Many believe that the first vaccinations we receive as children will protect us against a lifetime of diseases.

Well, this may generally be true as vaccinations we receive as children will protect us against many diseases, even as adults. However, diseases can evolve, and new ones emerge over time.

Malaysia’s National Immunisation Programme (NIP) has identified a series of vaccinations, based on recommendations by the World Health Organization (WHO), which is compulsory for babies and children up to 15 years old.

Without a shadow of a doubt, this plays a pivotal role in ensuring children are protected from many a deadly and infectious disease, including polio, measles, mumps and rubella.

In light of the recent news on influenza H5N1 and the H1N1, influenza has become a source of much scrutiny.

It is currently not one of the diseases that requires compulsory vaccination in Malaysia.

So is it much ado about nothing? Firstly, not all influenza diseases are created equal. Among humans, some are caused by the Type A virus and others by Type B. For now, we will not include Type C, which rarely infects people.

Worldwide, the strains of influenza A that predominate are the H1N1 and H3N2. This closely mirrors the situation in Malaysia.

Of late, there have been outbreaks of the H5N1 strain in Kelantan. The H5N1, also known as “avian flu”, spreads predominantly from bird to bird, but if not contained or handled carefully, can spread to humans who come into close contact with infected birds.

We are thankful that due to the meticulous action by our Health Ministry, this aggressive influenza strain seems to have been contained, and as yet, there are no reports of humans being affected in Malaysia.

In 2009, a new rapidly spreading H1N1 strain of the influenza virus or “swine flu” emerged.

The 2009 H1N1 affected thousands of people in many countries across several continents. By the time WHO declared a pandemic in June 2009, a total of 74 countries and territories had been affected, including Malaysia.

Thankfully, in 2010, the WHO concluded that the H1N1 pandemic was officially over, though it admits that pockets of outbreaks do still occur.

Then there is the recent “Influenza-Like Illness” (ILI). The term itself covers a wide and generalised category of non-specific respiratory illnesses which may include a possible diagnosis of influenza or any other illness presenting with a set of common symptoms.

These symptoms are fever above 37.8°C with either a sore throat and/or cough.

The generalised definition was first developed by the Armed Forces Health Surveillance Center (AFHSC), formerly the Army Medical Surveillance Activity of the United States, in the summer of 2007 as an epidemiological tool.

Later, the term was widely adopted by the US Centers of Disease Control and Prevention (CDC).

However, while it has its place in the healthcare sector, it can also be a source of confusion for the public. This is mainly because it implies that a disease that is like influenza is not necessarily influenza.

This is where things can get cloudier and unhelpful for the general public.

Two of the most common ILI are the cold and flu. Many Malaysians often use the terms “flu” and “cold” interchangeably, and are none the wiser that these illnesses are actually two very separate and distinct diseases.

The common cold is caused by over 200 different viruses, with the rhinovirus being the most prevalent.

Generally it is a much milder disease that affects the upper respiratory tract, specifically the nose, throat and sinuses.

More severe symptoms, including a high fever, headache and aching muscles, can also occur, although rarely.

There is no cure or vaccine for the common cold and treatment largely focuses on rest, temperature control, hydration and nasal decongestants.

Overall, a cold rarely results in serious morbidity or mortality.

The word “flu” is derived from influenza. The flu or influenza refers to an illness only caused by the influenza virus.

People with the influenza virus often show similar symptoms as people with a cold, though symptoms are usually more severe in the former.

Certain members of the community are at a higher risk of severe symptoms upon contracting the influenza virus. Hospital admissions, severe chest infections and even death are higher in influenza when it affects children below the age of five years old, adults with pre-existing complex medical illness such as bronchitis, asthma and chronic obstructive pulmonary disease, and the elderly, especially those above the age of 65.

That is why the WHO recommends that these high-risk groups are vaccinated against the influenza virus.

Another high-risk group who should be vaccinated are healthcare professionals who are usually at the frontline of any influenza outbreak.

In temperate climates, seasonal epidemics occur mainly during winter, and as such they are known as the “seasonal flu”. Most people recover from the seemingly harmless seasonal flu fever and other symptoms within a week without requiring medical attention.

However, as mentioned, the influenza virus can cause severe illness or death, especially in people at high risk. This is made worse because every few years or so, the world experiences an influenza epidemic that can affect hundreds of thousands of people.

The WHO estimates that worldwide, these epidemics result in about three to five million cases of severe illness, and about 250,000 to 500,000 deaths.

The CDC has reported that the 2016/17 season saw influenza-related cases increase in parts of the US compared to previous years, with several deaths as a result.

As of March 7, 2017, flu activity was still elevated in the US and this is expected to continue for several weeks.

Largely, the influenza season in the US has hitherto been moderate. Notwithstanding this, in a so-called moderate flu season, the American Academy of Pediatrics has reported 40 paediatric deaths from influenza in the 2016/17 season thus far.

This in my book, is an absolute tragedy as even one preventable death is one too many.

In the context of tropical Malaysia, seasonal flu can and does occur at any time of the year even though it is more prevalent during the rainy season and at year-end.

We all know how unpredictable the weather is these days, and rain is as likely as sunshine, which makes the flu not very seasonal after all.

Furthermore, as the world becomes a smaller place and more people travel, disease spreads that much more easily today than it did even a decade ago.

While there may be a lack of definitive data to indicate influenza is on the rise in Malaysia, the disease should not be taken for granted.

Many do not realise the severity of the disease due to influenza and cold symptoms being very similar.

While bed rest and over-the-counter medications may generally work to fight against influenza, those in high-risk groups must take extra precautions. At the first sign of flu-like symptoms, consult a doctor.

However, unless a lab test is done, it is difficult to differentiate the flu from a cold. What’s more, a prescription of antibiotics would only be effective if it was a bacterial infection, not viral.

“Prevention is better than cure” is an age old adage. When it comes to diseases, it makes absolute sense.

Unlike the common cold, influenza is a vaccine-preventable disease.

The WHO recommends it for those in countries like the US and for high-risk groups elsewhere.

It is recommended for children six months and older and adults alike, including pregnant mothers who are also categorised as high risk and can get the influenza vaccination at any time during their pregnancy.

The influenza vaccination or flu jab is also recommended annually as the virus strain can mutate and evolve each year.

Flu vaccination jab for children

It is safe for children, with the most severe side-effects usually being temporary discomfort or a mild fever.

Vaccination plays a vital role in controlling vaccine-preventable diseases successfully and cost effectively, preventing between two to three million deaths a year worldwide as a result, according to the WHO.

It has also come to light that 99% of deaths in children under five years of age with influenza related lower respiratory tract illnesses were found in developing countries [Source: Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. Nair H, Abdullah Brooks W, Katz M et al. Lancet 2011; 378: 1917–3].

While the NIP of Malaysia does not include the influenza vaccination at this juncture, given the dire complications that can arise from the disease, all those in the high-risk groups should opt for a flu jab as it offers up to approximately 70% protection against the disease.

If you ask me, this makes a good case for prevention being better than a cure, especially when one considers the downside of hospitalization, burden of disease and rising healthcare costs.


Dr Mohammad Iqbal Mohammad Sarwar is a paediatrician and neonatologist. This article is courtesy of IMU Healthcare.