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It’s been a good winter for the Cape. We had some rain, snow and a proper cold season. It feels like the winters I remember from my UCT days; wet, wild and windy. They were not fun days pre a car and long walks from distant parking to various hospitals around the peninsula and the inevitable snotty nose and thick phlegmy coughs.

I will admit upfront that I have been a poor supporter and user of the annual Flu (Influenza) vaccine, though unlike the multi anecdotal tails spread around of “I had the worst flu ever the year I had the vaccine”. I have no excuse for my own lack of uptake, nor my pushing the vaccine harder in my patient group/practice. It is a weird one. For sure I believe it is safe and effective and relatively cheap compared to some other vaccines, but maybe I was blurred by the effects of Respiratory Syncytial Virus in my younger patients, or I am just tired of pushing the regular routine vaccines in an ever-sceptical society.

So why am I confessing?

As usual, it is rather reactionary; because I have spent the last few weeks/months dealing with a much heavier burden of influenza disease. The telephone conversations, WhatsApp chats and admissions to hospital of varying ages of children with brutal temperatures, muscle and body pains so debilitating that walking is not possible and secondary pneumonia/sinusitis/otitis, all now much more easily proven to be Influenza with rapid-fire PCR (and expensive) testing. The question of why testing is often raised, particularly by medical aids, as the tests do run into 1000 + rands, and again I will defend my actions. The test allows reassurance and hopefully more rational antibiotic use; it helps to give parents and families answers and can also guide protection through anti-viral prophylaxis to protect, as yet, unvaccinated family members.

I believe that the Influenza epidemic, though a routine annual process, is exacerbated by the weather; the cold keeps us indoors with our windows shut, gathered around the fire or heater and at creches and schools, kids are kept indoors in groups where a sneeze or cough can infect 10’s of people within seconds. Within 48 hours, Influenza B has people doubled over with abdominal pain and vomiting, so severe referrals to surgeons and radiology to exclude appendicitis explode, followed by severe fevers and nasal congestion and days of lethargy and weeks of recovery. The H1N1 Swine Flu strain is even more debilitating from muscle pain and respiratory tract inflammation, again with terrible fevers. Big Pharma scores as cough syrups, anti-inflammatories and “cold” remedies fly off the shelves to try and make our aching bodies, snotty noses and painful coughs marginally better, followed by a course of antibiotics when the phlegm becomes the “bacterial” green.

And all this is safely and easily prevented with a vaccine costing well under 100 rand. Sure it won’t stop the Rhinovirus Common Cold nor the croupy Parainfluenza virus, but these have a far less severe effect on the individual, for a far shorter period of time and cause fewer days off school or work. I always say it is the season to be snotty, sung with the Christmasy vibe of “jolly”, but why are we globally but tragically locally so poor at making it less so with a simple safe and effective vaccine?

A study in 2015 by Lalloo showed in patients with medical aid the overall uptake of Flu vaccine in season was 5%, varying according to age form < 2% in under 5-year-olds to 16% in > 66-year-olds; indicating GPs and old age homes are the more effective purveyors of prevention than me and my fellow paediatricians.

The herd protection of 2 vaccinated individuals in an office of 10 people is 20 fold. Schools, work places, creches and hospitals would be safer; more productive if employers, heads of schools and hospitals and even hotels demanded, or even better, provided vaccines for their cohorts.

2018 may have filled our dams, but it has also filled our wards; our noses/sinuses and lungs. I vaccinated myself a little later than recommended, but I will be pushing and injecting with a lot more vigour in the future.