Measures to prevent the spread of covid-19 have also fended off flu

As the world begins to reopen, will it see a resurgence of influenza? | International

9/24/2021 11:08:00 AM

It takes manufacturers at least six months to create large quantities of flu vaccines, so they need to decide well ahead of the flu season which versions of which viruses to target

As the world begins to reopen, will it see a resurgence of influenza? | International

N2 subtypes (named for the structures of two proteins on their surfaces) also infect humans. Influenza B infects only humans.As these viruses mutate and spread, they are adept at reconfiguring the proteins that sit on their surfaces, making them less recognisable to people’s immune systems, even those that have encountered similar viruses before. As a result, flu vaccines need to be updated and re-administered every year.

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It takes manufacturers at least six months to create, test and manufacture large quantities of flu vaccines, so they need to decide well ahead of the flu season which versions of which viruses vaccines should target. It is at this point that the World Health Organisation (

WHOThe Global Influenza Surveillance and Response System (GISRS) is a network of laboratories and public-health institutions in 123 countries that collect respiratory samples throughout the year. They sequence the genes of any influenza viruses and characterise the proteins on their surfaces to build a detailed picture of the most prevalent influenza viruses in circulation, how those viruses are evolving and which new ones are emerging.

Armed with these data, every February and September theWHObrings together experts to recommend which strains of flu should be targeted by the forthcoming vaccines for the northern and southern hemispheres respectively.In February 2021 those experts, using information from the viruses circulating in previous months in the southern hemisphere, selected four viruses for this year’s vaccines for the northern hemisphere. By the start of October, those vaccines should start going into arms.

The first big uncertainty for the coming winter is whether they picked the right viruses. This is always a problem but it is especially acute this year. Far less information was available fromGISRSbecause the 2020-21 flu season was such a non-event across the world (see chart). Less than 0.2% of samples globally tested positive for influenza between September 2020 and January 2021, according to the

WHO. Between 2017 and 2020 the rate was 17%. The number of flu hospitalisations in America in the 2020-21 season was the lowest since such records began in 2005. The Centres for Disease Control and Prevention said it received one report of a child dying of flu in the 2020-21 season in America, compared with 199 in 2019-20.

What explains such low levels of flu? Because of covid-19, people were wearing face masks, social distancing, washing their hands, avoiding public transport and staying at home. This also helped limit the spread of other respiratory viruses, including influenza.

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This happy result has a troubling corollary. Vaccines for influenza are generally less effective than those for covid-19; they prevent about 70% of detectable infections in healthy adults and about 50% in the elderly. How well a vaccine works is a function of how well its components match the viral strains that a person actually encounters. When they are poorly matched, vaccines are less effective at preventing both infection and severe disease, resulting in worse epidemics. Given the paucity of information available about which strains of flu are circulating, the Academy of Medical Sciences (

AMS) in Britain reckons the likelihood of mismatches is higher this year.A second big unknown is how people’s immune systems, which have largely avoided influenza for more than a year, will respond when they do encounter it. The mild or non-existent influenza season of 2020-21 was probably welcome at a time when covid-19 was killing tens of thousands of people and putting many more in hospitals. But it also means that many fewer people will have been exposed to the circulating flu viruses in the past year so the levels of natural immunity in populations will be relatively low. A wave of influenza in such an environment “could be problematic”, warned the

AMS.Even those who have previously been exposed are at risk. Immunity diminishes over time. Worse, flu viruses change rapidly, so the immune system’s memory of one season’s flu may be of limited use against new viruses. Some have little or no protection against flu—babies and young children who have never been exposed to it.

Research on previous flu outbreaks in America provides some clues for what might happen in 2021. A study in 2013 examined what happened after mild winters, when rates of influenza transmission tended to be lower than usual and therefore resulted in lower-intensity epidemics. The researchers found that 72% of the subsequent epidemics were more severe than average. They started 11 days sooner and the epidemic growth rate was 40% higher. Their severity was probably exacerbated by their earlier onset because fewer people would have been vaccinated at that point.

Modelling by theAMShas shown that, if Britons returned to their pre-pandemic way of life, the country could at worst face a winter influenza epidemic 2.2 times more deadly than normal. In recent years flu has typically killed 10,000-30,000 people annually in England. The 2017-18 season was the most recent bad season, with about 26,000 deaths.

Respiratory syncytial virus () provides more clues as to what could be in store for the northern hemisphere.RSVis a major cause of hospitalisation and death in young children, particularly those less than a year old. Reports from around the world showed a 98% reduction in cases of

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RSVduring the pandemic. But researchers in Australia also found that, after physical distancing restrictions had been relaxed in the last few months of 2021,RSVcases shot up. They peaked in December (the country’s summer), instead of the usual June or July (its autumn/winter). The peak itself was almost three times higher than usual and there were many more cases of infection in older children. Doctors in New York City found similar results after March 2021.

In the grippe of winterIf influenza orRSVsurge when covid-19 levels are high, some doctors worry that people could be struck by several respiratory viruses at once. Around a fifth of children who end up in hospitals with bad lung disease are infected with multiple viruses, says Stephen Holgate, a pharmacologist at the University of Southampton. Growing evidence suggests that influenza and

Read more: The Economist »

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There have been no cases of the flu since March 2020. Why would anyone need a flu shot? Covid seems to have cured it. RT : It takes manufacturers at least six months to create large quantities of flu vaccines, so they need to decide well ahead of the flu season which versions of which viruses to target

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