Flu Season 2014-2015

Influenza Bulletin Number 4, 2014-2015
From: Mark S. Drapkin, MD, Associate Chief, Infectious Diseases
To: Newton-Wellesley Hospital Community
Date: January 2015

Dear Colleagues,
Flu has hit the U.S. with a vengeance.

This week, the CDC released the following bulletin http://www.cdc.gov/flu/news/flu-activity-expands.htm

January 5, 2015 – Flu continues to expand its reach in the United States this season, with the latest CDC FluView report showing that 43 states are experiencing either high or widespread flu activity, mostly resulting from circulation of drifted H3N2 viruses. Patient visits to doctors for influenza-like-illness (ILI) are now almost even with the peak of 2012-2013 season, the last time H3N2 viruses predominated. Relatively higher flu hospitalization rates seen so far this season are similar to what has been observed during some past H3N2-predominant seasons. CDC continues to encourage influenza vaccination and prompt treatment with flu antiviral drugs for people at high risk of serious flu complications including people 65 and older, children younger than 5 years (and especially those younger than 2 years), pregnant women and any person with certain health conditions. (You may click the link to see the list.)

I don’t think you are surprised. I suspect that your family and friends have already been coming down with the flu, as have mine.

As I mentioned in the last flu bulletin, the match between this year’s H3N2 strain and that in the vaccine is not too good, so – alas – even those who have been immunized may not be well protected. Please bear the following in mind, however:

  1. The vaccine has either four (as the one we are using at Partners) or three components – A H1N1 and A H3N2 and one or two strains of B. And in most flu years at least one A and one B tend to circulate. For example, even in this 2014-2015 season 32% of A H3N2 strains analyzed by the CDC so far ARE covered by the vaccine, as are all 2,300 B strains. So flu immunization is still very worthwhile.
  2. It’s not too late to get the vaccine! Here in New England, flu tends to peak in February to March. This year promises not to be an exception, as the peak now seems to be occurring in the country’s midsection but not yet on the coasts (see CDC FluView).
  3. Health care facilities need to rev up for a severe respiratory illness season. This means having plans to handle lots of patients including working out flow within facilities to expedite care and to identify those needing more urgent treatment; emphasizing hand hygiene and, when appropriate, using masks; limiting visitors to as few as possible; and instructing those who are ill not to visit. Here at NWH, we will decide upon and circulate specific visitor restriction policies within the next week.
  4. Common sense must prevail. Infants are very susceptible to serious, life threatening influenza. In this flu season there have already been 21 pediatric deaths across the U.S. – each one a tragedy – and as in other years the rate of hospitalization has been greatest in children zero to four years of age. Here in Massachusetts, the first flu death in Boston occurred this week, in a recently married 23 year-old-man who reportedly had an underlying illness. It makes sense to try not to expose infants to large gatherings or crowds. This likewise applies to other groups at risk, such as those with cardiovascular disease, chronic pulmonary disease, diabetes, and pregnancy.
  5. 100% of all influenza strains tested this season by CDC remain sensitive to oseltamivir (Tamiflu) and similar drugs (called neuraminidase inhibitors). So, given the reduced activity of this year’s vaccine, it is very reasonable to prescribe this agent for treatment (typically twice daily for five days) or prevention (usually once daily for ten days) when exposure is known to have occurred, especially when the individual is in a high risk group as described in the link above. Oseltamivir has been deemed safe for use in adults of all ages and in all children down to the age of 2 weeks.
  6. FYI: This week the FDA approved the first CLIA-waived RNA-based test for diagnosing flu in 15 minutes in physician offices and clinics. The test raises sensitivity to over 90%, as compared with the 60 to 80% sensitivity of previous rapid tests based on antigen detection rather than RNA. View FDA’s press release  But 90% is still not 100%, so false negatives can occur. And the test requires a specific instrument, so I’m not sure how many offices will want to pursue this.

It is the responsibility of every one of us to make sure we do as much as we can to protect the vulnerable with whom we live and work and for whom we care.

Best wishes for a happy, healthy, fulfilling – and influenza-free – 2015.


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