Maria Theodoridou clarifies flu and COVID-19 vaccine questions

The latest health bulletin from the National Public Health Organization (NPHO) covers a variety of health topics, featuring questions about vaccinations directed to the Chair of the National Vaccination Committee, Professor Emerita of Pediatrics at the National and Kapodistrian University of Athens, Maria Theodoridou, along with her responses. In light of the winter months ahead, dropping temperatures, and the anticipated “viral cocktail,” flu and COVID-19 vaccinations are increasingly relevant.

Ms. Theodoridou addresses questions regarding who should get vaccinated, whether vaccines have side effects, why it is important to update COVID-19 doses annually, and the newest vaccines expected in Greece. Here is her full interview.

Ms. Theodoridou, as Chair of the National Vaccination Committee, can you explain who should get the flu vaccine and why it is important for the Greek population?
Each year, before flu season begins, the Ministry of Health issues a circular detailing recommendations for flu vaccination as determined by the National Vaccination Committee (NVC).

The flu virus affects the respiratory system and can cause severe complications. For example, in the U.S. last year, 716,000–829,000 hospital admissions and 45,007–71,710 deaths were reported.

Vaccination is primarily recommended for high-risk groups, such as the elderly (due to immunosenescence in those over 60), young children, individuals with chronic conditions, pregnant women, and those with high exposure risk (e.g., healthcare personnel).

It is worth noting that obese individuals—a significant number in Greece—have not fully recognized the risks, reflected in lower vaccination rates. It’s important to remember that by getting vaccinated, one not only protects themselves and those around them but also reduces strain on the healthcare system.

What are the latest developments in flu vaccines?
Flu vaccines face the ongoing challenge of antigenic drift in the virus, necessitating the World Health Organization’s (WHO) annual updates. The 2024-25 flu vaccines in other countries, including the U.S., are trivalent, containing two A strains and one B strain, as the B/Yamagata strain has not circulated globally since 2020. Besides the inactivated injectable vaccines, live attenuated vaccines administered via nasal spray (such as Fluzone, and Afluria) have been developed, though they are not yet available in Greece.

For this season, Greece offers quadrivalent inactivated vaccines (QIVe), including strains A(H1N1 pdm09), A(H3N2), and both B/Yamagata and B/Victoria, along with cell-based QIVe vaccines. Enhanced vaccines, like QIV-IHD (high-dose) and aQIV (adjuvanted), are available for individuals over 65, prescribed by a physician. Research focuses on developing a vaccine offering broader, long-term protection against multiple virus variants. Although creating a universal flu vaccine remains challenging, advancements in mRNA and DNA techniques bring optimism for future flu vaccine developments.

Despite the long history and safety record of the flu vaccine, some people remain hesitant. What are the most common side effects, and should people worry about them?
Flu vaccines are very safe, and people should get vaccinated without fear or anxiety. The most common side effects are local reactions at the injection site (redness, swelling, pain) in 15-20% of recipients, which subside within 1-2 hours. Some may experience fever, chills, and muscle aches, which also resolve quickly. Allergic reactions are rare, and egg allergies do not contraindicate flu vaccination. Although Guillain-Barré syndrome was linked to the 1976 flu vaccine (1 in 100,000), subsequent evidence does not show a connection, and if it exists, it is extremely rare (1 in 1,000,000). Individuals who develop Guillain-Barré syndrome within six weeks of vaccination are advised to avoid the flu vaccine.

Do you personally get the flu vaccine every year? If so, what message would you give to the public?
As a pediatrician at the University Clinic of Agia Sophia Children’s Hospital, I received the flu vaccine annually. I believe workplace vaccination programs significantly increase uptake. Over time, age has added to my health profession as a criterion. This year, I plan to receive both the flu and the updated monovalent JN.1 vaccine on the same day. My message is that prevention is always better than treatment, and setting an example with vaccination builds trust in vaccines and promotes public health.

COVID-19

What are the key benefits of the COVID-19 vaccine, especially now that the Committee has extensive efficacy data?
The primary benefit of vaccination was reducing hospital admissions to ICUs and deaths from COVID-19. Vaccination helped the healthcare system withstand unprecedented pressure and meet patient needs. The first year of SARS-COV-2 vaccination saved an estimated 20 million lives.

Could you tell us about the common side effects of the COVID-19 vaccine and whether people should be concerned?
According to a July 2023 statement by ICMRA and the European Medicines Agency, over 13 billion doses worldwide have shown that COVID-19 vaccines are safe for all age groups, including children, those with chronic conditions, immunocompromised individuals, and pregnant women. COVID vaccines typically have local side effects, rare allergies, and extremely rare serious effects (such as pericarditis and myocarditis, or cavernous sinus thrombosis, linked to a vaccine no longer in use). The overwhelming benefit of vaccination outweighs any minimal risks.

There was widespread misinformation when the COVID-19 vaccine was introduced, exploiting public fears and causing confusion. Given national and global data, were the initial skepticism and safety concerns about the COVID-19 vaccine justified?
Since the first smallpox vaccine, baseless fears and conspiracy theories have arisen. The “new” and unfamiliar mRNA method for the COVID-19 vaccine naturally created some hesitation, which required detailed information to dispel. About 7.6 million people in Greece chose to get vaccinated, demonstrating responsible and cautious behavior. Historically, pandemics have spurred reactions rooted in ignorance, fear, and prejudice.

Many people argue against further COVID vaccinations, citing prior doses. What would you say to this?
COVID vaccination is now targeted, not mass, and recommended for individuals over 60 and those of any age with underlying health conditions. The new Omicron JN.1 variant vaccine (Comirnaty JN.1 by BioNTech/Pfizer) is an updated vaccine that aligns with the currently circulating virus and will offer protection against anticipated mutations. It should be considered the seasonal COVID-19 vaccine, updated annually like the flu vaccine.

What message would you give to the public?
During the COVID-19 pandemic, an annual vaccine was the goal. The updated monovalent JN.1 vaccine is close to this goal. Fatigue from previous vaccinations and the assumption that the pandemic is over should not deter high-risk individuals from vaccination for the 2024-2025 season.

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