I procrastinated about getting my flu shot in the fall. I had planned to get one on a visit to my family doctor for another matter, but forgot to ask. However, a major H1N1 swine flu virus outbreak in Texas, with the epidemic rapidly spreading across North America, sent me to my pharmacist for a shot on Christmas Eve. At this writing, about 25 people have so far died from this season’s outbreak, and the Texas Department of State Health Services (DSHS) has issued an “influenza health alert,” urging all citizens to get their annual flu shot.
DSHS’s latest flu surveillance classifies the geographic distribution of flu activity in Texas as “widespread,” indicating increased influenza-like illness or institutional outbreaks in at least half of the state’s regions as well as recent laboratory-confirmed evidence of influenza in those regions of the state. All Texas Regions have reported laboratory confirmed influenza, and the percentage of specimens positive for influenza is over 10%. ILI intensity is high, and influenza is widespread in Texas.
Flu kills an average of 23,600 Americans a year, according to estimates from the Centers for Disease Control and Prevention (CDC). Persons over age 65, pregnant women, young children and people with chronic health conditions are most at risk for complications, so it’s especially important for them to be vaccinated. The estimated benefits of vaccination for the 2012-2013 season were higher than any other season for which CDC has produced similar estimates, and a are attributable to the severity of the season. A CDC report estimates that last season there were a total of 31.8 million influenza-associated illnesses, 14.4 million* medically attended illnesses, and 381,000 hospitalizations in the United States.
“Flu is on the rise and causing severe illness in certain people. It is not unexpected this time of year, but it’s a good reminder for people to get vaccinated and stay home if they’re sick,” said Dr. David Lakey, DSHS commissioner in a release. “Flu can be deadly. People who have not been vaccinated should do so now. It’s the best defense we have.”
The DSHS says everyone 6 months and older should get vaccinated now, and that children ages 6 months to 8 years who did not get a dose of last year’s vaccine should get two doses this year. The vaccine takes a couple of weeks for full protective effectiveness to kick in, but it’s better to be vaccinated against this flu than not, and it’s not too late for a shot even in Officially, flu season runs from October through May, although most flu illnesses in Texas usually occur in December, January and February. Flu is unpredictable and can happen at any time. “If you have not gotten your flu vaccine yet this season, you should get one now,” says the CDC’s Anne Schuchat, MD. “The bottom-line is that influenza can cause a tremendous amount of illness and can be severe. Even when our flu vaccines are not as effective as we want them to be, they can reduce flu illnesses, doctors’ visits, and flu-related hospitalizations and deaths.”
This flu isn’t something to trifle with. H1N1 is a particularly nasty strain that you really don’t want to get. It first appeared in 2009 in central Mexico, and subsequently spread to more than 70 countries, and is estimated to have killed approximately 284,000 people, according to the CDC. The 2009-’10 H1N1 outbreak for more than a year was declared a global pandemic virus, H1N1 was called a swine flu in 2009, but it’s stuck around throughout each annual flu season since then, and is consequently is consequently now considered a human seasonal virus strain. It was thus fortuitously included as one of the target strains in the seasonal trivalent influenza vaccine for 2013-2014, as per recommendations by the World Health Organization (WHO) for the northern hemisphere. Specifically, the 2013-2014 trivalent influenza vaccine targets the following three viruses:
• An A/California/7/2009 (H1N1)pdm09-like virus
• An A(H3N2) virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011
• A B/Massachusetts/2/2012-like virus
H1N1 is highly contagious, spreads easily from person to person via by large respiratory droplets generated when an infected person coughs or sneezes in close proximity to an uninfected person, and unlike “normal” flu strains that typically mostly cause illness among the elderly, H1N1 is less discriminating, afflicting people in younger demographics as well. The DSHS recommends staying home if you’re sick, rather than “spreading the joy” to others as a mobile disease vector, and having a plan to care for sick family members at home. Common H1N1 symptoms include high fever with alternating sweats and chills, persistent cough, lymph node swelling, sore throat, severe nasal and chest congestion, muscle aches, nausea and vomiting, digestive upset and severe abdominal pain. Most people generally recover from flu in 1-2 weeks, but some people develop complications such as pneumonia, bronchitis, sinus infections, ear infections, and respiratory failure, and sometimes death. Rapid onset is another sign that the sufferer has something more serious than a cold.
The Texas Department Of State Health Services notes that Oseltamivir and zanamivir are chemically related antiviral medications known as neuraminidase inhibitors that have activity against both influenza A and B viruses, and that early antiviral treatment can shorten the duration of fever and illness symptoms, may reduce the risk of complications and death, and may shorten the duration of hospitalization. Clinical benefit is greatest when antiviral treatment is administered early, especially within 48 hours of influenza illness onset. Consequently, they advise that decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza.
Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who
• Is hospitalized.
• Has severe, complicated, or progressive illness.
• Is at higher risk for influenza complications.
Prevention-wise, aside from getting a flu shot, it’s general sound advice to stay well-hydrated, get adequate sleep, and reduce stress to help optimize your immune system activity during flu season. The DSHS recommends frequent hand washing with warm water and soap, lathering up all hand surfaces front and back for at least 20 seconds after touching common surfaces. Alcohol-based hand sanitizer is also effective, but note well that antibacterial soaps are no more so than plain soap in washing away virus contamination.
Be mindful of and avoid as much as possible contact with frequent virus infection vectors like doorknobs, keyboards and touchscreens, lightswitches, counter tops, phones, remote controls, gas pump handles, toys at day care centres between handwashings. If possible, frequently clean commonly touched surfaces your home. Viruses can reportedly survive on dry surfaces for up to 48 hours, so even at home it’s wise to be cautious touching door handles and items brought into the house that could be virus vectors. Replacing handshakes with fist bumps or non-contact acknowledgment gestures is also a wise cultural trend to get on board with. Cover coughs and sneezes with a handkerchief or direct them into your sleeve. A key flu-avoidance policy is to avoid touching your face anywhere, but especially your eyes and nose which are primary entry-points for flu viruses. For shopping excursions or any environment where you’ll be touching common contact surfaces, wearing gloves isn’t a bad idea. Neither is shedding shoes worn in public places at the door to avoid tracking germs into your home, especially if children play on its floors.
CDC Report Highlights Benefits of Flu Vaccine
Flu vaccination prevented an estimated 6.6 million influenza-associated illnesses, 3.2 million medically attended illnesses, and 79,000 hospitalizations during the 2012-2013 flu season, according to a CDC report in the Morbidity and Mortality Weekly Report (MMWR). Children aged 6 months through four years and persons aged 65 and older, who are among those most vulnerable to influenza, accounted for an estimated 69% of prevented hospitalizations last season. “Most of estimated hospitalizations last season were in people 65 and older. This shows how hard a severe H3N2 season can hit this vulnerable group,” CDC Director Tom Frieden, M.D., M.P.H. comments in a release, also noting that while older adults were hardest hit last season, “there were also 169 deaths among children reported to CDC, the highest number in a non-pandemic season since this type of reporting began in 2004.” Three influenza deaths among children have been reported to CDC so far this season.
The DSHS has posted a Flu Fighters Page of downloadable materials to help teach elementary school students how to protect themselves from flu.
Despite the proven benefits of vaccination, the CDC also reported in mid-December that despite the benefits of flu vaccination, only 40% of Americans 6 months and older (39% of adults and 41% of children) had reported getting a flu vaccine this season as of early November 2013. “We could prevent even more illness by increasing use of flu vaccines among people of all ages” says Dr. Frieden. The MMWR report estimates if 70% of the population had been vaccinated last season, another 4.4 million flu illnesses, 1.8 million medically attended illnesses, and 30,000 flu hospitalizations could’ve been prevented.
Other online coverage reports indicated that vaccination among pregnant women (41%) and health care providers (63%) is about the same as it was this time last year. Among health care providers, the agency again noted high vaccination rates among clinical providers like pharmacists (90%) physicians (84%), and nurses (79%) but much lower vaccination rates among assistants or aides (49%) and health care providers working in long-term care facilities (53%).
“We are happy that annual flu vaccination is becoming a habit for many people, but there is still much room for improvement,” said CDC’s Anne Schuchat, MD. “The bottom-line is that influenza can cause a tremendous amount of illness and can be severe. Even when our flu vaccines are not as effective as we want them to be, they can reduce flu illnesses, doctors’ visits, and flu-related hospitalizations and deaths.”
Centers for Disease Control and Prevention (CDC)
Texas Department of State Health Services (DSHS)
World Health Organization (WHO)
Centers for Disease Control and Prevention (CDC)