Flu Shot Selfie Challenge - #flushotselfiedal

It’s that time of year again – flu season.  That means it is time to protect yourself, the people you love, and your community by getting the flu shot. And by sharing your flu shot selfie with us, you could win a $50 Starbucks gift card.

To mark the start of the 2018-2019 flu season and the rollout of this year’s vaccine, we have initiated the Dalhousie Flu Shot Selfie challenge. Dr. Craig McCormick, Dr. Denys Khaperskyy, and I (Dr. Alyson Kelvin) of MICI and the Dept of Pediatrics here at Dal, WANT to see your FLU SHOT SELFIE.  Students and faculty can enter for a chance to win a $50 gift card to Starbucks. Along with a Starbucks gift card, I will also be giving away copies of my favourite popular virology book, Spillover by David Quammen.

To enter, submit your flu shot selfie using the hashtag #flushotselfiedal on social media (twitter or Instagram). If you don’t have a twitter or Instagram account you can still enter by emailing your photo directly to us: akelvin(at)dal.ca or craig.mccormick(at)dal.ca or D.Khaperskyy(at)dal.ca. The deadline to get your entries in is December 1st. Winners will be announced December 5th.

Follow Craig (@MCraig.McCormick), Denys (@Dkhaperskyy), and me (@akelvinlab) on twitter or on my lab Instagram @akelvinlab to see #flushotselfiedal progress.  I will be sharing my own flu shot selfie this week.

Thank you for participating in the program and for contributing to Community Immunity! … We are all grateful! By getting your flu shot, you are protecting yourself and also helping protect those who are unable to receive the vaccine as well as those who have a greater susceptibility to severe disease from the flu. That includes our grammas and grandpas, newborns, and those with lower immune responses. 

*Be sure to discuss which flu shot is right for you with your health care provider or pharmacist before vaccination.

** This initiative is supported by NSHRF

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Last year was a bad flu year

Last year was a bad flu season.  In Canada, there were over 60,000 confirmed influenza cases, over 5,000 hospitalizations, and over 300 confirmed deaths (PHAC - https://www.canada.ca/en/public-health/services/diseases/flu-influenza/influenza-surveillance/weekly-influenza-reports.html).  Since these numbers represent only the confirmed cases of influenza determined by medical testing, the actual number of flu-infected individuals and influenza related-deaths were likely much higher. Estimates of the actual number influenza-related deaths per year in Canada have been as high as 3,000. The 2017-2018 season was particularly bad for those over age 65 years. Over 65% of hospitalizations and more than 80% of deaths were in this age category.  My grandfather was one of those hospitalized.

The US also had a particularly bad flu season. The Centers for Disease Control and Prevention (CDC) reported more than 80,000 deaths from flu with more than 180 pediatric confirmed deaths.  According to the CDC, these numbers were the highest recorded in more than 40 years (since 1976).  Importantly, 80% of the children who died had not received the seasonal influenza vaccine.  Moreover, more than 50% of these pediatric deaths were in children considered to be previously healthy without evidence of underlying health conditions. This means that the circulating viruses last year caused just as much devastation in healthy people as it did in those with pre-existing medical conditions. These statistics also reinforce the importance of being vaccinated – vaccination may prevent severe disease.

Background

Influenza burden and recurrent infection

Influenza A virus is a recurrent and unsolved public health problem. Two types of Influenza (Orthomyxoviridae), influenza A and influenza B, each with its own subtypes and lineages, currently circulate in humans. Together, there are 4 kinds of flu strains infecting humans each year: H1N1 and H3N2 (influenza A) and B-Yamagata and B-Victoria (Influenza B). These viruses cause millions of hospitalizations and thousands of deaths yearly infecting between 5 and 30% of the global population. Its well-known that yearly cycling of the influenza virus is fueled by its frequent genetic mutations. As a result of the frequent viral strain mutations, vaccines need to be reformulated every year to match circulating strains.

Circulating strains

In the northern hemisphere, we experience our flu season during the winter months, October to May, with cases peaking at the end of December and throughout January. As mentioned above, there are typically four types of influenza viruses that circulate in humans each year. The four circulating strains of flu represent two subtypes of influenza A (H1N1 and H3N2) and two lineages of influenza B (B-Yamagata and B-Victoria). These viruses compete with one another for the opportunity to infect people. The virus that infects the most people in a year is referred to as the Predominant influenza strain of that year. During infection in humans, the virus strains mutate leading to new circulating strains.

The predominant circulating influenza strain last year was a strain of H3N2.  Canada, the US, Australia, and the UK all reported H3N2 strains to be the virus most often detected in confirmed flu cases. Many researchers have concluded that the predominance of this H3N2 strain was the cause of the high amount of influenza burden last year.

The Influenza Vaccine

Yearly influenza vaccination is recommended by the National Advisory Committee on Immunization (NACI) of Canada and the World Health Organization (WHO) as the most effective strategy for reducing influenza burden. The formulation of the yearly vaccine may cover all four circulating viruses or two influenza A subtypes (H1N1 and H3N2) and only one of the B virus lineages. These are known as the quadrivalent influenza vaccine and the trivalent influenza vaccine, respectively. As a reaction to this high amount of influenza cases and mortalities, this year’s quadrivalent influenza vaccine includes last year’s circulating strains of H3N2. This year’s vaccine also includes last year’s H1N1 and influenza B strains.

Although vaccination is not 100% preventative, vaccination has been shown to offer protection, reduce disease severity, and decrease viral shedding during flu infection. Those at high risk for developing severe disease are people over 65, the pediatric population (infants and toddlers), and patients with previous existing health conditions such as neurological diseases, immunosuppression, the obese population, and those with asthma. Last year there was a high burden of disease in those over age 65. Since influenza vaccine effectiveness in the elderly is low, new more effective vaccines have been developed.  One example of a vaccine designed toward the aging immune system is the Sanofi Fluzone High Dose. Since healthy adults typically have high levels of protection following influenza vaccination, it is important for this population to be vaccinated yearly. When a high percentage of the population is immune to a pathogen such as influenza, there is a community effect extending protection to those who are immunosuppressed or are unable to receive the vaccine due to medically related reasons. This is Community Immunity or Heard Immunity.

There was a lot of inaccurate information being spread regarding the effectiveness of last year’s influenza vaccine. The actual overall effectiveness for the 2017-2018 seasonal influenza vaccine in the US was ~40% for the total coverage of all circulating influenza viruses. Breaking it down, protection by virus type and subtype was: 25% against A(H3N2), 65% against A(H1N1), and 49% against influenza B viruses.  This means that although there was a low effectiveness for the H3N2 component, there was still a 65% effectiveness for H1N1.  It is important to recognize that low effectiveness for one component should not negate the entire vaccine.  The vaccine may still offer protection against other circulating strains.