Let Data Talk: Is Nature or Humans to Blame for the Outbreak of Influenza this Winter? (2)

A natural disaster due to WHO’s errors in predicting influenza strains?

The trivalent vaccine predicted and recommended by WHO at the beginning of 2017 is only for H1N1 and H3N2 strains of influenza A, and Victoria lineage subtype of influenza B; certainly, the tetravalent influenza vaccine recommended by WHO is also for the other Yamagate lineage of influenza B which is the fiercest strain in 2017/18 influenza season in China, however, the influenza vaccine adopted by China this year is the trivalent vaccine for H1N1 and H3N2 strains of influenza A, and Victoria lineage subtype of influenza B as recommended by WHO, therefore, China was completely wrong in selecting the vaccine for one of the two subtypes of influenza B, and the current vaccine is completely ineffective to the Yamagate lineage subtype in influenza B that has the fiercest outbreak in China.

However, it is unnecessary to criticize the National Health and Family Planning Commission of the P.R.C. (NHFPC), because even if WHO was correct in the prediction and China chose the correct vaccine, the winter influenza epidemic situation this year would not change much: according to the introduction of Feng Zijian, the Deputy Director of the Chinese Center for Disease Control and Prevention (China CDC), in the press conference of the NHFPC on January 9, 2018, China produces 26 million doses of influenza vaccines every year, however, only about 20 million are available for use, but there is still nearly 1/4 left, namely, the vaccination rate is less than 2% of the total population. Such a low rate has little action on the malevolent influenza viruses. Next, let’s see the influenza vaccination in the U.S.: the influenza vaccination rate of the minors reached 43.3% and of the adults reached about 59.0% in 2016-2017 in the U.S.

Fig. 3 Number of Outbreak of Influenza Virus by Subtype in East Asia (Specimen Data in December 2017)

Man-made disaster: Extremely low influenza vaccination?

Perhaps someone will think that vaccination is of little use because WHO was already wrong in the prediction, however, is that so? We can check WHO’s influenza epidemic statistical data (Fig. 4) for the North America (mainly the U.S.) in 2017: in the entire 2017, the North America only underwent outbreak of influenza in spring, with a sharp decline of the influenza incidence rate thereafter; the rate did not pick up until winter but was far lower than that in spring. After outbreaking in spring, the A(H3) strain did not outbreak in a large scale thereafter in the whole year, and A(H1N1) infected even less people. In contrast, the trend is completely different in the East Asian region (in fact, the main data are from China) (Fig. 3): there were three significant outbreaks in the year, and A(H3) strain outbroke in a large scale at the beginning and in the middle of the year. There are also many people infected by the H1N1 and H3N2 of influenza A in this winter influenza outbreak. Therefore, the antibody in the body obtained after the outbreak at the beginning of the year cannot guarantee that the influenza will not outbreak again.

The reason for such regional difference is simple: A(H3) strain was predicted by WHO, and the influenza vaccination rate of the minors reached 43.3% and of the adults reached about 59.0% in 2016-2017 in the U.S., but according to the introduction of Feng Zijian, the Deputy Director of the China CDC, in the press conference of the NHFPC on January 9, 2018, China produces 26 million doses of influenza vaccines every year, however, only about 20 million are available for use, but there is still nearly 1/4 left, namely, the vaccination rate is less than 2% of the total population. From this, we can see that the effect of influenza vaccination is clear in controlling the influenza outbreak.

The vaccine stockpiled by China as recommended by WHO is also for those two A strains, therefore, if the vaccination rate could have been higher, China would be like the North America to completely avoid the influenza outbreak in the middle of 2017 and would have much less people infected by influenza A in this winter outbreak. Therefore, China shall increase the influenza vaccination, to reduce risk of influenza outbreak.

Fig. 4 Number of Outbreak of Influenza Virus by Subtype in North America

(Specimen Data in December 2017)

Man-made disaster: wrong civil cognition and official behavior in presenting influenza statistical data result in low influenza vaccination rate?

Many Chinese has long been holding the thought that only Caucasians represented by the Americans fear of influenza because their influenza mortality is high, while the Chinese do not fear influenza because they will almost recover, with extremely low mortality. And many people around me still hold such view today, which is not groundless: let’s see the following statistical data: there are about 200 thousand influenza inpatients in the U.S. every year according to statistics, wherein, about 30-49 thousand people die of influenza and complications from influenza, with the mortality of about 15-24.5%; while the statistical data of the China CDC are very interesting: the population infected was 195,723 in 2015, with 8 dead, was 306,682 in 2016, with 56 dead; the population infected by H7N9 was 264 in 2016, with 73 dead; the population infected by influenza was 121,800 in December 2017, with 5 dead: not taking H7N9 into account, the average mortality was less than 0.01% in those years. Therefore, it would not be necessary for us to take influenza seriously if we looked at only the official statistical data. However, let’s see the report of the Department of Health of Hong Kong, S.A.R., China: according to the data by August 2017, the Hong Kong, S.A.R., China population infected by influenza was 14,713, with 307 dead, and the mortality of about 2.1%. If the influenza mortality in China being different from that in the U.S. was because of race difference, how could this explain the large difference in the data of mainland China and Hong Kong, S.A.R., China. Therefore, the above saying that the Caucasians represented by the Americans have high influenza mortality and the Chinese do not fear influenza is perhaps not true, but only because of the different statistical method: the U.S. counts the death caused by the complications from influenza into death caused by influenza, but the center for disease control and prevention in each place of China completely rules out the death caused by the complications statistically, to avoid unnecessary troubles, which results in the influenza mortality to be extremely low in China. This has led to that the Chinese people have long been holding that the Chinese do not fear influenza and influenza is not a big deal, and this might also result in the Chinese to reject influenza vaccination. Certainly, the Chinese government’s efforts in promoting influenza vaccines are far from enough, therefore, the correct official guidance will also be very important to improve people’s initiative to receive influenza vaccines.

P.S.: The above data are all from WHO and website of the China CDC.

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