#MSCOVID19: has coronavirus cancelled the flu season?


Barts-MS rose-tinted-odometer: ★★★★★

I think COVID-19 has just cancelled the flu season. 

I and many public health officials were very concerned that we were heading for a double-whammy this winter with a second and third surge of COVID-19 and a bad influenzae pandemic superimposed on it. It is looking like this may not happen. In the Southern hemisphere,  including my country South Africa, it seems as if the flu season was cancelled. Incredibly the number of documented annual cases has dropped by over 99% (see table below). 

South Africa71110946
Documented cases April through mid-August. Source Science 28-Aug-2020

It is clear that the behavioural changes we have put in place, such as social distancing and wearing of masks, has prevented the spread of influenzae virus. Will these behaviours become the new norm during future flu seasons? I am not sure if people realise that influenzae is one of the biggest infectious disease killers each year so preventing the spread of the virus via behavioural change makes sense. 

Saying this the UK Government has just ordered many more doses of influenzae vaccines than it normally does and is extending the so-called at-risk adult group who can get the vaccine free on the NHS this year. 

Does this change our recommendations regarding getting the annual flu-jab? No, it doesn’t. All pwMS should take up the offer by the NHS to get the annual flu vaccine.

Please note, if you are severely immunosuppressed and have small children, please make sure they don’t get the live intranasal flu vaccine at school. There is a risk that this attenuated vaccine strain, which they may bring home, will cause disease in severely immunocompromised subjects. If you want your children to be vaccinated against influenza they will need to be given the component vaccine by injection. The latter is done via GP practices and some pharmacists. Please note it is only patients recently treated with alemtuzumab and HSCT that fall into this category.

I suspect that after reading the post on complications in the Oxford-AstraZeneca coronavirus vaccine study many of you are nervous about vaccinations in general. Please don’t be. The regulatory authorities assess the efficacy and safety of all vaccines and make an informed decision that at a population level the risks justify the benefits. Influenzae vaccination is the most studied vaccine in pwMS and it has been shown to be safe, i.e. it does not appear to trigger relapses and/or MRI activity. 

CoI: multiple

Twitter: @gavinGiovannoni 

Medium: @gavin_24211

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • Hi – quick question about LAIV:

    In the article you say: ”
    Please note, if you are on immunosuppressive therapies and have small children, please make sure they don’t get the live intranasal flu vaccine at school. There is a risk that this attenuated vaccine strain, which they may bring home, will cause disease in immunocompromised subjects.”

    On the summary of product characteristics it advises, “Some people should not get the nasal spray flu vaccine: […] People who care for seriously immunosuppressed patients who require a protected environment (or avoid contact with those people for 7 days after receiving the nasal spray vaccine)”

    So, if my son gets it at school and it’s possible for me to avoid contact with him for 7 days after he gets the spray vaccine, would that do the job? Or should we just avoid altogether? (We’re in separate households, it could be possible).



    • Re: “So, if my son gets it at school and it’s possible for me to avoid contact with him for 7 days after he gets the spray vaccine, would that do the job? Or should we just avoid altogether? (We’re in separate households, it could be possible).”

      Yes, that makes sense. But the risk of flu from the live attenuated vaccine is low.

  • We need to keep things in perspective. COVID-19 and SARS-CoV-2 have taught us that MS DMTs, apart from anti-CD20 therapies, don’t appear to affect the risk of getting severe viral infections. I suspect we can probably extend what we have learnt in the last 6 months to influenza and the influenza vaccine.

      • It looks as if anti-CD20 increases your chances of getting symptomatic and severe COVID-19 infection. How it does this is linked to the duration of treatment and blunting cross-reactive immunity to other coronaviruses that protect you from getting COVID-19. I see no reason that if this hypothesis is correct that it won’t apply to influenza.

  • Me being on a DMT (ocrelizumab) does not qualify kids to get the alternative non-live version through the funding mechanisms available. I was told last year in no uncertain terms by the local health team responsible for vaccinating kids at school that it only applied to people in strict isolation – eg after chemo – who weren’t circulating in ‘normal’ society, as it then was anyway!

  • In March it was looking like we were heading for a bumper (and early flu season). On top of social distancing and hand hygiene measures, in Australia flu vaccinations were approx 50% higher than last year, resulting in almost no flu. I saw some data last week that for 40,000 flu tests there was only 46 +ve over a 2 week period in August. We have also done more flu tests (about 4-5xI think) this year because some test centres do a panel of respiratory virus tests in addition to COVID.
    Don’t let COVID stop you from getting your flu vax.

    • Yes, Australian mainstream media is reporting that if you have flu like symptoms, you are more likely to have COVID-19 than the flu. I guess this is based on the testing numbers (reflected above).

      Living with someone who is immunocompromised (wife completed year 2 alemtuzumab 3 months ago), the news from the AZ trial is concerning. This is the horse the Australian government has backed.

      Please everyone, continue to be vigilant and maintain social distance. Help protect those in our community that are most vulnerable. I understand the devastating effect this is having on everyone’s mental health (myself included), but we just can’t rely on a vaccine.

      Wishing you all a safe Tuesday.

      • Rhinovirus is most common respiratory infection in Australia at the moment, but even that is pretty low.
        As an Aussie who has just finished year 2 of cladribine, I am really hoping the UQ molecular clamp comes through (the other likely option for Aussies). Might take a bit longer but I like the technology and I think it will show the results. That being said, the Oxford vaccine trial is expanding to South Africa, specifically in HIV patients, so from an immunocompromised perspective it will be interesting to see.

        • Yes, that deal is with CSL. However, I don’t believe PII trials have started yet. They are expanding the PI to include older participants. So, this vaccine is a solid 12-18 months away (and I think that’s being optimistic).

          I will pay close attention to the upcoming Oxford data and eager to hear the thoughts from neurologists moving forward.

  • I work in a primary school, I’m due to have my 2nd ocrevus treatment on 21st. Our children have the intranasal vaccine, should I be worried about being around them?

    • This really only applies to severe immunodeficiency. The SmPc says the following

      4.4 Special warnings and precautions for use

      In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded.

      As with most vaccines, appropriate medical treatment and supervision should always be readily available to manage an anaphylactic event or serious hypersensitivity event following the administration of Fluenz Tetra.

      Fluenz Tetra should not be administered to children and adolescents with severe asthma or active wheezing because these individuals have not been adequately studied in clinical studies.

      Vaccine recipients should be informed that Fluenz Tetra is an attenuated live virus vaccine and has the potential for transmission to immunocompromised contacts. Vaccine recipients should attempt to avoid, whenever possible, close association with severely immunocompromised individuals (e.g. bone marrow transplant recipients requiring isolation) for 1-2 weeks following vaccination. Peak incidence of vaccine virus recovery occurred 2-3 days post-vaccination in Fluenz clinical studies. In circumstances where contact with severely immunocompromised individuals is unavoidable, the potential risk of transmission of the influenza vaccine virus should be weighed against the risk of acquiring and transmitting wild-type influenza virus.

  • Re: “Will wearing of masks and socialdistancing become the norm during flu season?”

    There is no need due to the availability of seasonal vaccine. Would someone rather wear a mask and social distance or get the vaccine? I think the latter, this isn’t 1918. I hope people realize the importance of getting vaccinated after the coronavirus pandemic is over.

    • The problem is that the flu vaccine uptake has been historically low and the anti-vaxxers are having a big impact on people in relation to bot the flu vaccine and the upcoming coronavirus vaccines.

      • I fear the news from the AZ study is going to create more anti-vaxxers. This is problematic as the most susceptible in our community rely on people being immunised.

        • Part of me wants all the data to be transparent and available, but then part of me thinks that the anti-vaxxers will misinterpret it to support the anti-vax cause.

By Prof G



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