November 3, 2020
No Reason To Fear Flu Vaccines
Experts Sound Call for Widespread Flu Vaccination After Ministry of Health Malaysia Lifts Temporary Cessation on The Use of Two Flu Vaccines
The Malaysian Influenza Working Group (MIWG) comprises experts working together to improve the prevention, management and control of influenza in Malaysia. We have been concerned over recent news reports alleging deaths following flu vaccination in South Korea.
Although the matter has since been clarified, we would like to take this opportunity to affirm that flu vaccination is safe and also a highly necessary preventive healthcare measure. Thus, we urge healthcare professionals and members of the public, alike, to urgently get their flu shots.
This small step could help avert tremendous physical, emotional and financial suffering resulting from severe flu and related complications. Flu is undesirable at any time, but even more now as all Malaysians face another deadly health threat – the surging COVID-19 pandemic.
The Korean Conundrum
The Ministry of Health (MOH) Malaysia issued an advisory on October 28, 2020, instructing healthcare professionals to temporarily stop using two flu vaccine brands – Vaxigrip Tetra and SKYCellflu Quadrivalent 1. MOH Singapore issued a similar advisory on October 25, 20202.
The advisories occurred after the Korea Disease Control and Prevention Agency (KDCA) reported that a number of people (83 individuals as at October 31, 2020) had died amid the country’s on-going national flu vaccination programme3. Over 16 million individuals had received their flu shots by then4.
While 11 of the cases were still being probed (at the time of writing), KDCA’s detailed investigations and autopsies revealed that the other 72 deaths were most likely due to underlying diseases and other fatal events. There were no instances of anaphylaxis, an extremely rare but potentially fatal adverse reaction to vaccination.
The South Korean government was satisfied with KDCA’s findings and decided to allow the national flu vaccination drive to continue, using all the different influenza vaccines (including Vaxigrip Tetra and SKYCellflu Quadrivalent) in the programme.
MOH Malaysia and MOH Singapore have since rescinded their temporary cessation orders, based on KDCA’s investigations and their technical reviews. They have confirmed that both vaccine brands are safe and may continue to be used.
MIWG welcomes the move as it will help restore the public’s confidence at a time when flu vaccination is greatly needed.
Flu Vaccines Are Safe
Numerous studies have consistently shown that flu vaccines are safe5. This is reflected by the fact that, to date, no flu vaccination-related deaths have been reported in Malaysia1 or Singapore2. In South Korea, the Prime Minister, Health Minister6 and other top health officials7 have themselves taken their flu shots in recent days to demonstrate their uncompromising faith in flu vaccine safety.
Flu vaccines are well tolerated in most age-groups5. However, like all other vaccines, flu vaccines may sometimes cause side effects. In most cases, these side effects are mild, ranging from redness, pain, swelling at injection site, or fever. These adverse effects usually resolve on their own.
Thus, there is no reason to be afraid of flu vaccines. Instead, we should rely on them to help prevent influenza, a disease that afflicts 3 to 5 million people each year with severe illness and complications (such as pneumonia, inflammation of the heart and brain, sepsis, multi-organ damage) with 290,000 to 650,000 respiratory deaths8.
Advice for The Public
As recommended by the US Advisory Committee on Immunisation Practices (ACIP), everyone over the age of 6 months old should be protected with a flu shot every year. This is especially important if you belong to any of the following high-risk groups9.
Annual flu vaccination in older persons aged 50 or more is associated with lower flu hospitalisation rates and flu-related complications and death10. People living with chronic health conditions also stand to benefit.
In heart disease patients, annual flu vaccination may help lower the risk of major cardiovascular events11. In people with diabetes, there is a reduced likelihood of dying from a heart attack or stroke12. Elderly patients with chronic kidney disease exhibit a lower risk of hospitalisation due to heart failure13.
In people with chronic obstructive pulmonary disease (COPD), annual flu vaccination is associated with a reduction in the number of exacerbations, hospitalisations, outpatient visits, and all-cause and respiratory mortality14. People with asthma see a reduced frequency of respiratory illness, asthma attacks and other influenza-related asthma complications15.
Flu shots given to pregnant women reduce the risk of flu-induced complications, pre-term labour, premature birth, congenital disabilities and stillbirth16. Annual flu vaccination protects young children aged over 6 months from potentially fatal flu-related complications (such as pneumonia, severe dehydration, and brain dysfunction)17.
Advice for Healthcare Professionals Amid COVID-19
Flu vaccination has become even more critical as the COVID-19 pandemic continues to rage across the globe. In the current environment, the WHO Strategic Advisory Group of Experts (SAGE) has put healthcare workers among the highest priority groups to be vaccinated against the flu18.
Getting a flu shot will prevent us from unwittingly spreading the disease to our patients. It will also enable us to support the World Health Organisation’s (WHO) call for widespread flu vaccination19.
Many nations (eg, Japan, South Korea, Taiwan, China, Australia, the UK, the USA, and most European countries) have already ramped up their existing national flu vaccination efforts, accordingly20, 21. However, without a similar programme of our own in Malaysia, we healthcare professionals will have to do our best to personally and pro-actively advocate flu vaccination to all our patients.
It will help protect them from severe flu and related complications, as well as the unthinkable prospect of getting both flu and COVID-19 at the same time – a disastrous mix that may lead to a 10,000-fold increase in coronavirus replication in human cells, as new research suggests22.
From a health system perspective, widespread flu vaccination will minimise the number of people getting hospitalised for flu, thereby allowing critical yet limited healthcare resources to be reserved for COVID-19 cases.
We are living in uncertain times. However, we can trust that flu vaccination is safe and take advantage of the protection it offers to healthcare professionals and members of the public, alike.
MALAYSIAN INFLUENZA WORKING GROUP
A Special Interest Group under the Malaysian Society of Infectious Diseases & Chemotherapy
Aligned with the Asia-Pacific Alliance for the Control of Influenza (APACI)
This media statement is endorsed by:
Academy of Family Physicians of Malaysia
Academy of Medicine Malaysia
College of Physicians – Academy of Medicine Malaysia
Malaysian Family Medicine Specialist’ Association
Islamic Medical Association of Malaysia
Malaysian Health Coalition
Malaysian Medical Association
Malaysian Paediatric Association
Malaysian Public Health Physicians’ Association
Malaysian Society of Geriatric Medicine
Malaysian Society of Infectious Diseases and Chemotherapy
Malaysian Thoracic Society
- Influenza Vaccines: Evaluation of the Safety Profile. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861790/
- Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices 2020 https://www.cdc.gov/mmwr/volumes/69/rr/rr6908a1.htm
- Vaccines for preventing influenza in the elderly https://pubmed.ncbi.nlm.nih.gov/29388197/
- Association Between Influenza Vaccination and Cardiovascular Outcomes in High-Risk Patients A Meta-analysis https://jamanetwork.com/journals/jama/fullarticle/1758749
- 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
- Influenza Vaccination Reduces Hospitalization for Heart Failure in Elderly Patients with Chronic Kidney Disease: A Population-Based Cohort Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884756/
- WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic https://www.who.int/immunization/policy/position_papers/Interim_SAGE_influenza_vaccination_recommendations.pdf?ua=1