To jab or not to jab; that is the question!

Flu, short for Influenza, is one of those diseases that everyone knows. Whether you have suffered from it yourself, or whether a friend or family member has, it is one of those conditions that we are aware of from very young age, similarly to the common cold or chicken-pox. However, unlike the common cold, flu has a devastating effect on people’s lives year on year. While for most of us flu will clear up on its own after a week or so, flu can cause serious complications such as pneumonia and meningitis. The World Health Organisation (WHO) estimates that flu causes 3-5 million serious infections and 500,000 deaths across the globe every year! To help combat this, WHO recommend that a free flu jab should be offered to ‘at-risk’ groups to reduce chances of flu, however there are many myths surrounding whether this annual jab actually works.

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Flu is coming to get you!!!!

What actually is Influenza?

Influenza is caused by the influenza virus that can be found in one of three types; A, B or C. Each of these types of virus have different structures and properties. Influenza A viruses are the most common strain of virus to cause flu and are the only strain able to infect both animals (such as swine and bird flu) and humans. Influenza B viruses are the second most common form of flu and can only be found in humans. This form is thought to have originated from Asian countries but now has spread globally. Influenza C viruses are rare and usually only cause mild flu symptoms in children.

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Ham from Toy Story makes sure he’s vaccinated against swine flu!
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Don’t be a chicken! Get your jab!

Both A and B viruses can be further divided into subtypes by their structure.  A viruses are sub-classified depending on which proteins are found on the virus’ surface, specifically which form of the proteins haemagglutinin (H) and neuraminidase (N).  Each of these two proteins exists in a number of forms, specifically 18 forms of haemagglutinin and 9 forms of neuraminidase. The two most common forms of A viruses are the ‘H1N1’ (i.e. the virus contains type 1 of the haemagglutinin protein and type 1 of the neuraminidase protein) and ‘H3N2’ virus subtypes. B viruses fall into one of two groups, or ‘lineages’, called Yamagata and Victoria. While the viruses fall into these broad subtypes or lineages, they are not all identical. Each group has a variety of viruses where each is said to be a different ‘strain’.

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3D animation of the complex flu virus

Dissecting the Flu Jab

Vaccines are one of the most beneficial discoveries in modern medicine.  By using weaker versions of the disease, vaccines can trigger our body’s immune system to fight off the infection, our body can remember which viruses it has fought against, allowing a faster response in the future. A vaccine for flu, the flu jab, has been approved for human use since 1945 and usage has been on the rise ever since. There are two forms of the jab, a Trivalent Vaccine, which can protect a person against 3 strains of the influenza and a newer Quadrivalent Vaccine which can protect against 4 strains which was approved in 2012.  Both forms of the vaccine protect against two A-Strains and one B-Strain with the Quadrivalent including protection against an addition B-Strain. The exact strains that are chosen for the vaccine are decided by WHO on an annual basis and patients and public alike must have the jab re-administered every year.

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Don’t forget the annual flu season from October to February this year!

How effective is it?

A popular news story surrounding the flu jab is that it “doesn’t work”, however the situation is a little more complex than that. The influenza virus is known to ‘shift’ and ‘drift’ meaning that the virus can mutate at any time, or even fuse to other influenza viruses, to form a new strain. Because of this, new strains of influenza are present every year, meaning we need a new vaccine every year to combat these new strains. In order to do this, we predict which strains of the virus shall be the most prominent year on year. This is done by an influenza specific subdivision of WHO, the Global Influenza Surveillance and Response System (GISRS) Network.  The network collects surveillance data, both from hospitals and laboratories, computer simulations, genetic profiling, vaccine effectiveness and other forms of data on the influenza virus every year. WHO then evaluate this evidence twice a year and select which strands are to be included in that year’s vaccine, once for the northern hemisphere in February and once for the southern hemisphere in September. Each year WHO recommends an A/H1N1 strain, an A/H3N2 strain, a B/Victoria strain and a B/Yamagata strain of the influenza virus to be included in the vaccines. These predictions need to be done around 9 months before the next flu season for the recommendations to be approved and the vaccines to be mass produced. However, if these recommendations are wrong and are not the most prominent strains of the influenza virus, the jab does not protect patients.

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Don’t let a little prick stop you from getting your jab!

Protecting those in need

As with most vaccines, the flu jab is available to the general public who wish to receive the jab, however certain demographics are advised to receive the jab over others. WHO recommends that 75% of the elderly, children, pregnant women and patients with chronic conditions should all receive free flu jabs from their respective countries. WHO also recommend health care workers to receive flu jabs and here in the UK, the NHS launched a flu jab awareness campaign to increase the numbers of protected healthcare workers to help protect not only themselves, but also their patients.

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NHS England wants to make sure that you stay well this winter.

However, annual uptake of the flu jab still remains remarkably low in these groups across Europe. More action still needs to be done by governments and hospitals alike to help protect those in need from the dangers of influenza.

Science Scandals: Anti-Vaccination

The science community, just like any other community, has had its fair share of scandals over the years with one of the most well known being the ‘Anti-Vaccination’ movement.

Vaccinations are used by medical professionals to protect or immunise patients from diseases. They use weaker versions of a disease, or group of diseases, that are injected into the body. Our body’s immune system of white blood cells are activated and easy destroy these weak strains of diseases. One member of the immune system, B-Cells, remembers the disease so that if it comes into contact with it again, the disease can be easily and quickly destroyed.

Those in the movement have been found to be against vaccinations for a number of reasons, ranging from religious reasons to fears about safety. Many believe that the vaccination procedure causes more harm than good, with a specific belief that vaccinations cause Autism. This began when a paper published by Dr Andrew Wakefield in 1998 claimed that children who had the MMR vaccination (that uses the virus for Measles, Mumps and Rubella) had an increased chance of developing autism. The paper was published in The Lancet, a very well regarded academic medical journal, and was quickly grasped by the media posting headlines such as ‘MMR Killed My Daughter’ and ‘New evidence shows MMR link to autism’ over the years. The study’s affects has been one of the major factors in a decrease of children receiving the MMR vaccine as well as outbreaks of measles in recent years.

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An image of the Rubella virus under a microscope. Image taken from The Telegraph. Photo credit: The Science Picture Company

The original paper looked at 12 children who were brought to Dr Wakefield and his colleagues with gastrointestinal problems such as diarrhoea and abdominal pains (stomach cramps). These children had also recently started developing behavioural disorders, most commonly being autism which was noted to be after the MMR vaccine. However, his study was retracted in 2010 for accusations of ethical and scientific misconduct. Specifically, Dr Wakefield had not disclosed that he was partially funded by families suing the vaccine companies, had not received permission for invasive procedures on children and accusations of fraud, i.e. making up or selectively ignoring data.All these accusations led to an enquiry by the General Medical Council who stripped Dr Wakefield of his licence.

Numerous studies have now been conducted over the last decade into the link between MMR and Autism and these have collectively found that there is no link between the MMR Vaccine and development of Autism, however this confirmation of the vaccine’s safety cannot reverse the damage caused by this MMR-Autism scare.