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Autumn has begun, temperatures are dropping and we are spending more time indoors again. Seasonal infectious diseases such as influenza ("flu") begin to circulate more widely among the population during this time of the year.

The STIKO recommends full vaccination of vulnerable groups against influenza in view of the COVID-19 pandemic

Autumn has begun, temperatures are dropping and we are spending more time indoors again. Seasonal infectious diseases such as influenza ("flu") begin to circulate more widely among the population during this time of the year. With SARS-CoV-2 infections on the rise, many fear that a combination of the COVID-19 pandemic and the wave of influenza could place a significant burden on the health care system if no appropriate countermeasures are taken. Although there is evidence that measures to contain the COVID-19 pandemic also limit the transmission of influenza,a vaccination is still considered to be the best protection against influenza.

Influenza vaccination: Yes, but for whom?

While a vaccination against influenza is usually recommended for particularly vulnerable people such as the elderly (≥ 60 years) or people with chronic illnesses, this years advice is different. The German Federal Minister of Health, Jens Spahn, is calling on everyone to get themselves and their children vaccinated, if they want to. The President of the German Medical Association (Bundesärztekammer, BÄK), Klaus Reinhardt, also recommends vaccination for  an extended group of people. To ensure the continued operation of day-care centres and schools, not only children but also educational staff should ideally be vaccinated against influenza on a large scale. There is just one problem: according to the German Standing Vaccination Commission (Ständige Impfkommission, STIKO) of the Robert Koch Institute (RKI), there will be about 25 million doses of influenza vaccine available for Germany this season. Although this amount is higher than in previous years, it is by no means sufficient to vaccinate all the above-mentioned population groups or even the entire population of Germany.

Senior citizens and chronically ill people: Increased risk of severe courses of influenza and COVID-19

With both COVID-19 and influenza, the elderly people (in particular, ≥ 60 years of age) and people with chronic illnesses have a higher risk of severe courses and hospital admissions. Therefore, the STIKO recommends that these groups (including residents of nursing and retirement homes) receive a vaccination against influenza. There is an urgent need for improvement, as only about one in three people over 60 years of age have received an influenza vaccination in the past years. It is also advisable to vaccinate medical and nursing staff to prevent the spread of influenza in hospitals and nursing and retirement homes. As usual, the STIKO also recommends pregnant women to get the influenza vaccination. However, the STIKO does not consider to extend their recommendations for the influenza vaccination because of the COVID-19 pandemic, as otherwise, the vaccine doses would not be sufficient for the risk groups. Furthermore, in this autumn and winter season, it cannot be assumed that herd immunity by vaccination will play a particularly important role if people adhere to the preventive measures (distance, hygiene, community masks).

Coinfection influenza and SARS-CoV-2 should be avoided

Due to the limited number of vaccine doses, priority should be given to vaccinating risk groups against influenza in the autumn and winter season of 2020/2021. Members of non-risk groups are, of course, also free to be vaccinated against influenza. Although there is currently no evidence of a particularly severe course in younger and otherwise healthy individuals who have been infected with both viruses, co-infection with influenza and SARS-CoV may increase the risk of complications and should therefore be avoided.

 

Sources:
1. Robert Koch-Institut; Epidemiologisches Bulletin No. 16 2020. April 2020. (in German language only)
2. Tagesschau.de 30.08.2020. Aufruf zur Grippeimpfung: Sorge vor Grippewelle in Corona-Zeiten. (in German language only) 
3. Tagesschau.de 03.09.2020. Präsident der Bundesärztekammer: Mehr Impfen gegen die Grippewelle. (in German language only)
4. Robert Koch-Institut; Ständige Impfkommission (STIKO). (in German language only) 
5. Robert Koch-Institut; Epidemiologisches Bulletin No. 32/33 2020. August 2020. (in German language only)   
6. Robert Koch-Institut; Epidemiologisches Bulletin No. 44 2019. Oktober 2019. (in German language only)   
7. Ozaras et al. Influenza and COVID‐19 coinfection: Report of six cases and review of the literature. J Med Virol. 2020.