Quebec does not offer universal vaccination against influenza to protect the hospitals in anticipation of a second wave of COVID-19 and instead focus its fire on the at-risk populations.
At the moment it is the conclusion to which arrived the Committee d’immunisation du Québec (CIQ), which advises the government on the directions to take in terms of vaccination. For several weeks, this committee is juggling the possibility of getting ahead of the calendar of vaccination of influenza and expand it to multiple sections of the population to ensure that an epidemic of influenza did not alter the ability of the hospitals to cope with the possible spike in cases of COVID-19 over the next few months.
However, according to Dr. Gaston De Serres, a member of the IQC and epidemiologist at the Institut national de santé publique du Québec (INSPQ), in the light of current information, the Committee concludes that vaccination of vulnerable populations, including young children, the elderly and adults with chronic diseases, will be sufficient to prevent a rise in hospitalizations.
“Our goal is to increase coverage of people at risk, not people in good health that the risk of complications and hospitalizations are very low,” says Dr. Greenhouse.
In the context of the pandemic COVID-19, the problem is not that many people contracted the influenza, he adds, but some develop complications (including pneumonia), which would exert an additional pressure on hospital admissions or intensive care units.
Some organizations, including the Coalition priorité cancer au Québec, claimed that the vaccination is accelerated and expanded in order to avoid, inter alia, that the care of patients with cancer can be disrupted by a new load shedding activity in response to an overload in the hospitals.
Our goal is to increase coverage of people at risk, not people in good health that the risk of complications and hospitalizations are very low
— Gaston De Serres
But according to Dr. De Serres, there is nothing to indicate, at the present time, that the influenza outbreak is corsera in the coming months and will add to the burden already generated by the COVID-19. “If you look at what is happening in the southern hemisphere, especially in Australia where the flu season has already begun, the indicators are at their lowest level,” he says.
For the moment, epidemiologists hypothesized that the months of containment and prevention measures against the COVID-19, in which the port of the mask and the distancing physical, have had a direct effect on the circulation of the influenza virus, also less contagious than the SARS-CoV-2. “It is quite possible that the next influenza season is very quiet. Everything will depend on the behavior of people, ” says Dr. Greenhouse.
“The only good news is that all that we have done for the COVID we help to contain influenza, as well as all of the other respiratory viruses that cause symptoms are flu-like,” adds this expert.
Moreover, the significant increase in demand for vaccines against influenza, anywhere in the world, makes it practically impossible for the acceleration of the vaccination schedule. Quebec has ordered two million doses, or 25% more than last year. “The vaccines are given in October due to delays in manufacturing. A vaccination early does not depend on us, but the stock availability, ” explains the member of the IQC.
Target the most fragile
For this reason, Québec will focus its next awareness-raising campaign against the flu on people with chronic diseases, of whom only 39 % were vaccinated during the season 2017-2018, and less than a quarter of children under the age of 65 years. A ratio that is far from optimal, according to Dr. De Serres.
The vaccine protection was capped at 48 % among those 65 to 74 years in 2017-2018 and to 65% in the over 75 years of age. However, it did not exceed 38% among health care workers, identified as vectors of contagion important among hospitalized patients, particularly at the height of the pandemic COVID-19.
“We will urge health care workers to vaccinate. Unlike the COVID, the flu is only contagious when people are sick. Therefore, the elements that have negatively affected in the case of the COVID in our network, including the presence of asymptomatic carriers, are not the same. But it is clear that, whatever the virus, the recommendation not to go to work when sick will be put in prior to even more closely this year, ” adds Dr. De Serres.
School-based Vaccination in danger ?
The containment of last spring has led to a marked slowdown in the vaccination of young children against rubella, measles and mumps (MMR vaccine), ” says the epidemiologist. It urges that this vaccination again become ” a high priority “. However, he’s afraid of the uncertain context related to school and wondered ” if the situation of the pandemic will make possible the vaccination this fall “, given the necessary labour. “If we control the situation of the [COVID], it’s going to be able to continue. Otherwise, it will be necessary to assess the risk arising from the deferral of these vaccines. “
At the secondary level, the fate of the vaccination programs provided in schools will also depend on the ability to mobilize vaccination teams and arrangements for the next school year.
The vaccination of students against hepatitis A and B and against the human papilloma virus (HPV) which is carried out in secondary 4, and meningococcal C, diphtheria and tetanus in the 3rd secondary school has also been disrupted by the pandemic. But, according to Dr. De Serres, the one-year delay of these vaccines is of no great consequence.