The flu is around every year, but it is not always the same. Yes, certain aspects of the illness remain constant, but there are minute changes between each season that makes the flu extremely difficult to cure. Understanding the nature of the beast may help you stay healthy this year. With the flu season coming to a head, it may be beneficial to look back at this year’s flu to see what we can learn and how we can prepare for next year.
What is the Flu?
The flu is considered an upper respiratory infection that affects the nose, throat, and can potentially infect the lungs. Depending on your immune system, the flu can wreak havoc on your body and can potentially cause death. Most people have mild symptoms, which can include fever or chills, vomiting, cough, diarrhea, fatigue, sore throat, runny or stuffy nose, headaches, and body aches.
The flu generally has a fast onset and lasts from a few days up to a week. Flu season itself tends to starts in October and November, peaks between December and February, and can last into May.
Influenza (another name for the flu) can be spread by tiny droplets that hang around in the air after an infected individual has sneezed or coughed. It is also possible to catch the flu if you touch something after a sick person has handled it and then immediately contact your mouth or hands. This is not usually how the illness is spread, but it can’t hurt to be careful.
Best estimates suggest that each year, around eight percent of the population comes down with the flu. Those affected are typically children, while adults older than age sixty-five seem to be immune to the illness. Those most at risk for contracting the condition are also pregnant women, anyone with a chronic medical disease and health care workers.
Though we know who can come down with the illness, how many individuals are hospitalized due to the flu? It is estimated that as many as 200,000 people a year are put in the hospital due to the flu, with 20,000 of that total being children. And these are only the people who see a doctor: what about everyone else? The CDC estimates that around 26,176,000 million individuals will come down with the flu this year.
A good question to clear up here is how long a person remains contagious. Due to the sudden onset of symptoms, it is quite possible to infect other people before your symptoms develop. For the first three to four days after symptoms have developed is when a person is most contagious.
If you have a compromised immune system, it is possible to infect people longer than those first few days. As a rule of thumb, it usually takes about two days after being exposed to the virus before symptoms develop.
Do not think for one minute that the flu can be completely harmless. Multiple complications can occur due to influenza, including sinus infections, bacterial pneumonia, and ear infections. It can also worsen chronic symptoms such as diabetes, congestive heart failure, and asthma.
The best thing you can do for yourself is to get a flu shot before you become ill. You can also protect yourself by staying away from infected individuals, washing your hands, and covering your sneezes and coughs.
While diagnosis is complicated based on symptoms alone, most people can figure out if they have the flu or not. If you are seeking relief, there are some influenza antiviral medications out there, but they typically have to be taken shortly after symptoms start.
Vaccination does not always ensure perfect health. It is still possible to develop the flu even after being vaccinated against it. How does this happen? There are a few different possibilities. First, it may be possible that you were exposed to the flu virus immediately after being vaccinated; it takes time for the vaccine to work at protecting you against the infection (it takes up to 2 weeks for antibodies against the virus to be abundant in the body).
Another possibility is that you were exposed to a strain of the virus that was not included in the vaccination. Remember that researchers guess at the top four strains that will cause illness in any given year, and there are way more than just four strands of the flu virus.
It might be an excellent place to start and explain what exactly is contained within a vaccine. Some people believe that the flu shot gives you the flu, and that is not true. The flu shot contains the deactivated virus, which provides the body with the ability to build up its immune system and learn how to fight the infection.
This year, the flu vaccine needed to be tweaked to combat the specific virus that rampaged through the United States. The A(H1N1)pdm09 vaccine component was updated from an A/Michigan/45/2015 (H1N1)pdm09-like virus to an A/Brisbane/02/2018 (H1N1)pdm09-like virus. The A(H3N2) vaccine component was updated from an A/Singapore/INFIMH-16-0019/2016 A(H3N2)-like virus to an A/Kansas/14/2017 (H3N2)-like virus. Some things did stay the same, however. Both B/Victoria and B/Yamagata virus components from the 2018-2019 flu vaccine remain the same for the 2019-2020 flu vaccine.
All vaccine types provided this flu season will be quadrivalent (both regular dose and recombinant vaccines), meaning that it will be useful against two type A viruses and two type B viruses. The vaccines are also being produced differently this year; all four vaccine viruses will be grown in cells, not eggs.
There are tons of different vaccine types out there, and depending on your age, some will work better than others. We have already talked about the regular dose, which can be given to any individual, usually in the muscle (for those years 18 to 64, you can get your shot with a jet injector which uses high pressured fluid to penetrate the skin in place of a needle). Live attenuated vaccines are made with live viruses and can be given via nasal spray. High dose shots and shots made with adjuvant ( an ingredient added to the vaccine to produce a greater immune response in the patient) are recommended for individuals older than 65.
Doses of vaccinations have also been altered this year. The changes all started in January. The first change came concerning the drug called Fluzone Quadrivalent; doses are now higher for children aged 3 to 6 years old. It is now recommended that children receive 0.5 milliliters instead of 0.25 milliliters of the drug. The next change came in October, and this time the drug was Afluria Quadrivalent. What changed here is the age range: it is now safe for children as young as six months! Doses do differ depending on the age of the child: children six months to 3 years old should receive 0.25 milliliters while all older children should receive 0.50 milliliters.
While the last two vaccines were altered, this next one is a new treatment that just came out in October. Baloxavir is best suited for non-complicated flu symptoms in children twelve years or older. There is a small drawback to this new development; it is only useful is taken two days after symptoms have started.
For best results, both adults and children should receive their vaccinations by the end of October; treatments last about six months, so receiving a shot in October ensures your health until the end of the flu season. Be warned: vaccinating too early can cause the vaccine to be less effective. If you typically receive two doses of the flu shot (children between 6 months and 8 years of age), it would be most beneficial to get the first dose as soon as flu shots become available and then to receive the second dose by the end of October as treatments need to be spread out by four weeks.
While companies have been preparing for the flu season by manufacturing millions of flu shot doses, there may be a delay in delivery in some parts of the United States. While shipments may not be arriving when expected, it should not impact how many doses will be delivered. Reports say that the latest shipment should arrive by the end of November, which still allows patients plenty of time to receive their flu shot before the season peaks. What exactly caused the delay? Manufacturers needed to recalibrate the vaccine to try to cover the viruses that are circulating in the community.
In the past, vaccines have stirred up much discussion concerning their safety. No need to worry; all types of influenza vaccines are safe and effective. Granted, they are not without their own set of side effects: some patients may experience redness, soreness, or swelling at the injection site, which may last up to a few days after the dose was given. Individuals may also experience a headache and low-grade fever after treatment.
Now that we have talked a lot about this year’s vaccinations let us talk about which viruses are causing the problem this year. Since the flu mutates so quickly, it is difficult to come up with a one hundred percent effective vaccine. Each year the virus types are analyzed, and vaccines are updated accordingly. The vaccine is created to protect against the top four virus types experts believe will be the most significant problems.
There are four different types of influenza viruses: A, B, C, and D. As stated earlier, the flu vaccine only protects against A strains and B strains of the virus, which tend to cause the most problems. C strains can cause upper respiratory infections, but it does not wreak havoc like the A and B strains. No worries about D strains: they only seem to affect cattle.
There are trivalent and quadrivalent vaccine types. This year, the trivalent vaccine will work against A/Brisbane/02/2018 (H1N1)pdm09-like virus (updated),
A/Kansas/14/2017 (H3N2)-like virus (updated) and B/Colorado/06/2017-like (Victoria lineage) virus. The quadrivalent vaccine will fight the three infections above, plus B/Phuket/3073/2013-like (Yamagata lineage) virus.
There is a special note this year about children and how many doses of vaccinations they should receive. Children ages six months to 8 years old should be receiving two doses of the flu vaccine. Any children in this age group who have not received two or more doses of any trivalent or quadrivalent vaccines will need to be given two doses this year. Even if your child turns 9 in between the two treatments, it is still recommended that they receive the second dose.
However, not all children are eligible to receive a vaccine. Any child six months or younger may not receive a flu vaccination as of this year. The best thing you can do is vaccinate yourself if you are around children who can not be protected against the virus. It has also been shown that pregnant women who get a flu shot protect their child after birth for a few months.
It is estimated that private companies will produce between 162 and 169 million doses of the flu vaccination this year.
In the past, the nasal spray vaccine has not been recommended as an effective treatment against the flu. However, we have seen that this year, experts are urging the spray. Why is that? Manufacturers this year have changed the game: they have changed the H1N1 vaccine virus, making it more effective at treating this particular strain of the virus.
The nasal spray does have its own unique set of side effects: individuals may experience a runny nose, sore throat, fatigue, or cough after they receive the treatment.
It is tough to determine how effective the flu vaccine will be; there are too many variables determining the onset of illness. The two main contributing factors as to whether or not the vaccine will be effective for a particular individual are the overall health of the individual being vaccinated as well as how closely the viruses in the vaccine match up to what is circulating in the community. In general, the flu vaccine has an efficacy rate of between 40 and 60 percent.
This year experts are saying that the vaccine will be effective against the H1N1 strain and the H3N2 strain as well as the two B strains that are currently circulating.
Keep in mind why it is so challenging to produce a perfect vaccine; the vaccine is partially built from information from the previous year’s flu, which means that researchers have to use old data to make a new vaccine. Because they have to develop the vaccine months before the season starts, it is not always the most effective treatment. What is worse is that the virus can change during the season; it can mutate and become immune to the vaccine. Do not be discouraged, though; even if the vaccine is not a perfect match, it can still protect from closely related viruses.
Due to the activity in Australia this year, experts predict that our flu shot will not be a perfect match against the flu viruses that will circulate our communities. Decisions were made for this year’s vaccine back in March based on the previous year’s virus circulation. Why is that? It takes at least six months to produce enough flu shots for the population, so decisions need to be made way before the flu season starts. This also does not leave enough time to watch the Southern Hemisphere’s flu season unfold.
While the vaccine may not be 100 perfect effective, it is still worth your time to get a flu shot: since there are similarities between flu virus strains, you may still receive some protection and may not have as severe symptoms and will avoid hospitalization.
There may be some good news, though: our vaccine is developed by looking at which strains are circulating through the United States as well as Australia, so our vaccine may be more effective than theirs was this season.
Even though it is early on in the flu season this year, we have already experienced loss across the United States. Minnesota, Arkansas, North Carolina, California, Wisconsin, and Indiana recently reported their first deaths. New York also recently declared its first death, that of a child. The good news is that only two children have perished so far this flu season.
As of last month, the flu seems to be well-contained within the United States. The two locations that seem to be experiencing an outbreak at this time are Louisiana and Puerto Rico.
Our flu activity is often based on what Australia’s flu season looks like. This year, Australia’s flu season hit two months earlier than expected; similar reports have emerged from Arkansas, as they have already started reporting cases before flu season typically begins. To safeguard yourself, get a flu shot as early as possible this year.
Why did Australia get struck this year for its flu season? It seems that scientists were not good at predicting which viruses to protect against this year. It appears that one of the virus strains that was circulating mutated through antigenic drift, which changes the outside composition of the virus, making it harder for antibodies to attack and neutralize them. The concern is that the same thing will happen in the United States.
Work is currently being done to develop a universal flu vaccine that will cover more than just four strains in a single dose. This would hopefully ensure that more people are protected against the types of viruses that are making people ill. To date, fifteen universities across the country are working together on this new development.
The hope is that this new vaccine will invoke a stronger and longer immunity to the virus and that it will protect against more than just four strains of the virus. The ultimate goal is to make a vaccine that lasts about five years.
The CDC stated this year that those who suffer from Guillain-Barre syndrome within six weeks of a previous flu vaccination should not be vaccinated this year.
A special note is also needed for pregnant women. Concern has been given to the fact that some women who received flu shots eventually had miscarriages. The CDC came out to address the matter by advising pregnant women to get a flu shot but not the nasal spray.
When people come down with the flu, what happens? They stay home from work! So it is no wonder that the flu costs the United States each year from lost productivity. It also costs money to visit a doctor once you become sick, and some individuals pay out of pocket for their flu shot. The Center for Disease Control estimates that the flu costs around $10.4 billion just in outpatient costs and doctor’s visits. Lost wages amount to a figure of $16.3 billion annually from the flu.
Weekly reports are generated during flu season to track the progression of the epidemic. The last report was created on October 26, 2019. The rate of the flu is currently low, but it is slowly rising. Specimens collected from patients show that 2.4% were infected with the influenza virus. The virus profile indicates that Influenza A(H3N2) and Influenza B/Victoria viruses have been the most common thus far in the season, with the A strain being slightly more prevalent than the B strain.
More people are consulting their doctor as well: 1.9 percent of outpatient visits were due to the flu. This is still good news, though; this is lower than the baseline percentage of 2.4. The only state so far that is reporting no flu activity in Rhode Island.
As was stated previously, deaths are already being reported. What was not mentioned earlier was that there had been deaths attributed to pneumonia (complications of the flu caused 5.1 percent of all pneumonia deaths). Again, this is still below the epidemic threshold, which is considered to be 5.8 percent. The good news is that there are no new pediatric deaths!
A majority of reports of influenza are coming from the south; 75 percent of all influenza viruses and 86 percent of the B strains, to be exact. Specifically, influenza B/Victoria has been the most prominent in the south and southeast regions of the country.
While most activity has been seen in Louisiana and Puerto Rico, other states are experiencing lower levels of influenza activity. The low activity has been reported in Virginia, Alabama, Texas, Connecticut, South Carolina, Georgia, and Missouri. Minimal influenza activity has occurred in the District of Columbia, New York, and every other state besides Rhode Island.
The CDC also monitors the spread of the illness. The regional spread of influenza has been reported solely in Louisiana. Local spread of the flu has been observed in Arizona, Texas, Georgia, Tennessee, Hawaii, Nevada, Idaho, Mississippi, Kentucky, and Indiana. Sporadic dispersion of the disease was reported in the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and all other states except Rhode Island.
It has been touched upon multiple times earlier that the United States predicts it’s flu season based on what happens in Australia. It only seems appropriate to spend some time exploring their fu season in full detail so that we can prepare ourselves for what is to come.
This year, Australia has experienced one of its worst flu seasons in recent history. They have already reported more cases of the flu than they did their entire 2017 season. In 2017, Australia reported 229,000 cases of laboratory-confirmed influenza. This year they have already surpassed that number with a total number of cases of 272,146.
Their flu season generally starts in June and ends in September with a peak in August. As stated earlier, flu season commenced two months early, and it is still rampaging through the country. This year, influenza activity increased in March and through May with a peak in June and July.
This year there were more flu-related deaths than typically occurs in a year. Hospitalization rates were also quite high, and there was an extreme problem in nursing homes.
Deaths in Australia are calculated a little bit differently than they are here in the United States. Australia only counts deaths that the hospital deems were caused directly from influenza. This year’s flu season caused 662 deaths. Most deaths were associated with some type of A strain of flu; 128 were caused by A(H3N2) and 29 with A(H1N1)pdm09. Just 30 deaths were due to a B strain of flu.
The current flu season was dominated by the H3N2 strain, which tends to cause more hospitalizations and deaths compared to other strains.
Things are starting to look up for Australia, however. Over the past few weeks, fewer reports are coming in concerning influenza and influenza-related illnesses. Although levels were very high during the interseasonal period, reports of flu are now slowly declining.
The severity of the epidemic is determined by the number of patients who have been admitted to the ICU as well as deaths; this year, it was determined that the severity of influenza was low. This year, 246 individuals who sought treatment for the flu were sent to the ICU.
Another item measured by Australia is impact, which looks at how influenza impacts society. They do this by looking at how many hospital beds are being occupied as well as how many people are absent from their jobs. This year it was determined that the impact was low to moderate.
The four strains that were included in this year’s vaccine are A/Michigan/45/2015, (H1N1)pdm09-like virus, A/Switzerland/8060/2017, (H3N2) like virus, B/Phuket/3073/2013 like virus, Yamagata lineage and B/Colorado/06/2017 like virus, Victoria lineage. The vaccine was determined to have good effectiveness.
There were some antiviral resistances recorded this year. Influenza viruses are tested for neuraminidase inhibitor resistance; one virus tested demonstrated reduced inhibition to Oseltamivir and Zanamivir.
There is some good news in all of this mess. Because the flu season started early, it is predicted to end soon as well. This is because once the season begins, it typically only lasts between 12 and 16 weeks. It was concluded that Australia had such a bad year due to its geography; thus, it is not likely that other countries will experience the same problems.
Our close neighbor, Canada, also determines their flu season based on what happens in Australia. It is only fitting to spend some time exploring what their expected flu season will be this year.
Canada’s flu season generally starts in the fall and peaks between December and February, just like in the United States. While Australia began its season early, it does not seem like that will happen here; Canada just started receiving their first cases of influenza, which is pretty typical for this time of year. It is predicted that this year the peak will happen in December.
Estimates suggest that the flu season will not be a rough one; experts say only 40,000 individuals will become infected over the season. The only downfall prediction comes regarding the vaccine; experts say that if H3N2 strains are abundant this year, the vaccine may not be as effective as initially hoped.