Fighting the flu can be a matter of life and death – so what more can we do?

As Australia endures one of its worst flu seasons in more than a decade, questions are being raised about how the public can be better prepared and what can be done to protect the most vulnerable.

At least 170,000 influenza cases have been confirmed this season, almost two-and-a-half times more than in 2016. The federal health department logged 72 flu-related deaths by Thursday, including that of eight-year-old Rosie Andersen in Melbourne. Experts say Australia is on track for a record number of confirmed cases.

Sarah Hawthorn, from the regional town of Cobram in northern Victoria, remains in a critical condition in hospital after contracting the flu late in her pregnancy. After giving birth to a healthy boy, she was placed in an induced coma.

Despite tragic cases such as these, the spike in flu cases is a pattern that plays out globally every 10 to 15 years. The difficulty with influenza viruses is that different viruses circulate the population each year that may not be covered by current flu vaccines, and those viruses that are covered can mutate, a phenomenon known as viral drift, making the vaccinations against them less effective. Vaccines also remain effective for only one season.

Unlike other vaccines that are more than 95% effective at protecting against a specific disease when a full dose is administered – for example, the chickenpox and polio ones – the flu vaccine is, on average, only 40% protective, although this varies depending on the flu strain. By comparison, staying home from work when suffering the flu, hand-washing, and covering one’s mouth when coughing and sneezing protects against spreading the disease 68% of the time.

Leading infectious diseases expert Dr Peter Collignon has called for better identification of patients suffering bacterial infections secondary to the influenza virus.

Collignon, a professor of microbiology and a medical doctor, who has worked with the World Health Organisation and as a government adviser, says the rise in the number of cases could also be because laboratory tests to diagnose influenza are improving almost every year. But he says the current peak in cases should not come as a surprise.

“The strain we are predominantly seeing this year is influenza A strain H3N2, and this is the same strain that hit last winter in the UK and other European centres and caused problems there,” Collignon says.

“What they found in those countries was that the vaccine for H3N2 basically didn’t work and was zero per cent effective for those over 65. So maybe you could say it was predictable we would see similar issues in Australia this season.

“The thing is, yes, influenza knocks a lot of people around but most recover, have only mild infections, and some don’t even suffer symptoms. Basically, we need a better vaccine, but that’s tricky because it’s a difficult virus that changes all of the time.”

Given the vaccine’s lack of efficacy and mutations of flu strains, Collignon says more research and funding needs to be directed towards identifying those most at risk of dying once they have the flu.

While it is well known that pregnant women, those over the age of 65 or in nursing homes, children under five and those with chronic conditions such as heart or lung disease are more susceptible to the flu, Collignon says monitoring these groups alone will not necessarily allow doctors to pinpoint those at risk of death.

“The majority of people die not of the influenza but due to secondary bacterial infections,” he says.

“Of the children who die after contracting the flu, they find golden staph as a complication in a lot of them. One of the things the flu perversely does is set up the throat to become ripe for bacterial infection. Death seems to especially affect those who got sick, got better, then got sick again.”

This is important because these bacterial infections can usually be treated with antibiotics. But routinely treating people with antibiotics without knowing if they have had a bacterial infection, can lead to antibiotic resistance, Collignon says.

“Only 1 or 2% of those with flu get these secondary infections, so we must get better at identifying them and identifying them early,” he says. “That’s where we need more research, and education, so that parents know if their child gets sick for a few days from the flu, then seems to get better and then worse, they should get their child treated.”

In the case of influenza-related deaths, hospitals should record the course of illness and whether the symptoms seemed to improve for a time, he says.

He emphasises the importance of those in higher-risk groups getting the vaccine, including pregnant women, who can get immunised for free under the national immunisation program.

“Even 30% or 40% protection against going to hospital is better than nothing,” Collignon says.

Australia’s health minister, Greg Hunt, has asked the chief medical officer, Professor Brendan Murphy, to ensure that all aged care workers are properly vaccinated. There is no mandatory requirement for this at present.

“I will work with the medical authorities, healthcare workers and the aged care providers on how we can make it compulsory for those working in aged care facilities,” Hunt says.
“We cannot continue to have a situation where people whose immunity is already low are at risk from others who may be infected.”