On December 4 the Centers for Disease Control or CDC held a press conference to announce that the flu vaccine already given to millions is not effective this year because it was developed for a strain that turns out to not be widespread this year. This is no one’s fault; the selection process is complex and this year the agencies involved guessed wrong.
The prevalent flu variant this year is Influenza A, H3N2. Unfortunately the particular H3N2 strain that was expected is not the one we are seeing so the vaccine produced for this year, and already given to millions, is expected to provide very limited protection.
Even worse, in the years when an H3 flu virus is the predominant infectious agent, these tend to be among the very worst years with more deaths and more hospitalizations than the average year even when the correct vaccination is available.
We can expect an especially bad flu season this Winter 2014/2015 year and those people who are most at risk should be prepared both to (1) avoid situations where they will be exposed and (2) stockpile one of the four anti-viral drugs that are actually effective against influenza – Tamiflu and Relenza are prominent and well-known, being the first two such drugs which were approved for treatment in the U.S.
The four anti-viral drugs currently approved for flu treatment in the United States are oseltamivir (Tamiflu), zanamivir (Relenza), amantadine (Symmetrel), and rimantadine (Flumadine).
You should check with your doctor about which of these four drugs might be best for you and do so well in advance of any actual symptoms because you must begin taking the drug almost immediatly after your first symptoms which include fever and muscle aches.
But be warned that these drugs may be in short supply at local pharmacies. For many elderly and disabled this means you may want to have some in your medicine cabinet ready to use since if, for example, you showed initial symptoms on Friday morning you probably couldn’t get an appointment to see your regular doctor even on an emergency basis until Monday, which would already be too late to start treatment.
Although taking Tamiflu or Relenza can literally be a life-saving move for the elderly, fewer than one quarter of people who should take these anti-flu drugs do so.
The CDC reports that about half of the H3N2 viruses analyzed this season are different from the version of the H3N2 virus that’s included in this year’s flu vaccine, different enough that protection from vaccinations against these H3N2 viruses may be lower than we usually see. Flu viruses mutate(change) quickly as they spread through a population and this genetic “drift” is already seen to occur in the present influenza strain.
Most of the other viruses identified are the same as the viruses covered by the vaccine so the CDC still recommends getting the flu vaccine as the single best way to protect yourself against the flu. Vaccine will protect against the strands that are covered in the vaccine and may have some effectiveness against the drifted strain. While vaccination is still important, it isn’t perfect unless you are exposed to one of the variants which are targeted in the current vaccine.
You can find “official” treatment information at http://www.flu.gov/symptoms-treatment/treatment/.
Here are the guidelines for treating patients having caught the Flu but without anti-viral/anti-flu medication:
>Get plenty of rest (Not difficult since the patient would be in significant pain and weakness.)
>Drinking clear fluids like water, broth, sports drinks, or electrolyte beverages to prevent becoming dehydrated. Forcing fluids is useful if there isn’t too much vomiting and Gatorade turns out to be useful in the treatment by replacing electrolytes.
>Placing a cool, damp washcloth on your forehead, arms, and legs to reduce discomfort associated with a fever
>Putting a humidifier in your room to make breathing easier
>Gargling salt water (1:1 ratio warm water to salt) to soothe a sore throat
>Covering up with a warm blanket to calm chills
The CDC statement reads, in part, “Every season is different with different flu viruses spreading and causing illness. So far, this season influenza A, which is called H3N2 viruses have been detected most frequently and in almost all states in the U.S.A. We know that in seasons when H3 viruses predominant, we tend to have seasons that are the worst flu years, with more hospitalizations from flu and more deaths from the flu. Unfortunately, about half of the H3N2 viruses that we’ve analyzed this season are different from the H3N2 virus that’s included in this year’s flu vaccine. They are different enough that we’re concerned that protection from vaccinations against these drifted H3N2 viruses may be lower than we usually see. Most of the other viruses identified are the same as the viruses covered by the vaccine. We continue to recommend flu vaccine as the single best way to protect yourself against the flu. Vaccine will protect against the strands that are covered in the vaccine and may have some effectiveness against the drifted strain. While vaccination is still important, I want to emphasize a second tool to fight the flu and the complications that flu causes, and that is antiviral medications. Antivirals are not a substitute for vaccinations.”
“Vaccinations prevent flu, but antivirals are an important second line of defense to treat the flu. This year, treatment with antiviral drugs is especially important, particularly for people who are at high risk of serious flu complications or for people who are very sick with flu. It’s especially important to get antiviral medicines quickly if you have flu. They work best when you start them within two days of the beginning of flu symptoms, and we strongly recommend that if doctors suspect the flu in someone who may be severely ill from the flu, they don’t wait for the results of a flu test before starting antivirals.”
Influenza A, H3N2 viruses have predominated so far with lower levels of detection of influenza B viruses and very few of the H1N1 viruses we’ve seen a few years ago. During the week ending November 22nd, 91 percent of the approximately 1,200 flu positive tests reported to the CDC were influenza A, and 9 percent were influenza B viruses. As noted above , of the influenza A viruses, nearly all were H3N2, and of those, about half were antigenetically different from the H3N2 component of the 2014 flu vaccine. These changes can signal that the immune response provided by vaccinations won’t protect as well for these viruses, and there’s a lot of numbers there.
1. To sum up, this is definitely an H3 year and is therefore likely to be a very bad year for the flu with very sick people and a number of fatalities. That would be true even if
2. Because the wrong vaccine was produced there is little protection expected from the vaccine this year.
3. Those at serious risk should consider taking one of the four available anti-viral, anti-flu drugs.
Author’s advice follows:
Although often taken lightly as if it were nothing worse than the common cold, the regular Influenza kills tens of thousands of people every year just in the United States alone and that’s with first class treatment – unfortunately while people and government officials are panicked about a few cases of Ebola appearing in the United States, they totally ignore the yearly influenza for which there is a treatment which fewer than one in four patients actually get.
One season, just at the end of WWI, a flu variant killed between 50 and 100,000,000 people. So far Ebola has killed about 6,000 and is very difficult to catch.
I am elderly and have chronic illnesses so we take precautions and our family hasn’t experienced the flu for more than a decade. The precautions we take are simple and as follows.
Especially those in high risk categories such as the elderly, chronically ill, very young, or anyone who is in regular contact with any of those groups need to take special precautions to avoid catching and spreading the flu.
This includes simple things such as shopping at off hours when there are few people around who may be infected. During the height of the flu season midnight is a great time to grocery shop – better yet, shop online and get items delivered even meat, flour, and salt.
If I walk into a store and hear a dozen people coughing I leave immediately and either shop online using the amazing Amazon Prime home delivery system, or some other delivery service. Walmart already delivers all our dog food.
You should consider wearing gloves while shopping, using anti-bacterial wipe as soon as you are out of the store, and wearing an N-95 category mask both to prevent spreading the disease yourself and to block the tiny aerosol particles which carry the virus.
I always wear a tight pair of leather gloves, the kind known as police search gloves. No one has ever commented since the weather is cold but I couldn’t care less. I wear them most of the cold months because I have arthritis but they also provide protection against my automatically touch my face after opening a door – the most dangerous practice there is when moving among infected individuals in stores.
The gloves mostly act as a reminder not to touch my face but also protect against any minor cut or scrape which could easily permit infection from a door handle.
The new H3 flu variants which have now become prominent were only discovered in March, too late to include in the vaccine production for this flu season.
According to the CDC, this season we have four different strains of flu circulating: The B strain, the h1 strain, the well matched H3 strain, and the poorly matched H3 strain, and only time will tell which of them, if any, will predominate for the following weeks and months of this year’s flu season. Flu always has a potential to be serious, but H3N2 viruses tend to be associated with more severe seasons. The rate of hospitalization and death can be twice as high as or more than in flu season when H3 doesn’t predominate. People with certain health conditions like asthma, diabetes, heart disease, lung disease, and pregnancy are also at high risk. We’re also noting our hospitalizations for the year, and we know, sadly, that so far there have been five pediatric deaths associated with influenza. We’ve also heard of outbreaks in schools and in nursing homes. During some seasons when the viruses are antigenically drifted, vaccine effectiveness can be lower, but that’s not always the case.
If we have a severe season with H3N2 virus predominating, getting a vaccine even if it does not provide as good as protection as we hope would be more important than ever and remains the single most important way to protect yourself against the flu. In addition, a vaccination will offer the usual protection of circulating viruses that have not undergone antigenetic draft. We continue to recommend vaccination, because though far from perfect, it still offers us the best chance for prevention.
We can’t predict what will happen over the entire season. The influenza vaccine is designed to protect from three or four, depending what vaccine you get, different influenza viruses. Any of these could circulate at any time in the season, and if we have a severe season, getting a vaccine that provides partial protection may be more important than ever, so, first, we urge people who have not been vaccinated to get a vaccine now.
Companies have already distributed close to 150 billion doses this year. As I mentioned earlier, antiviral treatment is particularly important this year. Many people believe that since flu is a virus, there’s no treatment for it. In fact, there are antiviral drugs that work to reduce the severity of influenza. There are two FDA approved drugs recommended for use in the U.S. during this season, Oseltamivir and Zanamivir. Treatment with antiviral drugs works best when they are begun 48 hours of getting sick, but they can still be helpful in some patients when given later in the course of the illness.
Treatments with antiviral drugs for influenza can make your illness milder and shorter. It can reduce the likelihood you’ll end up in a hospital or in intensive care, and we believe treatment with antiviral drugs can reduce the risk of dying from influenza. Prescription antiviral drugs, however, are greatly under prescribed, particularly for people who are at very high risk of getting the flu. Probably fewer than one in six people who are severely ill with the flu get antiviral drugs. Very important that we do better for people who are severely ill or who could become severely ill with influenza. That’s the single most important message today.
I keep N-95 masks in stock both for dust protection and for their anti-flu protection. I also wear gloves almost always when outside and don’t handle food packages from the store until they have sat several hours – most flu viruses quickly die from exposure to dry air and light.
Despite being an ordained minister, I also avoid communion religiously.