What is the concern about the TWINDEMIC of COVID 19 & Influenza? My talk on the digital IAP platform in Dec 2020 for the pediatricians across the country

1. Prevention of Influenza –
with reference to COVID 19
Dr. Gaurav Gupta
Charak Clinics, Mohali
docgaurav@gmail.com

4. Why did SH escape?
• COVID 19 risk mitigating practices
• Less virulent flu virus
• Partial immunity
• Was it less testing ?

5. Influenza
vaccination
in Australia
Flu vaccination
doses
2017 8 million
2019 13 million
2020 18 million

7. 4 ways to
prevent
Twindemic

8. Covid-19 &
Influenza

9. Comparing
COVID 19 &
Influenza

11. Numerous overlap between risk factors for
COVID-19 & Influenza

13. Influenza and
COVID 19 • Differentiating other causes of respiratory illness
from COVID 19 is difficult, especially during the
flu season, because manifestations of COVID 19
like fever, cough & breathlessness mimic those of
Influenza.

17. The tools for
minimizing a
‘Twindemic’
are both
obvious &
available
•Today the best firewall against
Influenza is a vaccine

18. Influenza
vaccine
Even if unable to prevent infection wouldEven
Ease severity of diseaseEase
Lessen burden on hospitals & ICU bedsLessen

19. The tools for minimizing a ‘Twindemic’ are
both obvious & available
• Today, the best firewall against Influenza is a vaccine!

20. Children Play a Central Role in Influenza Transmission
Inferred from: Massong J et al. 2008 Mar 25;5(3):e74. doi:
10.1371/journal.pmed.0050074 , Glezen WP, et al. N Engl J Med.
1978;298:587-592: Weycker D, et al. Vaccine. 2005;23:1284-1293,
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21. Influenza Attack Rate in Children, Meta Analysis, 2014
| 21Jayasandura et al. BMC Infectious Diseases , 2014, 14:670
Adapted from Jayasandura et al. 2014
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22. Global Burden of Influenza in Children
www.thelancet.com. Published online November 11, 2011
……concluded that, in 2008,
90 million cases of influenza
occurred among children < 5
20 million cases of ALRI, one
million cases of severe ALRI and
28,000-111,500 deaths
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23. Influenza is Under-reported
23
Poehling KA, et al. N Engl J Med 2006;355:31–41 [17]
Beard F, et al. Arch Dis Child 2006;91:20–25 [18]
• Only 28% of hospitalizations and 17% outpatient
visits by children with lab confirmed influenza
had discharge diagnosis of influenza
Under-recognised
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24. Influenza Burden Summary from Indian
Academy of Pediatrics, 2018
Balasubramanian, S. et al. Indian Pediatrics, Vol 55, 1066-1074, Dec15, 2018
Incidence (/10,000) in
2010-2012 in 2 Regions
Highest
incidence
rate in 2010
Highest
incidence
rate in 2011
Highest
incidence
rate in 2012
Ballabgarh,
Haryana
3.8-5.4 <1 year >59 years 1-4 years
Vadu,
Maharashtra
20.3-51.6 1-4 years <1 year 5-14 years
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25. Vaccination the most effective way to prevent Influenza
Esposito et al Clinical and economic impact of influenza vaccination on healthy children aged 2–5 years; Vaccine 2006,24(5):629-35, Heikkinen T et al Influenza vaccination in the prevention of acute otitis media in
children.Am J Dis Child. 1991 Apr;145(4):445-8. , Kramarz et al J Pediatr 2001;138:306-10 Influenza vaccination in the prevention of acute otitis media in children, Loeb M et al Effect of Influenza Vaccination of
Children on Infection Rates in Hutterite Communities: A Randomized Trial JAMA. 2010;303(10):943-950
Vaccination reduces
complication of Influenza in
Children
When children are vaccinated against influenza
the benefit to the community is cumulative –
providing herd protection
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27. Influenza – an important cause of VPD in
adults

28. Some questions for all of us…

29. Role of Pediatricians

30. Guidelines for
Influenza
vaccinations
during current
Pandemic

31. Inactivated
Influenza Vaccines

33. Latest IAP recommendations – Nov 2020,
preprint

35. Universal dose 0.5 ml

36. Summary
• Influenza is a common Pediatric problem, especially in developing
countries
• Together COVID 19 & Influenza ‘Twindemic’ can cause tremendous strain
on the healthcare resources
• Plan for flu shot for self, staff & children & caregivers

37. Vaccines do not save
lives..
Vaccinations Do!
MAT-IN-2000849