Influenza Set To Make A Comeback In Malaysia

by BERNAMA / pic by TMR FILE

KUALA LUMPUR – As Malaysia transitions to the endemic phase of COVID-19, one big question arises – should we be concerned over the return of influenza?

Influenza, commonly known as the flu, is a contagious respiratory illness caused by influenza viruses and it can be a serious health threat to high-risk groups such as pregnant women, young children, people with chronic health conditions and the elderly. The flu usually occurs all year round in Malaysia and occasionally causes outbreaks, some of which can be major.

As shown by the COVID-19 pandemic, respiratory diseases usually hit senior citizens the hardest.

Older persons especially those with chronic conditions are at higher risk of developing severe flu and life-threatening complications which may require hospitalisation or intensive care in some cases.


According to consultant paediatrician and paediatric cardiologist at KPJ Selangor Specialist Hospital Professor Datuk Dr Zulkifli Ismail, the flu virus is now “making a tenacious comeback” after having practically vanished when the COVID-19 pandemic hit the nation.

Besides Malaysia, other countries have also been reporting a spike in flu cases in recent months, he said.

He also voiced his concern over the anticipated increase in flu activity following the reopening of Malaysia’s international borders and other sectors as more people will be travelling and mingling freely.

The upcoming Hari Raya celebrations, which will include family gatherings and open houses, may also contribute to increased flu activity, he added.

“When this happens, most people will be somewhat defenceless as they are not vaccinated against the flu. The fact that flu viruses have not been circulating in the last two years compounds the problem because the population’s immunity (against the flu) will be low,” he told Bernama.

Dr Zulkifli, who is chairman of the Immunise4Life (IFL) Technical Committee, also said that many Malaysians often confuse the flu with the common cold or perceive it as a winter illness that only happens in temperate countries.

“Both notions are not correct,” he pointed out.


Meanwhile, Dr Tan Maw Pin, a professor in geriatric medicine at Universiti Malaya (UM) shared some alarming data on the flu. Quoting a recent study published by The Lancet, she said adults with both the flu and COVID-19 were four times more likely to receive invasive mechanical ventilation while their risk of death was doubled. 

She said another recent study showed that seven out of 10 people aged above 65 who contract the flu have a higher risk of developing complications such as pneumonia, inflammation of the brain, multi-organ failure and sepsis (extreme immune system response to infection).

“Their weakened immune system and declining lung function increase the likelihood of catching the flu, getting hospitalised and probably dying from the disease. Yet, many families are not even aware when their aged parents or grandparents have the flu,” she said.

Dr Tan said the disease also tends to present with atypical symptoms in older people. These include dizziness that may result in falls, and confusion or delirium with or without a fever.

“Rapid breathing reveals oxygen insufficiency and may contribute to dehydration. Without treatment, severe flu and acute respiratory distress syndrome (ARDS) may set in,” she added.


Honorary professor at UM’s Department of Medicine Dr Chan Siew Pheng said diabetes can also significantly exacerbate the flu, adding that persistently high blood glucose can suppress the immune system and increase the frequency and duration of flu infections.

“Many people with diabetes also have other co-morbidities such as high blood pressure and kidney disease; these only heighten the likelihood of serious flu complications,” the consultant endocrinologist said, adding that over 40 percent of Malaysians aged 60 and above are living with type 2 diabetes.

She explained that the flu can make it even harder for them to control their diabetes, thus causing blood glucose levels to rise.

“The flu may also reduce their appetite and food intake, causing blood glucose levels to fall. Their worsening condition may also result in life-threatening diabetes emergencies,” she added.

Dr Chan, who is also president of the Malaysian Endocrine & Metabolic Society, said besides diabetics, people with heart disease also face a higher risk of developing complications – they are six times more likely to have a heart attack after coming down with the flu.

“More surprisingly, it is now clear that flu infection increases the risk of a heart attack and a stroke by up to 10 times and eight times respectively in individuals without a history of cardiovascular disease,” she added.


Dr Zulkifli, meanwhile, said the flu can have devastating consequences on older persons as well as their families. This can happen when aged parents are admitted to the hospital and their children have to bear the cost of treatments.

Should recovery be slow and long, caregivers may need to take time off from work, which will create hardship for the families, especially those from the lower-income brackets.

“Older adults who are hospitalised or confined to prolonged bed rest may suffer bed sores, lose their muscle strength, develop irreversible functional decline and lose their ability to perform simple daily tasks. Losing their independence and becoming a burden to their loved ones would leave them depressed and utterly deprived of the quality of life they deserve,” he said.

He said financial and emotional distress can be avoided by making flu prevention a part of the healthy ageing journey.

“Hence, the most effective way to prevent the flu is by getting the annual flu shot. This is especially important for older persons, as it will help reduce the risk of severe disease and hospitalisation associated with the disease,” he said.

Statistically, the flu shot can reduce the severity of symptoms, while also reducing the risk of major cardiovascular events by 36 percent, the risk of hospitalisation by 45 percent and the risk of death by 42 percent, according to Dr Zulkifli.

“As of now, MOH (Ministry of Health) does not have any flu vaccination programme. We hope that this will change in the future starting with annual flu vaccinations for the elderly and those with co-morbidities.

“At the moment, flu vaccination is given by private medical practitioners in clinics and private hospitals,” he added.