KeepHealthCare.ORG – After a Punishing Flu Season, Hope Persists for a Universal Vaccine | Health & Science
Every day about 46 people tested positive for the flu — and every 38 hours someone died from it — during the most recent flu season in Connecticut.
Those disturbing statistical averages from late August last year through late April this year were part of an epidemic nationwide and point out the devastating toll the flu has wrought on Connecticut residents.
“The 2017-18 flu season started earlier and activity increased more quickly than in most past seasons,” says Alan Siniscalchi, a surveillance coordinator for the state Department of Health’s infectious diseases section. “The level of flu activity reported during the 2017-18 season was higher and more geographically widespread than activity observed since the 2009-10 H1N1 (swine flu) pandemic.”
The number of people nationally who went to doctors’ offices, emergency rooms and outpatient clinics during the past flu season, according to Richard Benson, a spokesman for the federal Centers for Disease Control and Prevention, was greater than the number during any season since the swine flu crisis. “Additionally,” he says, “the overall hospitalization rate is the highest ever recorded in our surveillance system [which began in 2010].”
CDC hospitalization data, which is collected in 13 states, shows there were 101.6 hospitalizations from the flu for every 100,000 people in the country from Oct. 1, 2017, through early April 2018.
In Connecticut, 11,351 people tested positive for the flu from Aug. 27, 2017, through April 28, 2018, and 3,322 — an average of nearly 14 per day — were hospitalized with it, according to state Department of Health statistics. There were 147 associated fatalities. Of the deaths, the vast majority were people older than 65. The number of flu-associated deaths is the highest it’s been in Connecticut in about five years, and those who have died include three children younger than 18.
With warnings of intensifying seasons in the future, health officials and a member of the state’s congressional delegation are calling for increased funding and research to confront the annual menace.
The flu, medically known as influenza, is a contagious respiratory illness caused by flu viruses, including two basic types, group A and group B, that circulate in the U.S., according to the state Department of Health. Symptoms typically include fever, aching muscles, sore throat, dry cough, runny nose, headache, burning sensation in the chest, eye pain and light sensitivity.
Influenza A may cause “moderate to severe illness in all age groups” and infects humans and animals, according to the department. Influenza B causes “milder symptoms” and affects only humans, primarily children.
The 2017-18 flu season was different than others in the past because the “two influenza strains circulated through the community simultaneously, rather than sequentially, as they usually do,” says Dr. Michael Parry, the chair of infectious diseases at Stamford Health.
The predominant flu strain circulating nationally during the recent season, Benson says, “was an influenza A virus known as H3N2, which is associated with more severe illness, hospitalizations and deaths, especially among children and people older than 65.”
A second wave of flu hit in the latter half of April, when health officials saw a sudden surge in type B illnesses.
Dr. James Sabetta, the section head of infectious diseases at Greenwich Hospital, says the hospital usually sees an increase of patients admitted for the flu in January and February. Greenwich Hospital admitted 140 patients with influenza during the 2017-18 season, according to the hospital’s statistics through March 3. That was a substantial jump from 88 patients admitted during the 2016-17 season and 20 patients during the 2015-16 season.
Sabetta and the CDC recommend that everyone older than 6 months get the flu vaccine every year. People should “adhere to strict hand washing and pay attention to respiratory etiquette by avoiding close contact with people who are coughing and sneezing,” he says. “If you have a significant respiratory infection, get tested to see if you have the flu. If you have the flu, get treated with Tamiflu, and stay home.”
An oral medication, Tamiflu can “shorten the course of illness and diminish its severity if given within the first 48 hours of onset,” Parry says. Seasonal influenza and pneumonia that can develop from the flu virus increase death rates, and influenza also increases the number of heart attacks, he says.
To protect against contracting the flu, people over age 65 should receive “a high-dose flu shot” annually, Parry says. The high-dose vaccine was first approved for use in the U.S. in 2009.
People 65 and older, the CDC says, are “at greater risk of serious complications” from the flu, because human immune defenses become weaker with age.
Estimates show that 71 to 85 percent of seasonal flu-related deaths — and 54 to 70 percent of seasonal flu-related hospitalizations — occur in that age group, according to the agency.
A high-dose vaccine designed for those ages contains four times the amount of antigen as a regular flu shot. A clinical trial of more than 30,000 participants, the CDC says, showed that adults 65 and older who received the high-dose vaccine had 24 percent fewer influenza infections than those who received the standard-dose vaccine.
Flu vaccines are often updated each season to protect against the flu viruses that research indicates will be most common during the upcoming season.
Unfortunately, vaccines to prevent the flu are often ineffective.
Only 36 percent of the vaccines administered during the 2017-18 flu season were effective in preventing the flu, including a 25 percent efficacy rate for the most prevalent A H3N2 strain, according to the CDC. The 36 percent rate is a drop from 40 percent in 2016-17 and 49 percent in 2015-16, but a much higher success rate than 19 percent in 2014-15.
U.S. Rep. Rosa DeLauro, D-3, introduced legislation in February to invest $1 billion toward the development of a universal flu vaccine that would “provide a lifetime of protection after being administered just once or twice.”
The bill, called the Flu Vaccine Act, is “a good first step, because it could take more than five years to develop a universal flu vaccine,” DeLauro says. “We need to start somewhere by ensuring there are dedicated resources.”
Though it’s an amount much smaller than the $1 billion DeLauro is seeking, she applauds a $40 million increase for universal flu vaccine research that was passed by Congress in a March spending bill, bringing total funding to $100 million for such research in fiscal year 2018.
“This funding is a good start, but I will continue to push for my universal vaccine bill which calls for $200 million a year for the next five years to develop this vaccine,” DeLauro says. “The opposition — like it is for most bills — is the cost and the congressional majority not making it a priority.”
DeLauro says estimates suggest the flu costs the United States more than $10 billion annually for hospitalizations and outpatient visits for adults and $7 billion per year in lost productivity and sick days. “So the $1 billion in funding the Flu Vaccine Act calls for would save us all a lot of money and hassle in the long run,” she says.
Many workers who contract the flu continue on their jobs and get others sick.
More than 37 million people in the country do not have access to paid sick leave, and many will go to work when they have the flu, says DeLauro, who is also sponsoring a bill that would allow workers to earn paid sick leave. “So the flu not only affects their health, but the health of their fellow workers, commuters, customers and clients,” she says.
For workers and others who may face the flu, the immediate future is worrisome. Siniscalchi, of the state Department of Health, says “anything and everything” should be expected.
“We should expect newly emerging strains of influenza viruses to develop, including viruses with pandemic potential,” he says. “Viruses to watch include avian flu strains, such as highly pathogenic avian influenza viruses causing large outbreaks of poultry and wild bird die-offs, as well as new reassortment flu virus combinations found to infect mammals and humans.”
More flu surveillance systems need to be funded and established throughout North America and worldwide, Siniscalchi says. In addition, he sees there’s a need to fund and plan more “preparedness activities,” including vaccine distribution and mortality containment exercises.
For DeLauro, mortality from the flu hits home.
“This issue is personal for me.” the congresswoman says. “My grandfather died in 1918 during the Spanish flu pandemic. It is completely unacceptable that over 100 years later we are still dealing with this problem when we have a clear path forward for a solution.”