Influenza

This morning I had a brief discussion with one of our patients; she is on the cusp of her 65^th birthday. And, for those involved in the administration of the flu vaccine, this is a thing.

Under 65s get one vaccine and overs another.

Why would this be?

At first, my assumption was that as older people are more susceptible, they would get a better or more powerful vaccine this is only kind of true; I’ll explain why, and readers can decide whether the professors in the Department of Health have got it right…

For adults, there are two different flu vaccines in use in the UK:

Quadrivalent influenza vaccine – this has four different strains of influenza.

Adjuvinated* trivalent vaccine – that has only three different strains, but they have a special component added to make them more immunogenic, that is, they have greater ability to stimulate the immune system.

This was my first misconception; younger people actually get more viruses than the older folk who are potentially more susceptible.

Why?

It transpires that one of the reasons for older people being more prone to the flu than those who are younger is that their immune system is less effective at producing antibodies.

Just like ageing skin, eyesight and bowels, the more years you have lived, the harder it is to perform like you were 18.

Older people are different to those who are younger, in many ways, as we all know.

This is why older people get the adjuvinated – to help their immune system produce antibodies.

Why not get a quadrivalent adjuvinated vaccine? In other words, the four virus strains younger people get with that extra bit added on – I am not sure why this isn’t available, perhaps it hasn’t been invented, is too expensive, or would be too much for immune systems to cope-with.

I think, for me the thorny issue relates to what my patient should have received. They are 65 next week…

I couldn’t find evidence anywhere to suggest one way or another beyond whether the person was otherwise hale, hearty and robust, in which case they are more of a ‘young 65’ than an ‘old 65’.

This gets silly, although it was quite apparent this morning during our flu clinic when we would ask, ‘Are you 65 or older?’ For many this was unnecessary, for others less so, although in general the question was taken as flattery, with responses of, ‘I’m 74!’ amongst others. (Generally, when someone is in their 80’s or 90’s it is obvious, and the question avoided).

Is it looking young that counts?

Again, this is tricky.

In my role as a doctor specialising in the care of older people, there are two tests I use to determine how ‘young’ a person is – from a physiological perspective, these are their speed of walking and whether they can stand from a chair without having to push-up  with their hands (the latter reflecting the strength of the quadriceps).

None of this says much about whether you are emotionally or psychologically old, but then, in terms of flu that probably isn’t an issue. In my experience those who are physically fit tend to be also fit in other dimensions.

Should a very fit 68-year-old get the young persons’ jab?

This is a difficult question and likely not one that your team at the local surgery will have time or capacity to discuss, given the priority is getting people in and out and through the door as quickly as possible to avoid a queue stretching on to the street.

I would probably recommend going with the official guidance, after all, there is more to the flu vaccine than what it does to you; herd immunity, whether your friends and family are immune is a major factor in your potential to catch the virus.

There was talk last year of making the flu jab compulsory for NHS staff; I haven’t heard much discussion this year, probably because most discussion has been about the no-deal Brexit scenario.

Be well everyone and either head down to your local surgery for a jab** or if you can’t get out, wait for someone to call (and if no one appears, chase them up!).

In a spirit of openness, I had my quadrivalent (young person) vaccine two weeks ago and have been fine.

Sniff.

*An adjuvant is a material added to a chemical or other substance to make it more effective.

**Apologies to my Scottish readers, I tried to fight against being converted from ‘jag’ to ‘jab’ – it happened some time when I wasn’t paying adequate attention to my ethnicity.