A joint statement issued recently by the Malaysian Influenza Working Group and the Malaysian Society of Geriatric Medicine urges the medical and the healthcare communities in Malaysia to prioritize flu vaccination for older persons, as the threat of the Covid-19 is also prevalent.
According to the statement, 2020 was particularly challenging due to the Covid-19 pandemic. In less than 12 months, the disease has spread across 190 countries, infected over 104 million people, killed over 2.2 million of them , destroyed countless livelihoods, and tested healthcare systems beyond their limits.
Because of the Covid-19, the world is confronted with the danger of living in a world without the protection of vaccines. Nobody is safe, but seniors are more at risk because of their age and chronic illnesses.
Flu in seniors
The flu shares many similarities with Covid-19. Both are contagious respiratory illnesses that spread through nasal and salivary droplets, and exhibit similar symptoms. The World Health Organisation (WHO) estimates that the flu claims 290,000 to 650,000 lives annually, with approximately 90% of the deaths occurring among senior citizens . In Malaysia, a local study has indicated that those above the age of 65 infected with influenza-like illnesses are at 10% greater risk of mortality .
People over the age of 65 tend to be more susceptible to the flu and its effects. Their immune systems become less able to activate the immune cells needed to clear the influenza virus from the lungs . Age-related changes also occur in the connective tissues of our lungs and structure of the thoracic cage.
All these factors diminish the elderly’s ability to fight off serious respiratory illnesses . They also become more prone to developing and dying from Acute Respiratory Distress Syndrome and a myriad of flu complications, the most common being pneumonia .
Protection through vaccination
Flu vaccination is a proven method of protecting our seniors from severe flu related complications. Studies have shown that it reduces the risk of having to visit the doctor for the flu by 45% and reduces the risk of developing pneumonia by 49% . By the same token, it has also averted the need for hospitalisation due to the flu by 45%, thereby reducing the accompanying physical suffering, emotional stress, treatment cost, and financial burden to the family.
Such clear benefits have led many countries to provide free or subsidised flu vaccination to senior citizens under their respective national immunisation programmes (NIP). These include the United States of America, Canada, United Kingdom, Australia, New Zealand, and most European nations . Asian examples include Taiwan, Japan, South Korea, and even Singapore.
Unfortunately, the uptake of flu vaccines within Malaysia country is still exceptionally low, with a distribution rate of only 7.48 doses/1,000 population, they stated, adding that it is still encouraging to note that more Malaysians have become more aware of the importance of flu vaccination, thanks to educational campaigns like “Flu Prevention Is An Act of Love”, organized by Immunise4Life.
As announced in the media recently, the campaign managed to garner over 360,000 public pledgesof support for flu prevention.
Advocating flu vaccination for senior citizens
“It is our belief that everyone has a role to play in protecting older persons from the flu. As such, we urge all healthcare professionals to actively advise their older clients to get vaccinated and reassure them of its safety and effectiveness.Do share how the annual flu shot may not only keep the infection at bay; it may also confer a host of related health benefits. These include lowering the risk of major cardiovascular events for patients with pre-existing heart conditions . The same could be said for patients with diabetes and chronic kidney disease, “ the experts said.
They added: “With caring advocacy, senior citizens can be persuaded to embrace flu vaccination as an important preventive health measure. This is especially because many also have non-communicable diseases that can be exacerbated by the flu.”
“For adult children caring for their aged parents, 2021 will be an opportune year to start giving them an annual flu shot. The government has granted tax exemption for the cost of certain vaccinations (including the flu), with effect from January 1, 2021. We hope the public will take full advantage of this welcomed relief affirming that ‘prevention is better than cure’.”
“All too often, society forgets the senior citizens in aged care homes. Infectious diseases are known to spread quickly and extensively in such establishments where residents live in close proximity with one another. This was tragically demonstrated by how aged care homes in the UK were decimated by Covid-19! Flu poses a similar threat which we hope can be mitigated by the government giving those in this extremely needy and marginalised group an annual flu shot to help keep them safe.”
They said that as Malaysia is moving steadily towards becoming an ageing nation, it is vital to implement measures needed to ensure the health and well-being of senior citizens. For example, working towards achieving the WHO’s flu vaccination coverage target of 75% among senior citizens.
“Flu vaccination for older persons is integral to the concept of life course vaccinationwhich, in turn, is fundamental healthy ageing as a right for all, “ they concluded.
iii The effects of age on clinical characteristics, hospitalization and mortality of patients with influenza-related illness at a tertiary care centre in Malaysia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182601/#irv12691-bib-0040
iv The immune response to influenza in older humans: beyond immune senescence https://immunityageing.biomedcentral.com/articles/10.1186/s12979-020-00181-1
v ARDS in Aged Patients: Respiratory System Mechanics and Outcome https://www.hsj.gr/medicine/ards-in-aged-patients-respiratory-system-mechanics-and-outcome.php?aid=19051
vi Influenza virus-related critical illness: pathophysiology and epidemiology https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2539-x
vii Effectiveness of influenza vaccine in aging and older adults: comprehensive analysis of the evidence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3292388/
ix Association between influenza vaccination and cardiovascular outcomes in high-risk patients https://jamanetwork.com/journals/jama/fullarticle/1758749
x Influenza Vaccination Is Associated With Reduced Cardiovascular Mortality in Adults With Diabetes: A Nationwide Cohort Study https://care.diabetesjournals.org/content/early/2020/07/03/dc20-0229