Influenza Season 2018 Update

CDC Officials Among Those Concerned With Current Activity

Despite everyone’s familiarity with the “common cold,” influenza remains a point of confusion among many. From theories that portray one’s risk of contacting the flu by getting the flu shot to the general mischaracterizations of those who self-diagnose their own case of the flu, uncertainty hangs in the balance of essentially every cough and sneeze. One thing is without debate this flu season, however: “Overall [flu-related] hospitalizations are now the highest we’ve seen, even higher than 2014-15, our previous high season,” said Dr. Anne Schuchat, MD, acting director of the Centers for Disease Control and Prevention (CDC), during a recent conference call. “Flu is incredibly complex and difficult to predict, and this season is a somber reminder of why flu is one of the world’s greatest public health challenges.”

As January came to a close, there had continued to be an increase in influenza-like illness activity, hospitalizations, and flu-associated deaths in children and adults.

“We also continue to hear reports of crowded hospitals and spot shortages of antiviral medications and rapid influenza tests,” Schuchat said.

By Schuchat’s estimation, most flu seasons last up to 20 weeks and there’s “probably several weeks left of increased flu activity” this year. While influenza A H3N2 viruses continue to dominate the season, other flu viruses including H1N1 and influenza B are causing illnesses as well. In some cases there have been a disproportionate affect on certain age groups, according to the CDC. Entering the first week of February, an additional new 16 flu-related pediatric deaths for the season had been reported, which, as of this writing, had raised the total of children who have died of the flu this season to 53, which has continued to continued to fuel the level of concern across the country, including worries that the flu vaccine that many people received this year could be ineffective.

All told, Oregon had remained the one state across the country that is reporting less influenza activity statewide as of Jan. 27, a trend that the CDC hopes represents a decrease in activity out west.

“For the prior three weeks, we had 49 states with the widespread activity, which is something we hadn’t seen since we have been collecting these data,” said Dr. Dan Jernigan, MD, MPH, director of the CDC’s Influenza Division in the National Center for Immunization and Respiratory Diseases, during the same recent conference call, in an attempt to put into perspective the severity of this year’s activity.

“We’ve had two seasons in the last 15 years that were higher than [this season],” he said. “The first was the 2009 H1N1 pandemic, which peaked at 7.8% and the 2003-2004 season, which was a high severity H3N2 season, which peaked at 7.6%. In general, for doctors’ offices, urgent care clinics, and emergency departments, the western part of the country is beginning to see lower flu activity; the eastern part of the country is seeing somewhat higher activity. And southern states are continuing to see high activity at the same levels. Influenza-like illness has been elevated for 10 consecutive weeks so far this season.”

The 2014-15 season was characterized as “high severity” with an estimated 710,000 hospitalizations by season’s end, according to Jernigan, who said that if the current trend in today’s hospitalization rates is maintained through the season, it is possible that the number of flu hospitalizations could exceed the 710,000 seen in 2014-15.

Flu activity in children this season has been particularly perplexing to some extent, despite the fact that among pediatric deaths only 20% of kids had been vaccinated, CDC officials said.

“These deaths are associated with influenza A H3N2, H1N1 viruses as well as influenza B viruses, so all the different types of influenza are causing these deaths,” Jernigan added. “Pediatric deaths became nationally notifiable in 2004, and since that time they’ve ranged from 37-171 during regular seasons. The highest was during the 2009 pandemic, where 358 pediatric deaths were reported.”

However, even when considering the intricacies of this season’s performance, the CDC is not straying from their typical guidance when it comes to flu prevention and attempting to limit its rate of spreading.

“We continue to recommend the flu vaccine,” Schuchat said. “Even though we know most flu vaccines have low effectiveness against H3N2 viruses, effectiveness against other flu viruses is better, and there is more than one flu virus circulating this season. The vaccine may also reduce the severity of symptoms if you catch the flu in spite of being vaccinated, and it is not too late to get the vaccine. As of Jan. 12, more than 152 million doses of flu vaccine have been shipped nationwide.”

With one of the more serious consequences of the flu being bacterial pneumonias, the CDC is also stressing vaccination against pneumococcal pneumonia.

“Viral infections like flu can make people more vulnerable to secondary bacterial infections, and we recommend people 65 years of age and over get vaccinated against a common pneumonia caused by pneumococcus,” Schuchat added.

Healthcare providers, much like those in the general population, are being asked to help reduce the risk of contracting the flu and spreading the disease by staying home if they don’t feel well, promoting frequently hand washing, and to seek prompt treatment if illness is suspected. For those caring for and/or those who are parents of young children, one particular warning sign to be alarmed about would be when a child appears to rebound from a cold only to get sick again.

“That can indicate that you have one of those secondary bacterial pneumonias, and that can be a bad emergency,” Jernigan said. “You don’t want to feel like you’re getting better and then suddenly you’re not, you’re getting worse. You really want to seek attention if that’s happening.”

Dr. William B. Miller, Jr., MD, also encourages healthcare providers to utilize social media and to ramp up research efforts to positively influence influenza education.

“The influenza virus has been our common affliction for thousands of years; if the full historical record is considered, these types of outcomes [occurring in 2018]  are not uncommon and should be taken seriously,” said Miller, author of the book The Microcosm Within: Evolution and Extinction in the Hologenome, published by Universal Publishers in 2013. “Our experience with seasonal flu in the last few decades has followed a comforting norm. Most of the annual flu fatalities occur in the chronically ill and elderly. However, that pattern is merely chance at work. At many other times in human history, influenza has been a deadly scourge for the young and otherwise healthy part of the population.”

To best utilize social media, Miller suggests promoting and or starting campaigns that will encourage specific patterns of personal hygiene, such as hand washing, as an easy, effective easy way to send messages to the masses.

“This flu season is a good time for all of us to rethink our place in the global village and embrace reciprocal stewardship through common need,” said Miller, an internationally recognized evolutionary biologist and an expert on the emerging science of the microbiome. “Zoonotic diseases are ever occurring. Some are relatively harmless; yet, others may intermittently and unpredictably spread with such ferocity that unprepared and inadequate health systems will surely be overwhelmed. A prompt coordinated redirection of a significant proportion of our limited resources for climate remediation should instead be directed towards infectious disease research. This is the vital lesson of the terrible scourges of the past and our precarious response to the recent Ebola epidemic.”

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