Dr. Kevin Most: Flu News

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Well we have not talked about the flu for awhile, but right now may be a good time.  As in the past few years the influenza illness is hitting at the same time. We noted a ramp up towards the end of January but now we are looking at full blown activity in Illinois. But we are not alone,  40 states including Illinois now have widespread influenza infections. It is hitting very hard across the country and impacting many workplaces. Influenza is not an illness that has  mandatory reporting, but we do have sights across the state that do report. In the past here at CDH we did extensive testing for influenza, however we studied this and the test is not as sensitive or specific as we need so now we treat based on history, symptoms, timing and physical exam. This change may actually lower the reporting rate in many states as we were not the only health team to slow the use of the nasal swab test.

So what do we know about this years flu bugs, well the majority of the infections are being caused by the Influenza A type.  There are 2 strains that have been noted,  A H1 N3 and A H3 N2. The good thing about those 2 strains is they were present in this years vaccine. That does not mean that if you got the vaccine you don’t have to worry about it as we know the vaccine is not 100% effective. However if you did get this years vaccine you are in much better shape than those who did not get the vaccine.

Is there any good news for those who did not get the vaccine?  Yes, the strains noted this year have been shown to be susceptible to the anti viral medications at close to 100%. Tamiflu and Relenza appear to be great agents to fight this years influenza. The mostimportant thing for patients who did not get vaccinated and feel they have been hit by the flu is to seek treatment quickly. Tamiflu is a great medication but we have to understand what it will do. It will shorten the length of time you are ill in most cases. Influenza typically will last for 7-10 days, pateints who start Tamiflu within the the first 48 hours of symptoms will often see that shortened by 2 days. However patients who come in on day 3 or 4 , really do not see any benefit from Tamiflu. If you are at day 3 or beyond, treat the symptoms and save your money, as Tamiflu will not make much of an impact that late.

The pattern of illness is not unexpected, we are seeing high rates in individuals over 65. These high rates are also coupled with high hospitalization rates for these individuals as well. This highlights the need for Seniors to not only get vaccinated but to make sure they get the proper vaccine for that age group. You will remember that we have a high dose vaccine for seniors. We are also seeing high rates in children, again a vulnerable population especially those under 6 months. Remember the earliest a child can be vaccinated is 6 months, so if you are ill at all stay away from visiting any infants. A child under the age of 6 months does not have an advanced immune system that could fight this virus.

 During the flu season do not visit hospitals if you are not feeling well. Bringing influenza into the hospital setting can be devastating. You will see at the entrance to most hospitals now a station where masks and tissues are provided. This is good to help us identify and inform those who are ill and are visiting, but what is more important is the message that if you are ill it is best to not visit the patient in the hospital. Give the friend a call vs giving them influenza.  Individuals in the hospital are ill, often they are fighting off another infection. Laying influenza on these often weakened patients can be devastating to their health. We also want to protect our caregivers as we can’t afford widespread illness in our workforce. Flu shots are mandatory in most hospitals for the staff.

Is it too late to get a flu shot?  The answer is no, get one today if you have not gotten one as we will have influenza around for the next 3 months and we will probably see a peak here in the next few weeks.

We always talk about the importance of flu shots. This year we talked about the importance of the timing of flu shots. If you remember we discussed that seniors should be getting their flu shots in the morning when their cortisol levels are the highest. This has been shown to impact the effectiveness of the vaccine.  I have always recommended that individuals receive their vaccine in October – November to maximize the coverage and allow for the needed response time before influenza hits.  In recent years we have started seeing flu shots available in late July and early August. Often these are highlighted and offered in pharmacies across the country.  Last month a study came out from the CDC that showed in some people the effectiveness of the vaccine is reduced dramatically at 6 months after being vaccinated. This is quite concerning as the individual who would receive their vaccine in August may lose its effectiveness by right now as the flu is hitting.

The result of this study by the CDC is quite concerning and should be taken into consideration when planning on your flu shot for next year. This study was triggered after reviewing the flu season of 2011-2012. That season the flu hit very late in Europe and they saw huge numbers of ill people who actually got vaccinated. What they found was individuals who were vaccinated early had little to no immunity  to one strain of the flu by the time the flu hit. The other 2 strains in the vaccine continued to have high effectiveness. The bad thing is the strain that they noted the sharp decline in effectiveness is one of the strains hitting us this year.

This was the first look at the data, and it may not be as clear as it seems. We may have had individuals who have chronic illnesses rushing to get vaccinated early thinking it will help, when in fact it may harm them. It may be that the virus has evolved.  However the CDC has looked at this over the past 4 years and has shown that there is a steady decline of protection by about 7 % a month. That 7% may not seem like much but remember we are not starting at 100%. We know that the flu vaccine is not 100% effective.

I would say to individuals who received their flu shot in July or August, discuss with your doctor about a possible booster this year.

So the big picture is, don’t get your vaccine in the summer, wait until October.  For Seniors, the best time to get the vaccine is in the am in mid October, and get the higher dose.  It is interesting compare this to what we said 5 years ago, vaccines only made with chicken eggs, no information on early am vaccine, no information on high dose vaccine and no information that the protection wanes over months. So although we think something as simple as a flu shot does not change, it actually does and we are getting better and smarter about influenza.