UK POLICY BRIEF IN UK POLICY BRIEF IN UK 8 8 Policy Brief in UK regarding the Problem of Diabetes Type 2 Name of the Student Name of the University Author Note Introduction

Flu in the elderly (UK) 2,500 word policy brief (due through Turnitin by 14:00 on 16 /03/ 2020) A growing requirement among public health practitioners is the ability to communicate research to policy makers in a way that will contribute to changes that will enhance health in the population. The aim of this assessment is to equip you with the necessary skills to enable you to succinctly summarise research into a policy brief that can be used in a specific country in relation to a particular communicable disease or addiction. You will submit a single word document which will include the following: 1-Introduction to the country selected for the assessment in order to explain the setting of the policy (1 page- maximum 500 words) 2-The Policy brief (4 pages maximum 2,000 words )

Running head: POLICY BRIEF IN UK
Policy Brief in UK regarding the Problem of Diabetes Type 2
Name of the Student
Name of the University
Author Note

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Introduction to the Country
Around the world, the issue of flu is one of the major problems and people of all age
groups can be easily affected by this problem. As per the data of 2011 census, UK is the 21st
most inhabited country in the world and its overall density is almost 259 people per square
kilometre and it is reported that England is more populated than that of Scotland ,Wales and
Northern Ireland. Among all the population, almost one-third of the people live in the South-
east part of England and in the capital of the country that is London the population density
are almost 5200 per square kilometre. The United Kingdom’s population is dominated by the
White British as the country is located near to continental Europe. It is assumed that the
population of the country will enhance by 3.6 million in between 2016 to 2026 that depicts an
annual growth of 0.5 per cent during this time period (Public Health England 2016).
However, it is also reported that the rate of population growth is almost 5.9 per cent in
England, in case of Wales this population growth rate is almost 3.1 per cent. On the other
hand the population growth rate of Northern Ireland and Scotland is 4.2 per cent and 3.2 per
cent respectively. In United Kingdom there are almost 13 urban areas and total population of
UK is almost 63 million as per the data of 2011 census and among them 31 million were male
and 32 million were female. The data of UK suggested that the rate of influenza related
infection is a serious area of concern among the people who are under the age group of 40 to
64 years and the rate of consultation to hospitalization is almost 9.2 per 1000 population. As
per the information of the National Health Service (NHS) it is stated that less number of
individuals are affected by the disease compared to the children in the country. The report of
UK Government most of the elderly people in the county avoid the vaccination process of the
flu and thus they are risking their life and as a consequence of this World Health
Organization (WHO) aims to vaccinate 75 per cent of the people aged 65 years and more to
reduce the disease burden. The study showed that in the year of 2018- 2019 almost 16,133

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people are affected by the flu and pneumonia in winter in England. In this context, it should
be mentioned that the almost more 5370 people in England are affected and hospitalized due
to the flu related infection in the country (Gallagher 2019). According to the National
Institute for Health and Care Excellence (Nice) (2019), it is stated that due to this disease
condition, the average cost of hospitalization due to the flu related infections is almost 3000
euro per person. In England, almost 8000 people under the age group of 65 year or more face
the issue of mortality due to the flu related conditions. Moreover, it is also reported that the
area with more dense population have lower rate of flu vaccination. The application of flu
vaccines in London Borough among the age group of 65 years or more is the lowest among
all other regions of the country and it is lower than the national vaccination rate as well (72
per cent is the national vaccination rate). In a survey, it is stated in the South London area
there are a few reasons of not performing the vaccination process and they are mainly
associated with their though processes. As a part of this it can be mentioned that those people
believe the vaccination will cause disease in them instead of reducing the disease condition.
Along with this, those people also believe that they are not at all vulnerable to the disease
condition and so they need not be vaccinated. However, as a part of the health service, the
NHS is responsible for providing ambulance services, emergency services, hospital facilities
along with free vaccination and all these services are free of costs in England. Therefore, it is
there duty to make the people understand about the importance of flu vaccination. As a part
of this, it must be mentioned that the flu vaccination is free for all the people in the country
and almost 25 million of people in England will be provided free vaccination by NHS
(Sullivan, Price and Regan 2019).
Policy Brief
Executive Summary

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This report discussed about the problem of influenza among the elderly population in the
country and the rate of influenza related infection is a serious area of concern among the
people under the age group of 40 to 64 years and the rate of consultation to hospitalization is
almost 9.2 per 1000 population. World Health Organization (WHO) aims to vaccinate 75 per
cent of the people aged 65 years and more to reduce the disease burden. The study showed
that in the year of 2018- 2019 almost 16,133 people are affected by the flu and pneumonia in
winter in England. Influenza is mainly condition that affects the upper respiratory organs
such as nose, throat, and lungs. Most of the (72%) of flu related deaths in hospital happened
among 65+ year olds with co-morbidities and the mortality rate is lower among the children
under the age group of 15 years and only 12 deaths are reported among this age group in UK
per year. As a part of recommendation, it can be stated that vaccination can lower the overall
impact of the disease among the elderly people in UK.
Introduction
The issue of flu and related infection is a major health related threats to the elder;y
population of the country and it is mentioned that those people are mainly at high risk
condition who are fragile or suffering from various other conditions. As a consequence, the
cases of flu infections are also enhancing day by day in the country. The main reason of this
type of high prevalence of flu infection in England is associated with various factors and they
are mainly associated with the weather condition, deprivation in having medical facilities,
poor health related education. Therefore, it is reported that the flu or Influenza is mainly
condition that affects the upper respiratory organs such as nose, throat, and lungs.
Furthermore, it is also true that the disease has similar symptoms of common colds and thus it
is confused with common cold. While discussing about the risk factors of the disease it can
be stated that mainly the children are affected by this disease condition, However, older
adults are not at all safe due to their age and thus age is one of the major risk factors for

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developing the flu infections. According to the data of Centre for Disease Control and
Prevention, the people of 65 years or more are at the high risk zone due their aging process as
it is quite evident that along with the aging process, the immune system of the body is also
weakened and thus those people are more prone to get the infection. Along with this, Centre
for Disease Control and Prevention also states that the onset of flu infections among the older
adults, can alter the long term health conditions such as lung disease, heart disease and
asthma (Centres for Disease Control and Prevention 2020).
According to the study of Smetana et al. (2018) it is stated the influenza season lasts
for 8-10 weeks and with this time period, almost 80 per cent of outbreak cases are reported by
the researchers. Therefore, it is also reported that the time frame may vary from late autumn
to early winter due to the antigenic drifts of the pathogens and it also functions as virological
driver for the yearly vaccine deployment and development. The issue of seasonal flu is
associated with acute febrile illness along with a mild to extremely serious and in some
scenarios it is stated that such conditions can cause mortality as well. Seasonal influenza is
naturally categorized by a cough, severe malaise, headache, sudden onset of fever, muscle
pain, sore throat and joint pain. Most people improve from infection condition without
sequelae within 1–2 weeks without demanding superior medical care. As per the data of
WHO, it is stated that every year almost 10-15 per cent of the population is infected by
influenza and the disease has the global burden of nearly 1 billion of infected individuals.
Among the total disease condition, almost 3 to 5 million of people may face severe infection
condition and almost 250 000 to 500 000 deaths are reported. Moreover, WHO also admitted
that in mostof the developed countries of the world, the influenza related deaths are observed
among the elderly population. For the elderly population, the risk of mortality is enhanced
sharply specifically for the age group of 65 years or more. According to the study of Smetana
et al. (2018), it is stated that along with the advancement of ages, the initial innate immunity

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response by the macrophages and neutrophils is lowered and along with this, phagocytic
activity and oxidative burst are also diminished. Toll-like receptors (TLRs), trans-membrane
proteins on phagocytic cells, offer an important channel between the adaptive and innate
responses by distinguishing non-self proteins and activating the intracellular signalling
conduits which facilitate the antigen-specific response. In the macrophages of the elderly
people, defects in the TLR expression are reported and thereby the impairment in the critical
responses are also reported by the researchers. Furthermore, the age related disturbances in
the innate immunity system is associated with the reduction of antigen uptake in the body and
thereby enhances the chances of getting flu infection among the elderly people. United
Kingdom has a prolonged immunisation agenda presenting inactivated vaccine to the people
under the age group 65 years of age and older and to those who are under the age group of 6
months to less than 65 years of age along with an basic medical risk issues. After assessing
the advice from the Joint Committee on Vaccination and Immunisation (JCVI), the country
has initiated the Incremental Introduction of a Universal Influenza Vaccine Programme in the
2013/14 influenza season. In the 2016/17 influenza season in the country, the disease is
characterized by the early transmission of influenza A(H3N2) viruses. The outbreak of this
disease in the country is characterized by a huge number of care home outbreaks, enhanced
admission rate to the hospitals compared to the previous years, enhanced mortality rate
among the elderly population in the country. Among the total infected population, it is stated
that the a huge number of people is infected by this condition in spite of having vaccination
and in case of elderly people, almost 70 per cent of the infected people previously was
vaccinated (Pebody et al. 2017).
About the Research Studies
In order to prevent the cases of flu infection among the individuals, various
interventions can be recommended and various studies recommended different types of

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interventions. In this regard, mainly 4 studies are discussed and all of them try to provide
solution to the problems of diabetes type among the individuals in UK.
In the study by, Cromer et al. (2014), the researchers mainly performed a primary
study method and they mainly reviewed the laboratory reports from the national database
regarding influenza and 7 other respiratory pathogens were taken out and after that the
researchers used a regression model to examine the proportion of acute respiratory infection
outcomes attributable to every causative pathogen. Moreover the researchers used a
quantitative study design in which they collected the data of the target population in order to
understand the underlying causes of the problems. In another study by Matias et al. (2016)
the authors tried to estimate the age specified flu related hospitalization and mortality rate in
the country. The researchers used the virology reports provided by Public Health England
(1996–2009) of influenza and respiratory syncytial virus detections. The researchers used an
extended set of ICD-codes to guess the load of illness attributable to influenza. In this study,
again the researchers used a linear regression model along with stratification by age and the
occurrence of comorbid risk status. In another study by Pebody et al. (2018) the researchers
examined the effectiveness of vaccine to reduce the impact of the flu related problems. In this
study the authors used the test-negative case–control (TNCC) design in order to estimate
vaccine effectiveness along with the study executed in the registered population of five
sentinel general practice (GP) investigation networks across the UK. The schemes are mainly
the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC)
network, Specialist Microbiology Network (SMN), the Public Health England (PHE) and the
national sentinel schemes of Wales, Scotland and Northern Ireland. In another report by
Public Health England (PHE) (2016) the government tried to establish the association in
between the disease and its causative factors among the people of UK.
Findings of Various Studies

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Burden of Influenza in England
The study findings of Cromer et al. (2014) reported that the influenza is responsible
for the 10 per cent of overall respiratory infections and deaths in the hospitals. The age
specific rate of influenza showed that the healthy children under the age group of 5 years had
the highest rate of influenza admission in the hospitals and the existence of co- morbidities
amplified the rate of admission by 5.7 fold among the 5–14 year olds (from 0.1 to 0.56/1000).
The relative risk is reported falling to 1.8 fold among the 65+ year olds population (from 0.46
to 0.84/1000). On the contrary, most of the (72%) of influenza related deaths in hospital
happened among 65+ year olds with co-morbidities and the mortality rate is lower among the
children under the age group of 15 years and only 12 deaths are reported among this age
group in UK per year. The study findings showed that in spite of vaccination, the rate of
deaths due to influenza is quite high among the people under 65 year or more age group.
Therefore, the study recommended that additional strategies are required to reduce the
adverse impact of the disease among the elderly people in UK.
Effectiveness of Influenza Vaccination
In the study by Pebody et al. (2017) estimated the effectiveness of the vaccination among the
different age group of people and the researchers found that the vaccination process is not at
all effective against influenza A or specifically A(H3N2) among the people under the age
group of 65 years and above (aVE: -68.4%; 95% CI: -248.9 to 18.7) and the same result was
also obtained against influenza B.
Estimation of Age Specific Influenza- related Hospitalization in UK
The study of Matias et al. (2016) assessed the 28,516 and 7163 deaths and the study result
showed that the rates of incidence of influenza-attributable hospitalisations and deaths were

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detected in adults under the age group of 75+ years (252/100,000 and 131/100,000
population, respectively). Therefore, the study reported that the implementation of influenza
prevention or early intervention with anti-viral treatment may reduce the impact of the
disease among this age group of people.
The National Flu Immunization Programme 2016/17
This Policy implemented by the Government mainly aims to enhance the immunization
program in order to reduce the overall disease burden of the country and simultaneously aims
to vaccinate at least 75 per cent of elderly people in the country. As a part of this flu
immunization program, the government mainly aims to conduct the vaccination program
among all age group of people in the country (Public Health England 2016).
Conclusion
Hence, it can be concluded that the issue of flu among the elderly is one of the crucial
problem for the people of UK and in this country a flu immunization program has started
with the help of NHS. In spite of taking various measures, the cases of flu infection have
significantly contributed to the overall disease burden. In order to improve the condition, a
few recommendations such as vaccination can be recommended to the patients.

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References
Centres for Disease Control and Prevention, 2020. Influenza among Adults 65 & Over.
Cdc.gov. Retrieved from- https://www.cdc.gov/flu/highrisk/65over.htm [Accessed on 15th
March 2020]
Cromer, D., van Hoek, A.J., Jit, M., Edmunds, W.J., Fleming, D. and Miller, E., 2014. The
burden of influenza in England by age and clinical risk group: a statistical analysis to inform
vaccine policy. Journal of Infection, 68(4), pp.363-371.
Gallagher, P., 2019. Tens of thousands of elderly people put lives at risk by avoiding the flu
vaccine. Inews.co.uk. Retrieved from- https://inews.co.uk/news/health/flu-vaccine-elderly-
warning-hospital-deaths-820253 [Accessed on 15th March 2020]
Matias, G., Taylor, R.J., Haguinet, F., Schuck-Paim, C., Lustig, R.L. and Fleming, D.M.,
2016. Modelling estimates of age-specific influenza-related hospitalisation and mortality in
the United Kingdom. BMC public health, 16(1), p.481.
Pebody, R., Warburton, F., Ellis, J., Andrews, N., Potts, A., Cottrell, S., Reynolds, A.,
Gunson, R., Thompson, C., Galiano, M. and Robertson, C., 2017. End-of-season influenza
vaccine effectiveness in adults and children, United Kingdom,
2016/17. Eurosurveillance, 22(44).
Public Health England, 2016. Flu Plan Winter 2016/17. Department of Health. Retrieved
from- https://www.gov.uk/government/publications/flu-plan-winter-2016-to-2017 [Accessed
on 15th March 2020]
Smetana, J., Chlibek, R., Shaw, J., Splino, M. and Prymula, R., 2018. Influenza vaccination
in the elderly. Human vaccines & immunotherapeutics, 14(3), pp.540-549.

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Sullivan, S.G., Price, O.H. and Regan, A.K., 2019. Burden, effectiveness and safety of
influenza vaccines in elderly, paediatric and pregnant populations. Therapeutic advances in
vaccines and immunotherapy, 7, p.2515135519826481.
The, L.R.M., 2018. Elderly at risk as severe influenza season looms large. The Lancet.
Respiratory medicine, 6(1), p.1.

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Appendices
Appendix 1.
<6 m 6m- 4y 5-14Y 15-44 Y 44-64y 65+ y All ages
0
50000
100000
150000
200000
250000
300000
350000
Admissions
Incidence rate per 1000
Deaths
Deaths/ Admission
Figure 1.- Admission, hospitalization and death rates among different age group people in
UK.
Appendix 2.

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Estimated Admission Estimated Deaths in
Hospital Deaths/ 1000
Influenza admission
0
500
1000
1500
2000
2500
3000
3500
Series1
Series2
Fig.2: Estimated annual number of influenza admissions and deaths in hospital
Appendix 3.
Fig. 3: Flu in different regions of UK
Red Area- Flu in London Region
Blue Area- Flu in Northern Ireland
Purple Area- Scotland Region