By Sarah Hill
As we move into December it isn’t just festive cheer that’s in the air but also a multitude of influenza (flu) viruses destined to bring classrooms and offices to a snivelling halt. December to February in the UK and other countries with temperate climates provide ideal conditions for flu viruses. Studies have shown that the flu virus thrives in cold and dry conditions since it most stable in the air at lower temperatures. The ability to remain stable in the air also accounts for the virus’ ease of infection as direct contact with an infected person is not a necessity to become infected yourself; simply being in the firing line of a cough or sneeze is sufficient to risk catching the flu.
The economic consequences of the “flu season” can be great. The flucentre estimate that over 40,000 general practitioner (GP) visits annually in England and Wales are a result of influenza. Flu can also lead to much more severe complications which can result in hospitalisation. According to Public Health England’s annual flu reports, during the 2012/13 flu season there were 946 intensive care unit/high dependency unit admissions for flu across the UK; of those admitted 11.3% resulted in death. In addition to the direct costs to the healthcare system there are also the indirect costs to other sectors of the economy as a result of sick days away from work or other productive activities. An estimated 6 million working days are lost each year from influenza in the UK.
Cost-Effectiveness of Flu Vaccination Program
An NHS flu vaccination program has been provided to high clinical risk groups for several decades and since the year 2000, folk over 65 years of age have also been eligible for free vaccination. Most recently pregnant women have also been included as an eligible high risk group. Vaccinations are particularly useful for containing influenza outbreaks due to their positive externality effects. In other words, they not only provide protection for those who receive the vaccine but also reduce the pool of potentially infectious people which slows the spread of disease to the non-vaccinated population. Numerous studies have been conducted to estimate the cost-effectiveness of vaccination against flu. According to GSK, estimates range from ~£27,000/QALY in the UK to ~$90,000/QALY in the US. A systematic review of the cost-effectiveness of the influenza vaccine found evidence that vaccination is cost-saving in ~40% of the studies and 90% of the remaining studies found cost-effectiveness ratios below $50,000.
Vaccinating against flu is clearly a cost-effective means of preventing a flu outbreak; however vaccination only offers protection against certain strains of influenza viruses. Occasionally a new strain of flu virus, against which current vaccines provide very little protection, enters the population and can lead to a pandemic. The World Health Organisation describes a pandemic as “… the worldwide spread of a new disease. An influenza pandemic occurs when a new influenza virus emerges and spreads around the world, and most people do not have immunity”. Flu pandemics have disastrous health consequences and can lead to very high rates of mortality and morbidity. The most infamous and deadly flu pandemic was the Spanish flu outbreak in 1918 which killed millions of people worldwide.
What Can We Learn from the Ebola Outbreak?
Virus pandemics in general are particularly deadly and we are unfortunately witnessing this first hand with the Ebola virus which has already infected and killed thousands of people in parts of West Africa.The 2014 Ebola outbreak has highlighted the unfortunate fact that we cannot always rely on modern health technology to prevent widespread disease and that often returning to the basics is the best form of protection. Good hygiene and hand washing practices cannot be underestimated in their effectiveness for preventing disease. Washing hands before eating or preparing food and after coughing, sneezing or using the toilet are highly effective methods of preventing the spread of disease to others and preventing yourself from becoming infected. This may sound obvious but studies have shown that few of us actually wash our hands often or thoroughly enough.
Why Does Hand Washing Work?
You may be wondering how much a humble bar of soap really can do to prevent catching the flu or other infectious diseases. A rudimentary “Andrew wash” (so called after my brother who had a tendency for just running his hands under some water and claiming he had washed them) will remove some germs from your hands; however to effectively remove stubborn germs soap is a must. Soap particles mechanically remove germs by attaching to particles of dirt on your hands at one end (the hydrophobic end) and water on the other (the hydrophilic end) so that when hands are rinsed after lathering the dirt and germs are pulled away from the hands along with the soap it is attached to. Even washing hands with soap and water doesn’t, however, guarantee that they are washed to a suitably thorough level. It takes 15 seconds of washing to effectively remove germs; however studies have shown that people only wash their hands for an average of 6 seconds. Fifteen seconds may not sound very long but next time you wash your hands try counting how long you take and you may be surprised quite how long 15 seconds is.
Alcohol-based hand sanitizers can be a good addition to your hand washing routine for times when soap and water may not be available. However, alcohol doesn’t kill all types of viruses therefore the age-old soap and water technique is still considered the gold standard in hand hygiene. So if you are looking for a flu-free Christmas this year a few bars of soap would not go amiss as stocking fillers!