Flu vaccine may have low effectiveness against dominant strain, Canada's top public health doctor says

Although it's "too early to actually tell," Canada's chief public health officer says the manufacturing process may have caused a mutation that reduces the flu vaccine's effectiveness against H3N2, a strain that tends to cause more severe illness among the elderly and children.

H3N2, associated with more severe illness among children and elderly, causing majority of flu cases

Even though it's possible the effectiveness of this season's flu shot may be limited against H3N2, a strain of influenza A that is causing the majority of flu illnesses in Canada, doctors are urging people to get vaccinated. (CBC)

Canada's chief public health officer says it's possible that this year's flu vaccine may have limited effectiveness against a particularly severe strain of influenza A that appears to be dominant throughout Canada.  

"In Canada it's still too early to actually tell how effective this vaccine will be," Dr. Theresa Tam told CBC News. "There is a potential ... of low vaccine effectiveness, but we really can't tell at this point in time."  

The reason for believing there's a potential weakness in the vaccine, Tam said, is the fact that countries in the Southern Hemisphere, which have their flu season before Northern Hemisphere countries, experienced "poor vaccine effectiveness" against H3N2, a subtype of influenza A that tends to cause more severe illness among vulnerable people, including the elderly and children. 

In addition, studies suggest that the process of manufacturing the vaccine may have compromised its effectiveness against H3N2 because it can mutate when grown in eggs — and Canada uses egg-based vaccines, Tam said.  

Vaccine manufacturers, the World Health Organization and others are studying the situation to determine if that was the case, she said.  

Doing so is "very important," Tam said, "as we move ahead to future years of vaccine program planning and recommendations."

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Influenza B appearing early

The potential for lower vaccine effectiveness makes it even more important that Canadians take "other measures" to protect themselves against the flu, she said, including handwashing, coughing into your sleeve, disposing of used tissues, and staying home when you're sick. 

Tam said there are also anti-viral medications, such as Tamiflu and zanamivir, to treat flu and help prevent outbreaks in long-term care homes and other facilities. 

But people should still get the flu shot, she said, because it offers protection against multiple strains.   

"Given the mix of influenza viruses circulating right now and more could still circulate later on in the ensuing months, we still recommend influenza vaccine for Canadians over six months of age," she said. 

One type of flu that's circulating earlier than usual this year is influenza B, according to data released by the Public Health Agency of Canada (PHAC) in its latest FluWatch report on Friday.

"What's important about influenza B is actually its impact on kids," Tam said. 

'Anyone that's had influenza, and I mean real influenza — not a sniffle or a cough or a cold — but real, true influenza, they'll know how severe this can be,' says Dr. Isaac Bogoch, an infectious disease specialist at University Health Network in Toronto.

Although children are more susceptible to serious illness from H3N2 than the general population, they are also particularly vulnerable to the "B" strain, possibly because of their lack of previous exposure, she said.   

Tam said that given the burden of influenza B on kids, the national advisory committee on immunization recommends children receive the "quadrivalent" vaccine, which protects against four strains of flu, including two B strains. The quadrivalent vaccine available in Canada right now covers the B strain that is currently circulating, she said. The other type of vaccine — called "trivalent" because it covers three strains of flu — "unfortunately" doesn't cover that B strain. 

Parents can ask their local public health agencies which vaccine is available in their area, she said. 

Flu 'in full swing'

The latest FluWatch report also says the number of flu cases overall continued to rise across the country in December, but "are within the range of expected levels for this time of year."

The type of flu detected is mostly H3N2, although influenza B detections continue to increase.  

"Influenza is in full swing in Canada," said Tam, noting that this year's flu season started earlier than normal. 

As of Dec. 30, 1,050 "influenza-associated" hospitalizations had been reported, with 93 cases requiring admission to intensive care. There have been 34 reported deaths.

Seniors have been the worst-affected, accounting for the majority of hospitalizations and deaths. 

The flu has also taken a toll on kids, with 195 people under age 18 admitted to hospital as of Dec. 30. There have been fewer than five pediatric deaths.  

PHAC's flu surveillance data are consistent with what health-care providers are observing, said Dr. Isaac Bogoch, an infectious disease specialist at University Health Network in Toronto.

"There are early indicators that this influenza season is a little bit more severe compared to prior influenza seasons. Certainly we're seeing that in the hospital," he said.  

"We know that the years when there are H3N2 strains that predominate, those are more severe years — meaning there are typically more infections, more severe infections, more hospitalizations and more deaths."

'Best protection we have'

Bogoch said the potential weakness in the flu vaccine's ability to protect against the H3N2 strain is an issue this year, noting he's seen early data suggesting it may be only 10 per cent effective.

Despite that, he said, "it's still extremely important to get the vaccine."

"Anyone that's had influenza, and I mean real influenza — not a sniffle or a cough or a cold — but real, true influenza, they'll know how severe this can be," Bogoch said. "I think many people would readily take that 10-per-cent reduction in risk just because this can be such a debilitating and severe illness."

"Even though it's not perfect, it's still the best protection we have." 





Nicole Ireland is a reporter with The Canadian Press.

With files from The Canadian Press