The warning signals are there: According to experts, a noticeable wave of flu could come in winter. Even if vaccination cannot always prevent infection, it is by no means superfluous.
Influenza viruses were almost forgotten during the Sars-CoV-2 pandemic: flu waves in the classic sense were canceled or took a different course than usual due to the corona measures imposed in many countries. Now masks, distance and caution are history for most people. The flu could also have an easier time of it again. “Many children and adults lack immunity due to previous infections during the pandemic years,” says Folke Brinkmann, who heads the pediatric pulmonology section at the Clinic for Pediatric and Adolescent Medicine at the University Hospital Schleswig-Holstein.
The flu wave usually peaks after the turn of the year
The flu season begins in around two weeks – in the window from October to mid-December, experts advise vulnerable groups such as those aged 60 and over to get a flu vaccination. According to the Paul Ehrlich Institute, around 18.8 million vaccine doses have been released so far. The flu wave usually only reaches its peak after the turn of the year. Several experts see the course of the flu season in the Australian winter as a warning signal. This is seen by some as a marker for what is to come in Europe. In general, the course and severity of the wave cannot be predicted.
Australia’s numbers indicate that an at least noticeable wave can be expected here too, said Markus Beier, chairman of the general practitioners’ association, in Berlin. He appealed to the groups that fall under the recommendation of the Standing Vaccination Commission (Stiko) to use the vaccination in order to get through the winter “as harmlessly as possible”.
Evidence from other countries
According to Beier, there was vaccination fatigue in parts of Australia, and there are signs of this here too. In consultations there is sometimes a certain mistrust after the discussion about corona vaccines, but also a desire for normality after the pandemic. The family doctors are not concerned with alarmism, said Beier. “It’s just that the increasing number of cases will simply push the outpatient system to its limit and then at some point the inpatient system too.”
Underrated disease
According to the Robert Koch Institute (RKI), an estimated 5 to 20 percent of the population, i.e. up to 16 million people, become infected during a wave, depending on its strength. As with Corona, the statistics only show laboratory-confirmed cases. From the point of view of experts, Germans have so far used the flu vaccination far too little. The aim is for 75 percent of older people to be vaccinated, but in fact less than one in two people aged 60 and over were vaccinated against flu in the 2020/21 season.
The term flu is sometimes used casually to refer to harmless symptoms such as malaise and a runny nose that are caused by completely different pathogens. However, real influenza has more serious consequences, with complications occurring in some patients. According to estimates, around 25,000 people died in the most violent flu wave in decades in Germany in the 2017/18 season. The severity of the waves can vary greatly from season to season.
What the flu vaccination can do – and what it can’t do
The RKI writes that vaccination is the most important measure against the disease, even if it does not offer 100% protection against infection. Nicola Buhlinger-Göpfarte, first deputy chairwoman of the Association of General Practitioners, emphasizes this: You shouldn’t give people the false promise that they won’t get sick thanks to vaccination. Rather, patients have to be explained that the immunization prevented something worse from happening: “They didn’t end up in the intensive care unit. They didn’t have pneumonia.” Experts also emphasized the benefits of vaccination in preventing flu-related cardiac diseases.
Australia’s flu epidemic affected many children
What is particularly striking in Australia is that children and young people were often affected. Many had symptoms so severe that they were taken to intensive care, as the Australian Guardian reported in July. In both Australia and New Zealand, the flu epidemic also started much earlier than usual. Experts are convinced that the lifting of the strict corona measures in particular spurred the flu epidemic.
“Fortunately, children are rarely seriously affected, but when the number of infections is very high, more children and more children become seriously ill,” explains Brinkmann. Children under the age of five and children with previous illnesses most often have severe cases. In rare cases, even healthy children could become seriously ill.
The incoming president of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (Divi), Florian Hoffmann, is holding back on forecasts for Germany because of the many imponderables – but developments in Australia must be taken seriously. He urgently called for timely vaccinations of risk groups and all healthcare workers. “This is the only way to mitigate the course of this wave,” said the senior physician at Dr. from Haunerschen Children’s Hospital in Munich.
Who is recommended to get the flu shot?
Stiko does not advise all German citizens to get the required annual vaccination. Only people over 60, pregnant women and children (from six months of age) and adults with certain previous illnesses. In addition, healthy people with a higher risk due to their job, such as doctors and nurses. Quadruple vaccines with the current antigen combination recommended by the WHO should be used. This changes every year because flu viruses are very versatile. More effective high-dose vaccines should be used for older people. There are overlaps between the groups and the Stiko recommendation for the new, adapted Corona booster vaccination. If you want, you can have both vaccines given at the same time.
RKI wants to take stock afterwards
As usual, the RKI only wants to assess the severity of the wave afterwards. It emphasizes that, for example, a severe course in one state cannot be inferred from a similar course in another state. The severity depends largely on the basic immunity in the population and the subtypes that were widespread in previous years.
In Germany, so-called inactivated vaccines are usually used against influenza, which cannot cause the disease. However, vaccination reactions with cold-like symptoms are possible. A real flu typically starts suddenly: with, for example, a high fever, aching muscles, headaches, and a pronounced feeling of illness. In addition, there is usually a dry, irritating cough.