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Meaghan Kall Profile picture
@kallmemeg
Oct 20, 2022 • 20 tweets • 10 min read • Read on X
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Do you know an older person (50+) who is hesitant about getting COVID-19 and Flu jabs this winter? 💉

It’s important that they do - and here’s what they should know.

Spread the word ⤵️
Start with some facts.

First, COVID-19 hasn’t gone away.

Ok. Twitter knows this. But in real life people constantly ask me if it is still a thing? Because it’s not in the news anymore.

COVID-19 is here, for good.

In fact, the predicted winter wave of COVID-19 is underway… Image
Second, both vaccines and infection provide long-term (~12 months or more) immunity that protects you from severe disease.

Recent infection or vaccination (the past 3-6 months) can* also protect against becoming infected.

(It’s not 100% but there is definitely an effect.)
BUT it is MUCH SAFER to get immunity from vaccines than infection for older people.

This is why timing of boosters is key ⏰

Time it right (eg Autumn before an expected winter wave) and you can gain protection from severe disease AND being infected in the first place.
BUT

Despite high levels of immunity in the population, age remains the biggest risk factor for severe COVID-19 disease and death.

Even today, with highly effective vaccines 💉 hospital admissions for COVID-19 are still highest among older people.

ons.gov.uk/peoplepopulati… ImageImage
How can this be? If vaccines work or I’ve had COVID-19 before?

Two reasons:

1️⃣ immunity wanes over time. Boosters top up your protection.

2️⃣ so far this wave, infection rates are highest in older people ImageImage
Why? Probably first infections.

People age 65+ have the lowest attack rate (% that has ever been infected)

1 in 4 have never had COVID-19 (as Aug 2022)

This is likely due to success of shielding, vaccines & other measures preventing infections.

mrc-bsu.cam.ac.uk/now-casting/re… Image
However, this leaves space for the immune evasive Omicron to bypass vaccines and infect people.

GOOD NEWS is this 🍁 Autumn we have updated vaccines to target Omicron variant (bivalent) which will provide better protection against infection and disease.
🍁 Autumn booster rollout started 1 September.

Anyone age 50+ can now book a booster: nhs.uk/book-a-coronav…

As of today, 1 in 3 people 50+ are boosted.

assets.publishing.service.gov.uk/government/upl… Image
Among 75+ it is much higher, nearly 60% have had 🍁 Autumn booster

This is undoubtedly having an impact on falling hospital admissions already ⤵️
But we need to keep a close eye on age 50-69.

This group hasn’t had a booster in a year, and infection rates are still rising…

Only ~ 1 in 10 have had 🍁 Autumn booster

Booking for over 50-64 opened up last week

It’s important to go and book a jab: nhs.uk/book-a-coronav… Image
Now… to INFLUENZA

Data published today shows an early rise in influenza.

Flu is seasonal, but this rise is tracking earlier than 2018 and 2019 season.

This mirrors what was seen in the Australia earlier this year

assets.publishing.service.gov.uk/government/upl… Image
So far, the sub-types are a mix of H1N1pdm09 and H3N2

🔺Per WHO, the predominant circulating sub-type globally is flu A H3N2

🔺H3N2 leads to worse outcomes for older people

(whereas H1N1 mainly affects children & young adults)

who.int/teams/global-i… ImageImage
If you’ve had flu, you know how debilitating it can be.

Like COVID-19, both flu vaccines and prior infection give immunity.

But flu practically disappeared for 2 years.

Immunity will have waned in that time, which could lead to a bad flu season.
As always, vaccines are the best protection against infection and disease for flu 💉

This year perhaps more than ever.

But… how effective is the flu jab?
Flu jab is updated each year & covers 4 strains (quadrivalent)

Historically, it is less effective for H3N2 BUT it depends how closely it matches the circulating type

This year’s jab contains H3 virus from major circulating group 2a.2

So far, looks like a good match for H3N2 👍🏻 Image
Finally - COINFECTION

Evidence* suggests co-infection (infection with COVID-19 and influenza at same time) significant increases the risk of severe disease and death.

*data from 2020-2021, most data were from pre-COVID vaccine era

assets.publishing.service.gov.uk/government/upl… Image
Coinfection risk is high with lotd of flu and COVID-19 circulating aka ‘twindemic’

Older folks have been hit so hard the past 3 years. The last thing they need is a bad respiratory virus season.

Vaccines are the best form of defence. #getboosted 💉

gov.uk/government/new…
UPDATE: thanks to @JusDayDa

🔺 Flu slides from @CDCgov clearly show the early high wave of flu in Australia - not mirrored in other Southern Hemisphere countries (South Africa 🇿🇦 Chile 🇨🇱)

🔺 H3N2 was the dominant subtype in Australia and Chile (>90% of subtyped specimens) ImageImageImage
UPDATE2: I seem to have offended some people by calling 50+ “older” - this was a (perhaps clumsy) attempt at shorthand in a number-heavy thread. Apologies for this!

I hear you and will reword in future.

But to be clear older does not equal old!

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More from @kallmemeg

Meaghan Kall Profile picture
Aug 7
Guess I can’t put this off any longer. Yesterday was officially my last day, and my bio must be updated…

After 15 amazing years, I am leaving UKHSA to start a 4-year @FPH specialty training programme in public health.

Pls indulge a short thread🧵 Image
When I got a job at the (then) Health Protection Agency in 2009 I told @dopapus and @vanessa_apea it was my dream job.

And it really was.

Wrangling real-world data. Influencing policy. Improving health. This is all within reach working at a public health agency. And I loved it.
Working for 10 years in the national HIV surveillance team, developing Positive Voices, the largest HIV patient survey in the world, is truly the highlight of my career.

To be able to give patients a voice in @UKHSA routine public health data has been an enormous honour.
Image
Image
Read 11 tweets
Meaghan Kall Profile picture
Dec 6, 2023
NEW: @UKHSA COVID-19 Variant Prevalence and Growth Rates

✅ JN.1 has been designated variant V-23DEC-01 due to increasing sequence prevalence in the UK and internationally.

gov.uk/government/pub…
Image
JN.1 is a BA.2.86 sub-lineage (BA.2.86.1.1), which contains the L455S mutation in Spike, known to aid immune evasion.

There are currently 223 cases in England. Image
As mid-November, JN.1 represented 7.9% of cases in England 🏴󠁧󠁢󠁥󠁮󠁧󠁿

At that time, JN.1 had a weekly estimated* growth rate advantage of 84% (64%-104%) against current XBB background

*model adjusted for geography and clustering
Image
Image
Read 5 tweets
Meaghan Kall Profile picture
Aug 18, 2023
NEW: @UKHSA variant risk assessment just published

⚠️ BA.2.86 designated a variant V-23AUG-01

gov.uk/government/pub…
Image
Been a while since I have done a Friday night data drop thread!

But important to note this is a risk assessment, rather than a data report, due to limited numbers of sequences (6 cases in 4 countries at time of publication)
The assessment was performed today by UKHSA public health teams in collaboration with counterparts in EW&NI, academics & clinicians.

Key points:

• The geographical distribution of cases without travel history “suggests there is established international transmission” Image
Read 11 tweets
Meaghan Kall Profile picture
Aug 2, 2023
NEW: @UKHSA COVID-19 Variant Prevalence and Growth Rates published

EG.5.1 is declared a variant (V-23JUL-01)

https://t.co/gqVsvmqD63gov.uk/government/pub…
Image
EG.5.1 is a derivative of the Omicron XBB lineage, the currently dominant strain in the UK.

A variant is declared if it is growing in prevalence and is considered significant enough to justify further characterisation. Image
Globally, EG.5.1 accounts for:

• 20% of sequences from Asia
• 10% of sequences from Europe
• 7% of sequences from North America.

Latest data shows EG.5.1 is 12% of sequences in the UK

{this % is likely be higher today due to sequencing/reporting lag} Image
Read 6 tweets
Meaghan Kall Profile picture
Apr 26, 2023
ICYMI: @UKHSA published a new COVID-19 variant technical briefing

🧬 XBB.1.16 update and designated variant V-23APR-01

assets.publishing.service.gov.uk/government/upl… Image
Current variant landscape🇬🇧

🔺XBB lineages dominate, now over 70% of sequenced cases

🔺XBB.1.5 led the takeover of BQ.1 and CH.1.1 earlier this year

🔺 XBB.1.16 (in pink below) is a small but increasing fraction

(Context will be relevant later on...) Image
XBB.1.16

First emerged in February 2023, XBB.1.16 has shown marked growth in India 🇮🇳 coupled with increasing cases and deaths there.

It also appears to be growing in other countries like the USA 🇺🇸, Singapore 🇸🇬, Brunei 🇧🇳 and Australia 🇦🇺 Image
Read 14 tweets
Meaghan Kall Profile picture
Jan 27, 2023
ICYMI: 🏴󠁧󠁢󠁥󠁮󠁧󠁿 GOV.UK Dashboard has changed how it presents COVID-19 deaths

@ONS death certificates are now the leading measure, replacing deaths within 28 days

This is because 28-day deaths is no longer a good proxy for COVID-19 deaths. A short thread🧵
This stems from a joint analysis between @UKHSA and @ONS, led by the brilliant @giulia_seghezzo

We have been monitoring how closely the 28-day deaths tracks COVID-19 death certificates.

khub.net/documents/1359…
Remember: deaths within 28-days was only ever a proxy for COVID deaths. It does not consider cause of death, because that information is too delayed.

@UKHSA 28-day deaths

✅ Pros: rapid measure, shows changing trends
❌ Cons: not specific to cause of death
Read 13 tweets

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