key: cord-0774767-hw0cfhpq
authors: Al Awaidy, Salah T.; Al Slail, Fatima; Al Kathiry, Dalal Abdul Aziz; Al Mayahi, Zayid K.; Koul, Parvaiz A.; Tanriover, Mine Durusu
title: A Case for Enhancing Coverage of Influenza Vaccination in Gulf Cooperation Council Countries in Patients with Diabetes Mellitus during COVID-19
date: 2021-11-30
journal: Oman Med J
DOI: 10.5001/omj.2021.132
sha: 9073e8bba040f30ff09c68f041cafc8b6e5f858c
doc_id: 774767
cord_uid: hw0cfhpq

nan

increase glucose levels in airway secretions, 4 which can result in increased influenza virus replication and worsening infection, as has been proved upon in vitro exposure of pulmonary epithelial cells to elevated glucose concentrations. 5 elevated airway glucose concentrations may also facilitate the replication of respiratory bacterial pathogens, 6 and it can be inferred that patients with dm may have increased bacterial outgrowth after an influenza virus infection.

Clinical outcomes of infections among patients with dm can be severe, resulting in hospitalization and sometimes even death. nearly 30% of adult patients hospitalized for influenza have underlying diabetes. 7 The presence of diabetes tripled the risk of hospitalization after infection, quadrupled the risk of admission to the intensive care unit, 8 and doubled the risk of a fatal outcome due to influenza infection. 9 Influenza vaccination prevents or decreases the risk of acquiring influenza infection among patients with diabetes and reduces the risk of severe complications, such as influenza-related pneumonia and cardiovascular events, reducing mortality. 10, 11 It has been shown that the seasonal influenza vaccination was associated with a 50% reduction in all-cause mortality during influenza seasons over a seven-year study period in adult patients with type 12 all GCC countries have a free vaccination policy for all high-risk groups, including the patients with dm. However, no information on influenza coverage rates has been published so far. despite all the non-pharmaceutical measures taken, SarS-Cov-2 continues to spread quickly worldwide and cause death, with GCC countries currently grappling with the second or third wave of the pandemic.

Individuals with dm have a two to three times increased risk of severe COvId-19, including death when compared with individuals without diabetes. This risk is exacerbated by poor glycemic control, diabetes-related complications, and social conditions in disadvantaged communities that lead to lower access to care and higher rates of comorbidities and thus are more likely to be infected and hence are at a higher risk for complications and death from COvId-19. 13 The prevalences of dm and prediabetes in the GCC countries varied between 7.6% to 66.4% among hospitalized COvId-19 patients in Saudi arabia 14 and the Uae, 15 respectively. The coexistence of dm and COvId-19 was associated with worse outcomes and higher mortality rates.

although the recent influenza season (2020/2021) has demonstrated an insignificant influenza activity in the northern Hemisphere, including GCC countries, influenza is a virus with unexpected behavior which requires continuous preparedness for pandemics and high vaccination coverage rates. Therefore, we should continue to place a particular emphasis on seasonal influenza vaccination during the 2021/2022 influenza season; indeed, the collision with SarS-Cov-2 would have devastating clinical results. additionally, symptoms of influenza and SarS-Cov-2 cannot be distinguished without specific testing for both viruses. vaccination against influenza should reduce the need for outpatient visits associated with influenza and diminish the unclear risk of simultaneous coinfection with both viruses. alleviating preventable stress with influenza vaccination on the current health system in the midst of COvId-19 thus seems necessary.

Given the high prevalence of dm in GCC countries, the impact of a co-circulation of influenza and COvId-19 in these high-risk populations would have devastating results. To this end, we recommend that GCC countries should attempt to aggressively prevent and control seasonal influenza during the coming 2021/2022 season. The following actions are recommended: (1) to increase influenza vaccine coverage amongst patients with dm by engaging with stakeholders in the region, assessing the factors responsible for poor uptake, and developing evidence-based and realistic policies; (2) to evaluate potential hesitation and factors associated with influenza immunization among patients with diabetes to develop targeted interventions to increase vaccine confidence and use; (3) to undertake regular public education campaigns using innovative social marketing techniques; (4) to review vaccine timing and availability, on-site vaccination for people with diabetes, and develop customized approaches for different parts of the community; (5) to enhance efforts to procure or sustainably produce influenza vaccines; and (6) to have regular year-wide surveillance in the region so that the seasonality is documented for timing the vaccination as well as identify the circulating strains, which could help contribute to the WHO's selection of the influenza virus strains for inclusion in the vaccines and result in a better match between the circulating strain and the vaccine strain of the viruses in a particular defined season. r efer ences

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