FLU SHOT OR NOT, FLU IS PREYING ON KIDS IN LARGE NUMBERS

Despite having gotten her flu shot, a 5-year –old Las Vegas girl succumbed to a flu infection allegedly caused by the same strain that was included in her vaccine. Her cause of death was cardiac arrest apparently resulting from a inflammation affecting her heart (and perhaps a reaction to meds she was receiving).

“She was healthy Friday. Sunday in the evening, her mother noticed that she was getting ill,” the girl’s aunt told reporters from FOX 5 VEGAS.  She developed a cough and fever on Sunday and was receiving treatment with steroids and a nebulizer (presumably for asthmatic symptoms) and then collapsed on Monday and was pronounced dead on Tuesday.  It all happened that fast.

According to the CDC, with 9 new cases this past week, the pediatric group death count from flu this season hit 56 (involving 23 states) and four have come from Nevada’s Clark County where this girl resided.

However, as bad as A-strain flu has been this year in children, it has been far worse in the elderly causing five to six times more hospitalizations (that we know of) and several hundreds of deaths in the elderly in all 50 states.

Pediatric deaths from flu spark a very emotional response because the children are so young and often healthy. Last year, 109 children died from flu. In typical seasons pediatric fatalities involve mostly kids who weren’t vaccinated but not this year. This flu season even children who got flu shots seem to be falling ill in much higher numbers, and that’s pretty much the same story for all age groups.

It’s largely because of three things: the “drift” involving the H3N2 virus that started back in March, the flu vaccines being rendered less effective by that mutation, and then lower-than-desired vaccination rates in all age groups—a triple “whammy” that is making this flu season “nastier than most.”

LUZERNE COUNTY APPROACHING WORST RECENT FLU SEASON

Pennsylvania’s most recent flu report showed Luzerne County has a growing flu problem and is already approaching numbers that will make it the worst in three years…and the way cases are increasing, perhaps the worst in the past decade.

A total of 1,114 confirmed cases have been reported in Luzerne County, more than triple the number from neighboring Lackawanna, and officials cautioned that reported cases are only a small fraction of the actual cases people are experiencing.

“When the flu is in your county, it has the ability to spread very rapidly,” said Holli Senior, a Pennsylvania Health Department spokesperson.

Last year during a one year period from September 2013 to September 2014, Luzerne had 1,332 confirmed flu cases and 1,232 reported during the six month period from October 2012 to April 2013. This year Luzerne is about to top those numbers after just 4 ½ months.

Statewide, flu has been widespread and severe this season with 30,868 cases reported and 104 deaths , ninety (90) of which involved people age 65 and over. The state health department does not break down deaths by county, Senior said.

In the week ending Jan. 11, there were 375 confirmed cases of the flu throughout the Geisinger Health System, said spokesman Matt Van Stone. “Flu incidence is still high and confirmed cases in the first three weeks of January have been consistent with what we typically see in early February,” he said.

An additional problem in Luzerne and neighboring counties has been shortages of the drug TAMIFLU.

A 26 year-old who got her flu shot in October as she does every year, came down with her first-ever case of flu right after New Years and her husband had great difficulty getting her prescription filled.

It was bad enough that her flu shot didn’t protect her the way she had hoped, but “The worst part is that Tamiflu was sold out everywhere,” she said. “My husband had to drive to a pharmacy 45 minutes away to get it.”

With Tamiflu in short supply in certain areas, many physicians are employing a strategy of prescribing it only for those who are “high-risk” and/or age 65 and over.

COULD SLEEP BE A KEY COMPONENT TO TREATING FLU?

Right now, good news about influenza and its treatment is hard to find. Cases are still increasing along with hospitalizations and fatalities, especially involving the elderly. H3N2 continues to be the dominant flu pathogen. Articles trumpet the fact that the current vaccines aren’t working as well as hoped rather than promoting the fact that any protection is better than none, and even the CDC and many physicians can’t seem to agree on how best to use antiviral drugs to the treat suspected flu cases.

In the fight against flu, flu seems to be winning…and it may continue to do so, at least for the next few rounds (aka, weeks).

But a press release from Washington State University-Spokane claims a group of its scientists have found a brain protein that boosts the healing power of sleep that speeds an animal’s recovery from the flu, and while the discovery took place in mice it offers promise of creating a whole new line of future treatments.

The brain-specific protein is uniquely involved in sleep responses triggered by the influenza virus in mice. Without the protein, animals develop more severe symptoms of flu infections and die at higher rates than regular or control mice.

WSU Regents Professor James M. Krueger said the discovery could lead to alternative treatments for influenza and many other infectious diseases, possibly by using intranasal sprays to stimulate the production of the brain protein called AcPb.

Previous research indicates that sleep is necessary factor for a healthy immune system and sleep plays a critical role in the body’s response to bacterial and viral infections.

Krueger showed this recovery involves AcPb and an immune system signaling chemical called interleukin-1. AcPb links up with interleukin-1 to help regulate sleep in healthy animals. It also prompts infected animals to spend more time sleeping during an illness.

His team found mice who lacked the gene for AcPb slept less after being infected with influenza virus. They also became chilled, grew sluggish, lost their normal circadian rhythms and ultimately died in higher numbers than the mice who slept longer.

Comforting to find that when “knocked out” by the flu, staying home from work or school and curling up in bed under the covers and sleeping may be one of the best things you can do…and it might “just be something the doctor orders with a prescription” in the near future.

The findings were reported in the journal Brain, Behavior, and Immunity in November.

MIXED NEWS FROM PENNSYLVANIA’S WEEK 2 FLU REPORT

There was both good news and some bad news in the PHD WEEK 2 FluReport (week ending January 17, 2015).

For the third consecutive week, new flu specimens submitted and testing positive declined slightly but total Y-T-D confirmed cases still grew by more than 5,200 specimens (about a 20% gain over the prior week).

Flu may be slowing but is not going away anytime soon.

Allegheny County cases reached 3,949 while runner-up Lehigh County’s cases leaped by almost 40% to 2,214 cases. Included in the “more than 1000-club” were Berks (1117), Lancaster (1003), Luzerne (1114), Montgomery (1450), Northampton (1039), Washington (1308), and Westmoreland (1196). In the “almost 1000-club” were Berks (974), Butler (927), and Dauphin (963).

Two other disturbing observations were: (1) B-strain cases rising in Pennsylvania by nearly 20% and (2) flu-related fatalities climbing by almost 50% to a total of 104, with 90 of those happening to persons 65 and older, after that group experienced a 50% increase in one week’s time.

Midway through January 2015, FLU in Pennsylvania was still “WIDESPREAD” and “HIGH” in intensity but cases appear to be in a slowly declining mode rather than a rapidly growing one. Hospitalizations and deaths seem to be happening more often in confirmed flu illnesses than in most recent years and there are still at least 6-8 more weeks of flu left on our calendars.

FLU CLAIMS PENNSYLVANIA’S FIRST INFANT FATALITY UNDER 6 MONTHS OF AGE

“Tragically, an infant under 6 months old recently died in Erie County from complications of the Influenza A virus,” Dr. Gale Burstein, the Erie County health commissioner, said in a statement. “Our thoughts and sympathies go out to this child’s parents and family during this time of unimaginable loss.”

The infant’s death occurred over the recent holiday period and marked the second flu-related pediatric death in Pennsylvania this season (the other was in a 10-18 year old).

There were six pediatric deaths in the state during the 2013-14 flu season, 14 in the season before that, and so far nationwide, there have been 45 flu-related deaths nationally among children, according to the Centers for Disease Control and Prevention.   Most of those deaths have come from fewer than a dozen states.

CDC started tracking flu-associated deaths in children after the 2003-2004 flu season, when there were 153 deaths reported from 40 states. Since that time, reported pediatric deaths during regular influenza seasons have ranged from a low of 35 deaths during the 2011-2012 flu season to a high of 348 in 2009-10, the year of the H1N1 flu pandemic.

A 2013 CDC study of eight earlier flu seasons found that flu-related deaths occurred in many healthy children rather than simply those with higher-risk underlying health conditions. In addition, most of the children in the study who died—90% in fact—had not received a flu vaccination.

Another key finding illustrated by the study was just how quickly the flu can kill. One-third of the children died within three days of developing symptoms, pointing out the importance of prompt medical attention for all infants suspected of having flu..

Burstein pointed out infants under 6 months are too young to get a flu shot and are especially vulnerable. Their immune systems are not yet fully functional and they don’t respond to vaccines the same way older children do (many of whom still require TWO flu shots to get a proper response).

Infants are dependent upon antibodies from their mother’s breast milk to ward off infections until their own systems become sufficiently mature to work on their own.

“Children younger than 6 months are at an extremely high risk of serious flu complications,” she said. “I cannot recommend strongly enough that all individuals, parents, family and any other caregivers who are in contact with infants under 6 months receive vaccinations against influenza”…not just to protect themselves but those infants as well.

Annual influenza vaccination has been recommended for all children 6 months to 18 years of age since the 2008-2009 influenza season, but vaccination rates among children, while higher than for all age groups other than the elderly, remain well below desired levels.

Nearly 60 percent of children age 6 months to 18 years received a 2013-2014 influenza vaccine, a small increase from the 56.6 percent who got vaccinated in 2012-13, according to CDC. But even at 60%, children’s flu vaccinations are well below the CDC target rate of 90% by 2020 (and at least 70% by 2016).

This season, for several reasons, estimated flu vaccination rates in children seem to have declined rather than increase, but officials are saying that finding may be true for ALL age groups not just children.

TAMIFLU….TAKE IT OR LEAVE IT?

This is one of those questions in medicine that delivers a strongly divided response, but which side one takes basically depends entirely upon whose data you believe.

A recent ALERT letter from the CDC asked physicians to increase their use of TAMILU (and other antivirals) in an attempt to reduce the morbidity and mortality being caused by this year’s flu epidemic. The agency’s letter is fueling controversy among practitioners taking sides over the “real” versus perceived value (or benefits) of antivirals and about who should receive them and when.

Needless to say, the debate, confusion, and  resulting indecisions about using antivirals for flu are the exact opposite of what the CDC hoped would occur…just one more “unpredictable” nature of this year’s unique influenza problem.

Genentech makes Tamiflu and their TV ad and website say that “if Tamiflu is taken within the first two days of flu symptoms, the illness and symptoms can be shortened by up to 1.5 days (in children less than 12 years old) or 1.3 days (in children over 12 and/or in adults)…an estimated benefit of about 30%.”

The Cochrane Group, an independent organization that regularly studies such matters, says they have found “a questionable benefit of just ½ day…and maybe no really measureable benefit at all.”

With a prevailing retail pharmacy cost of $15 per capsule ($150 for the 5-day, 10-dose pack) the drug is far from cheap, and for most people paying that amount for several hours worth of relief from flu wouldn’t be worth it (unless maybe it was at the absolute height of flu’s worst symptoms that were avoided)

I’ve heard CDC claims that antivirals should be used (at the very least in high-risk patients) because they can actually reduce risks of hospitalization and death from flu along with shortening illnesses but I have yet to see such data…and ditto for any data on Tamiflu’s ability to prevent flu illness as well.

I’ve had some personal experiences (about eight) with Tamiflu this year and I think taking it helped but lacking an appropriate placebo control group I have no way of knowing whether it prevented complications or a hospitalization. I will say my one friend who didn’t take it wound up in the hospital for 3 days and sick for a month.

Nausea and a little diarrhea were the only side effects I heard about, but my guess is any debate about antivirals is far from over and more data will be forthcoming.

WHERE IS FLU RAISING NEW FEVERS?

SO, EXACTLY WHERE IS FLU GETTING MORE ACTIVE NOW…in mid-January?

The WALGREENS FLU INDEX™ is a weekly report developed to provide state- and market-specific information regarding flu activity which then ranks those experiencing the highest incidences of influenza across the country. The INDEX uses hyper-local prescription data (both totals and changes) based upon zip codes to drive consumer awareness and prevention within communities, while also serving as a valuable resource for health departments, media and others at the local level.

According to that INDEX, for the week of January 12, 2015, these were the top ten Drug Market Areas and states showing INCREASING flu activity. They are not the worst activity but rather the greatest increases—most of them going from lower than normal levels previously.

Top 10 DMAs Flu Activity Gains
From week beginning 1/5/2015 to 1/12/2015
1. El Paso, Texas (Las Cruces, N.M.)
2. Greensboro-High Point-Winston Salem, N.C.
3. Buffalo, N.Y.
4. Phoenix (Prescott), Ariz.
5. Los Angeles, Calif.
6. Wichita-Hutchinson, Kan.
7. Tucson (Sierra Vista), Ariz.
8. San Diego, Calif.
9. Sacramento-Stockton-Modesto, Calif.
10. Boise, Idaho

 

Top 10 State Flu Activity Gains
From week beginning 1/5/2015 to 1/12/2015
1. Arizona
2. California
3. Massachusetts
4. Oregon
5. Rhode Island
6. Connecticut
7. Idaho
8. Washington
9. New Mexico
10. New York Clearly

most of these markets/cities and states have been “enjoying” lower levels of flu activity than other parts of the country and consumers’ thermometers are now “heating up.”   FOLKS IN THESE NEW “HOT ZONE” LOCATIONS ARE WARNED TO GET PREPARED….flu is picking up steam and heading your way.