January 13, 2017
William Schaffner, MD, a professor of preventative medicine in the department of health policy at Vanderbilt University School of Medicine and medical director of the National Foundation for Infectious Diseases, is a strong proponent of increasing the use of vaccines in pediatric and adult populations and has worked on numerous expert advisory committees that help establish national vaccination policies. Dr. Schaffner, who’s also past president of the National Foundation for Infectious Diseases, is a leading and respected voice on influenza vaccination and is dedicated to improving efforts to prevent the spread of seasonal flu. We recently caught up with Dr. Schaffner to discuss this season’s dominant flu strain, why society continues to underestimate the dangers of influenza, and the promise offered by the continuing quest to develop a universal flu vaccine.
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What’s the latest on the current flu season?
Influenza was quiet through the holidays, but infection rates began to increase during the first few weeks of the new year in many parts of the country, particularly along the east and west coasts. Here in Nashville, we’ve also seen a brisk upsurge in hospitalized cases of laboratory-diagnosed influenza. The A(H3N2 ) variant is the dominant strain that’s accounting for over 90% of this season’s influenza cases, according to the Centers for Disease Control and Prevention. That variant generally causes a more severe illness, particularly among the elderly, but there’s a very good match between the circulating strain and this year’s vaccine. My general recommendation to anyone who has not yet been vaccinated is to run, not walk, to the nearest pharmacy or clinic. We always have to remind people in January that it’s not too late to get vaccinated. It takes approximately 10 days to 2 weeks to get maximum protection. The virus is circulating, but it hasn’t infected everyone yet, so we’re still urging people to get vaccinated.
Why does influenza vaccination coverage continue to fall short of national goals?
Everyone’s very familiar with influenza, and that familiarity might not breed contempt, but perhaps nonchalance. Influenza is a big deal and the one virus that infectious disease experts are most concerned about, because it keeps mutating and causes so much illness among the population. It’s estimated that 200,000 flu-related hospitalizations occur each year and, depending on the severity of the season, the flu is to blame for 4,000 to 40,000 annual deaths. Based on those numbers, the country would go berserk if we changed the name of influenza to the Zika virus. In addition to all the direct illness influenza causes, it significantly increases medical care costs — think about those 200,0000 hospitalizations — and a great deal of distress and economic turbulence when employees miss work. Influenza delivers a big hit to our society on an annual basis, so we need to respect the virus.
What are the potential benefits of developing a universal vaccine?
Developing a universal vaccine that covers a whole spectrum of influenza virus types would change the entire concept of vaccination. Seasonal flu vaccines are largely effective, but have many limitations. Primarily, the composition of the vaccine must be changed annually in order to keep up with the constantly mutating virus. One of the knocks of the seasonal vaccine is that it’s not always effective, so some individuals wonder why they should bother getting it. A universal vaccine would eliminate that entire argument. Additionally, individuals presumably wouldn’t have to get annual vaccinations. They might have to undergo periodic reimmunization, but doing so every 5 to 10 years is a whole lot different and more convenient than having to get vaccinated before each flu season. Keep in mind that current immunization efforts focus on a very period in late fall and early winter. A vaccine that works for 5 to 10 years would allow vaccination to occur continually. That means we’d be able to protect a much larger proportion of the population.
What efforts are being made to develop a universal vaccine?
The round spherical ends of antigens on the surface of the influenza virus are constantly mutating and targeted by seasonal flu vaccines. A universal vaccine would be possible if researchers could create a vaccine that generates antibodies against antigen stalks, which are conserved across all influenza virus strains. That’s the major focus of the most promising research aimed at creating a long-lasting, universal vaccine.
How can healthcare providers help increase vaccination coverage?
They need to be vaccine advocates rather than vaccine recommenders. A vaccine recommender talks to patients about the benefits of the flu shot and asks if they’ve thought about getting vaccinated. What is there to think about? We don’t tell patients they ought to think about treating their diabetes — we tell them how we’re going to do it. Providers need to be just as assertive about making sure patients protect themselves against the flu. Vaccine advocates tell patients, Your flu shot is waiting for you, we give everyone the influenza vaccine, and we don’t let anyone leave unvaccinated.--Dan Cook