Cold season advice With winter and colder weather, everyone becomes more susceptible to illnesses such as viral infections like influenza (flu) or rhinovirus (common cold). This year we have the added threat of the ongoing COVID-19 pandemic. Research has shown that if you get flu and coronavirus at the same time, you're more likely to be seriously ill. Patients suffering from diseases which compromise or weaken their immune system, such as Aplastic Anaemia (AA), are at higher risk of more serious health-related complications because of them. Is the seasonal flu jab safe? Seasonal flu vaccines protect against influenza viruses that research indicates will be most common during the upcoming cold season. The decision about whether patients with AA should receive the flu vaccination is widely debated and you should always discuss with your haematologist first about whether you should get a ‘flu shot’ or not. Individual risks assessments can be carried out for each patient. What are the risks? There is a theoretical risk of relapse of Aplastic Anaemia, or an increased risk of a drop in your blood counts following any vaccination, particularly the flu jab. However, the evidence is limited and is based on anecdotal case reports, as well as an awareness that a viral attack is likely to be an important trigger in the development of the disease. In most circumstances the advice is not to receive the flu vaccination except for patients who have received a haematopoietic stem cell transplant. In these cases, you should/and will be routinely re-vaccinated as per a schedule which is recommended for all post-transplant patients. Having a viral infection, such as the flu, can be problematic for AA patients as it can further suppress your blood counts or increase your risk of secondary bacterial chest infections or pneumonia. Certain viral infections can be treated with antiviral medications but your haematology team may review your circumstances and infection before prescribing them for you. In some cases, you may need to be hospitalised. In certain instances, antibiotics are also prescribed to help prevent secondary bacterial chest infections. Some common-sense advice on how to prevent the flu To help reduce your risk of contracting the flu and other illnesses, there are a few steps you can take. Many of these are steps you should already be taking to protect yourself from COVID-19 Practice good hand hygiene by washing your hands regularly with soap and water or alcohol-based hand gels – encourage everyone you come into contact with to do the same. Avoid touching your eyes, nose or mouth as germs can spread easily this way Avoid contact with people who are displaying flu-like symptoms. If any of your family or friends have a flu-like illness, its best if they abstain from visiting you until they’re fully recovered. If anyone is displaying COVID-19 symptoms, they should be isolating themselves according to government advice. Avoid going out in public places at peak times or with high numbers of people. If you are neutropenic we'd usually recommend you wear a respiratory face mask in these circumstances (during the current pandemic we recommend masks are worn by everyone, in line with the law and with government advice.) Where possible, try to stay in well-ventilated areas. Cover your nose and mouth with a tissue when you cough or sneeze; promptly throw the tissue in the bin after you use it. Where possible ask your family members or others in close contact with you to get the flu vaccination as this may reduce your chances of getting the flu. Try to practice good health habits: eat nutritious foods and drink plenty of fluids. Try to get plenty of sleep and exercise well – stay active! Avoid cold temperatures, wrap up warm when going outside and regulate your temperature appropriately. Monitor your body temperature closely and treat any fevers as an emergency, seeking immediate medical attention if you develop a temperature of ≥38.0 ˚c. Remember if you develop any flu-like symptoms to contact your haematology team as you may need to be hospitalised, and in some instances, even isolated in a negative pressure room, where you may receive treatment for this involving medication. Advice developed with the Haematology Team at King's College Hospital, London. Reviewed and updated in November 2020. Cold season Q & A with Dr Austin Kulasekararaj Consultant haematologist Dr Austin Kulasekararaj joined us on 30 September 2021 for a live Q & A session about cold and flu season, vaccinations, and how aplastic anaemia patients should keep themselves safe. In this event recording: 1. Austin explains the different between a third dose Covid vaccination and a booster. 2. Austin answers pre-submitted questions about the flu vaccine and aplastic anaemia 3. Austin answers pre-submitted questions about the Covid-19 vaccine and aplastic anaemia 4. Austin takes follow-up questions from people in the call including how to ask your GP for a third dose vaccination and which Covid vaccination he would recommend for aplastic anaemia patients. Watch the recording of this event below: With Covid hanging around and uncertainty about vaccine efficacy and safety for people with aplastic anaemia, this is another challenging cold and flu season for our community. Why are many AA patients advised against having the flu vaccine, but told they should receive the Covid-19 vaccine? Should you book another Covid-19 jab? Should your children be vaccinated to protect a vulnerable parent? Dr Austin Kulasekararaj is a consultant haematologist at King’s College Hospital, London. He has trained and worked at King’s since 2004, undertaking research in molecular pathogenesis of MDS and aplastic anaemia. He specialises in bone marrow failures, myeloid malignancies and allogeneic bone marrow transplantation. He also leads the King’s PNH Centre, which is one of two NHS England-commissioned highly specialised services for PNH. For many years, it has been recommended that people with aplastic anaemia should not receive the flu vaccine. Does this advice still stand? This is actually quite a controversial topic. At its simplest, a vaccination triggers an immune response in someone’s body and that response will protect you against a specific virus. But the immune response in patients with aplastic anaemia is abnormal, so any viral infection or vaccination can potentially trigger a counter-productive immune response. There have always been cases where vaccinations have triggered a relapse of aplastic Anaemia or a vaccination has actually caused them to develop it. The general tendency in the UK has always been to avoid flu vaccinations but when I speak to colleagues around the world they would go-ahead with vaccinations. In these situations it’s all about assessing and balancing the risks. I personally feel that everyone should make their own individual choices and my worry is that these common cold viruses could come backstronger because of COVID-19. I regularly care for my grandchildren, and they will be receiving the live nasal flu vaccine soon. Do I need to avoid contact with them afterwards too? This is a very important question. The reason people are advising patients with aplastic anaemia to avoid contact is that there is a possibility that the virus in the live vaccine could actually infect you. The first way around it is to just distance yourself for a couple of weeks until the live virus is away from their system. Again, it’s all about balancing the risk and looking at your personal situation. If you have been treated and off the drugs for a while, you might be able to take that risk if your immune system could cope. Is it safe to have the Covid and flu vaccines at the same time? I believe there is a plan to bring in a combined vaccine for Covid and the flu. In the in The UK that has not been rolled out yet, we still have two separate vaccines. If you can stagger vaccinations, it’s always better. It can also be difficult to know what’s caused problems if there are any side effects. I have had five Covid vaccinations and I have had awful side effects from each of them. Do I really need a sixth dose? We have seen that aplastic anaemia patients have shown a positive response to Covid vaccines because we were worried that it might not be effective. If you have protective antibodies present, which can last from 6 to 12 months, I would advise staggering the protection throughout the flu season and maybe waiting until spring. This isn’t necessarily based on data, I’m coming from a pragmatic and practical angle. Have there been cases where people with aplastic anaemia have relapsed after receiving the Covid vaccine, or where people have been diagnosed with aplastic anaemia after being vaccinated? In March 2020, we collected and studied a series of patients throughout the UK and we saw some who, after developing COVID, were diagnosed with aplastic anaemia. Any viral infection can trigger an immune system response. We did see infections triggering the blood counts to decrease in patients who had known aplastic anaemia. In terms of the vaccination, in a large study in Leeds, we saw that vaccination did not appear to trigger a relapse but there has been some data from other countries where vaccinations did result in a relapse.There are some situations where there has been an increased risk and these things are rarely black and white. Should I have my Covid vaccine first, or my flu jab? I would stagger having my vaccinations but it doesn’t matter what you have first or second. If you have just recently had your Covid jab, it might be worth waiting for a few more months. I have regular blood transfusions to keep my blood count stable. Can having regular blood transfusions, and the antibodies within them, affect the efficacy of vaccines? No, I haven’t seen any data to suggest that it would be impacted. You might actually benefit from the transfusions as many of the donors have already been vaccinated which means you may actually receive some antibodies in the transfusion. I will be two years post-transplant early next year. Compared to last year when I wasn’t vaccinated, how careful do I need to be this year compared to last year? From a Covid perspective, we understand it better and the complications with the newer variant seem to be milder. It’s not always the rule but I am slightly more relaxed about it. We have preventative and early treatments now too. If you do contract Covid you cancontact your GP and you will be referred to the CMDU who will deliver early treatments. In terms of other viral infections, I would be careful. It’s worth remembering that these common cold viruses may come back stronger this year as they are able to circulate around the population more freely than in the past two years. Do you think that EVUSHELD will ever be available for use in the UK? There are a group of people who do not respond to Covid vaccinations. There is a drug called EVUSHELD that is available to people whose immune system is not able to build a sufficient antibody response to Covid. It could protect you from getting Covid. Unfortunately it’s not been approved in the UK but the success of the drug is quite variable. You can find more resources on Covid-19 here. Manage Cookie Preferences