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Flu shots play an important role in protecting against bird flu. But not for the reason you might think

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> A current strain of highly pathogenic avian influenza, commonly known as bird flu, has become a global problem. The virus has affected <a href="https://www.cdc.gov/bird-flu/situation-summary/data-map-commercial.html">many millions</a> of birds, some other <a href="https://www.cdc.gov/bird-flu/situation-summary/mammals.html">animal species</a>, and a <a href="https://cdn.who.int/media/docs/default-source/influenza/avian-and-other-zoonotic-influenza/joint-fao-oie-who-preliminary-risk-assessment-associated-with-avian-influenza-a(h5n1)-virus.pdf?sfvrsn=faa6e47e_28&download=true">small number of people</a>. Last week, the Australian government <a href="https://www.sbs.com.au/news/article/australians-issued-new-health-risks-travel-warning-for-europe-asia-and-the-americas/gmh1hk9py">issued a warning</a> to residents travelling to Europe, North America, South America and Asia about the risk of bird flu. The alert, published on the <a href="https://www.smartraveller.gov.au/news-and-updates/highly-pathogenic-avian-influenza-outbreak">Smartraveller website</a>, included advice to ensure your flu vaccine is up to date. If you are about to go travelling, this generally means if you’ve had a flu jab this year, although if it has been 3–6 months since your vaccine you should discuss this with your doctor. But the seasonal flu vaccine we get each year doesn’t actually prevent bird flu in humans. So why is it being recommended in this context? <h2>Some bird flu background</h2> Smartraveller notes <a href="https://www.smartraveller.gov.au/news-and-updates/highly-pathogenic-avian-influenza-outbreak">several strains</a> of bird flu are currently circulating. The most concerning strain, called the <a href="https://www.nature.com/articles/s41467-023-38415-7">2.3.4.4b clade</a>, emerged a few years ago from a type of influenza A (H5, or A/H5) that has been circulating for several decades. Clade 2.3.4.4b primarily affects birds, including wild birds and poultry. It has had <a href="https://theconversation.com/uk-poultry-can-roam-free-outside-again-but-bird-flu-risk-hasnt-gone-away-203361">devastating effects</a> on bird populations, as well as farmers and others involved in the poultry industry. In recent years, clade 2.3.4.4b has adapted to <a href="https://www.nature.com/articles/s44298-024-00039-z">infect some mammals</a>. Unfortunately it seems to cause severe disease in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11083745/">certain animals</a>. Some marine mammals have been hit particularly hard, with mass mortality events <a href="https://www.theguardian.com/environment/2023/dec/08/mass-deaths-elephant-seals-penguins-bird-flu-antarctic-ecological-disaster-aoe">reported</a> in elephant seals and sea lions. In the United States, bird flu has also spread <a href="https://www.cdc.gov/bird-flu/situation-summary/mammals.html">among dairy cows</a>. Compared to the huge number of animal cases, there have been a relatively small number of <a href="https://www.who.int/publications/m/item/joint-fao-who-woah-preliminary-assessment-of-recent-influenza-a(h5n1)-viruses">humans infected with bird flu</a>. Since 2003, <a href="https://www.who.int/publications/m/item/cumulative-number-of-confirmed-human-cases-for-avian-influenza-a(h5n1)-reported-to-who--2003-2023--3-october-2023">878 cases</a> of A/H5N1 influenza have been reported in humans, with a small proportion of these reported since 2020 when <a href="https://www.outbreak.gov.au/emerging-risks/high-pathogenicity-avian-influenza">clade 2.3.4.4b first emerged</a>. The reported cases have been people who have had close contact with infected animals. It does not appear to spread from person to person. As such, the <a href="https://www.ecdc.europa.eu/en/infectious-disease-topics/z-disease-list/avian-influenza/threats-and-outbreaks/risk-assessment-h5">risk to travellers is low</a>. There are some situations where the risk may be greater, such as for people visiting live markets, or those who are travelling specifically to work with wildlife or animals in food production. <a href="https://www.who.int/publications/m/item/joint-fao-who-woah-preliminary-assessment-of-recent-influenza-a(h5n1)-viruses">Infections in humans</a> with H5 influenza can vary significantly in severity, from mild conjunctivitis up to fatal pneumonia. H5 influenza strains appear to be <a href="https://asm.org/articles/2024/june/what-you-should-know-about-avian-influenza-a-h5n1">sensitive to antivirals</a> (oseltamivir, also known as Tamiflu) and they are generally <a href="https://www.cdc.gov/bird-flu/hcp/novel-av-treatment-guidance/">recommended</a> as treatment for human infection, but it’s <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01307-2/fulltext">not clear</a> whether they reduce the risk of death in those with severe disease. To date, one case of A/H5 influenza (not 2.3.4.4b) has been <a href="https://www.abc.net.au/news/2024-05-22/bird-flu-avian-influenza-human-detection/103879886">reported in Australia</a>, in a child who had recently returned from overseas. While <a href="https://www.fao.org/animal-health/situation-updates/global-aiv-with-zoonotic-potential/en">clade 2.3.4.4b has been detected</a> in all continents <a href="https://www.outbreak.gov.au/emerging-risks/high-pathogenicity-avian-influenza">except Australia</a>, other avian influenza strains (A/H7) <a href="https://www.outbreak.gov.au/current-outbreaks/avian-influenza">have been reported here</a> earlier this year. <h2>Seasonal flu vaccines are not effective against bird flu</h2> Seasonal influenza refers to the flu strains that circulate each year. Since the COVID pandemic, three different strains have circulated in various proportions – influenza A H1N1 (descended from the <a href="https://www.nature.com/articles/nature08182">2009 swine flu strain</a>), influenza A H3N2 (which has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149781/">circulated since 1968</a>) and an influenza B strain. Interestingly, a second influenza B strain (the Yamagata lineage) <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2314801">appears to have vanished</a> during the COVID pandemic. Seasonal influenza vaccines contain up-to-date variants of these types (A/H1N1, A/H3N2 and B) that are recommended by the World Health Organization each year. They are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5912669/">moderately effective</a>, reducing the risk of hospitalisation by about 40–60%. Influenza vaccines are quite specific in the protection that they provide. For seasonal vaccines, even the very small changes that occur in the virus from year to year are enough to allow them to “escape” vaccine-induced immunity. Therefore seasonal flu vaccines <a href="https://www.cdc.gov.au/topics/avian-influenza-bird-flu">do not provide any protection</a> against A/H5 influenza. <h2>Preventing a hybrid bird-human strain</h2> The rationale for recommending travellers have a flu shot in the context of the current bird flu outbreak is that seasonal flu vaccines may help reduce the risk of simultaneous infection with both A/H5 and a seasonal influenza strain. When this occurs, there is potential for a “recombination” of the genetic code from both viral strains. This could have the transmissibility of a seasonal human virus with the severity of an avian influenza virus. The 2009 swine flu strain <a href="https://www.nejm.org/doi/full/10.1056/NEJMra0904322">arose from the recombination</a> of several strains over years to become more transmissible in humans. Obviously a more effective vaccine would include a H5 strain, to generate immune responses specific to the H5 flu strain. Vaccine manufacturers have <a href="https://www.ema.europa.eu/en/medicines/human/EPAR/celldemic">developed H5 vaccines</a> over the years, but to date <a href="https://thl.fi/en/-/avian-influenza-vaccinations-begin-vaccine-to-be-offered-to-persons-at-increased-risk-of-infection">only Finland</a> has deployed a H5 vaccine in a small group of people who work closely with potentially infected animals. Currently the <a href="https://www.ecdc.europa.eu/en/infectious-disease-topics/z-disease-list/avian-influenza/threats-and-outbreaks/risk-assessment-h5">level of risk</a> posed by H5 to humans is not thought to be sufficient to require a specific vaccine program, as the potential benefits are small compared to the costs and the potential risks associated with any new vaccine program. <h2>The value of a flu shot for travellers</h2> Seasonal flu vaccines protect against influenza infection, and may also reduce the risk of simultaneous infection with human and bird flu strains. Bird flu aside, for most travellers who haven’t received a flu shot this year, reducing the risk of illness disrupting travel plans should be enough of a reason to get one. For those who have already received a flu shot this season, similar to COVID jabs, protection after vaccination appears to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8499703/">wane over time</a>. So if you’re travelling to the northern hemisphere during the winter months, and it’s been more than 3–6 months since you received a flu vaccine, your doctor may recommend you have another. Bird flu is only a small risk to most travellers, but people may want to take sensible precautions, such as avoiding close contact with birds at markets.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/237859/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, Professor of Infectious Diseases, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/flu-shots-play-an-important-role-in-protecting-against-bird-flu-but-not-for-the-reason-you-might-think-237859">original article</a>. </div>

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Aussie travellers warned over bird flu outbreak

Australian travellers have been warned to be cautious after concerns about the sudden outbreak of bird flu. Strains of Avian Influenza, known as the bird flu, are circulating across the globe, with <a href="https://www.smartraveller.gov.au" target="_blank" rel="noopener">Smart Traveller</a> warning of outbreaks in Europe, North and South America and Asia. “Human infection is rare. But be aware of increased health risks when travelling to impacted countries,” the alert states. The virus typically affects birds but can be transferred to other animals before being passed on to humans. “Eggs and poultry meat are safe to eat if handled and cooked using safe food handling practices,” the alert states. Travellers have been urged to look out for signs of infection, including eye redness or irritation (conjunctivitis), fever, cough, sore throat, runny or blocked nose, muscle or body aches, fatigue, shortness of breath or difficult breathing, and pneumonia. Travellers have also been urged to minimise contact with animals in areas affected by the bird flu, avoid contact with dead or sick animals (including wild birds), and avoid poultry farms and live bird “wet” markets. While there is no specialised vaccine for bird flu, travellers have been urged to check that their other influenza vaccines are up to date before travelling. Smart Traveller states, “If you feel unwell while travelling back to Australia, tell a crew member or airport staff. Make sure to tell them about any contact with sick people or animals.” Image credits: Shutterstock

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I feel sick. How do I know if I have the flu, COVID, RSV or something else?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> You wake with a sore throat and realise you are sick. Is this going to be a two-day or a two-week illness? Should you go to a doctor or just go to bed? Most respiratory illnesses have very similar symptoms at the start: sore throat, congested or runny nose, headache, fatigue and fever. This may progress to a dry cough. Best case scenario is that you have “<a href="https://lungfoundation.com.au/wp-content/uploads/2018/09/Factsheet-Common-Cold-Mar2016.pdf">a cold</a>” (which can be any one of hundreds of viruses, most commonly rhinovirus), which is short-lived and self-limiting. But some respiratory illnesses can be much more serious. Here is a brief guide to some important bugs to know about that are circulating this winter, and how to work out which one you have. <h2>Respiratory syncytial virus (RSV)</h2> For most people an RSV infection will feel like “a cold” – annoying, but only lasting a few days. However, for babies, older adults and people with immune issues, it can lead to <a href="https://www.rch.org.au/kidsinfo/fact_sheets/bronchiolitis/">bronchiolitis</a> or pneumonia, and even become life-threatening. RSV isn’t seasonal, which means you are just as likely to get it in summer as in winter. However, it is highly contagious so we noticed it <a href="https://pubmed.ncbi.nlm.nih.gov/32986804">disappearing almost completely</a> during COVID lockdowns. There is now a <a href="https://www.tga.gov.au/sites/default/files/2024-02/covid-19-rapid-antigen-self-tests-are-approved-australia-ifu-406813.PDF">rapid-antigen test (RAT) for RSV</a> which also checks for influenza and COVID, and is the best way of finding out if RSV is what is causing symptoms. Recently, a preventative immune therapy has become available for high risk babies (<a href="https://www.schn.health.nsw.gov.au/respiratory-syncytial-virus-rsv-monoclonal-antibody-factsheet">nirsevimab</a>) and there are also <a href="https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked">vaccines for higher risk adults</a>. Nirsevimab is also available to all babies for free in <a href="https://www.health.wa.gov.au/Articles/N_R/Respiratory-syncytial-virus-RSV-immunisation">Western Australia</a> and <a href="https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/immunisation/paediatric-rsv-prevention-program">Queensland</a>. But there are no specific treatments. Adults who get it simply have to ride it out (using whatever you need to <a href="https://www.mayoclinic.org/diseases-conditions/common-cold/diagnosis-treatment/drc-20351611">manage symptoms</a>). Babies and higher risk patients need to present to an emergency department if they test positive for RSV and are also looking or feeling very unwell (this might mean rapid shallow breathing, fevers not coming down with paracetamol or ibuprofen, a baby not feeding, mottled-looking skin, or going blue around the mouth). If a patient has developed a bronchiolitis or pneumonia, they may need to be hospitalised. <h2>Influenza</h2> Once you have had the “true flu” (influenza), you will find it frustrating when people call their sniffly cold-like symptoms a “flu”. Influenza infections generally start with a sore throat and headache which quickly turns into high fevers, generalised aches and excessive fatigue. You feel like you have been hit by a truck and may struggle to get out of bed. This can last a week or more, even in people who are generally fit and healthy. Influenza is a major public health issue internationally, with 3–5 million cases of severe illness and <a href="https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)">290,000 to 650,000 respiratory deaths annually</a>. People who are at <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu">greater risk of complications</a> from influenza include pregnant women, children under five, adults aged 65 and over, First Nations peoples, and people with chronic or immunosuppressive medical conditions. For this reason, annual vaccination is <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">recommended and funded</a> for vulnerable people. Vaccination is also readily available for <a href="https://www.health.gov.au/topics/immunisation/immunisation-contacts">all Australians who want it</a>, through pharmacies as well as medical clinics, usually at a cost of less than A$30. In <a href="https://www.vaccinate.initiatives.qld.gov.au/what-to-vaccinate-against/influenza#:%7E:text=The%20flu%20vaccine%20is%20free,.qld.gov.au">some states</a>, it’s free for all residents. Influenza is seasonal, with definite peaks in the winter months. This is why vaccines are offered from early autumn. If you think you may have influenza, there are now home-testing RATs: all current influenza RATs are in combination with COVID RATs, as the symptoms overlap. Treatment for most people is to manage symptoms and try to avoid spreading it around. Doctors can also <a href="https://theconversation.com/i-think-i-have-the-flu-should-i-ask-my-gp-for-antivirals-210457">prescribe antivirals</a> to vulnerable patients; these work best if started within 48 hours of symptoms. <h2>COVID</h2> It has been less than five years since COVID-19, caused by SARS-CoV-2, started to spread around the world in pandemic proportions. Although COVID is no longer a <a href="https://www.health.gov.au/news/ahppc-statement-end-of-covid-19-emergency-response">public health emergency</a>, it still causes <a href="https://www.abs.gov.au/articles/deaths-due-covid-19-influenza-and-rsv-australia-2022-may-2024">more deaths than influenza and RSV combined</a>. Unlike RSV and influenza, only those <a href="https://www.health.gov.au/topics/covid-19/protect-yourself-and-others/high-risk-groups">aged over 70</a> are in a high-risk age group for COVID. Other <a href="https://www.cdc.gov/covid/risk-factors/?CDC_AAref_Val=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html">factors besides age</a> may put you at higher risk of becoming very unwell when infected by this virus. This includes having other respiratory diseases (such as asthma or chronic obstructive pulmonary disease, also known as COPD), diabetes, cancer, kidney disease, obesity or heart disease. Unlike most respiratory viruses, SARS-CoV-2 tends to set off inflammation beyond the respiratory system. This can involve a range of other organs including the heart, kidneys and blood vessels. Although most people are back to their usual work or study after a week or two, a significant proportion go on to experience extended symptoms such as fatigue, breathlessness, brain fog and mood changes. When these last <a href="https://aci.health.nsw.gov.au/statewide-programs/critical-intelligence-unit/post-acute-sequelae">more than 12 weeks</a>, without any other explanation for symptoms, it’s called <a href="https://www.healthdirect.gov.au/covid-19/post-covid-symptoms-long-covid">long COVID</a>. COVID vaccines can prevent serious illness and have been <a href="https://pubmed.ncbi.nlm.nih.gov/38282394/">monitored</a> for several years now for their safety and effectiveness. Current vaccination recommendations are <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024?language=en">based on age and immune status</a>. It’s worth discussing them with your doctor if you are unsure whether you would benefit or not. <a href="https://www.health.gov.au/topics/covid-19/oral-treatments">Antivirals</a> can treat COVID in higher-risk people who contract it, whether vaccinated or not. Specific advice about what to do if you test positive on a RAT will vary according to your current state guidelines and workplace, however the <a href="https://www.health.gov.au/topics/covid-19/testing-positive">general principles</a> are always: avoid spreading the virus to others, and give yourself time to rest and recover. <hr /> <iframe id="ConNR" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/ConNR/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>What if it’s not one of those?</h2> So you’ve done your combined RSV/flu/COVID RAT and the result is negative. But you still have symptoms. What else could it be? More than 200 different viruses can cause cold and flu symptoms, including rhinovirus (mentioned above), adenovirus and sometimes even <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2130424/">undefined pathogens</a>. If an illness progresses to a cough which will not go away, and/or you start coughing up sputum, this could be a bacterial infection, such as pertussis (whooping cough), streptococcus pneumoniae, haemophilus influenzae or moraxella catarrhalis. So it’s worth <a href="https://www.racgp.org.au/getattachment/0a637812-c8f0-45a2-af9c-fa215b64f8e4/attachment.aspx">getting assessed by a GP</a> who may do a chest Xray and/or <a href="https://www.rcpa.edu.au/Manuals/RCPA-Manual/Pathology-Tests/M/MCS-sputum">test your sputum</a>, particularly if they suspect pneumonia. You also may also start out with what is clearly a viral infection but then get a secondary bacterial infection later. So if you are getting more unwell over time, it’s worth getting tested, in case antibiotics will help. However, taking antibiotics for a purely viral illness will not only be useless, it can contribute to harmful <a href="https://www.nps.org.au/consumers/antibiotic-resistance-the-facts">antibiotic resistance</a> and give you unwanted side effects.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234266/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-feel-sick-how-do-i-know-if-i-have-the-flu-covid-rsv-or-something-else-234266">original article</a>. </div>

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Are you up to date with your COVID, flu and other shots? It might depend on who your GP is

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/anika-stobart-1014358">Anika Stobart</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Too many older Australians are <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">missing out</a> on recommended vaccinations for COVID, flu, shingles and pneumococcal that can protect them from serious illness, hospitalisation and even death. A new <a href="https://grattan.edu.au/">Grattan Institute report</a> shows vaccination rates vary widely from GP to GP, highlighting an important place to look for opportunities to boost vaccination. Many people get vaccinated at pharmacies, and those vaccinations are counted in our analysis. But we looked at GPs because they have a unique role overseeing someone’s health care, and an important role promoting vaccination. We found that for some GPs, nine in ten of their older patients were vaccinated for flu. For others, the rate was only four in ten. The differences for shingles and COVID were even bigger. For pneumococcal disease, there was a 13-fold difference in GPs’ patient vaccination rates. While some variation is inevitable, these differences are large, and they result in too many people missing out on recommended vaccines. <h2>Some GPs treat more complex patients</h2> A lot of these differences reflect the fact that GPs see different types of patients. Our research shows older people who aren’t proficient in English are up to 15% less likely to be vaccinated, even after other factors are taken into account. And the problem seems to be getting worse. COVID vaccination rates for people 75 years and older fell to just 36% in May 2024. But rates were even lower – a mere 11% – for people who don’t speak English proficiently, and 15% for those who speak a language other than English at home. Given these results, it’s no surprise that GPs with fewer patients who are vaccinated also have more patients who struggle with English. For GPs with the lowest vaccination rates, one-quarter of their patients aren’t proficient in English. For GPs with the highest vaccination rates, it is only 1%. GPs with fewer vaccinated patients also saw more people who live in rural areas, are poorer, didn’t go to university, and don’t have regular access to a GP, all of which reduce the likelihood of getting vaccinated. Many of these barriers to vaccination are difficult for GPs to overcome. They point to structural problems in our health system, and indeed our society, that go well beyond vaccination. But GPs are also a key part of the puzzle. A <a href="https://www.ijidonline.com/article/S1201-9712(14)01379-4/fulltext">strong</a> <a href="https://www.tandfonline.com/doi/full/10.1080/21645515.2020.1780848">recommendation</a> from a GP can make a big difference to whether a patient gets vaccinated. <a href="https://www.aihw.gov.au/reports/primary-health-care/general-practice-allied-health-primary-care">Nearly all</a> older Australians visit a GP every year. And some GPs have room for improvement. <h2>But GPs seeing similar patients can have very different vaccination rates</h2> We compared GPs whose patients had a similar likelihood of being vaccinated, based on a range of factors including their health, wealth and cultural background. Among the GPs whose patients were least likely to get a flu vaccination, some saw less than 40% of their patients vaccinated, while for others in that group, the rate was over 70%. Among GPs with patients who face few barriers to vaccination, the share of their patients who were vaccinated also varied widely. Even within neighbourhoods, GP patient vaccination rates vary a lot. For example, in Bankstown in Sydney, there was a seven-fold difference in COVID vaccination rates and an 18-fold difference for pneumococcal vaccination. Not everything about clinics and patients can be measured in data, and there will be good reasons for some of these differences. But the results do suggest that some GPs are beating the odds to overcome patient barriers to getting vaccinated, while other GPs could be doing more. That should trigger focused efforts to raise vaccination rates where they are low. <h2>So what should governments do?</h2> A comprehensive national reform agenda is <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">needed to increase adult vaccination</a>. That includes clearer guidance, national advertising campaigns, SMS reminders, and tailored local programs that reach out to communities with very low levels of vaccination. But based on the big differences in GPs’ patient vaccination rates, Australia also needs a three-pronged plan to help GPs lift older Australians’ vaccination rates. First, the way general practice is funded needs to be overhauled, providing more money for the GPs whose patients face higher barriers to vaccination. Today, clinics with patients who are poorer, sicker and who struggle with English tend to get less funding. They should get more, so they can spend more time with patients to explain and promote vaccination. Second, GPs need to be given data, so that they can easily see how their vaccination rates compare to GPs with similar patients. And third, Primary Health Networks – which are responsible for improving primary care in their area – should give clinics with low vaccination rates the help they need. That might include running vaccination sessions, sharing information about best practices that work in similar clinics with higher vaccination rates, or offering translation support. And because pharmacies also play an important role in promoting and providing vaccines, governments should give them data too, showing how their rates compare to other pharmacies in their area, and support to boost vaccination uptake. These measures would go a long way to better protect some of the most vulnerable in our society. Governments have better data than ever before on who is missing out on vaccinations – and other types of health care. They shouldn’t miss the opportunity to target support so that no matter where you live, what your background is, or which GP or pharmacy you go to, you will have the best chance of being protected against disease.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234175/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, Program Director, Health and Aged Care, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/anika-stobart-1014358">Anika Stobart</a>, Senior Associate, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/are-you-up-to-date-with-your-covid-flu-and-other-shots-it-might-depend-on-who-your-gp-is-234175">original article</a>. </div>

Body

What’s the difference between ‘man flu’ and flu? Hint: men may not be exaggerating

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/thea-van-de-mortel-1134101">Thea van de Mortel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> The term “man flu” takes a <a href="https://www.oxfordlearnersdictionaries.com/definition/english/man-flu">humorous poke</a> at men with minor respiratory infections, such as colds, who supposedly exaggerate their symptoms. According to the stereotype, a man lies on the sofa with a box of tissues. Meanwhile his female partner, also with a snotty nose, carries on working from home, doing the chores and looking after him. But is man flu real? Is there a valid biological reason behind men’s symptoms or are men just malingering? And how does man flu differ from flu? <h2>What are the similarities?</h2> Man flu could refer to a number of respiratory infections – a cold, flu, even a mild case of COVID. So it’s difficult to compare man flu with flu. But for simplicity, let’s say man flu is actually a cold. If that’s the case, man flu and flu have some similar features. Both are caused by viruses (but different ones). Both are improved with rest, fluids, and if needed painkillers, throat lozenges or decongestants to <a href="https://activities.nps.org.au/nps-order-form/Resources/NPS-Cold-and-Flu-Brochure-May-2014.pdf">manage symptoms</a>. Both <a href="https://www.cdc.gov/flu/symptoms/coldflu.htm">can share</a> similar symptoms. Typically, more severe symptoms such as fever, body aches, violent shivering and headaches are more common in flu (but sometimes occur in colds). Meanwhile sore throats, runny noses, congestion and sneezing are more common in colds. A cough is common in both. <h2>What are the differences?</h2> <a href="https://www.cdc.gov/flu/about/keyfacts.htm">Flu</a> is a more serious and sometimes fatal respiratory infection caused by the influenza virus. Colds are caused by various viruses such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553670/">rhinoviruses</a>, <a href="https://www.cdc.gov/adenovirus/about/?CDC_AAref_Val=https://www.cdc.gov/adenovirus/symptoms.html">adenoviruses</a>, and common cold <a href="https://journals.lww.com/pidj/citation/2022/03000/proving_etiologic_relationships_to_disease_.18.aspx">coronaviruses</a>, and are rarely serious. Colds tend to <a href="https://www.cdc.gov/flu/symptoms/coldflu.htm">start gradually</a> while flu tends to start abruptly. Flu can be <a href="https://www.cdc.gov/flu/professionals/diagnosis/overview-testing-methods.htm">detected</a> with laboratory or at-home tests. Man flu is not an official diagnosis. Severe flu symptoms may be prevented with <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm">a vaccine</a>, while cold symptoms cannot. Serious flu infections may also be <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/racf-antiviral-treatments-and-prophylaxis.aspx">prevented or treated</a> with antiviral drugs such as Tamiflu. There are no antivirals for colds. <h2>OK, but is man flu real?</h2> Again, let’s assume man flu is a cold. Do men really have worse colds than women? The picture is complicated. <a href="https://www.sciencedirect.com/science/article/pii/S0022399922003324?via%3Dihub">One study</a>, with the title “Man flu is not a thing”, did in fact show there were differences in men’s and women’s symptoms. This study looked at symptoms of acute rhinosinusitis. That’s inflammation of the nasal passages and sinuses, which would explain a runny or stuffy nose, a sinus headache or face pain. When researchers assessed participants at the start of the study, men and women had similar symptoms. But by days five and eight of the study, women had fewer or less-severe symptoms. In other words, women had recovered faster. But when participants rated their own symptoms, we saw a somewhat different picture. Women rated their symptoms worse than how the researchers rated them at the start, but said they recovered more quickly. All this suggests men were not exaggerating their symptoms and did indeed recover more slowly. It also suggests women feel their symptoms more strongly at the start. <h2>Why is this happening?</h2> It’s not straightforward to tease out what’s going on biologically. There are <a href="https://www.nature.com/articles/nri.2016.90">differences</a> in immune responses between men and women that provide a plausible reason for worse symptoms in men. For instance, women generally produce antibodies more efficiently, so they <a href="https://www.nature.com/articles/nri.2016.90">respond more effectively</a> to vaccination. Other aspects of women’s immune system also appear to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2735332/">work more strongly</a>. So why do women tend to have <a href="https://www.nature.com/articles/nri.2016.90">stronger immune responses</a> overall? That’s probably partly because women have two X chromosomes while men have one. X chromosomes carry important <a href="https://www.nature.com/articles/nri.2016.90#Tab3">immune function genes</a>. This gives women the benefit of immune-related genes from two different chromosomes. Oestrogen (the female sex hormone) also seems to <a href="https://www.nature.com/articles/nri.2016.90">strengthen</a> the immune response, and as levels vary throughout the lifespan, so does <a href="https://www.science.org/doi/10.1126/sciimmunol.aan2946">the strength</a> of women’s immune systems. Men are certainly more likely to die from some infectious diseases, such as <a href="https://www.aihw.gov.au/reports/life-expectancy-deaths/deaths-in-australia/contents/covid-10-deaths">COVID</a>. But the picture is less clear with other infections such as the flu, where the incidence and mortality between men and women <a href="https://iris.who.int/bitstream/handle/10665/44401/9789241500111_eng.pdf?sequence=1&isAllowed=y">varies widely</a> between countries and particular flu subtypes and outbreaks. Infection rates and outcomes in men and women can also depend on the way a virus is <a href="https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2021.712688/full">transmitted</a>, the person’s age, and social and behavioural factors. For instance, women seem to be more likely to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077589/#R20">practice protective behaviours</a> such as washing their hands, wearing masks or avoiding crowded indoor spaces. Women are also <a href="https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-016-0440-0">more likely</a> to seek medical care when ill. <h2>So men aren’t faking it?</h2> Some evidence suggests men are not over-reporting symptoms, and may take longer to clear an infection. So they may experience man flu more harshly than women with a cold. So cut the men in your life some slack. If they are sick, gender stereotyping is unhelpful, and may discourage men from seeking medical advice.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231161/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/thea-van-de-mortel-1134101">Thea van de Mortel</a>, Professor, Nursing, School of Nursing and Midwifery, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-man-flu-and-flu-hint-men-may-not-be-exaggerating-231161">original article</a>. </div>

Body

"Worst nightmare": Teen dies one day after flu diagnosis

William Jones was complaining of a sore throat and cough last month and when his mum called the doctor, they were told that it was most likely the flu. However, the following morning when Rebecca Rollason went to check on her 16-year-old son, he was found unresponsive in his bed in their Wellington home. "We ask ourselves how what started as a sore throat, snotty nose and a cough on Tuesday to no longer with us three days later," the grieving mum told the NZ Herald. "No one understands, we don't know what happened... it feels like the worst nightmare that we cannot wake from." Rollason explained that her family have to "wait for results" in hopes of understanding what happened and how the teenager, who was barely sick, passed away so suddenly. "We just don’t understand how this can happen to a boy who was barely ever sick and was very healthy," she said. "It is an incredibly hard and devastating time for us." A family friend has helped set up a <a href="https://givealittle.co.nz/cause/rebecca-lost-her-son-william-last-friday" target="_blank" rel="noopener">fundraising page</a> to help relieve the financial pressure on her and William's two brothers while they grieve. "It is every parents worst nightmare and a shocking tragedy to lose a healthy child from a sudden and brief illness," a statement from the fundraising page read. "The money will help the family with funeral costs and ease Financial burden while they grieve and come to terms with Williams passing." On July 1 they shared an update on the fundraising page, saying: "Rebecca and family would like all to know that are incredibly grateful for all the support and kindness." Image: Givealittle

Caring

Bird strike: what happens when a plane collides with a bird?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/doug-drury-1277871">Doug Drury</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> Late last night, Virgin Australia flight VA 148 set out from Queenstown in New Zealand bound for Melbourne. Not long after takeoff, the right engine of the Boeing 737-800 jet started <a href="https://www.sbs.com.au/news/article/virgin-australia-flight-makes-emergency-landing-after-engine-catches-fire/iquv5w1is">emitting loud bangs</a>, followed by flames. The pilot flew on with the remaining engine, bringing the plane’s 73 passengers and crew to a safe emergency landing at nearby Invercargill airport. Virgin Australia says the dramatic turn of events was caused by a “possible bird strike”. Queenstown Airport <a href="https://www.theaustralian.com.au/business/aviation/bird-strike-blamed-for-fiery-virgin-australia-emergency-out-of-queenstown/news-story/9ef5c57829d0535baed223d2caf0b55f">played down</a> the likelihood of bird strike, saying “no birds were detected on the airfield at that time”. While we don’t know exactly what happened, bird strike is a common and real risk for aircraft. It can damage planes, and even lead to deaths. <h2>How common are bird strikes?</h2> A bird strike is a <a href="https://skyaviationholdings.com/bird-strikes-on-planes/">collision between</a> an aircraft and a bird. (Though the definition is sometimes expanded to include <a href="https://aawhg.org/">collisions on the ground</a> with land animals including deer, rabbits, dogs and alligators.) The <a href="https://digitalcommons.unl.edu/icwdm_usdanwrc/1459/">first bird strike</a> was recorded by Orville Wright in 1905, over a cornfield in Ohio. Now they happen every day, with some seasonal variability due to the <a href="https://www.faa.gov/air_traffic/publications/atpubs/aim_html/chap7_section_5.html">migratory patterns</a> of birds. Perhaps the most famous migratory bird strike occurred in 2009, when <a href="https://en.wikipedia.org/wiki/US_Airways_Flight_1549">US Airways Flight 1549</a> encountered a flock of migrating Canadian geese shortly after taking off from LaGuardia Airport in New York. Both of the plane’s engines failed, and captain Sully Sullenberger was forced to pilot it to an unpowered landing in the Hudson River. Between 2008 and 2017, the Australian Transport Safety Board recorded <a href="https://www.atsb.gov.au/publications/2018/ar-2018-035">16,626 bird strikes</a>. In America, the Federal Aviation Administration reported <a href="https://www.washingtonpost.com/travel/2023/04/25/bird-strike-plane-american-airlines/">17,200 bird strikes</a> in 2022 alone. <h2>Where do bird strikes happen, and what are the effects?</h2> According to the <a href="https://www.icao.int/Pages/default.aspx">International Civil Aviation Organization</a>, 90% of bird strikes happen near airports. In general, this is while aircraft are taking off or landing, or flying at lower altitudes where most bird activity occurs. The effect of bird strike depends on many factors including the type of aircraft. Outcomes may include shutting down an engine, as may have happened with the Virgin Australia flight. This plane was a Boeing 737-800, which has the capability to fly on a single engine to an alternate airport. In smaller aircraft, particularly single-engine aircraft, bird strikes can be fatal. Since 1988, <a href="https://aawhg.org/#:%7E:text=The%20majority%20happen%20at%20low,billion%20in%20aircraft%20damage%20annually.">262 bird strike fatalities</a> have been reported globally, and 250 aircraft destroyed. <h2>How do manufacturers and pilots defend against bird strike?</h2> Most <a href="https://aawhg.org/">bird strikes</a> occur early in the morning or a sunset when birds are most active. Pilots are trained to be vigilant during these times. Radar can be used to <a href="https://detect-inc.com/aircraft-birdstrike-avoidance-radar/?gad_source=1&gclid=Cj0KCQjwvb-zBhCmARIsAAfUI2ullN-s0MdDfzV2Hu9fLfdr8pKQCuyZWsoJfRN2W5s-tSm6Vo0wHgwaAgBMEALw_wcB">track flocks of birds</a>. However, this technology is ground-based and not available worldwide so it can’t be used everywhere. The two largest manufacturers of passenger jets, Boeing and Airbus, use <a href="https://aerospaceengineeringblog.com/jet-engine-design/">turbofan engines</a>. These use a series of fan blades to compress air before adding fuel and flame to get the thrust needed to take off. <figure><iframe src="https://www.youtube.com/embed/lgspIiTFWIk?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Engine manufacturers test how well they are likely to stand up to a bird strike.</figcaption></figure> Bird strike in one of these engines can cause severe damage to the fan blades, causing the engine to fail. Engine manufacturers test the safety of these engines by firing <a href="https://www.aerospacetestinginternational.com/news/engine-testing/faa-proposes-new-engine-test-for-bird-ingestion.html">a high-speed frozen chicken</a> at them while the engine is operating at full thrust. The Australian Government’s Civil Aviation Safety Authority <a href="https://www.casa.gov.au/wildlife-hazard-management">circular on wildlife hazard management</a> outlines what airports should do to keep birds and animals away from the vicinity of the airport. One technique is to use small gas explosions to mimic the sound of a shotgun to deter birds from loitering near the runway. In areas with high bird populations, airports may also use certain grasses and plants that do not attract the birds.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/232702/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/doug-drury-1277871">Doug Drury</a>, Professor/Head of Aviation, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/bird-strike-what-happens-when-a-plane-collides-with-a-bird-232702">original article</a>. </div>

Travel Trouble

With all this bird flu around, how safe are eggs, chicken or milk?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/enzo-palombo-249510">Enzo Palombo</a>, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> Recent outbreaks of bird flu – in <a href="https://www.cdc.gov/flu/avianflu/avian-flu-summary.htm">US dairy herds</a>, <a href="https://www.abc.net.au/news/rural/2024-06-04/third-victorian-poultry-farm-declares-outbreak-avian-influenza/103932694">poultry farms in Australia</a> and elsewhere, and <a href="https://theconversation.com/bird-flu-is-hitting-australian-poultry-farms-and-the-first-human-case-has-been-reported-in-victoria-heres-what-we-know-230691">isolated cases</a> <a href="https://www.statnews.com/2024/05/30/bird-flu-third-case-human-infection-caused-respiratory-symptoms/">in humans</a> – have raised the issue of food safety. So can the virus transfer from infected farm animals to contaminate milk, meat or eggs? How likely is this? And what do we need to think about to minimise our risk when shopping for or preparing food? <h2>How safe is milk?</h2> Bird flu (or avian influenza) is a bird disease caused by specific types of influenza virus. But the virus can also infect cows. <a href="https://www.cdc.gov/flu/avianflu/avian-flu-summary.htm">In the US</a>, for instance, to date more than 80 dairy herds in at least nine states have been infected with the H5N1 version of the virus. Investigations are <a href="https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/livestock">under way</a> to confirm how this happened. But we do know infected birds can shed the virus in their saliva, nasal secretions and faeces. So bird flu can potentially contaminate animal-derived food products during processing and manufacturing. Indeed, fragments of bird flu genetic material (RNA) were found in <a href="https://theconversation.com/how-bird-flu-virus-fragments-get-into-milk-sold-in-stores-and-what-the-spread-of-h5n1-in-cows-means-for-the-dairy-industry-and-milk-drinkers-228689">cow’s milk</a> from the dairy herds associated with <a href="https://www.statnews.com/2024/05/30/bird-flu-third-case-human-infection-caused-respiratory-symptoms/">infected US farmers</a>. However, the spread of bird flu among cattle, and possibly to humans, is likely to have been caused through contact with <a href="https://www.agriculturedive.com/news/contaminated-milk-equipment-potential-source-of-bird-flu-spread-to-cattle/712555/">contaminated milking equipment</a>, not the milk itself. The test used to detect the virus in milk – which uses similar PCR technology to lab-based COVID tests – is also highly sensitive. This means it can detect very low levels of the bird flu RNA. But the test does not distinguish between live or inactivated virus, just that the RNA is present. So from this test alone, we cannot tell if the virus found in milk is infectious (and capable of infecting humans). Does that mean milk is safe to drink and won’t transmit bird flu? Yes and no. In Australia, where bird flu has not been reported in dairy cattle, the answer is yes. It is safe to drink milk and milk products made from Australian milk. In the US, the answer depends on whether the milk is <a href="https://www.sciencedirect.com/science/article/abs/pii/B978184569216250013X?via%3Dihub">pasteurised</a>. We know pasteurisation is a common and reliable method of destroying concerning microbes, including influenza virus. Like most viruses, influenza virus (including bird flu virus) is inactivated by heat. Although there is little direct research on whether pasteurisation inactivates H5N1 in milk, we can extrapolate from what we know about heat inactivation of H5N1 in <a href="https://www.sciencedirect.com/science/article/pii/S0362028X22060732?via%3Dihub">chicken</a> and <a href="https://www.mdpi.com/2036-7481/13/4/60">eggs</a>. So we can be confident there is no risk of bird flu transmission via pasteurised milk or milk products. However, it’s another matter for unpasteurised or “raw” US milk or milk products. A recent <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2405495">study</a> showed mice fed raw milk contaminated with bird flu developed signs of illness. So to be on the safe side, it would be advisable to avoid raw milk products. <h2>How about chicken?</h2> Bird flu has caused sporadic outbreaks in wild birds and domestic poultry worldwide, including <a href="https://theconversation.com/bird-flu-is-hitting-australian-poultry-farms-and-the-first-human-case-has-been-reported-in-victoria-heres-what-we-know-230691">in Australia</a>. In recent weeks, there have been <a href="https://www.abc.net.au/news/rural/2024-06-04/third-victorian-poultry-farm-declares-outbreak-avian-influenza/103932694">three reported outbreaks</a> in <a href="https://agriculture.vic.gov.au/biosecurity/animal-diseases/poultry-diseases/avian-influenza-bird-flu#h2-0">Victorian poultry farms</a> (two with H7N3 bird flu, one with H7N9). There has been <a href="https://www.abc.net.au/news/rural/2024-05-23/bird-flu-detected-western-australia-chicken-farm/103880002">one</a> reported outbreak in <a href="https://www.agric.wa.gov.au/livestock-biosecurity/avian-influenza">Western Australia</a> (H9N2). The strains of bird flu identified in the Victorian and Western Australia outbreaks can cause human infection, although these <a href="https://agriculture.vic.gov.au/biosecurity/animal-diseases/poultry-diseases/avian-influenza-bird-flu#h2-8">are rare</a> and typically result from close contact with infected live birds or <a href="https://www.who.int/emergencies/situations/avian-influenza-a-(h7n9)-virus-outbreak">contaminated environments</a>. Therefore, the chance of bird flu transmission in chicken meat is remote. Nonetheless, it is timely to remind people to handle chicken meat with caution as many dangerous pathogens, such as Salmonella and Campylobacter, can be found on chicken carcasses. Always handle chicken meat carefully when shopping, transporting it home and storing it in the kitchen. For instance, make sure no meat juices cross-contaminate other items, consider using a cool bag when transporting meat, and refrigerate or freeze the meat within two hours. <a href="https://theconversation.com/no-you-shouldnt-wash-raw-chicken-before-cooking-it-so-why-do-people-still-do-it-192723">Avoid washing your chicken</a> before cooking to prevent the spread of disease-causing microbes around the kitchen. Finally, cook chicken thoroughly as viruses (including bird flu) <a href="https://www.sciencedirect.com/science/article/pii/S0362028X22060732?via%3Dihub">cannot survive</a> cooking temperatures. <h2>Are eggs safe?</h2> The recent Australian outbreaks have occurred in egg-laying or mixed poultry flocks, so concerns have been raised about bird flu transmission via contaminated chicken eggs. Can flu viruses contaminate chicken eggs and potentially spread bird flu? It appears so. A <a href="https://www.sciencedirect.com/science/article/pii/S0196655306011862?via%3Dihub">report</a> from 2007 said it was feasible for influenza viruses to enter through the eggshell. This is because influenza virus particles are smaller (100 nanometres) than the pores in eggshells (at least 200 nm). So viruses could enter eggs and be protected from cleaning procedures designed to remove microbes from the egg surface. Therefore, like the advice about milk and meat, cooking eggs is best. The <a href="https://www.fda.gov/food/egg-guidance-regulation-and-other-information/questions-and-answers-regarding-safety-eggs-during-highly-pathogenic-avian-influenza-outbreaks">US Food and Drug Administration</a> recommends cooking poultry, eggs and other animal products to the proper temperature and preventing cross-contamination between raw and cooked food. <h2>In a nutshell</h2> If you consume pasteurised milk products and thoroughly cook your chicken and eggs, there is nothing to worry about as bird flu is inactivated by heat. The real fear is that the virus will evolve into highly pathogenic versions that can be transmitted from <a href="https://theconversation.com/bird-flu-is-hitting-australian-poultry-farms-and-the-first-human-case-has-been-reported-in-victoria-heres-what-we-know-230691">human to human</a>. That scenario is much more frightening than any potential spread though food.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231280/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/enzo-palombo-249510">Enzo Palombo</a>, Professor of Microbiology, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/with-all-this-bird-flu-around-how-safe-are-eggs-chicken-or-milk-231280">original article</a>. </div>

Food & Wine

Molly the magpie carers rescue another native bird

Molly the Magpie's carers have rescued another native bird. Juliette Wells and Reece Mortensen, who went viral for the interspecies friendship between their two staffies and a magpie named Molly, shared the update on Facebook. “Meet Charlie the vulnerable little kookaburra,” the family wrote on Tuesday. The Mortensen's explained that Charlie had been in their care since the new year period, after a neighbour discovered him unable to fly following wild weather. “He was found by neighbours huddling at the bottom of a tree, they watched for a day and he was all alone and too young to face the world with many dangers around including a stray cat ready for its next feed we were called over to check out the situation,” they wrote. “Reece was in training for his wildlife licence so with the direction and support of wildlife carers specialising in kookaburras we were able to bring this little kookaburra back to our place.” Unlike Molly who developed a special bond with the family's dogs, Charlie was rehabilitated outside, with his own kin watching over him. “We kept him outside as much as possible so the kookaburras knew exactly where he was and could come in and feed him which they did,” they explained. “At times we would count 14 kookaburras keeping an eye on this little one. He would try to fly and achieved short distances but needed practice with his landing.” The family shared the update after Charlie “found the confidence” to return to the wild. “It was such an exciting thing to witness and to be part of,” the family wrote. It has been a wild year for the Queensland family, after Molly was <a href="https://www.oversixty.com.au/lifestyle/family-pets/outcry-after-authorities-seize-internet-famous-magpie-from-queensland-family" target="_blank" rel="noopener">voluntarily surrendered </a>to the Queensland Department of Environment, Science and Innovation in March, when authorities found the couple were not permitted to care for native wildlife. Over a month later, the Department of Environment, Science and Innovation (DESI) announced that they would return Molly to the family with a few special conditions, including obtaining a license and meeting specific requirements to ensure her ongoing health and wellbeing. The reunion was definitely one to remember with followers and animal lovers across the country over-joyed at the <a href="https://www.oversixty.com.au/lifestyle/family-pets/first-pics-of-molly-the-magpie-reunion" target="_blank" rel="noopener">reunion</a>. Images: Facebook

Family & Pets

Too many Australians aren’t getting a flu vaccine. Why, and what can we do about it?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/holly-seale-94294">Holly Seale</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Australia’s childhood immunisation program gets very good uptake every year – <a href="https://www.health.gov.au/topics/immunisation/immunisation-data/childhood-immunisation-coverage">almost 94% of five-year-olds</a> have had all their routine vaccinations. But our influenza vaccine coverage doesn’t get such a good report card. Looking back over <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/historical-national-influenza-vaccination-coverage-end-year-age">recent years</a>, for kids aged six months to five years, we saw a peak in flu vaccine coverage at the beginning of the COVID pandemic at 46%, which then declined to 30% by the 2023 season. While we’re still relatively early in the 2024 flu season, only <a href="https://ncirs.org.au/influenza-vaccination-coverage-data">7% of children</a> under five have received their flu shot this year so far. Although young children are a particular concern, flu vaccination rates appear to be lagging for the population as a whole. Reports indicate that <a href="https://www.abc.net.au/news/2024-05-07/calls-to-vaccinate-young-children-against-flu-as-season-begins/103783508">from March 1 to April 28</a>, 16% fewer people were vaccinated against the flu compared with the same period last year. So what’s going on, and what can we do to boost uptake? <h2>Why do we vaccinate kids against the flu?</h2> Last year, <a href="https://www.health.gov.au/sites/default/files/2023-12/aisr-2023-national-influenza-season-summary.pdf">reported cases of flu</a> were highest in children aged five to nine, followed by those aged zero to four. This is not a new trend – we record a high number of flu cases and hospital admissions in kids every year. So far <a href="https://nindss.health.gov.au/pbi-dashboard/">this year</a> children aged zero to four have had the highest number of infections, marginally ahead of five- to nine-year-olds. While kids are more likely to catch and spread the flu, they’re also <a href="https://theconversation.com/kids-are-more-vulnerable-to-the-flu-heres-what-to-look-out-for-this-winter-117748">at greater risk</a> of getting very sick from it. This particularly applies to children under five, and the flu vaccine is available for free for this age group. The flu vaccine isn’t perfect – it may not prevent infections entirely – but it’s definitely our best chance of protection. Research has shown influenza-related visits to the GP were <a href="https://pubmed.ncbi.nlm.nih.gov/27577556/">more than halved</a> in vaccinated children compared with unvaccinated children. <h2>So why are kids not receiving the vaccine?</h2> Often, it comes down to misunderstandings about who is eligible for the vaccine or whom it’s recommended for. But we can address this issue by nudging people via <a href="https://www.annfammed.org/content/15/6/507?sf174332549=1">a text message reminder</a>. Some parents <a href="https://www.sciencedirect.com/science/article/pii/S0264410X17318285">report concerns</a> about the vaccine, including the old dogma that it can cause the flu. The flu vaccine <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/flu-influenza-immunisation">can’t give you the flu</a> because it doesn’t contain live virus. Unfortunately, that myth is really sticky. For <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.15235">some parents</a>, the challenge can be forgetting to book or accessing an appointment. <h2>It’s not just kids at higher risk</h2> Adults aged 65 and over are also <a href="https://theconversation.com/im-over-65-and-worried-about-the-flu-which-vaccine-should-i-have-204810">more vulnerable</a> to the flu, and can receive a <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">free vaccine</a>. For this group, we usually get around <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/historical-national-influenza-vaccination-coverage-end-year-age">65% vaccinated</a>. So far this year, <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/national-influenza-vaccination-coverage-all-people-age-group">around 35%</a> of over-65s have received their flu vaccine. Aboriginal and Torres Strait Islander people are likewise eligible for a free flu vaccine. While previously coverage rates were higher among Aboriginal and Torres Strait Islander peoples compared to the overall population, this gap has narrowed. There’s even some movement backwards, especially <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/historical-national-influenza-vaccination-coverage-end-year-age">in younger age groups</a>. The flu vaccine is also free for pregnant women and anyone who has <a href="https://www.health.gov.au/topics/immunisation/when-to-get-vaccinated/immunisation-for-people-with-medical-risk-conditions">a medical condition</a> such as heart disease, chronic lung disease, diabetes or kidney disease. Past studies have found flu vaccine coverage <a href="https://www.phrp.com.au/wp-content/uploads/2022/06/PHRP31232111.pdf">for pregnant women</a> varies around the country from 39% to 76% (meaning in some jurisdictions up to 60% of pregnant women are not getting vaccinated). When it comes to adults with chronic health conditions, we don’t have a good sense of how many people receive the vaccine. The reasons adults don’t always get the flu vaccine overlap with the reasons for children. Often <a href="https://www.tandfonline.com/doi/full/10.1080/08870446.2021.1957104">concerns about side effects</a> are cited as the reason for not getting vaccinated, followed by time constraints. We also know <a href="https://www.aihw.gov.au/reports/primary-health-care/coordination-of-health-care-experiences-barriers/summary">accessing medical services</a> can be difficult for some people, such as those living in rural areas or experiencing financial hardship. <h2>Filling the gaps</h2> In Australia, GPs offer flu vaccines for all ages, while flu vaccination is also available at pharmacies, generally from age five and up. While some people make a conscious decision not to get themselves or their children vaccinated, for many people, the barriers are related to access. Programs offering vaccination outside the doctor’s office are increasing globally, and may assist in <a href="https://www.tandfonline.com/doi/full/10.1080/14760584.2019.1698955">filling gaps</a>, especially among those who don’t have regular access to a GP. For some people, their only point of contact with the <a href="https://pubmed.ncbi.nlm.nih.gov/34272104/">medical system</a> may be during emergency department visits. Others may have more regular contact with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046372/">specialist</a> who coordinates their medical care, rather than a GP. Offering vaccine education and programs <a href="https://journals.sagepub.com/doi/10.1177/0009922810374353">in these settings</a> has been shown to improve immunisation rates and may play a pivotal role in filling access gaps. Outside medical and pharmacy settings, the workplace is the most common place for Australian adults to receive their flu vaccine. A <a href="https://www.sciencedirect.com/science/article/pii/S1326020023004272">survey</a> showed Australian adults find workplace vaccination convenient and cost-effective, especially where free or subsidised vaccines are offered. Expanding vaccination settings, such as with <a href="https://journals.sagepub.com/doi/10.1177/19375867221087360?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">drive-through</a> and mobile clinics, can benefit groups who have unique access barriers or are under-served. Meanwhile, offering vaccination through faith-based organisations has been shown to improve uptake among <a href="https://pubmed.ncbi.nlm.nih.gov/37013523/">racial and ethnic minority groups</a>. Eleftheria Lentakis, a masters student at the School of Population Health at UNSW Sydney, contributed to this article.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/229477/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/holly-seale-94294">Holly Seale</a>, Associate Professor, School of Population Health, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/too-many-australians-arent-getting-a-flu-vaccine-why-and-what-can-we-do-about-it-229477">original article</a>. </div>

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There are new flu vaccines on offer for 2024. Should I get one? What do I need to know?

<a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Influenza is a common respiratory infection. Although most cases are relatively mild, flu can cause more severe illness in young children and older people. Influenza virtually <a href="https://pubmed.ncbi.nlm.nih.gov/33243355/">disappeared</a> from Australia during the first years of the COVID-19 pandemic when public health restrictions reduced contact between people. Since 2022, it has returned to a seasonal pattern, although the flu season has started and peaked a few months earlier than before 2020. It’s difficult to predict the intensity of the flu season at this point in the year, but we can sometimes get clues from the northern hemisphere. There, the season <a href="https://www.who.int/tools/flunet">started</a> <a href="https://gis.cdc.gov/grasp/fluview/flu_by_age_virus.html">earlier</a> than usual for the third year running (peaking in early January rather than late February/March), with a similar number of reported cases and hospitalisations to the previous year. Influenza vaccines are recommended annually, but there are now an increasing number of different vaccine types. Here’s what to know about this year’s shots, available from <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">this month</a>. <h2>What goes into a flu vaccine?</h2> Like other vaccines, influenza vaccines work by “training” the immune system on a harmless component of the influenza virus (known as an antigen), so it can respond appropriately when the body encounters the real virus. Influenza strains are constantly changing due to genetic mutation, with the pace of genetic change <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10421855">much higher</a> than for SARS-CoV-2 (the virus that causes COVID). The strains that go into the vaccine are <a href="https://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations">reviewed</a> twice each year by the World Health Organization (WHO), which selects vaccine strains to match the next season’s predicted circulating strains. All current influenza vaccines in <a href="https://www.tga.gov.au/resources/publication/meeting-statements/aivc-recommendations-composition-influenza-vaccines-australia-2024">Australia</a> contain four different strains (known as quadrivalent vaccines). One of the strains appeared to <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2314801">disappear</a> during the COVID pandemic, and the WHO has recently <a href="https://cdn.who.int/media/docs/default-source/influenza/who-influenza-recommendations/vcm-southern-hemisphere-recommendation-2024/202309_qanda_recommendation.pdf?sfvrsn=7a6906d1_5">recommended</a> dropping this strain from the vaccine. It’s expected trivalent (three strain) vaccines will become available in the near future. <h2>What’s different about new flu vaccines?</h2> There are eight brands of flu vaccines <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">available</a> in Australia in 2024. These include egg-based vaccines (Vaxigrip Tetra, Fluarix Tetra, Afluria Quad, FluQuadri and Influvac Tetra), cell-based vaccines (Flucelvax Quad), adjuvanted vaccines (Fluad Quad) and high-dose vaccines (Fluzone High-Dose Quad). Until recently, the process of manufacturing flu vaccines has remained similar. Since the development of the influenza vaccine in the <a href="https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-influenza-vaccination">1940s</a>, influenza viruses were grown in chicken eggs, then extracted, inactivated, purified and processed to make up the egg-based vaccines that are still used widely. However, there have been several enhancements to influenza vaccines in recent years. Older people’s immune systems tend not to respond as strongly to vaccines. In some flu vaccines, adjuvants (components that stimulate the immune system) are included with the influenza antigens. For example, an adjuvant is used in the Fluad Quad vaccine, recommended for over 65s. Studies <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">suggest</a> adjuvanted influenza vaccines are slightly better than standard egg-based vaccines without adjuvant in older people. An alternative approach to improving the immune response is to use higher doses of the vaccine strains. An example is Fluzone High-Dose Quad – another option for older adults – which contains the equivalent of four doses of a standard influenza vaccine. Studies <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">suggest</a> the high dose vaccine is better than the standard dose vaccine (without an adjuvant) in preventing hospitalisation and complications in older people. Other manufacturers have updated the manufacturing process. Cell-based vaccines, such as Flucelvax Quad, use cells instead of eggs in the manufacturing process. Other vaccines that are <a href="https://www.cdc.gov/flu/prevent/advances.htm">not yet available</a> also use different technologies. In the past, <a href="https://pubmed.ncbi.nlm.nih.gov/31151913/">manufacturing issues</a> with egg-based vaccines have reduced their effectiveness. Using an alternative method of production provides some degree of insurance against this in the future. <h2>What should I do this year?</h2> Given indications this year’s flu season may be earlier than usual, it’s probably safest to get your vaccine early. This is particularly <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">important</a> for those at highest risk of severe illness, including older adults (65 years and over), those with chronic medical conditions, young children (six months to five years) and Aboriginal and Torres Strait Islander people. Influenza vaccines are also recommended in pregnancy to protect both the mother and the baby for the first months of life. Influenza vaccines are widely available, including at GP clinics and pharmacies, while many workplaces have occupational programs. For high-risk groups, <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">four of the vaccines</a> are subsidised by the Australian government through the <a href="https://www.health.gov.au/our-work/national-immunisation-program">National Immunisation Program</a>. In older people, a number of vaccines are now recommended: <a href="https://www.health.gov.au/sites/default/files/2024-03/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024.pdf">COVID</a> and influenza, as well as one-off courses of <a href="https://www.health.gov.au/sites/default/files/documents/2020/06/national-immunisation-program-pneumococcal-vaccination-schedule-from-1-july-2020-clinical-advice-for-vaccination-providers.pdf">pneumococcal</a> and <a href="https://www.health.gov.au/topics/immunisation/vaccines/shingles-herpes-zoster-immunisation-service">shingles</a> vaccines. In general, most vaccines can be given in the same visit, but talk to your doctor about which ones you need. <h2>Are there side effects?</h2> All influenza vaccines can <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">cause</a> a sore arm and sometimes more generalised symptoms such as fever and tiredness. These are expected and reflect the immune system reacting appropriately to the vaccine, and are mostly mild and short-term. These side effects are slightly more common in <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">adjuvanted</a> and <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">high dose</a> vaccines. As with all medications and vaccines, allergic reactions such as anaphylaxis can occur after the flu vaccine. All vaccine providers are trained to recognise and respond to anaphylaxis. People with egg allergies should discuss this with their doctor, but in general, <a href="https://www.allergy.org.au/patients/food-allergy/egg-allergy-flu-vaccine">studies suggest</a> they can safely receive any (including egg-based) influenza vaccines. Serious side effects from the influenza vaccine, such as Guillain-Barré syndrome, a neurological complication, are very rare (one case per million people vaccinated). They are <a href="https://pubmed.ncbi.nlm.nih.gov/23810252/">thought</a> to be less common after influenza vaccination than after infection with influenza.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226623/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, Professor of Infectious Diseases, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/there-are-new-flu-vaccines-on-offer-for-2024-should-i-get-one-what-do-i-need-to-know-226623">original article</a>.

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I think I have the flu. Should I ask my GP for antivirals?

<a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/wesley-freppel-1408971">Wesley Freppel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>, and <a href="https://theconversation.com/profiles/yong-qian-koo-1457640">Yong Qian Koo</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> If you test positive for COVID and you’re eligible for antivirals, you’ll likely ask your GP for a script to protect you from severe disease. <a href="https://healthdispatch.com.au/news/immunisation-coalition-urging-people-with-flu-like-symptoms-to-g">Antivirals</a> are also available to fight influenza viruses, via a doctor’s prescription. But they have a mixed history, with their benefits at times <a href="https://theconversation.com/controversies-in-medicine-the-rise-and-fall-of-the-challenge-to-tamiflu-38287">overstated</a>. It can be difficult to get an appointment to see your GP. So when should you make the effort to see a GP for a prescription for influenza antivirals? And how effective are they? <h2>What exactly is influenza?</h2> The flu is primarily a viral infection of the respiratory system that can spread through sneezing, coughing, or touching contaminated objects then touching your nose or mouth. Common symptoms include headache, sore throat, fever, runny or blocked nose and body aches that last a week or more. Influenza is actually a group of viruses, divided into several <a href="https://www.cdc.gov/flu/about/viruses/types.htm#:%7E:text=There%20are%20four%20types%20of,global%20epidemics%20of%20flu%20disease,%20https://www.cdc.gov/flu/professionals/acip/background-epidemiology.htm">sub-groups</a>. Flu A and B are the <a href="https://www.health.gov.au/resources/collections/aisr?language=en,%20https://www.health.gov.au/resources/collections/australian-influenza-surveillance-reports-2023?language=en">most common groups</a> that circulate in humans. <h2>What are flu antivirals?</h2> Influenza antivirals, target specific parts of the viral life cycle, which prevents the virus replicating and spreading. Most flu antivirals <a href="https://www.nejm.org/doi/full/10.1056/NEJMra050740">target</a> neuraminidase, an important enzyme the virus uses to release itself from cells. On the other hand, COVID antivirals work by inhibiting other parts of the viral life cycle involved in the <a href="https://www.tga.gov.au/news/media-releases/tga-provisionally-approves-two-oral-covid-19-treatments-molnupiravir-lagevrio-and-nirmatrelvir-ritonavir-paxlovid">virus replicating itself</a>. Three influenza antivirals are <a href="https://australianprescriber.tg.org.au/articles/influenza-overview-on-prevention-and-therapy.html#r20">used in Australia</a>. Relenza (zanamivir) is an inhaled powder and Tamiflu (oseltamivir) is a capsule; both are five-day treatments. Rapivab (peramivir) is a single injection. These antivirals may also come with <a href="https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm">side effects</a>, such as a headache, vomiting, cough, or <a href="https://www.immunisationcoalition.org.au/resources/antiviral-treatments-for-influenza/">fever</a>. Tamiflu and Relenza generally cost A$40-50 in Australia, plus the cost of the consultation fee with your doctor, if applicable. <h2>How effective are antivirals for the flu?</h2> Antivirals have the greatest effect if started 24-72 hours after symptoms. This is to prevent the virus from reaching <a href="https://www.mdpi.com/1660-4601/19/5/3018">high levels in the body</a>. Among healthy adults, if Relenza or Tamiflu are started within 48 hours from your first symptoms, they can <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008965.pub4/full">reduce the duration</a> of symptoms such as cough, blocked nose, sore throat, fatigue, headache, muscle pain and fever by just under a day. For people who have developed severe flu symptoms or who have existing health conditions such as heart disease or chronic obstructive pulmonary disease (COPD), antivirals that start later (but still before day five of symptoms) can still reduce the <a href="https://academic.oup.com/cid/article/52/4/457/378776?login=true">severity of infection</a> and reduce the <a href="https://thorax.bmj.com/content/thoraxjnl/65/6/510.full.pdf?frbrVersion=3">chance of</a> <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/215903">hospitalisation</a> and <a href="https://academic.oup.com/jac/article/72/11/2990/4091484?login=false">death</a>. In a study from the 2009 swine flu (H1N1) pandemic in the United States, treatment with antivirals (Tamiflu and Relenza) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358088/">reduced</a> the chance of needing to be hospitalised. Around 60% of hospitalisations prevented were among 18-64 years olds, around 20% in children 0-17 years, and 20% in adults aged over 65. The research is less clear about whether antivirals prevent the development of flu complications such as secondary bacterial pneumonia. They might, but so far the data aren’t clear. <h2>Are flu antivirals becoming less effective?</h2> Antiviral resistance to Tamiflu has been <a href="https://link.springer.com/article/10.1007/s10096-020-03840-9">reported</a> around the world, mostly in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223162/">immunocompromised people</a>, as they <a href="https://link.springer.com/article/10.1007/s10096-020-03840-9">have</a> a weakened immune system that allows higher viral loads and prolonged viral shedding. The impact of the antiviral resistance is unclear but there is evidence indicating resistant strains can uphold their ability to replicate effectively and spread. So far it’s not clear if these stains cause more severe disease. However, government agencies and surveillance programs are constantly monitoring the spread of antiviral resistance. Currently there is <a href="https://www.cdc.gov/flu/treatment/antiviralresistance.htm">minimal concern</a> for strains that are resistant to Tamiflu or Relenza. <h2>Antivirals can also prevent the flu if you’ve been exposed</h2> Tamiflu and Relenza can also be used to <a href="https://onlinelibrary.wiley.com/doi/10.1111/irv.12046">prevent flu infections</a>, if we’re exposed to the virus or come into contact with infected people. Some studies suggest Tamiflu and Relenza can <a href="https://www.bmj.com/content/326/7401/1235.long">reduce the chance of developing symptomatic influenza</a> by 70-90%. Many health agencies around the world <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165743/">recommend</a> “prophylactic” treatment for high-risk patients in hospitals or age care setting when people have been in contact with others infected with influenza. <h2>So who should talk to their GP about a prescription?</h2> <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/racf-antiviral-treatments-and-prophylaxis.aspx#:%7E:text=The%20Australian%20Therapeutic%20Guidelines*%20recommends,of%20severe%20disease%20from%20influenza.&text=people%20with%20chronic%20conditions%20including,heart%20disease">Australian guidelines recommend</a> doctors offer antivirals to people with influenza who have severe disease or complications. Doctors can also consider treatment for people at higher risk of developing severe disease from influenza. This includes: <ul> <li>adults aged 65 years or older</li> <li>pregnant women</li> <li>people with certain chronic conditions (heart disease, Down syndrome, obesity, chronic respiratory conditions, severe neurological conditions)</li> <li>people with compromised immunity</li> <li>Aboriginal and Torres Strait Islander people</li> <li>children aged five years or younger</li> <li>residents of long-term residential facilities</li> <li>homeless people.</li> </ul> Doctors can prescribe antivirals for the prevention of influenza <a href="https://australianprescriber.tg.org.au/articles/influenza-overview-on-prevention-and-therapy.html#r20">in</a> vulnerable people who have been exposed to the virus. Antiviral treatment also can be <a href="https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#:%7E:text=Antiviral%20treatment%20also%20can%20be,48%20hours%20of%20illness%20onset">considered</a> for otherwise healthy symptomatic patients who have confirmed or suspected influenza, if they can start treatment within 48 hours of developing symptoms. In some instances a doctors can make a clinical diagnosis of influenza based on the symptoms and known close flu positive contacts of the patient. However, it is preferred to have flu diagnosed by one of the approved diagnostic tests, such as a <a href="https://24-7medcare.com.au/influenza/australian-gp-influenza-2023-guide/">rapid antigen test</a> (RAT) or the more accurate <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/influenza_factsheet.aspx">PCR test</a>, similar to what is perfomed for COVID. There are also now combo tests that can <a href="https://www.tga.gov.au/news/media-releases/first-combination-covid-19-and-influenza-self-tests-approved-australia">distinguish between SARS-CoV-2 and influenza virus</a>. Remember, the flu can cause <a href="https://www.abc.net.au/news/2023-07-23/flu-season-hitting-children-hard-antivirals-may-help/102633722">severe illness or death</a>, particularly among people from the high-risk groups. So if you think you might have the flu, wear a mask and stay away to avoid spreading the virus to others. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/210457/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, Research Leader in Virology and Infectious Disease, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/wesley-freppel-1408971">Wesley Freppel</a>, Research Fellow, Institute for Glycomics, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>, and <a href="https://theconversation.com/profiles/yong-qian-koo-1457640">Yong Qian Koo</a>, , <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-think-i-have-the-flu-should-i-ask-my-gp-for-antivirals-210457">original article</a>.

Body

Taking an antidepressant? Mixing it with other medicines – including some cold and flu treatments – can be dangerous

<a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> In the depths of winter we are more at risk of succumbing to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522168/">viral respiratory infections</a> – from annoying sore throat, common cold and sinusitis, to the current resurgence of respiratory syncytial virus (RSV), influenza and COVID. Symptoms of upper respiratory tract infection range in severity. They can include fever, chills, muscle or body aches, cough, sore throat, runny or stuffy nose, earache, headache, and fatigue. Most antibiotics target bacteria so are <a href="https://pubmed.ncbi.nlm.nih.gov/32495003/">not effective</a> for viral infections. Many people seek relief with over-the-counter medicines. While evidence varies, guidelines suggest medicines taken by mouth (such as cough syrups or cold and flu tablets) have a <a href="https://pubmed.ncbi.nlm.nih.gov/25420096/">limited but potentially positive</a> short-term role for managing upper respiratory infection symptoms in adults and children older than 12. These include: <ul> <li>paracetamol or ibuprofen for pain or fever</li> <li>decongestants such as phenylephrine or pseudoephedrine</li> <li>expectorants and mucolytics to thin and clear mucus from upper airways</li> <li>dry cough suppressants such as dextromethorphan</li> <li>sedating or non-sedating antihistamines for runny noses or watery eyes.</li> </ul> But what if you have been prescribed an antidepressant? What do you need to know before going to the pharmacy for respiratory relief? <h2>Avoiding harm</h2> An audit of more than 5,000 cough-and-cold consumer enquiries to an Australian national medicine call centre found questions frequently related to drug-drug interactions (29%). An 18-month analysis showed 20% of calls <a href="https://pubmed.ncbi.nlm.nih.gov/26590496/">concerned</a> potentially significant interactions, particularly with antidepressants. Australia remains in the “<a href="https://www.aihw.gov.au/mental-health/topic-areas/mental-health-%20prescriptions#Prescriptionsbytype">top ten</a>” antidepressant users in the <a href="https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_PHMC">OECD</a>. More than <a href="https://www.aihw.gov.au/mental-health/topic-areas/mental-health-prescriptions">32 million</a> antidepressant prescriptions are dispensed on the Pharmaceutical Benefits Scheme each year. Antidepressants are commonly prescribed to manage symptoms of anxiety or depression but are also used in chronic pain and incontinence. They are classified primarily by how they affect chemical messengers in the nervous system. These classes are: <ul> <li>selective serotonin reuptake inhibitors (SSRI) such as fluoxetine, escitalopram, paroxetine and sertraline</li> <li>serotonin and noradrenaline reuptake inhibitors (SNRI) such as desvenlafaxine, duloxetine and venlafaxine</li> <li>tricyclic antidepressants (TCA) such as amitriptyline, doxepin and imipramine</li> <li>monoamine oxidase inhibitors (MAOI) such as tranylcypromine</li> <li>atypical medicines such as agomelatine, mianserin, mirtazapine, moclobemide, reboxetine and vortioxetine</li> <li>complementary medicines including St John’s wort, S-adenosyl methionine (SAMe) and L-tryptophan</li> </ul> Medicines within the same class of antidepressants have similar actions and side-effect profiles. But the molecular differences of individual antidepressants mean they may have different interactions with medicines taken at the same time. <h2>Types of drug interactions</h2> Drug interactions can be: <ul> <li>pharmacokinetic – what the body does to a drug as it moves into, through and out of the body. When drugs are taken together, one may affect the absorption, distribution, metabolism or elimination of the other</li> <li>pharmacodynamic – what a drug does to the body. When drugs are taken together, one may affect the action of the other. Two drugs that independently cause sedation, for example, may result in excessive drowsiness if taken together.</li> </ul> There are many <a href="https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/pnp.429">potential interactions</a> between medications and antidepressants. These include interactions between over-the-counter medicines for upper respiratory symptoms and antidepressants, especially those taken orally. Concentrations of nasal sprays or inhaled medicines are generally lower in the blood stream. That means they are less likely to interact with other medicines. <h2>What to watch for</h2> It’s important to get advice from a pharmacist before taking any medications on top of your antidepressant. Two symptoms antidepressant users should monitor for shortly after commencing a cough or cold medicine are central nervous system effects (irritability, insomnia or drowsiness) and effects on blood pressure. For example, taking a selective SSRI antidepressant and an oral decongestant (such as pseudoephedrine or phenylephrine) can cause irritability, insomnia and affect blood pressure. Serotonin is a potent chemical compound produced naturally for brain and nerve function that can also constrict blood vessels. Medicines that affect serotonin are common and include most antidepressant classes, but also decongestants, dextromethorphan, St John’s wort, L-tryptophan, antimigraine agents, diet pills and amphetamines. <a href="https://reference.medscape.com/drug-interactionchecker">Combining drugs</a> such as antidepressants and decongestants that both elevate serotonin levels can cause irritability, headache, insomnia, diarrhoea and blood pressure effects – usually increased blood pressure. But some people experience orthostatic hypotension (low blood pressure on standing up) and dizziness. For example, taking both a serotonin and SNRI antidepressant and dextromethorphan (a cough suppressant) can add up to high serotonin levels. This can also occur with a combination of the complementary medicine St John’s Wort and an oral decongestant. Where serotonin levels are too high, <a href="https://pubmed.ncbi.nlm.nih.gov/15666281/">severe symptoms</a> such as confusion, muscle rigidity, fever, seizures and even death have been reported. Such symptoms are rare but if you notice any of these you should stop taking the cold and flu medication straight away and seek medical attention. <h2>Ways to avoid antidepressant drug interactions</h2> There are a few things we can do to prevent potentially dangerous interactions between antidepressants and cold and flu treatments. 1. Better information Firstly, there should be more targeted, consumer-friendly, <a href="https://www.webmd.com/interaction-checker/default.htm">online drug interaction information</a> available for antidepressant users. 2. Prevent the spread of viral infections as much as possible Use the non-drug strategies that have worked well for COVID: regular hand washing, good personal hygiene, social distancing, and facemasks. Ensure adults and children are up to date with immunisations. 3. Avoid potential drug interactions with strategies to safely manage symptoms Consult your pharmacist for strategies most appropriate for you and only use cold and flu medications while symptoms persist: <ul> <li>treat muscle aches, pain, or a raised temperature with analgesics such as paracetamol or ibuprofen</li> <li>relieve congestion with a nasal spray decongestant</li> <li>clear mucus from upper airways with expectorants or mucolytics</li> <li>dry up a runny nose or watery eyes with a non-sedating antihistamine.</li> </ul> Avoid over-the-counter cough suppressants for an irritating dry cough. Use a simple alternative such as honey, steam inhalation with a few drops of eucalyptus oil or a non-medicated lozenge instead. 4. Ask whether your symptoms could be more than the common cold Could it be influenza or COVID? Seek medical attention if you are concerned or your symptoms are not improving. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/208662/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, Assistant Director of Pharmacy, Mater Health SEQ in conjoint appointment as Associate Professor of Pharmacology, Bond University and as Associate Professor (Clinical), <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/taking-an-antidepressant-mixing-it-with-other-medicines-including-some-cold-and-flu-treatments-can-be-dangerous-208662">original article</a>.

Body

What happens in our body when we encounter and fight off a virus like the flu, SARS-CoV-2 or RSV?

Body

6 habits of people who don’t get sick

Winter is a dangerous time. Although cold temperatures themselves don’t cause us to get sick, our winter habits invite the spread of germs and risk of contagion is high. If you find yourself sick every winter, here are some useful habits of those healthy people to take up. 1. They get enough sleep It’s easy to experience disrupted sleep during winter. When air is too cold, it will negatively affect melatonin production and cause the body's sleep cycle to be disrupted. However, research shows that people who sleep only five to six hours a night have a 30 per cent chance of catching a cold when exposed to the virus; those who get more than seven hours reduce their risk to 17 per cent. 2. They pay extra attention to hygiene With more germs in the air, now is the time to stay conscious about where they may be festering. Key areas include bathroom door handles, taps, fridges, elevator buttons and public transport. Keep antibacterial wipes on you so whenever you touch a high risk surface, you can cleanse you hand before eating, or touching your face and eyes. 3. They exercise regularly Winter is notorious for zapping our work-out motivation. However, exercise strengthens the immune system and makes you less likely to catch upper respiratory infections. 4. The get their flu shot Flu shots, approved for all adults, are effective 50 to 60 per cent of the time in preventing the flu and may also reduce the severity of symptoms. 5. They don’t smoke Cigarette smoke appears to damage the mucus membranes, which act as the frontline barrier to infectious agents, making smokers twice as likely to catch a cold and several times more likely to develop the flu. 6. They enjoy a drink Harvard University School of Public Health researchers found that red wine was particularly protective against colds, probably due to the anti-inflammatory action of the phenol, resveratrol. Just keep in mind that drinking more than two glasses a day raises the risk for infections. Image credit: Shutterstock

Body

Parents' grim warning after losing 3-year-old to flu

Doctors have issued a crucial warning for parents after a healthy and happy Perth toddler became the youngest person in Western Australia to die from the flu in 2023. Muhammed Saadiq Segaff is being remembered as a cheerful but cheeky boy after dying from a strain of the flu virus, influenza A. The three-year-old’s health rapidly declined at Fiona Stanley Hospital, located about 16km from the state's capital, where the toddler went from having difficulty breathing to cardiac arrest. As a result, he underwent open heart surgery before being transported to Perth’s Children's Hospital where doctors and nurses had to use a machine to keep Muhammed’s blood pumping during the transfer. Yet despite their best efforts, they couldn’t save his life, with his parents making the painful decision to turn off his life support on May 26 after his family flew in from Singapore to say their goodbyes. Although influenza is a common virus, it can be fatal in high risk groups as it attacks the lungs, nose and throat. Typical symptoms include chills, fever, fatigue, headaches and muscle aches, with most fit and healthy people able to recover without seeing a doctor. However, young children, senior adults, unhealthy adults and pregnant women have an increased chance of contracting more severe cases due to being immunocompromised. Doctors advise getting a flu shot annually, but statistics are showing that the uptake of flu vaccines in WA in 2023 is slower than usual. “We have a significant and effective prevention strategy for flu, it’s a flu vaccine,” Perth Children’s Hospital infectious diseases specialist Chris Blyth told 7News. Despite the chilling warning, less than 14 per cent of children under five have gotten the vaccination in WA, with a slimmer figure for those aged between five and 15 years old. Dr Blyth said about 10 per cent of children who are admitted to hospital with the flu require intensive care. Parents are advised to monitor children for unusual symptoms associated with the flu, such as breathlessness and fast breathing, which Dr Blyth warned could impact the heart. “Confusion or drowsiness is another important sign. Both of those things would make me want to seek medical advice,” he said. “In the middle of winter, our hospitals are full of people with respiratory illnesses but if parents think their child is much sicker than they normally are they should be seeking advice.” Muhammed’s parents hope that by sharing their son’s heartbreaking story, more parents will consider vaccinating their children against the flu annually. “No parents want this to happen to their own children,” Muhammed’s mother Shikin Hasnawi told 7News. “We just miss him so much,” his father Segaff Sinin said. The WA government has extended its free flu vaccine rollout to children and seniors until the end of June in an attempt to encourage further uptake of the shot. Image credit: 7 News Perth

Caring

I’m over 65 and worried about the flu. Which vaccine should I have?

<a href="https://theconversation.com/profiles/magdalena-plebanski-1063786">Magdalena Plebanski</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/jennifer-boer-1210047">Jennifer Boer</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/katie-louise-flanagan-1066858">Katie Louise Flanagan</a>, <a href="https://theconversation.com/institutions/university-of-tasmania-888">University of Tasmania</a>, and <a href="https://theconversation.com/profiles/kirsty-wilson-1103649">Kirsty Wilson</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> Influenza, or the flu, is a virus transmitted by respiratory droplets from coughing and sneezing. It can cause the sudden onset of a fever, cough, runny nose, sore throat, headache, muscle and joint pain. In Australia, the flu is responsible for <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4004f.htm">more than 5,000 hospitalisation and 100 deaths</a> a year. The highest rates are among those over 65, whose immune systems aren’t as effective as they used to be, and children under five, whose immune systems are yet to mature. To combat the decline in immunity as we age, specific vaccines are available for people aged 65 and over. So how do they work, and why exactly are they needed? <h2>Remind me, how does the immune system work?</h2> The immune system uses multiple mechanisms to fight viral infections, which can be divided into two major arms of the immune system, called innate and adaptive immunity. Innate immunity involves multiple inflammatory cells and chemicals that are triggered immediately, or within hours of encountering an infection. They activate the immune system to clear the infection. Adaptive immunity takes a little longer (weeks) to work and involves memory T cells and antibody-producing B cells, which can be reactivated when the body encounters a virus or other pathogen. The combined innate and adaptive immune response determines how well we respond to an invading virus like influenza. <h2>Why are older people more at risk from the flu?</h2> Generally, as we age past 65, the innate cells become less effective at their job of clearing infections. They also start <a href="https://www.annualreviews.org/doi/full/10.1146/annurev-cellbio-100616-060718">producing more inflammation</a>. New T and B cell numbers also decrease with increasing age and hence the adaptive immune response is also not as effective as when we are younger. This immune system decline is called immunosenescence, which leads to increased susceptibility, hospitalisation and death from influenza.Certain medical conditions, such as cancer and heart and lung conditions, increase susceptibility to severe influenza, with older people being more likely to have additional medical conditions than younger people. <h2>What flu vaccines are available?</h2> <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">Annual flu vaccines</a> are recommended to protect against the common circulating strains of influenza, which can differ from year to year. The standard flu vaccines offered to adults aged under 65 consist of surface proteins of the virus or inactivated (killed) virus from four influenza strains: two A strains (H1N1 and H3N2) and two B strains. When you’re vaccinated, your immune system makes antibodies from B cells which protect you if you become exposed to these strains of the virus. However, the standard influenza vaccine is less effective in older people. Two stronger or augmented vaccines have been made targeting this age group. They contain the same components as the standard vaccine, but one vaccine – called <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2020-CMI-01074-1&d=20230529172310101">Fluad</a> – uses a strong adjuvant (an agent used to increase the immune response to vaccination) called MF59 to stimulate better immunity. The other augmented vaccine, called <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2020-CMI-02062-1">Fluzone</a>, uses a four-fold higher dose of each influenza strain to increase immunity. <h2>How do they compare?</h2> <a href="https://academic.oup.com/cid/article/73/11/e4251/5992287?login=false">Studies comparing Fluad and Fluzone</a> show both vaccines stimulate stronger immunity against influenza than the standard flu vaccine and are therefore likely to provide better protection. Studies directly testing for improved clinical outcomes with vaccines for over-65s show a small benefit of receiving either of the vaccines over the standard vaccine, including a modest decrease in lab-confirmed influenza, <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(17)30235-7/fulltext">hospitalisations</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563546/">emergency department visits</a> compared to the standard influenza vaccine. They are however yet to show and impact on flu-related deaths. <figure class="align-right "> </figure> In the few studies comparing <a href="https://academic.oup.com/cid/article/73/11/e4251/5992287?login=false">Fluad and Fluzone directly</a>, there is little evidence of a difference between them in reducing influenza and serious flu outcomes. <a href="https://www.health.gov.au/resources/publications/atagi-advice-on-seasonal-influenza-vaccines-in-2023">The Australian Technical Advisory Group on Immunisation therefore recommends</a> using either Fluad or Fluzone. While both have been Therapeutic Goods Administration (TGA) approved since 2020, only Fluad is available for free on the National Immunisation Program for people aged 65 and over. Fluzone is only available with a private prescription if you’re 60 years and over, at a cost of around A$65-70. If neither augmented vaccine is available, a standard influenza vaccine is also acceptable for older people, since any influenza vaccine is preferable to receiving none. Flu vaccines can also be given at the same time as COVID vaccines. <h2>How else can we protect against the flu?</h2> While influenza vaccination is the single most effective way of preventing influenza, other measures such as social distancing and wearing a mask or N95 respirator can also provide some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779801/">community protection</a>. Wearing a mask or N95 respirator significantly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779801/">reduces the risk</a> of infecting others when infected. The evidence for protecting oneself against infection is less conclusive, mainly because it’s linked to early, consistent and, importantly, the <a href="https://cdn.who.int/media/docs/default-source/influenza/advice-on-the-use-of-masks-in-the-community-setting-in-influenza-a-(h1n1)-outbreaks.pdf?sfvrsn=24a45a95_1&download=true">correct use of masks</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/204810/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/magdalena-plebanski-1063786">Magdalena Plebanski</a>, Professor of Immunology, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/jennifer-boer-1210047">Jennifer Boer</a>, Postdoctoral Research Fellow, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/katie-louise-flanagan-1066858">Katie Louise Flanagan</a>, Infectious Diseases Specialist and Clinical Professor, <a href="https://theconversation.com/institutions/university-of-tasmania-888">University of Tasmania</a>, and <a href="https://theconversation.com/profiles/kirsty-wilson-1103649">Kirsty Wilson</a>, Postdoctoral Research Fellow, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/im-over-65-and-worried-about-the-flu-which-vaccine-should-i-have-204810">original article</a>.

Body

Magpie murderer slapped with massive penalty

A Victorian man has copped a $2,349 penalty after inflicting “callous” acts on magpies. His sentence comes after an investigation by Victorian authorities who were tipped off that birds were being shot at a property in the state’s Sunraysia region. After inspecting the property in 2021, investigators discovered four dead magpies as well as two so severely injured they had to be euthanised. The 57-year-old was placed on a good behaviour bond after appearing at the Mildura Magistrates Court. He admitted to 10 offences of wounding and inflicting aggravated cruelty on the native birds. While Victoria does allow wildlife to be killed by property owners, they must apply for a permit before they start shooting. After the sentence was handed down, the state’s Conservation Regulator Glen Smith warned offenders would be prosecuted. “Magpies are an iconic native bird and they are protected in Victoria. There is no excuse for unlawfully killing or injuring them," he said. “The Conservation Regulator takes wildlife crime extremely seriously and this court result should act as a warning that we will pursue penalties for offenders.” These “callous” acts on the native birds come soon after another Australian man was found guilty of <a href="https://www.oversixty.com.au/finance/legal/man-who-killed-350-kookaburras-ordered-to-pay-fine" target="_blank" rel="noopener">shooting and killing</a> a staggering 350 kookaburras. Anyone with information about wildlife crime can report it anonymously to Crime Stoppers on 1800 333 000. Image credit: Shutterstock

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American zoo apologises to disgruntled New Zealanders

An American zoo has issued an apology after admitting it made a “huge mistake” that outraged an entire country. Footage of Miami Zoo’s paid encounters with Paora the kiwi went viral online, showing the bird being handled and passed around for pictures in broad daylights and under bright lights despite being a shy, nocturnal animal. The handling of their national icon had New Zealanders fired up, with a petition to save the “mistreated” animal being launched amid the video, which received more than 10,000 signatures. “He has been tamed and is subjected to bright fluorescent lighting four days a week, being handled by dozens of strangers, petted on his sensitive whiskers, laughed at, and shown off like a toy,” the petition read. “Kiwi are nocturnal animals, who should be kept in suitable dark enclosures, and minimally handled. “The best practice manual for kiwi states that they shouldn’t be handled often or taken out of their burrow to be held by the public. He is kept awake during the day, with only a small box in a brightly lit enclosure to mimic his natural underground habitat.” The zoo’s communications director Ron Magill has confirmed the attraction has been cancelled and has issued his own apology in an interview with the New Zealand Herald. “We regret the unintentional stress caused by a video on social media depicting the handling of Paora, the kiwi bird currently housed within Zoo Miami,” Magill said. He also told RNZ he had informed the zoo’s director that “we have offended a nation”. “When I saw the video myself I said we have made a huge mistake here,” he said. “I am so sorry. I am so remorseful. Someone asked how would you feel if we did that to your bald eagle, and you’re 100 per cent right. “I never want to come across as making excuses, I am here to apologise … to everyone. I feel profoundly terrible about this.” However, Magill noted Paora was healthy and well despite the uproar. “He eats like he’s on a spa day every day and he’s doing well. It doesn’t excuse what he was subjected to. But I promise it will never happen again,” he said. After the video went viral, the zoo was bombarded with complaints, with New Zealand’s Department of Conservation confirming it would be “discussing the situation with the American Association of Zoos and Aquariums to address some of the housing and handling concerns raised”. New Zealand prime minister Chris Hipkins also weighed in, claiming the ordeal “shows a lot of Kiwis take pride in our national bird when they’re overseas”. “The New Zealanders who witnessed what was happening there caught it pretty quickly,” he said, adding that the zoo had “made public statements of regret on what’s happened, and I acknowledge that and thank them for taking it seriously”. The kiwi is considered to be a Taonga species - native birds, plants and animals of special cultural significance and importance to native New Zealanders. Image credit: Getty

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Should I get a flu vaccine this year? Here’s what you need to know

<a href="https://theconversation.com/profiles/paul-griffin-1129798">Paul Griffin</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> After having low rates of influenza (flu) transmission in recent years thanks to our COVID control strategies, case numbers are now rising. So far this year, Australia has had <a href="https://www.immunisationcoalition.org.au/news-data/influenza-statistics/">more than 32,000</a> lab-confirmed cases of the flu and 32 deaths. Getting a flu vaccine is the best way to protect against getting the flu. These are reformulated each year to protect against the most widely circulating strains – if our predictions are right. Below you’ll find everything you need to know about the 2023 flu vaccine. But first, some flu basics. <h2>What are the different types of flu?</h2> There are two main types of influenza: influenza A and influenza B. On the surface of the influenza virus there are two main proteins, the hemagglutinin (HA or H) and neuraminidase (NA or N). Different strains are named after their versions of the H and N proteins, as in H1N1 or “swine flu”. <figure class="align-center "><img src="https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" alt="" /><figcaption>HA is the yellow spike, while the NA is the green oval. <a class="source" href="https://www.shutterstock.com/image-vector/structure-influenza-virus-infographics-vector-illustration-542924464?src=ixiW0w-59I3I17RpN4L3wQ-1-12">Shutterstock</a></figcaption></figure> Minor changes in the proteins (HA and NA) on the surface are common because the enzyme the virus uses to make copies of itself is prone to errors. Sometimes the influenza virus can change more abruptly when it mixes up components from different influenza viruses – including influenza viruses that typically infect birds, pigs or bats – to create a virus that’s basically new. The regular change in the virus is the reason the vaccine is updated every year. The <a href="https://www.tga.gov.au/about-tga/advisory-bodies-and-committees/australian-influenza-vaccine-committee-aivc">Australian Influenza Vaccine Committee</a> meets late in the year to plan what should be included in the vaccine for the following season, after considering what happened in our last flu season and in the Northern hemisphere winter. <h2>What strains does this year’s flu shot protect against?</h2> Modern flu vaccines typically protect against four strains. For this year’s vaccine, the committee <a href="https://www.tga.gov.au/resources/publication/meeting-statements/aivc-recommendations-composition-influenza-vaccines-australia-2023">has recommended</a> it includes: <ul> <li> an A/Sydney/5/2021 (H1N1)pdm09-like virus </li> <li> an A/Darwin/9/2021 (H3N2)-like virus </li> <li> a B/Austria/1359417/2021 (B/Victoria lineage)-like virus </li> <li> a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus. </li> </ul> The naming of the viral components can sometimes be confusing. The name is <a href="https://www.cdc.gov/flu/about/viruses/types.htm">derived from</a> the virus type (A or B)/the place it was first isolated/strain number/year isolated (virus subtype). This year’s vaccine therefore includes an influenza A virus similar to the 2009 pandemic-causing H1N1 isolated from Sydney in 2021 and a second influenza A virus (H3N2) isolated in Darwin in 2021. Influenza B viruses are classified into 2 lineages: Victoria and Yamagata. This year’s vaccine includes an influenza B isolated from Austria in 2021 (Victoria lineage) and an influenza B isolated in Phuket in 2013 (Yamagata lineage). <h2>Who should get a flu shot?</h2> Health authorities <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">recommend</a> everyone aged six months of age or over should get the flu vaccine every year. <a href="https://www.health.gov.au/news/2023-national-immunisation-program-influenza-vaccination-early-advice-for-vaccination-providers">Some groups</a> are at greater risk of significant disease from the flu and can access the flu vaccine for free. This includes: <ul> <li> Aboriginal and Torres Strait Islander people aged six months and over </li> <li> children aged six months to five years </li> <li> pregnant women at any stage of pregnancy </li> <li> people aged 65 years or over </li> <li> people aged five years to 65 years who have certain underlying health conditions affecting the heart, lungs, kidneys or immune system, and those with diabetes. </li> </ul> <h2>How can I get it?</h2> You can get a flu shot from your local general practice or pharmacy. Or you may have an opportunity to get vaccinated at your workplace if your employer supplies it. While the vaccine is free for those in the <a href="https://www.health.gov.au/sites/default/files/2023-02/fighting-flu-starts-with-you-consumer-fact-sheet.pdf">above groups</a>, there can be a consultation or administration fee, depending on where you get your vaccine. If you aren’t eligible for a free vaccine, it usually costs around A$20-$30. <h2>Are there different options?</h2> For over 65s, whose immune systems may not work as well as when they were younger, a <a href="https://www.health.gov.au/sites/default/files/2023-03/atagi-advice-on-seasonal-influenza-vaccines-in-2023.pdf">specific vaccine</a> is available that includes an adjuvant which boosts the immune response. This is free for over-65s under the national immunisation program. A high-dose vaccine is also available for people aged 60 and over. However this isn’t currently funded and costs around $70 on a private prescription. People with egg allergies can safely get the egg-based flu vaccine. However there is also a cell-based immunisation for people who don’t want a vaccine made in eggs. When vaccines are grown in eggs, sometimes the virus can change and this might affect the level of protection. Cell-based vaccines aim to address this issue. The cell-based vaccine isn’t funded so patients will pay around $40 for a private prescription. <h2>How well do they work?</h2> The vaccine’s effectiveness depends on how well the strains in the vaccine match those circulating. It generally <a href="https://www.health.gov.au/resources/publications/aisr-2022-national-influenza-season-summary">reduces</a> the chance of being admitted to hospital with influenza by <a href="https://www.health.gov.au/sites/default/files/documents/2022/08/influenza-vaccine-efficacy-effectiveness-and-impact-explained.docx">30-60%</a>. <h2>What are the side effects?</h2> You can’t get the flu from the vaccine as there’s no live virus in it. When people get a flu-like illness after the vaccine, it can be due to mild effects we sometimes see after vaccination, such as headaches, tiredness or some aches and pains. These usually go away <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine#possible-side-effects-of-influenza-vaccination">within a day or two</a>. Alternatively, symptoms after getting a flu shot may be due to another respiratory virus such as respiratory syncytial virus (RSV) that circulates in winter. <h2>When’s the best time to get your flu shot?</h2> The vaccine provides <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu#vaccine-information">peak protection</a> around three to four months <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine#when-to-get-the-influenza-vaccine">after</a> you get it. The <a href="https://www.immunisationcoalition.org.au/news-data/influenza-statistics/">peak of the flu season</a> is usually between June and September, however this changes every year and can vary in different parts of the country. Given this, the best time to get the vaccine is usually around late April or early May. So if you haven’t already, now would be a good time to get it.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/203406/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/paul-griffin-1129798">Paul Griffin</a>, Associate Professor, Infectious Diseases and Microbiology, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/should-i-get-a-flu-vaccine-this-year-heres-what-you-need-to-know-203406">original article</a>.

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