effects and the benefit is clear,” as has been known for decades.
These are the communities that have established mandatory masks in health centers due to the resurgence of respiratory viruses
The false mantra that children do not get seriously ill from the flu
Armenteros and Domínguez believe that there may be some fatigue among the population to get vaccinated once again, before this wave of flu, to which the wave of covid has been added among certain population groups. “It is a paradoxical thing – the doctor believes – that in Spain, which has vaccination records, childhood flu vaccination has not penetrated the population.” Two factors may have to do with this: that it was not indicated until now among all boys and girls; and that during the covid pandemic the idea that children do not usually get seriously ill from coronavirus became popular.
For Domínguez, this idea has been able to be extrapolated to the flu. However, the ratesand hospitalization in children under 5 years of age are typically the same or higher than those of those over 65 years of age, according to data from the Spanish Association of Vaccinology. Specifically, each year more than 4,200 children are admitted due to the disease. More than half of those who end up in the ICU had no risk factors. However, the mortality figures are not disproportionate. Every season, fifteen kids die from the flu in Spain.
The children’s population, which has been in need of flu vaccination, has led consultations in Primary Care for flu symptoms – along with the respiratory syncytial virus, RSV. Almost 60,000 visits a year, specifically. “Flu is the most common immunopreventable disease in Pediatrics,” adds Fernando Moraga-Llop, pediatrician and senior member of the AEV, who presented some of these figures at a press conference at the beginning of the campaign.
“The main actor in influenza epidemiology is the child, He is the first to be infected. “Between 10% and 40% of the child population is infected with the flu each year.” Between 5% and a maximum of 15% of adults become infected each year. For Dr. Domínguez, there is a very extensive culture of childhood vaccination in Spain, a country that is very little anti-vaccine, but not enough to give recurrent immunizations, such as those for flu or covid.
There is still time for flu vaccination in childhood “and the rest of the population”
”The recommendation is that all those who have not been vaccinated and who can do so, do so. Including children. “The more children vaccinated, the less sick they are.” This is what pediatrician and epidemiologist Quique Bassat says from ISGlobal, in line with official recommendations. It’s not late.
For the remainder of the respiratory virus season, both Health and the autonomous communities have called for reinforce vaccination against flu, but also against COVID-19, among the target population. Likewise, immunization against bronchiolitis in babies continues, whose campaign debuted at the end of September with a novel injectable antibody. For Dr. Domínguez it has been “a success.” This year’s hospitalization rates for RSV have been notably lower than last season.
Why get a flu vaccine if the epidemic is subsiding? “The cases have decreased in Primary Care –Armenteros explains– but not in hospitals”, hence the relevance of still getting vaccinated. Before the pandemic, during almost all flu seasons (October-May) the flu epidemic curve increased in incidence over 4 to 6 weeks, peaked, and began to decline.
From the Carlos III Health Institute, the person in charge of surveillance of respiratory diseases Amparo Larrauri explains that “the high transmissibility of the flu is, without a doubt, influencing hospitalization to continue to rise, especially in people over 60 years of age.” , although so far no parameters have been observed that indicate greater severity than in previous seasons.” That is where the vaccine is key, which the researcher encourages to get, from the SMC of Spaineven though there are indications that “the maximum peak of flu activity in the last week of 2023” has been exceeded.
And after the flu wave, a covid wave? It cannot be ruled out, there is a new subvariant, but there are still no signs of an epidemic wave.
What happens from this week is unpredictable and experts do not rule out that there could be a rebound after returning to school or the offices. But “at the moment there are no indications to think this, or the opposite.” Nor can it be ruled out covid rebound, as the flu subsides. “Each virus seems to have its niche and, although it is possible to be infected with more than one at a time, the peaks are not simultaneous,” says Armenteros.
Domínguez highlights how this sequential behavior of peaks can occur in what has been called the ‘tripledemia’ of RSV, flu and covid. Is it the coronavirus’s turn now? “It could be,” according to Armenteros. “Covid is not strictly seasonal” and positivity has gone up, according to the most recent SIVIRA report.
The latest version of the anticovid vaccines administered does not coincide with, in turn, latest version of SARS-CoV-2 that is beginning to appear in Spain: the JN.1 omicron variant. “We do not have 100% protection with the vaccine.” Together with its relative BA.2.86 (Pirola), it may be behind52% growth in global infections in just one month, although without clear signs of greater severity.
To avoid infections, Armenteros remembers the basic tools in addition to vaccination (which, above all, prevents serious illness, rather than infection): hygiene; face mask in crowded, closed places and with people with symptoms; and greater effort in ventilation“it is not about being cold, but about having good air filters which, for example, should be installed in schools,” he concludes.
2024-01-12 16:30:03
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