Safeguarding Senior Citizens From The Insidious Threat Of Influenza

Medical bodies and NGOs urge doctors and the community to prioritise flu vaccination for older persons, based on clinical evidence, health economics, and the right to healthy ageing.

Petaling Jaya, February 4, 2021 – While each year is not without its difficulties, 2020 was particularly challenging due to the COVID-19 pandemic. In less than 12 months, the disease has spread across 190 countries, infected over 104 million people, killed over 2.2 million of them[1], destroyed countless livelihoods, and tested healthcare systems beyond their limits.

COVID-19 has brought the world face-to-face with the perils of living in a world without the protection of vaccines. While no one is safe, the threat looms even larger for older persons who are rendered more vulnerable by advancing age and chronic diseases.

The global endeavour to create a safe and effective COVID-19 vaccine is beginning to bear fruit. A handful of vaccines have now been authorized for use in certain countries, while many more remain in development[2]. We in Malaysia will be rolling out our own COVID-19 vaccination drive in the next few months.

However, we should not allow the focus on COVID-19 overshadow the fact that, for decades, many older Malaysians have been stricken and killed by a more common, persistent and equally deadly infectious disease, called influenza or the flu. We need to put a stop to this preventable tragedy.

Flu in Seniors

The flu shares many similarities with COVID-19. Both are contagious respiratory illnesses that spread through nasal and salivary droplets, and exhibit similar symptoms. The World Health Organisation (WHO) estimates that the flu claims 290,000 to 650,000 lives annually[3], with approximately 90% of the deaths occurring among senior citizens[4]. In Malaysia, a local study has indicated that those above the age of 65 infected with influenza-like illnesses are at 10% greater risk of mortality[5].

People over the age of 65 tend to be more susceptible to the flu and its effects. Their immune systems become less able to activate the immune cells needed to clear the influenza virus from the lungs[6]. Age-related changes also occur in the connective tissues of our lungs and structure of the thoracic cage.

All these factors diminish the elderly’s ability to fight off serious respiratory illnesses[7]. They also become more prone to developing and dying from Acute Respiratory Distress Syndrome and a myriad of flu complications, the most common being pneumonia[8].

Protection Through Vaccination

Flu vaccination is a proven method of protecting our seniors from severe flu related complications. Studies have shown that it reduces the risk of having to visit the doctor for the flu by 45% and reduces the risk of developing pneumonia by 49%[9]. By the same token, it has also averted the need for hospitalisation due to the flu by 45%, thereby reducing the accompanying physical suffering, emotional stress, treatment cost, and financial burden to the family.

Such clear benefits have led many countries to provide free or subsidised flu vaccination to senior citizens under their respective national immunisation programmes (NIP). These include the United States of America, Canada, United Kingdom, Australia, New Zealand, and most European nations[10]. Asian examples include Taiwan, Japan, South Korea, and even Singapore[11]^,[12],[13]. 

Such population-based flu vaccination initiatives have consistently turned in promising results. For example, the US managed to reduce the flu mortality rate in seniors by 50% after implementing a nationwide flu vaccination strategy[14].

Unfortunately, the uptake of flu vaccines within our country is still exceptionally low, with a distribution rate of only 7.48 doses per 1,000 population[15]. Nonetheless, it is encouraging to note that more Malaysians have become more aware of the importance of flu vaccination, thanks to educational campaigns like “Flu Prevention Is An Act of Love”.

As announced in the media recently, the campaign managed to garner over 360,000 public pledges of support for flu prevention[16]. We heartily congratulate the organiser, Immunise4Life, for this achievement and hope it will result in more senior citizens getting vaccinated against the flu.

Advocating Flu Vaccination for Senior Citizens

It is our belief that everyone has a role to play in protecting older persons from the flu. As such, we urge all healthcare professionals to actively advise their older clients to get vaccinated and reassure them of its safety and effectiveness. Do share how the annual flu shot may not only keep the infection at bay; it may also confer a host of related health benefits. These include lowering the risk of major cardiovascular events for patients with pre-existing heart conditions[17]. The same could be said for patients with diabetes[18] and chronic kidney disease[19].

With caring advocacy, senior citizens can be persuaded to embrace flu vaccination as an important preventive health measure. This is especially because many also have non-communicable diseases that can be exacerbated by the flu.

For adult children caring for their aged parents, 2021 will be an opportune year to start giving them an annual flu shot. The government has granted tax exemption for the cost of certain vaccinations (including the flu), with effect from January 1, 2021[20]. We hope the public will take full advantage of this welcomed relief affirming that ‘prevention is better than cure’.

All too often, society forgets the senior citizens in aged care homes. Infectious diseases are known to spread quickly and extensively in such establishments where residents live in close proximity with one another. This was tragically demonstrated by how aged care homes in the UK were decimated by COVID-19! Flu poses a similar threat which we hope can be mitigated by the government giving those in this extremely needy and marginalised group an annual flu shot to help keep them safe.

Malaysia is moving steadily towards becoming an ageing nation[21]. As such, it is vital that we start putting in place the measures needed to ensure the health and well-being of our senior citizens, for example, working towards achieving the WHO’s flu vaccination coverage target of 75% among senior citizens[22].

Flu vaccination for older persons is integral to the concept of life course vaccination which, in turn, is fundamental healthy ageing as a right for all[23].

Jointly issued by

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).

MALAYSIAN SOCIETY OF GERIATRIC MEDICINE

This media statement is supported by:

1. ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA
2. ACADEMY OF MEDICINE MALAYSIA
3. ASSOCIATION FOR RESIDENTIAL AGED CARE OPERATORS OF MALAYSIA (AGECOPE)
4. COLLEGE OF PHYSICIANS – ACADEMY OF MEDICINE MALAYSIA
5. GERONTOLOGICAL ASSOCIATION OF MALAYSIA
6. IMMUNISE4LIFE
7. LUNG FOUNDATION OF MALAYSIA
8. MALAYSIA HEALTHY AGEING SOCIETY
9. MALAYSIAN HEALTH COALITION
11. MALAYSIAN RESEARCH INSTITUTE ON AGEING (MYAGEING)
12. MALAYSIAN SOCIETY OF INFECTIOUS DISEASES AND CHEMOTHERAPY
13. MALAYSIAN THORACIC SOCIETY
14. NATIONAL COUNCIL OF SENIOR CITIZENS ORGANISATIONS MALAYSIA
15. U3A BANDAR UTAMA
16. U3A MALAYSIA
17. U3A PETALING JAYA
18. USIAMAS

References
[1] https://coronavirus.jhu.edu

[2] https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html

[3] https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)

[4] https://www.cdc.gov/flu/spotlights/2018-2019/hopitalization-rates-older.html

[5] The effects of age on clinical characteristics, hospitalization and mortality of patients with influenza‐related illness at a tertiary care centre in Malaysia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182601/#irv12691-bib-0040

[6] The immune response to influenza in older humans: beyond immune senescence https://immunityageing.biomedcentral.com/articles/10.1186/s12979-020-00181-1

[7] ARDS in Aged Patients: Respiratory System Mechanics and Outcome https://www.hsj.gr/medicine/ards-in-aged-patients-respiratory-system-mechanics-and-outcome.php?aid=19051

[8] Influenza virus-related critical illness: pathophysiology and epidemiology https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2539-x

[9] Effectiveness of influenza vaccine in aging and older adults: comprehensive analysis of the evidence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3292388/

[10] https://data.oecd.org/healthcare/influenza-vaccination-rates.htm

[11] https://www.moh.gov.sg/resources-statistics/subsidised-vaccine-list

[12] The Korean Influenza National Immunization Program: History and Present Status https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5754334/

[13] Taiwan’s Annual Seasonal Influenza Mass Vaccination Program—Lessons for Pandemic Planning https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129648/

[14] Impact of Influenza Vaccination on Seasonal Mortality in the US Elderly Population https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/486407#:~:text=Background%20Observational%20studies%20report%20that,1980%20to%2065%25%20in%202001.

[15] Seasonal influenza activity based on laboratory surveillance in Malaysia, 2011-2016 https://www.researchgate.net/publication/327563856_Seasonal_influenza_activity_based_on_laboratory_surveillance_in_Malaysia_2011-2016_SAM_et_al

[16] https://actoflove.ifl.my/

[17] Association between influenza vaccination and cardiovascular outcomes in high-risk patients https://jamanetwork.com/journals/jama/fullarticle/1758749

[18] 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

[19] 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/

[20] https://www.thestar.com.my/lifestyle/family/2020/11/06/budget-2021-kinder-to-senior-citizens

[21] https://www.nst.com.my/news/nation/2019/12/550082/malaysia-needs-prepare-ageing-population

[22] https://www.euro.who.int/en/health-topics/communicable-diseases/influenza/vaccination/seasonal-vaccination-policies-and-coverage-in-the-european-region

[23] Guidelines for Adult Immunisation 3^rd Edition, 2020, Malaysian Society of Infectious Diseases and Chemotherapy.