Vaccination – Page 3 – Medical Centre

The failure of England’s Test and Trace system means we will be in and out of lockdowns for some time

Azeem Majeed, Professor of Primary Care and Public Health

13 November 2020

Whether we will come of the 4-week lockdown on schedule will depend on how low the government’s Covid-19 strategy brings the R-value for the country. The R value is the average number of people that each new case of Covid-19 infects. If the R value for England is less than one, the daily number of cases will start to fall; and if the R value is greater than one, the daily number of cases will continue to increase. Once the R value is below one, and the daily number of cases start to fall, the number of people being admitted to hospital and the number of deaths will also start to fall.

There is though a lag before the number of hospital admissions and deaths begin to fall. This is because it can take 1-2 weeks from becoming infected before a person is unwell enough to need hospital treatment. There is then as further period of time before death. Hence, case numbers start to fall first, followed by the number of people admitted to hospital and then finally, the number of people dying from Covid=19.

The “nightmare scenario” that we will face is that the new lockdown measures are not strict enough or people do not comply with them, meaning that the R value stays above one and the numbers of cases, hospital admissions and deaths do not fall. This will mean continuing restrictions after the 4-week lockdown period ends. Even if the number of Covid-19 cases does fall to a more manageable level by the end of the lockdown, there will still be ongoing restrictions on social activities, resulting in Christmas 2020 being very different from a normal Christmas.

It’s also possible that we will see future waves of Covid-19 infection after lockdown measures are relaxed – as we saw earlier in the year – meaning that we may get further lockdowns followed by periods of relaxation of lockdown measures. Unfortunately, ever since the start of the pandemic, England’s Test and Trace system has not worked well enough to suppress local outbreaks promptly and keep the number of cases low – as we have seen in countries such as New Zealand, Taiwan and South Korea.

Hence, this cycle of lockdowns and restrictions of activities, followed by some loosening of these restrictions, may not end until we have a safe and effective vaccine that can finally bring Covid-19 under control in England and across the rest of the world. The encouraging news is that the early results about the safety and effectiveness of the new vaccines being developed for Covid-19 are very positive; and we may be able to launch a large-scale vaccine programme in the United Kingdom very soon. This vaccine programme is going to be complex and challenging to deliver but the NHS does have the expertise to do this.

Who is responsible for the vaccination of migrants in Europe?

Azeem Majeed, Professor of Primary Care and Public Health

9 May 2018

An article from Imperial College London published in the Lancet discusses vaccination from migrants in Europe. Ensuring high levels of coverage is a key priority of the European Vaccine Action Plan, whereby all WHO Europe Member States have committed to eliminating endemic measles and rubella (>95% coverage with the measles mumps rubella vaccine), sustaining polio-free status, and controlling hepatitis B infection.

Flu vaccine may reduce the risk of death and hospital admission in people with type 2 diabetes

Azeem Majeed, Professor of Primary Care and Public Health

1 October 2017

The flu vaccine may reduce the likelihood of being hospitalised with stroke and heart failure in people with type 2 diabetes, according to new research. The study from Imperial College London also found the patients who received the influenza vaccination had a 24 per cent lower death rate in the flu season compared to patients who weren’t vaccinated.

The team, who published their findings in CMAJ (Canadian Medical Association Journal) studied 123,503 UK adults with type 2 diabetes between 2003 and 2010. Around 65 per cent of these patients received the flu vaccine. We found that, compared to patients who had not been vaccinated, those who received the jab had a 30 per cent reduction in hospital admissions for stroke, 22 per cent reduction in heart failure admissions and 15 per cent reduction in admissions for pneumonia or influenza. Furthermore, people who were vaccinated had a 24 per cent lower death rate than patients who were not vaccinated.

We also found a 19 per cent reduction in hospital admissions for heart attack among vaccinated type 2 diabetes patients during the flu season, but this finding was not statistically significant.

Dr Eszter Vamos, lead author of the study from the School of Public Health at Imperial, said: “Most flu deaths every year occur in people with pre-existing health conditions such as type 2 diabetes. This study suggests the vaccine may have substantial benefits for patients with long-term conditions. Not only might it help reduce serious illness such as stroke – and possibly heart attack – in high-risk individuals, but it may also reduce the risk of death in the flu season. Currently more than one-third of people with diabetes do not receive their flu vaccine year-by-year in England. By increasing the number of people receiving influenza vaccine annually, we could further reduce the risk of severe illness not addressed by other measures.”

Type 2 diabetes results in a person being unable to control their blood sugar properly and affects around 2.7 million people in UK. People with the condition are at high risk of cardiovascular disease, which includes heart disease and stroke, possibly due to high blood sugar levels damaging blood vessels. Furthermore, flu infection has been found to increase the risk of heart attack or stroke in patients with cardiovascular disease, although scientists are unsure why.

In the UK the NHS offers the annual flu vaccine to children and adults with underlying health conditions such as type 2 diabetes, as well as to all over-65s and pregnant women.

Professor Azeem Majeed, co-senior author from the School of Public Health at Imperial added: “There are few studies looking at the effectiveness of the influenza vaccine in people with diabetes. Although there have been questions surrounding the effectiveness of the flu vaccine in recent years, this research demonstrates a clear advantage for people with diabetes. The findings of the study illustrate the importance of flu vaccine in reducing the risk of ill-health and death in people with long-term conditions. The flu vaccine is available free to these patients from GPs and pharmacists, and patients with diabetes should ensure they receive the vaccine every year.”

In the study, we looked at a representative sample of patients with type 2 diabetes in England. We then tracked these patients over a seven year period, and monitored the number of hospital admissions in this patient group for heart attack, stroke, heart failure, pneumonia, influenza. We also looked at the number of deaths. We then adjusted their figures for demographic and social factors, as well as existing health conditions.

The research was supported by the National Institute of Health Research North West London Collaboration for Leadership in Applied Health Research and Care Scheme and the NIHR Imperial Biomedical Research Centre.

Media Coverage
http://www.foxnews.com/health/2016/07/25/flu-vaccine-may-help-keep-diabetics-out-hospital.html

http://www.eurekalert.org/pub_releases/2016-07/cmaj-fvr072016.php

http://medicalxpress.com/news/2016-07-flu-vaccine-death-diabetes-patients.html

http://healthmedicinet.com/news/flu-vaccine-may-reduce-risk-of-death-for-type-2-diabetes-patients/

http://healthmedicinet.com/i/flu-vaccine-may-reduce-risk-of-death-for-type-2-diabetes-patients/

http://goo.gl/fTQPVI

http://www.reuters.com/article/us-health-diabetes-flu-shot-idUSKCN1051W7

http://www.bmj.com/content/354/bmj.i4130

http://www.doctorslounge.com/index.php/news/hd/65293

http://health.usnews.com/health-care/articles/2016-07-26/flu-shot-tied-to-fewer-hospitalizations-deaths-in-type-2-diabetes-patients

http://www.diabetes.co.uk/news/2016/jul/flu-jab-could-reduce-stroke-and-heart-failure-risks-in-type-2-diabetes-94994360.html

https://consumer.healthday.com/diabetes-information-10/type-ii-diabetes-news-183/flu-vaccine-tied-to-lower-deaths-hospitalizations-in-type-2-diabetes-patients-713085.html