Flu!

This is a bad one, folks. For over a week, flu-like illnesses have been climbing across the U.S. Hospitals in my area are filling up, leaving patients waiting for hours in emergency rooms and in “virtual beds” (i.e., a hallway with a curtain). This is right on the heels of a recent spike in norovirus-like illnesses (so-called ‘stomach flu’, unrelated to the influenza virus). It’s been a busy time in doctor land.

People with the flu look like absolute crap: sweaty, shivering, pale. They are coughing, and complaining that everything hurts, even their hair. It’s misery. Thankfully, samples being tested are showing that this year’s vaccine is a good match to the circulating viruses (especially the influenza A viruses). That doesn’t mean that vaccinated people can’t get the flu, but they are less likely to, and if they do get sick, they are likely to be a bit less ill than unvaccinated people.

There’s been significant controversy over the last year especially about mass influenza vaccination policies, with experts disagreeing publicly about how big the impact of mass vaccination really is. These arguments are more about policy than medicine, about who to target, cost-effectiveness, and degree of benefit. Clinicians and scientists working with influenza are still recommending vaccination, and it’s not too late.

Just for fun, I cracked open the notebook where we keep the records of flu tests we run in the office.  A definition of an “influenza-like illness” (ILI) has been developed for reporting purposes. It’s pretty basic: a fever of 100 deg F or above, cough or sore throat, and no other cause for the illness.

At our office, we don’t use CDC surveillance methods. We do tend to test for flu in people whom we suspect of having the real thing. Guidelines for testing are pretty loose and subjective, so I tend to check people in whom I strongly suspect flu and in whom a diagnosis would make a difference. For the sake of this discussion, I’m defining all my patients tested as having an ILI.

From the beginning of December until today, here’s the data I’ve put together:

chart_1 (2)

And here’s a similar graph from the CDC:

WhoLab52My graph shows cases rather than percentages, but the percentages are close. We are seeing more ILIs, and more and more of them are testing positive for influenza (usually influenza A). I’m going to keep tracking this, since it’s really, really interesting to medicine geeks like me.

The take home message though is more basic: it’s an early and bad flu season. Wash your hands, sneeze and cough into the crook of your elbow. Get vaccinated. And if you do get sick, the current flu viruses are susceptible to the anti-flu drugs. They’re not for everyone, but it’s worth asking your doctor. The quicker you start the meds, the more likely they are to help.

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24 Comments

  1. For the last week, do they have incomplete data, or are we on a downtrend now?

  2. A. Marina Fournier

     /  January 10, 2013

    For the last three years, I’ve heard from the various members of my medical team: “And you’ve had your flu shot, right?”

    Well, no, I haven’t. I’ve never had this immunization–and NOT because I’m an anti-vaxxer, because I’m not.

    While my son was developing his immune system about 16 yrs ago (he’ll be 19 this month), I got one heck of a workout on my own IS. I actually cannot remember the last time I had the flu, and it’s been at least 12 yrs. I might get one cold a year (the rest of the household is likely to get any that pass by), and if I do, I’m the last in the household to get it. Unfortunately while it’s a less intense session for me, it’s also a bit longer. I can’t sleep when I’m congested/congestion makes me cough/allergic to codeine and vicodin, thus no heavy-duty cough meds for me/can’t get to sleep if I’m coughing every 5 minutes…

    My MiL allegedly knows better, but believes we should go to a doctor when we have a bad cold, the idea being to get a medicine, which of course won’t work on a virus because it doesn’t have the part that a bacterium has, on which said med would work.

    Last Feb/March when the allergen/pollen count was phenomenally higher than usual, you’d have thought I had either walking pneumonia or whooping cough, due to the intensity of my coughing. I *did* ask for some relief from the coughing, but there’s still nothing for me that works. I did *not* ask for AB’s, because I knew it was allergy-generated.

    Maybe I eat more nutritiously than the rest of the household, dunno. I do wash my hands a lot, cough into my elbow or knees (from the intensity of the cough), and rest. Sleep might elude me, but lying about with a book seldom hurts anyone.

    • Getting the flu vaccine is more about protecting the people around you – and you should know that…

      • A. Marina Fournier

         /  January 17, 2013

        That would make sense if they weren’t already getting their flu from places I am not found. Belle-mere gets her shot, son probably should (he’s in school), husband gets it from work, dance class gets it and brings it in…so why aren’t I getting it?

        • What sort of “medical” team are you a part of exactly?
          Maybe you’re just one of those lucky people who is resistant to flu viruses – that doesn’t mean you can’t spread it, which is reason enough to get the vaccine.

      • saffronrose

         /  January 18, 2013

        I don’t recall saying I’m a member of any medical team–I’m not. Also, I was unclear: Belle-Mère gets a shot, husband used to (given by the bldg mgmt, who make a fair profit on rent there), son likely should. Son brings home flu from school, husband brings it from work, dance team & class bring theirs from wherever. When I have had the flu, or a cold, I’ve been the last in the circles to get it. It is milder, but hangs on longer.

        Were I part of a medical team (or worked in a public health or medical facility, where it is almost required as part of the job), worked at a school or other public facility or retail business, with lots of people coming by each day, I would be getting a shot, for them, and for me. I’m not, and aside from the aforementioned folk, seldom get in sneezing distance of anyone in the season. Were I around folk with compromised immune systems, I’d get one, then, as well, whether I needed it or not.

        Now if my insurance would pay for shingles vaccine…

        • Maybe you should re-read what you write – you sound really confused.
          I assume that when someone writes “For the last three years, I’ve heard from the various members of my medical team: “ — that they’re part of a medical team; unless what you mean are people you seek health care from.

          First you write “I actually cannot remember the last time I had the flu”,
          then – “When I have had the flu, or a cold, I’ve been the last in the circles to get it.”

          So, either you get the flu or you can’t remember the last time you had it. (Flu and colds are different things with different treatments and can’t be lumped together.)

          “Were I around folk with compromised immune systems, I’d get one,” – How can you tell? – Do folk with compromised immune systems wear signs?

          Can’t really figure out what you’re asking…

          • saffronrose

             /  January 20, 2013

            You can get a reaction to tetanus shorts that acts like it in a mild form. He’s had this over 50 yrs of getting the innoculations.
            I regret that what I wrote appeared unclear. I am often rather tired when I get to read email.

            “My medical team” are those who treat me, not anyone I work alongside. Were I working alongside them, I’d say “my colleagues” or “my co-workers”, or even “my team at work”.

            In the comment on 18th Jan., in the first para., I said “I don’t recall saying I’m a member of any medical team–I’m not. ” In the next para, I wrote: “Were I part of a medical team (or worked in a public health or medical facility, where it is almost required as part of the job)”.

            Whether it is the cold or the flu, and I do know the difference, I seem to be, every time, the last one to get whatever the current wave of germ, WHEN I get either. Last spring, it was the pollen count doing me in, rather than germs, and I knew that difference as well, even though several symptoms were the same.

            I do actually know folk (who are usually quite upfront and vocal about it) with compromised immune systems, and when I’m sick for any germy reason, I won’t be where they are. We were very careful with our sitter who had CF, asthma, a rare epilepsy, nerve deafness, and I don’t remember what else–neither she nor her sisters would be hired while anyone in the household was sick.

            Yes, they don’t wear signs, but they often wear/carry other things: masks, inhalers, and most of the ones I know just don’t look healthy, and I stand back at least six feet from them when we encounter each other. I also don’t get that near babies or pregnant women during flu season–and most of those are strangers out in public.

            We live in rather cramped quarters and don’t entertain there.

          • “a reaction to a tetanus shot” is not “acting as a mild form” – you’re misunderstanding what the vaccine does.
            You’re also missing the point on being around immune-suppressed individuals; fact is – you can never know, better to have the flu vaccine even if you “never get it”- for the benefit of those around you.

          • saffronrose

             /  January 20, 2013

            You write: “a reaction to a tetanus shot” is not “acting as a mild form” – you’re misunderstanding what the vaccine does.”

            Well, then what do *you* call what he has after every single tetanus vaccine injection? Simply telling me I don’t understand does nothing to advance the discussion, nor explain to anyone anything they don’t already know.

          • starskeptic

             /  January 20, 2013

            I already told you – a reaction to the vaccine…

  3. Tsu Dho Nimh

     /  January 10, 2013

    @MHX … looks like Christmas break. There should be another spike in mid-January when the kids go back to school and share viruses they got from the cousins they visited.

  4. So, if the flu season seems unusually bad (or different) this year, and the vaccine is a good match for the circulating strains, and the H1N1 component hasn’t changed since 2010-2011, that would seem to imply it is either a A/Victoria/361/2011 (H3N2)-like virus strain or B/Wisconsin/1/2010-like virus strain that is the reason for the difference in this year’s flu season.

    Some cursory research indicates that it is indeed this year’s particular H3N2 strain that it the culprit.

  5. H3N2s tend to be kind of bad actors

  6. Didn’t know there was a norovirus lurking about – that explains my father’s recent bout with something lacking the typical cough/sore throat.

    I cannot believe people are so queasy about a little flu shot. I’ve been sticking needles in my body since 1983 (type 1 diabetes), it’s seriously no big deal. Stop veiling it as “oh I’m just naturally healthy”. You have needle phobia. Get over it.

    P.S. I’ve gotten flu shots every year for at least the past 20 yrs. Haven’t gotten the flu ONCE. Lots of colds and almost-flus, but nothing bad. And yes, I got a pneumonia vaccine as well. What can I say, I love shots ;)

  7. I keep seeing and hearing a log of bad/mediocre reporting about this, especially regarding the vaccine and the strains it protects against.

    From a Reuters report:
    “Public health authorities were correct in their forecast of which flu strains would emerge this season and therefore what vaccine to make: one against influenza A as well as influenza B”

    I don’t really expect mainstream reporting to necessarily worry too much about using terms such as genus, species, sub-type, and strain properly, but I wish they would at least get the basic details right, and not use confusing wording that implies one need to get multiple flu vaccinations, one for each strain.

    I normally would suspect that the reporter was told by some public health official that the 2 changes to this year’s flu vaccine were good matches to the circulating strains, and the reporter didn’t understand that there vaccine is always targeted at three strains, one strain each from A/H1N1, A/H3N2, and B, but the H1N1 strain stayed the same.

    In this case, the writer, Sharon Begley is the senior health & science correspondent at Reuters, and she has a decent CV, at least on the surface. I suppose it could be the the result of an editor making changes to the published story. The more I look at her CV ( http://www.sharonlbegley.com/home ), the harder I find it to believe she wrote the article as posted.

    I’m also a bit annoyed when I hear H1N1 or H3N2 referred to a strains. During the 2009 pandemic, a lot of the reporting that was done implied that the 2009 H1N1 virus was the same strain that caused the 1918 pandemic, which is incorrect.

  8. Vicki

     /  January 12, 2013

    The governor of New York has now declared a public health emergency; the only concrete effect of this mentioned in the news story is that pharmacists can now give flu shots to anyone more than six months old, instead of only to legal adults. That story also quoted the CDC as saying this year’s vaccine is effective in 62% of cases, but not whether this is about average, particularly good, or particularly poor.

    Oh, and the mayor and governor both made a show of being vaccinated within the last week; if it’s not pure show (maybe with simple saline) I’m unimpressed with how long they’ve waited. Especially Bloomberg, who spends a lot of time talking about things that are supposed to improve other people’s health. (Yes, I think some of those ideas are better than others, but the question is whether it’s easier to tell other people to drink less soda than to get vaccinated.)

  9. Spent the last week nursing a flu patient. Despite her getting the shot, she was incapacitated, and developed bronchitis as a complication.
    Me, I didn’t get the shot because I invariably have an unpleasant reaction (blacked out the last one I got in 2009). I must have gotten the bug to some extent because I have had headaches over the week, but not much else. I guess it depends on how well you match up against the flu as well as how well the vaccine matches against it.

    • saffronrose

       /  January 18, 2013

      Do you also have an unpleasant reaction to tetanus vaccines? My husband dreads them because he gets a minor case of tetanus for a week, with every joint aching and headaches.

      • starskeptic

         /  January 18, 2013

        You can’t get tetanus from the tetanus vaccine.

  10. I had the flu once as a child – in the middle of a nasty blizzard/power outage. My father was also ill, but he recovered before I did. They actually put me in a bath tub filled with snow in an attempt to bring down my fever and stop the seizures.

    I haven’t had the flu since, but I get my flu shot.

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