Q&A

Dr. Jeff Kwong

Dr. Jeff Kwong is an associate scientist in the Veterans Research Program at Sunnybrook Research Institute. He is also a scientist at the Institute for Clinical Evaluative Sciences (ICES), an assistant professor at the University of Toronto and a family doctor at Toronto Western Hospital. He spoke with Alisa Kim about his research.

Dr. Jeff Kwong is an associate scientist in the Veterans & Community Research Program at Sunnybrook Research Institute. He is also a scientist at the Institute for Clinical Evaluative Sciences, an assistant professor at the University of Toronto and a family doctor at Toronto Western Hospital. He spoke with Alisa Kim about his research.

Illustration: Anthony Hare

How did you become interested in infectious diseases?

It was a bit of serendipity. When I was doing my master's thesis, I was supposed to be looking at diabetes in immigrants. We got caught in a lot of red tape, and my thesis supervisor, Doug Manuel, said, "I've got this project looking at Ontario's universal flu shot program." I switched projects, then became an influenza guy.

Why is a personal decision—whether to get the flu shot—a public health issue?

Influenza, as with a lot of infectious diseases, is not just about protecting yourself. By getting vaccinated, you also protect others. What's interesting about the flu shot is that the people who need it most are the people who get the least protection from it: the elderly, young children and people with chronic diseases. They're most likely to get sickest from influenza, but because their immune systems don't work as well, the flu shot doesn't work as well in them. So, it probably makes sense for everyone around these individuals to get the flu shot to prevent infecting them.

The data suggest that about only one in three Canadians get the flu shot. Why is that?

I think there are a few issues. People don't think influenza is a big deal, and that's true for most people. But some people get really sick and die from it. A lot of people don't realize that. Second, because you have to get it every year, it's not as convenient as other vaccines where you get it once, or [get] a series of shots, and you're done for the rest of your life. That you have to get a vaccine every single year [seems like] a lot to ask of people.

What has been your most interesting finding?

We showed that people who are severely obese are more likely to be hospitalized during flu season. Before the 2009 H1N1 pandemic, we didn't appreciate obesity as being a risk factor for influenza, like lung diseases, heart disease and diabetes. We did a study using data from health surveys where we had information about body mass index (BMI) and linked that to administrative data. [In] people with a BMI above 35 (30 is considered obese; over 35 is considered severely obese), [there was] a big risk in being hospitalized during non-pandemic flu seasons.

So, if you had to prioritize who to vaccinate, if you have somebody who's morbidly obese, you want to consider him just as you would somebody who's got asthma.

What should people know about the burden of infectious diseases?

We haven't conquered infectious diseases—far from it. People think of the big diseases like cancer or heart disease, and a person may have died because of lung cancer, but oftentimes the pneumonia is actually what killed them. It affects potentially everyone, from babies to the elderly. We're all susceptible. [With the] H1N1 pandemic, we were lucky it was a very mild virus; if there's a bad one, then it could be very bad.

Kwong's research is funded by the Canadian Institutes of Health Research.