2017 worst influenza season in Australia since 2012 with New South Wales hit the hardest

Quick facts

  • Influenza is a very contagious respiratory virus which is spread by sneezing or coughing commonly.
  • There are two strains of influenza with many variations due to proteins within the DNA. This allows continual mutations from year to year.
  • Worldwide 3-5 million people become infected every year with 250,000 to 500,000 deaths annually.
  • In Australia approximately 18,000 people are hospitalized each year with 3,500 deaths.
  • The World Health Organization has been monitoring and producing vaccines for influenza since 1952 with 142 monitoring centres in 112 countries.
  • Five international centres produce the vaccines used every year, including one in Melbourne.
  • While criticism of the level of outbreak for 2017 in Australia is mixed statistics showed that there were more reported cases this year than at any point since 2012
  • Of the 217,559 cases of influenza reported in Australia up to October 2017 over half (101,793) were reported in New South Wales.
  • Officials recognize an issue with how the influenza outbreak was handled in Australia this year, however they are divided on possible solutions to prevent a repeat in years to come.



With 2017 thought to have been a horror year for influenza in Australia, I thought I would  research where our flu vaccines come from, how are they chosen and why has this year in particular been so bad?

A little about influenza

Flu, or more correctly known as influenza, is a respiratory virus which has similar symptoms to that of a common cold. The difference is the severity and quality of those symptoms. Surprisingly there are only two strains of influenza: A and B. However, within those two strains are combinations with varying protein chains of H and N. This is what gives the influenza virus the ability to mutate and evade eradication. Influenza can strike at any time of the year; however the colder months are more likely to see the spread of the virus. One possible explanation I heard a few years ago is that during the colder months people are more likely to congregate together indoors which would allow influenza to spread more readily. This could be due to the fact that influenza transmits via airborne means such as sneezing and coughing.

Globally the World Health Organization (WHO) estimates that between three to five million cases of severe influenza occur each year worldwide and of those 250,000 to 500,000 cases result in deaths. Australia specifically sees 18,000 hospitalizations for influenza annually with an average of 3,500 deaths. Influenza is also estimated to account for 10% of all yearly workplace absenteeism in Australia.

Worldwide vaccine efforts

As a virus you cannot cure it with antibiotics; once infected all you can do is wait it out. However, vaccines work by introducing a weak or dead strain of the virus into the body where antibodies can be produced which when confronted with the influenza virus will kill the virus before it takes hold of the host’s body and produce debilitating symptoms. The production of antibodies can take three to four months before fully effective so experts recommend having the flu vaccine early in the season to allow for immunity to develop.


The WHO has been responsible since 1952 for the monitoring of influenza and vaccine research through their Global Influenza Surveillance and Response System. Different influenza strains become more prominent from year to year, and strains can mutate. Therefore the WHO runs 142 monitoring centres in 112 countries. Five of those centres host World Health Organization Collaborating Centers for Reference and Research on Influenza:

  • Atlanta, Georgia, USA (Centers for Disease Control and Prevention, CDC);
  • London, United Kingdom (The Francis Crick Institute);
  • Melbourne, Australia (Victoria Infectious Diseases Reference Laboratory);
  • Tokyo, Japan (National Institute for Infectious Diseases); and
  • Beijing, China (National Institute for Viral Disease Control and Prevention)

These five centres are also produce vaccines for the different influenza strains. Monitoring of influenza occurs year-round, however production of vaccines takes approximately six months and therefore decisions on which strains (usually three to four) are included are made half a year before the major flu season starts. The actual vaccine doses are then manufactured by private companies with the strains produced by the centres above.

The 2017 influenza season

So with all of the knowledge of influenza and the work of the WHO and CDC along with other scientific groups, what happened this year? Well that depends on who you ask. According to the Australian Department of Health the peak of the influenza season was mid-August of this year. The department did state that there appeared to be higher-than-usual numbers of cases being reported, however mitigated that fact by saying that testing was more readily used and could have contributed to the larger number of reports. Influenza A seems to be the dominant culprit this past season. The department’s report also goes on to say that they number of hospital admissions this season were ‘moderate’ compared to previous years, and that the vaccines given seem to have had a good effect.

NSW health minister Brad Hazzard would disagree with the federal department of health report. According to Minister Hazzard “I think at this stage what we got unfortunately was a vaccine, with the benefit of hindsight — and hindsight is a wonderful thing — that wasn’t quite up to it.” Peter Collingnon, executive director of ACT Pathology and a physician at the Canberra Hospital Infectious Diseases, went onto say that he felt the vaccine this year had very low efficacy for the A H(3) strain responsible for so many hospitalizations and deaths. Although the vaccine supplied to Australians was up to the global standard many patients were being seen by GPs with influenza despite being vaccinated.

According to the Immunisation Coalition in Australia as of the 24th of October 2017 there were 217,559 cases of influenza confirmed.  Of those cases over half (101,793) were reported in New South Wales. The next highest rate was Queensland which only had 53,487. So in my state of New South Wales was by far the worst hit this past season. The reported number of cases nationwide, according to the Immunisation Coalition, in 2017 were significantly higher nationwide than at any point in the last five years.

The future?


So is this a trend, or just a one-off event?  That is very hard to know. According to the information I read the experts are mixed. One possible suggestion is that our vaccine processes are out-dated and we need to re-think how vaccines are produced. Additionally, community hygiene practices could be reviewed to limit spread of influenza, particularly in peak times. What we do know is that influenza won’t be going away anytime soon. And at least for 2017 New South Wales bore the brunt of the outbreak.

As a member of the acute healthcare team I applaud every member of healthcare for their work and dedication during this flu season. Ask any person working in this industry, particularly in New South Wales, and they will tell you it was a very busy and trying time.

Until next time,



National Centre for Immunisation Research and Surveillance- Influenza fact sheet= http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/influenza-FAQs.pdf

Centers for Disease Control and Prevention- CDC’s World Health Organization (WHO) Collaborating Center for Surveillance, Epidemiology and Control of Influenza= https://www.cdc.gov/flu/weekly/who-collaboration.htm

Centers for Disease Control and Prevention- Selecting Viruses for the Seasonal Influenza Vaccine= https://www.cdc.gov/flu/about/season/vaccine-selection.htm

World Health Organisation- Influenza (Seasonal) Fact sheet= http://www.who.int/mediacentre/factsheets/fs211/en/

Influenza Specialist Group- Influenza Fast Facts= http://www.isg.org.au/index.php/clinical-information/influenza-fast-facts-/

Australian Department of Health- Australian Influenza Surveillance Report and Activity Updates= http://www.health.gov.au/flureport

ABC news- Influenza: NSW Health Minister says current vaccine ‘not up to the job’ after deadly flu season= http://www.abc.net.au/news/2017-10-30/influenza-australia-deadly-year-prompts-calls-for-new-vaccine/9098598

Immunisation Coalition- Influenza Activity Surveillance 2017= http://www.immunisationcoalition.org.au/news-media/2017-statistics/


Drug resistant staph infections more common in the community


An article in Business Insider Australia has highlighted that drug resistant staph infections are now more commonly acquired in the community than in hospital. In the report Dr. Agostino, a researcher from ANU medical school, stated that upwards of 60% of these staph infections are picked up in the community. This is a marked change from the early 2000s in which most infections originated from hospitals.

But, as the report suggests, effort now needs to focus on community education and proper drug use. Hospitals have implemented policies such as the “Five moments of hand hygiene” and regularly conduct hand washing audits on wards. Protocols for antibiotic use are much more prevalent and help to control the spread of these infections.


What needs to be done to rid the community of these problematic infections which can be lethal to the elderly, young or pregnant women? With the increased co-mingling of individuals and lack of rigor towards hygiene procedures the infectious disease community will need to re-think its approach to dealing with the spread of infections outside of the hospital setting.

Business Insider Australia- Drug-resistant staph infections have escaped from Australia’s hospitals

Should Australia adopt a national Dementia plan?


Anyone who works in healthcare, particularly those in aged care, can attest to the fact that dementia is one of the largest problems facing our aged population. Here are a few Australian facts courtesy of Alzheimer’s Australia:

  • There are more than 413,106 individuals in Australia living with dementia
  • Currently 244 new individuals will be considered has having dementia every day
  • Dementia is the second leading cause of death of Australians
  • In 2017 the cost of caring for those with dementia in Australia is estimated to be 14.67billion
  • Dementia is the single biggest factor leading to disability of adults over the age of 65
  • Dementia accounts for 52% of those residing in aged care facilities (RACF)

It is a huge problem! In an article on the 2nd of June in Australian Ageing Agenda Maree McCabe of Alzheimer’s Australia has strongly encouraged Australia to join the international community in developing and funding a national Australian dementia policy. In the article it states that the World Health Organization (WHO) has adopted a Global Plan of Action on Dementia, and that Australia should join other countries in adopting it.

What is Australia doing about it?

The government’s response has not been favorable to Alzheimer’s Australia’s (AA) request. Dr Margot McCarthy told a Senate estimates committee that, although she was aware of AA’s request there was no national strategy but a series of increased funding for research and new dementia-specific programs. Dr. McCarthy also in her statement referred to the National Framework on Action on Dementia, but said the government had to decide on how to follow-through with the framework.

The National Framework on Action for Dementia 2015-2019 was developed by the  Australian Health Ministers Advisory Council (AHMAC) through a consultative process and merely serves to

The purpose of the Framework is to guide the development and implementation of actions, plans and policies to reduce the risk of dementia and improve outcomes for people with dementia and their carers. It does this by drawing on current evidence to promote dementia friendly societies and delivery of consumer-focused care.

The keywords here is ‘guide’ and ‘development and implementation’. This is NOT a national framework, but merely a fact-finding paper with the results of interviews and consultations on the problem. While the national framework policy does not give any direct action to the problems of dementia, there have been some attempts by the government to tackle dementia issues.

In June of 2016 the government began a commitment to tackle the issue of dementia in the community by the initiation of the Severe Behviour Response Teams (SBRT), a partnership between the government and Hammond Care. The SBRT is meant to be an assessment and management team designed to visit the individual and work to identify and create strategies to handle adults who suffer from dementia-related behaviours. The government also acknowledged at the time that specific dementia facilities for those with behaviours would be needed. Dr. Judd, then chief executive of Hammond Care, indicated that accreditation standards for aged care facilities had led to those facilities increasing in size and therefore “as nursing homes get bigger and bigger, it becomes harder not to have institutional buildings which are less homelike and more regimented… Today, the public areas of some aged care ‘facilities’ look more like airport lounges than lounge rooms” (quote by Dr. Judd taken from this article).

A year later and the Ageing Australian Agenda article confirmed that the special dementia units promised in 2016 were largely not developed. Therefore, the bulk of dementia-specific management of older adults rests squarely on the shoulders of current residential aged care staff and caregivers when dementia-sufferers are at home. But what about the WHO’s Global Action on Dementia? Wouldn’t that give some indication on where Australia should go?

The World Health Organization and Dementia

I have looked through the WHO’s website and cannot see any agreed final document on the global action on dementia. According to the WHO dementia has been labeled as a public health priority in 2012 and a Ministerial Conference on Global Action on Dementia did occur in 2015, resulting in a draft document of the same name. In the push for WHO development of information a site entitled The Global Dementia Observatory was meant to be a sharing house for information relating to statistics on global dementia and development of strategies to treat and handle those with dementia. However, in my research neither has the Global Action on Dementia been finalized nor has the Global Dementia Observatory been created and implemented despite statements made by Alzheimer’s Australia.

So from my perspective after looking at all of the information the WHO is no further in looking for a unified dementia strategy than Australia is. We continue to develop reactionary stop-gap measures to modify behaviours and reduce pressure on caregivers. But that does not help identify and treat the root cause. Non-government organizations like Alzheimer’s Australia and Hammond Care are doing great things to try and help this looming national (and international) epidemic.

We in healthcare are at the front-line of this issue. Of the patients I see a vast majority are over the age of 65, as they take up more acute healthcare beds. And while I do not have specifics of those with dementia I can say with my experience that many who enter our beds do. Dementia causes quite a few issues that can lead to life-shortening situations.

My thoughts

Those who follow this blog know that I have talked twice about the concept of ‘premature deaths’ a topic surrounding why individuals in aged care facilities are dying from un-natural causes. Falls was listed as the greatest cause of these premature deaths. I wonder if Mr. Ibrahim’s proposed study would look to identify of those falls how many patients have a diagnosis of dementia? Being reasonable and looking at common sense, if I do not have dementia and have all of my faculties would I not use the vast range of mobility aids and ask for help to prevent falling when I look to walk or even stand? Those with dementia do not have the for-sight to realize that they are no longer able to mobilize without help, and therefore are at higher-risk of falling.

Interestingly Dr. Judd in his address in 2016 also talked of aged care facilities becoming larger. This is another troubling point. Larger facilities mean more residents for staff to monitor in a larger space. Another interesting study could look at the amount of time each staff is given per resident. I think it would find that staff have difficulty in adequately supervising residents, particularly those with dementia who are prone to stand and walk- and therefore fall.

Unifying Australia’s stance on dementia and the associated research and programs would give clarity and focus within all aspects of the aged care community. Let’s face it, the aged care population is faced to grow over the next few years. And with it those with dementia is also most likely going to grow. It is a debilitating condition that we need to know more about to effectively care for and treat. I agree with Mrs. McCabe, Mr. Judd and the WHO that we need to put more focus on a unified and strategic plan to deal with this growing epidemic.


Australian Ageing Agenda: Australia behind as global dementia plan endorsed


Australian National Framework for Action on Dementia 2015-2019

Australian Ageing Agenda: Coalition to fund special dementia care units for severe behaviours

Dementia Behaviour Advisory Service

Hammond Care: Severe Behavoiour Response Team

World Health Organization: Dementia



Australian drug names to get an overall in keeping with international standards

According to an article published on the GIZMODO website by Rae Johnston the Therapeutic Goods Administration (TGA) is planning to change the name of approximately 200 medications in Australia over a seven year period to better align with the international community. According to the article the TGA determines the approved names for medications, however in some cases the names may deviate from the internationally known name as identified by the World Health Organization. During the transition period the TGA will insist that labels show both the old and new medication names.

There is a website setup by the TGA acknowledging the name changes and listing some of the medications names which will be changed. Most will stay relatively the same with only minor variations due to the differences of spelling. Interestingly enough the TGA website was published in November, 2016 and the article in GIZMODO published yesterday. I wonder if there is a delay in the name-change process?


GIZMODO: 200 Australian Medications Are Getting A Name Change

Theraputic Goods Administration: Updating medicine ingredient names – list of affected ingredients