Azlan Othman
As the nation transits into to the Endemic Phase of COVID-19, one question arises – should we be concerned over the return of influenza?
Brunei media representatives recently joined a virtual media forum featuring a group of Malaysian experts themed ‘Come Out Stronger, Protect Them Better’, organised under the ‘Flu Prevention is an Act of Love’ campaign of the Immunise4Life (IFL) programme.
According to Chairman of the IFL Technical Committee Professor Datuk Dr Zulkifli Ismail, Malaysians often confuse the flu with the common cold or perceive the flu as a winter illness that only happens in temperate countries. Both notions are not correct.
“The flu is a serious health threat to high-risk groups such as pregnant women, young children, people with chronic health conditions, and especially older persons. The flu occurs all year round in Malaysia and occasionally causes outbreaks, some of which can be major,” he said.
“The flu practically vanished when the COVID-19 pandemic hit but the flu virus is now back.
Malaysia and many other countries have been reporting flu cases in recent months.
“Flu activity is bound to increase as the travel and other sectors open up and people mingle more freely.”
Professor Datuk Dr Zulkifli highlighted a specific concern. “When this happens, Malaysians would be somewhat defenceless. Most are not vaccinated against the flu. This compounds the fact that, without circulating flu viruses in the last two years, population immunity would also be low.
“We advise all high-risk individuals, especially older persons, to get an annual flu shot as soon as possible; it will help reduce the risk of severe disease and hospitalisation associated with the disease.”
As shown by the pandemic, respiratory diseases usually hit senior citizens the hardest. This was pointed out by consultant geriatrician Professor Dr Tan Maw Pin who chairs the Flu and Older Persons Sub-Committee of the Malaysian Influenza Working Group (MIWG). She added that older persons are just as susceptible to the flu as they are to COVID-19.
“Their weakened immune system and declining lung function increase the likelihood of catching the flu, getting hospitalised and probably dying from the disease. Yet, many families are not even aware when their aged parents or grandparents have the flu,” said Professor Dr Tan.
“This is because the disease tends to present with atypical symptoms in older people. These include dizziness that may result in falls, and confusion or delirium with or without a fever.
Rapid breathing reveals oxygen insufficiency and may contribute to dehydration.
“Without treatment, severe flu and acute respiratory distress syndrome (ARDS) may set in. Potentially fatal complications are likely to follow, including pneumonia, inflammation of the brain and muscle tissues, and multi-organ failure.”
Additionally, commenting on the pandemic, Professor Dr Tan said, “A recent study published in The Lancet reported that adults with both flu and COVID-19 had four times higher odds of invasive mechanical ventilation and double the risk of death. “COVID-19 booster shots and standard operating procedures (SOPs) continue to be vital. However, we seriously need to prioritise flu prevention for older persons as a highly vulnerable group immediately.”
According to President of the Malaysian Endocrine and Metabolic Society Professor Dr Chan Siew Pheng, over 40 per cent of Malaysians aged 60 and older are living with Type 2 diabetes. Persistently high blood glucose can suppress their immune system, increase the frequency and duration of flu infections, and lead to overall greater risk.
The consultant endocrinologist explained, “The flu can make it harder to control their diabetes, causing blood glucose levels to rise.
“The flu may also reduce their appetite and food intake, causing blood glucose levels to fall. Their worsening condition may result in life-threatening diabetes emergencies. On the other hand, diabetes could significantly exacerbate the flu.”
“Many people with diabetes also have other comorbidities, such as high blood pressure and kidney disease – these heighten the likelihood of serious flu complications,” Professor Dr Chan explained.
“People with diabetes, even when well-managed,” Professor Dr Chan concluded, “are advised to make flu prevention an integral component of diabetes management. An annual flu shot will provide a boost to their healthcare.”
Additionally, older persons would do well to prevent the flu for the sake of their hearts. Those with heart disease are six times more likely to have a heart attack after coming down with the flu. Strikingly, flu infection increases the risk of a heart attack and a stroke by up to 10 times and eight times respectively in individuals without a history of cardiovascular disease.
According to Founding Member and Advisor to the Malaysian Healthy Ageing Society Professor Nathan Vytialingam the flu can have devastating consequences on the elderly and their families.
“When aged parents are admitted into hospital, their children may have to bear the cost of treatment,” he said. “Should recovery be slow and long, caregivers may need to take time off work.
“These situations create hardship for the families, especially those from the lower income brackets. Meanwhile, older adults who are hospitalised or confined to prolonged bed rest may suffer bed sores, lose muscle strength, develop irreversible functional decline, and lose their ability to perform simple daily tasks.
“Losing their independence and becoming a burden to their loved ones would leave them depressed and deprived of the quality of life they deserve.”
This, Professor Nathan said, can represent a key motivator. “Fortunately, the financial and emotional distress can be avoided by making flu prevention a part of the healthy ageing journey.
“As loving families and members of a caring society, we need to come together to encourage and support annual flu vaccination for the older generation. After the painful lessons of the pandemic, let’s come out stronger and protect them better.”
