New Adjuvanted Flu Vaccine 'To Prevent Over 700 Hospital Deaths'

Peter Russell

September 12, 2018

A more effective influenza vaccine for people aged 65 and over could prevent hundreds of deaths and significantly reduce pressure on the NHS this winter, Public Health England (PHE) has said.

The effectiveness of the influenza vaccine tends to erode as people age. Last season's vaccine was effective in only around 1 in 10 over-65s.

An 'adjuvanted' vaccine, which will be offered for the first time in the UK this year, is expected to significantly improve effectiveness by boosting the body's immune response to the vaccine.

According to PHE, the vaccine could:

  • Reduce GP consultations by 30,000

  • Reduce hospitalisations by over 2000

  • Prevent more than 700 hospital deaths from influenza in England

Quadrivalent Vaccine

Meanwhile, all eligible adults under 65 in 'at risk' groups, including pregnant women and those with long-term health conditions, will be offered a 'quadrivalent' vaccine in injected form. This will help protect against a total of four strains of influenza: two strains of flu A and two strains of flu B.

The vaccination programme will be further improved this winter by extending the nasal spray influenza vaccine to primary school children in year 5. This will mean that the vaccine will now be offered to children in reception classes and years 1, 2, 3, 4 and 5.

Public health experts have prioritised younger children because, having poorer hand hygiene than adults, they are known as 'super spreaders' of the flu virus.
 

Flu Vaccine Uptake by Healthcare Workers

One obstacle for public health officials is the almost 1 in 3 frontline healthcare workers in England who declined the vaccine during the 2017-18 influenza season.

Professor Jane Cummings, chief nurse for England, said:  "Faced with the worst flu season in a decade, NHS staff last winter did a remarkable job providing care for patients. This year, the public will be better protected from flu than ever before, with at-risk groups being offered the most effective vaccine available and every member of NHS staff expected to get their jab."

We asked Peter Openshaw, president of the British Society for Immunology, and professor of experimental medicine at Imperial College London, about the new influenza vaccine for over-65s.

Q&A

Medscape UK: Why has the influenza vaccine proved so ineffective in older people in recent years?

Prof Openshaw: It has been really disappointing the last couple of years just how ineffective the vaccine has been.

I think it's a number of factors, but very hard to anticipate what it is that's going to be circulating by way of influenza strains; and I think the mismatch has been unfortunate, but there are some other factors that have made it particularly ineffective.

I think the estimate for last year was that the overall vaccine effectiveness was only 15%; and it was about double that in the children who had the nasal spray vaccine – so that's quite good, and it looks like the nasal spray vaccine is having ongoing, secondary benefits in susceptible, older adults.

But in the over-65s, I think the efficacy of the vaccine was only about 10%. So, really disappointing, and I think fully justifies this change to the new adjuvanted vaccine.

Medscape UK: Before we get on to the new vaccine, is it just that older people have more inefficient immune systems, or could there be other factors behind the lack of success seen with the traditional vaccine?

Prof Openshaw: I think we generally just put it down to a less efficient immune system. It's difficult to put your finger on what it is that deteriorates, particularly in the frail elderly.

I think it's important to emphasise it's not everyone over 65 who responds badly.

The immune response becomes more variable in the over 65s, and really can be anything from a perfectly robust response through to one which is virtually non-existent. But, on average, older people just do respond much more poorly in many different immune parameters that you can measure.

Medscape UK: So, what are the characteristics of this new vaccine?

Prof Openshaw: It's got this stuff in called MF59, which is designed to basically 'pep up' the immune system by stimulating the macrophages and other cells which collect around the injection site.

So, when you inject the flu vaccine, or any other vaccine into the tissue, it causes a bit of trauma in the muscle, or in the subcutaneous tissue, or wherever you put the vaccine, and that makes the inflammatory cells come in, which include these cells called macrophages.

And MF 59 is amongst the agents that cause greater activation of those macrophages. And so macrophages take up the vaccine better and so stimulate a better immune response, and so more antibodies are generated in the blood, and the protection is much greater.

So, adjuvants are routinely used whenever we are trying to raise an immune response.

In any animal study you wouldn't think of just injecting a pure protein – you always would inject it with an adjuvant, some of which cause really quite marked inflammation and which are really essential in order to get a good vaccine response if you have a highly purified product.

 

Medscape UK: Public Health England is predicting 30,000 fewer GP consultations, at least 2000 fewer hospital admissions and at least 700 fewer hospital deaths as a result of this new vaccine. Do you think these are realistic figures?

 

Prof Openshaw: There's obviously quite a wide margin of error on those. But, the statisticians who work on flu at Public Health England are really very good at making these calculations.

So, I would say that these are pretty reliable figures. They're average figures; they're not 'reasonable worst case' and they're not 'reasonable best case' – they're 'reasonable average' figures.

Prof Peter Openshaw’s research is funded by the Wellcome Trust, the MRC, BBSRC and the European Union. He has received honoraria or consultancy fees from GSK, Janssen, and Mucosis BV.

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