The influenza season now is in full swing in the Northern Hemisphere, with four strains of the disease in circulation this year, as is typical. In Europe, however, the most frequently administered jabs, known as trivalent vaccines, only protect against three of these four strains. With data suggesting that the fourth strain—the influenza B Yamagata strain, or “Japanese flu”—is now the most prevalent on the continent, is it time for European healthcare providers to start administering quadrivalent vaccines, which provide a greater breadth of protection?
By most measures, the 2017–2018 influenza season has thus far been particularly severe, and the disease is currently placing a significant burden on healthcare services in Europe and North America. According to the European Centre for Disease Prevention and Control (ECDC), the number of health service consultations for influenza-like illness (ILI) in some regions is up by over 150% from the same time last year. The situation is also concerning in the US, where patient visits due to influenza are currently at their highest rates since the “swine flu” pandemic of 2009–2010; according to the US Centers for Disease Control and Prevention (CDC), 6.3% of all consultations were attributed to ILI during the second week of 2018.
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Each year, influenza vaccines are manufactured to protect against multiple strains based on recommendations from the World Health Organization (WHO). Vaccines can be split into two different categories: trivalent vaccines, which protect against three strains of influenza, and quadrivalent vaccines, which also protect against a fourth strain. The more expensive quadrivalent vaccines are the most prescribed influenza vaccine in the US. However, most European patients still receive the trivalent vaccine, and a report from GlobalData estimated that only 5% of influenza vaccines administered across the five major European markets (5EU: France, Germany, Italy, Spain, UK) in 2015 were the full quadrivalent vaccine.
Comparisons of the data released by the CDC and the ECDC on the prevalence of different strains in circulation suggest that use of the trivalent vaccine may have impacted which strains are observed in infected individuals. In Europe, 65% of all cases tested in the 2017–2018 season to date have been Influenza B, and although strain B genotyping is not performed pan-continentally, reports from individual countries suggest that the majority of these infections are the Yamagata strain. In the US, where patients have been receiving the quadrivalent vaccine, the H1N1 Influenza A strain is the most prevalent at 78% of infections, and only 9% of patients have been found to have the Yamagata strain.
The data used in the figure below was taken from the CDC’s weekly online U.S. influenza surveillance report, and the ECDC and WHO’s Flu News Europe website.
There are several factors that could contribute to the difference in influenza strains observed between continents. For example, a high prevalence of the H3N2 strain in Europe during the 2016–2017 season is expected to have carried over some protection against the strain this year, which could account for the relatively low prevalence of H3N2 when compared to the US. However, given the stark difference in prevalence of the Yamagata strain between Europe and the US, it seems reasonable to suggest that this is at least partially due to greater levels of quadrivalent vaccine use in North America.
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By GlobalDataThe key quadrivalent influenza vaccines that are currently available in Europe are GlaxoSmithKline’s Fluarix Quadrivalent, which launched in 2013, and Sanofi Pasteur’s VaxigripTetra, which launched in 2016. These vaccines cost approximately $1–3 more per dose than the trivalent equivalent, which seems to be the greatest barrier towards their increased use. However, given the high prevalence of the Yamagata strain in Europe this season, GlobalData expects that these vaccines will begin to see greater use in the future.
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