Potential influenza resurgence poses risks to elderly

Influenza prevention measures for older persons must be intensified as the COVID-19 pandemic transitions into an endemic phase, urge health experts.

At a recent media forum titled “Come Out Stronger, Protect Them Better”, a panel of representatives from several medical associations voiced their consensus on the dangers that a potential resurgence of influenza posed to high-risk groups.

The forum was organized by Immunise4Life (IFL) under its “Flu Prevention is an Act of Love” campaign, supported by the Vaccination Is Protection (VIP) initiative.

According to Professor Datuk Dr Zulkifli Ismail, consultant paediatric cardiologist and IFL Technical Committee chairman, a low influenza vaccination rate among Malaysians would be compounded by reduced herd immunity rates due to reduced influenza virus circulation in the last 2 years.

Zulkifli noted that while influenza “practically vanished when the COVID-19 pandemic hit”, cases were rising in many countries, including Malaysia. He advised that high-risk individuals, such as pregnant women, young children, those with chronic health conditions, and especially older persons, should be encouraged to take the annual influenza vaccine urgently to reduce risk of severe complications.

“Flu activity is bound to increase as the travel and other sectors continue opening up and people mingle more freely,” he added.

Professor Dr Tan Maw Pin, consultant geriatrician and Malaysian Influenza Working Group (MIWG) Flu and Older Persons Subcommittee chairperson, added that a recent report in the Lancet found influenza and SARS-CoV-2 coinfection in adults was associated with “four times higher odds of invasive mechanical ventilation and double the risk of death”. [2022;399(10334):1463–1464]

“COVID-19 booster shots and SOPs continue to be vital,” said Tan. “However, we seriously need to prioritize flu prevention for older persons as a highly vulnerable group starting now.”

Speaking at the same forum, Professor Dr Chan Siew Pheng, consultant endocrinologist and Malaysian Endocrine and Metabolic Society (MEMS) president, said that common comorbidities in older persons such as diabetes and cardiovascular disease (CVD) could compound the dangers posed by an influenza infection.

According to Chan, influenza could indirectly destabilize blood glucose control in a person with diabetes by affecting their appetite and daily activities, increasing their risk of diabetic emergencies. Diabetes could likewise exacerbate influenza complications due to other comorbidities such as hypertension and kidney disease.

“People with diabetes, even when well-managed, are advised to make flu prevention an integral component of diabetes management,” said Chan.

Influenza’s impact on older persons can also have ripple effects on their families and caregivers, noted Professor Nathan Vytialingam, occupational therapist and Malaysian Healthy Ageing Society (MHAS) founding member and advisor.

“When aged parents are admitted into hospital, their children may have to bear the cost of treatment.  Should recovery be slow and long, caregivers may need to take time off work. Both situations would create hardship for the families, especially those from the lower income brackets,” said Nathan.

He added that older adults subject to prolonged bed rest or hospitalization might also experience bed sores, muscle wasting, functional decline, and reduced ability to perform daily tasks, potentially leading to a loss of independence, reduced quality of life, and declining mental health.

“As loving families and members of a caring society, we need to come together to encourage and support annual flu vaccination for the older generation,” said Nathan. “After the painful lessons of the pandemic, let’s come out stronger and protect them better.”

IFL is a community education programme jointly organized by the MOH, Malaysian Paediatric Association, and the Malaysian Society of Infectious Diseases and Chemotherapy (MSIDC). Collaborating societies include the MIWG, Malaysian Medical Association (MMA), MEMS, National Heart Association of Malaysia (NHAM), and the MHAS.