Influenza Exposed: Unmasking the Hidden Burden and Solutions Beyond the Respiratory Illness

Amongst the complex concerns of the public, no other condition comes close to influenza in terms of being underappreciated. Often relegated for being a fleeting and seasonal inconvenience, discussions about this disease have often been boxed in to the respiratory illness that it is known for, effectively masking, and diluting the greater public health burden that it actually is. Together with the heightened global health consciousness from the pandemic, the need for factual and timely information about influenza cannot be over emphasized. A recent interview with Dr. Mario Panaligan, infectious disease specialist at the St. Luke’s Medical Center, BGC, put in context the often-overlooked healthcare burden of influenza and the imperative recalibration of current management strategies.

The Hidden Burden
Far from just being a transient illness, influenza poses a significant healthcare burden. With the capacity to wreak havoc across different major organ systems, Dr. Panaligan pointed out that influenza can magnify the impact of other illnesses and affect anyone regardless of social demographics and health status. He explained for example, that adults 40 years old and above face an 8x increased risk of stroke and a 10x increased risk of heart attack within the first 3 days of infection. Patients with type 2 diabetes mellitus are reported to have a 75% increase in abnormal glycemic events during influenza infection. Hospitalized older adults are among the hardest hit with 23% experiencing functional decline post-hospitalization. No doubt the burden of respiratory symptoms is just the tip of the influenza iceberg.

Paradigm shift
Considering the undervalued burden of influenza, Dr. Panaligan sees the need for a paradigm shift in the current approach to influenza. And the starting point is the recognition and acknowledgment of the burden of its myriad of complications. The protection of the identified vulnerable population then becomes paramount. And this calls for a concerted effort to bring about behavioral change towards routine vaccination and policy change towards greater investments in prevention across the life course for better healthcare system sustainability.

Protecting the vulnerable
“Clearly, we need to vaccinate”, said Dr. Panaligan, when asked how the needs of the vulnerable population can be immediately addressed. Improving availability and access to vaccines, especially those proven to protect beyond mere flu prevention, must be prioritized. This means resetting standards of vaccine efficacy to include preventing serious illness and hospitalizations. Recent data from improved flu vaccines, albeit not yet available in all regions, underscore their superior efficacy in preventing flu-related complications and hospitalizations impacting not just healthcare costs but public health safety as well. Doctor Panaligan expressed his elation over the availability in the local market of a vaccine that has shown protection against adverse cardiovascular outcomes in randomized control trials (RCTs). “Not all flu vaccines are the same”, stressed Dr. Panaligan, “and as physicians, we need to call for equitable access to proven superior vaccine for specific populations.”

Quality Assurance
The efficacy and quality of vaccines is critical to the success of influenza management. As such, Dr. Panaligan advocates for the institution of a rigorous evaluation process that seeks robust evidence of efficacy and safety from randomized controlled trials (RCTs), systematic reviews and meta-analyses. Evidence should demonstrate the ability of vaccines to impact severe complications and hospitalization rates beyond decreasing influenza infection rates. And newer vaccines that will be introduced to the local market should first prove superiority to standard doses through comparative scientific assessments.

Recalibration
Amidst a deeper awareness of the true burden of influenza, Dr. Panaligan calls for a recalibration of the approach to its management. New standards of care should integrate vaccination into patient care programs. And the call for physicians is to raise awareness of the risk of influenza, be strong advocates of vaccination and vaccinate as soon as available. Key opinion leaders should influence shaping policies that recognize the severe complications of influenza beyond the respiratory illness, initiate discourse for the inclusion of vaccination in patient support programs and engaging more allied health professionals to become champions of vaccination.

“Let us collaborate and share one voice for vaccination,” said Dr. Panaligan in closing.