HEALTH: This Year’s Flu Season: Repeat of Last Year or a ‘Twindemic?’

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Nov. 19, 2021 — Cases of the flu, that once annual viral intruder that was regularly the country’s worst annual health crisis, is showing signs of waking up again this fall.

But, experts say, it is far too early to say if the country will have a normal – i.e., bad – flu season or a repeat of last year, when the flu all but disappeared amid the COVID-19 pandemic. This flu season looks more like the ones before the pandemic. About 2% of all visits to doctors and outpatient clinics through Nov. 13 were flu or flu-like illnesses, compared to about 1.4% a year ago, the CDC says. Cases so far are being counted in the hundreds – 702 through Nov. 13.

Still, while cases are low, they are increasing, the agency says. Flu spread is already very high in New Mexico, and moderately in Georgia. According to the CDC, there is little activity in the rest of the country.

This time last year, cases of flu, hospitalizations and deaths were down dramatically, despite fears that a drastic ”twindemic” could occur if cases of COVID-19 and influenza increased greatly, and in tandem. Comparisons of flu season statistics from last year to previous years are quite startling.

In the 2019-2020 season, more 22,000 people in the U.S. died from flu; last year, deaths decreased to about 700 for the 2020-2021 season.

So, what might happen this year? What will happen to flu this year? Several top experts say it’s complicated:

“It’s a hot question and I’d love to give you a concrete answer. But everyone is having trouble predicting.” Stuart Ray, MD is a professor of medicine at Johns Hopkins Medicine in Baltimore.
“It’s very hard to predict exactly where the flu season will land. What seems to be the case is that it will be worse than last year, but it’s unclear whether or not it will be an ordinary flu season. ” — Amesh Amalja, MD senior scholar at Johns Hopkins Center for Health Security.
“There will be flu, but I can’t tell you how bad it will be.” “We know flu will return.” William Schaffner MD, an infectious disease specialist at Vanderbilt University Medical Center, Nashville.

Already, Schaffner says, “we are beginning to hear about some outbreaks. “

One outbreak triggering concern is at the University of Michigan, Ann Arbor, where 528 flu cases have been diagnosed at the University Health Service since Oct. 6. The CDC sent a team to investigate the outbreak. Large outbreaks were also reported at Florida State University and Florida A&M University this month.

Outbreaks on college campuses are not surprising, Schaffner said. Schaffner said that “that’s a population who is under-vaccinated” and that students often live in close quarters with others. University of Michigan officials said 77% of the cases are in unvaccinated people. “

Predictions about this year’s flu season also have to take into account that mask wearing and social distancing that were common last year, but have become less common or sometimes nonexistent this year.

Despite uncertainty about how this year’s flu season will play out, several changes and advances in play for this year’s flu season are aimed at keeping illness low.

The composition of the vaccines has been updated — and each vaccine targets four viruses expected to circulate.
The flu vaccine and the COVID vaccines can be given at the same time.
The CDC has updated guidance for timing of the flu vaccine for some people.
A new dashboard is tracking flu vaccination rates nationwide, and the CDC has an education campaign, fearing the importance of the flu vaccine has taken a back seat with the attention largely on COVID and its vaccine since the pandemic began.

What’s in This Year’s Vaccine?

This year, all the flu vaccines in the U.S. are four component (quadrivalent) shots, meant to protect against the four flu viruses most likely to spread and cause sickness this season. The FDA’s Vaccines and Related Biological Product Advisory Committee(VRBPAC), selects which viruses each year’s vaccine should target. They consider surveillance data, information about influenza cultures and responses to previous vaccines, as well as other information.

Both the egg-based and cell- or recombinant vaccines target two influenza strains, respectively. You can choose to inject or spray the virus.

Several of the formulas are approved for use in those age 65 and up, including a high-dose vaccine and the adjuvanted flu vaccine. Each of these formulas is designed to boost the immune system as our immune systems age. The CDC warns against delaying vaccination while you wait for adjuvanted or high-dose vaccines. Experts say that getting the vaccine as soon as it is available is the best option.

Vaccine Timing

In general, September and October were good times for flu vaccinations, the CDC says. Although it is best to get flu shots by October 31, the CDC recommends that you wait until then.

Even if you’re not vaccinated in December, or January, it is still a good idea. Schaffner agrees. He says that you would still be protected, as flu peak in February in the United States. He stresses the importance of getting vaccinated sooner than later.

While children can get vaccinated as soon as doses are available — even July or August — adults, especially if 65 and older, because of their weakened immune systems, should generally not get vaccinated that early. Because their protection will decline over time, and may not protect them for the entire flu season. The CDC states that it is better to get vaccines early than never.

A few children between 6 and 8 years old may require two doses flu vaccine. Two doses of flu vaccine are required for those who have never been vaccinated. They should be administered 4 weeks apart. Others in this age group who only got one dose previously need to get 2 doses this season.

Early vaccination can also be considered for women in the third trimester of pregnancy, because the immunization can help provide protection to their infants after birth. Infants can’t be vaccinated until age 6 months.

Two Arms, Two Vaccines

With millions of Americans now lining up for their COVID-19 boosters, experts urge them to get the flu vaccine at the same time. Experts agree that it is acceptable to receive both vaccines on the same day.

” You can [even] do two in one arm, separated by an inch,” L.J. Tan, PhD is chief policy officer and partner officer at Immunization Action Coalition. This organization is dedicated to increasing immunization rates. “We co-administer vaccines to kids all the time. “

And, Tan says, ”the flu vaccine is not going to amplify any reaction you would have to the COVID vaccine. “

Tracking Vaccinations

According to the CDC National Flu Vaccination Dashboard, about 162 million doses of flu vaccine have been distributed as of Nov. 5.

It expects about 58.5% of the population to get a flu shot this season, up from about 54.8% last season.

Undoing the ‘Flu Isn’t Bad’ Thinking

One common misconception, especially from parents, is that ”the flu is not bad, it doesn’t cause serious problems,” says Flor M. Munoz, MD, MSc, medical director of transplant infectious diseases at Texas Children’s Hospital in Houston.

“Flu by itself can be serious,” she says. She says that COVID is a concern. Both infections could make someone very sick. “

Among the potential complications in kids, especially those under 5 years, are pneumonia, dehydration, brain dysfunction and sinus and ear infections. She also informs parents that the flu vaccine, just like COVID, doesn’t always work. “In a good year, it gives 60 to 70% protection. ” It can also be less protective than this. However, if you are vaccinated but still have the flu, your chances of getting it will be lower. “

Anti-Virals to the Rescue

When flu symptoms — fever, cough, sore throat, runny nose, body aches, headaches, chills and fatigue — appear, anti-viral treatments can lessen the time you are sick by about a day, according to the CDC. These drugs can only be prescribed and should be started within two days of getting sick with flu symptoms.

Four antiviral drugs to treat flu are FDA-approved, including:

Oseltamivir phosphate (generic or as Tamiflu)
Zanamivir (Relenza)
Peramivir (Rapivab)
Baloxavir marboxil (Xofluza)

Depending on the drug and method of administration, the drugs are given for 1 to 5 days, generally, but sometimes longer than 5 days.

Track Local Flu Rates

Ray of Johns Hopkins suggests keeping an eye on how widespread flu is in your community, just as we’ve gotten used to tracking COVID rates, and then taking precautions such as masking up and social distancing. He believes that we may be more agile in responding to risks now, thanks to the COVID practice.

He believes that adapting these behaviors to respond to flu outbreaks will be beneficial and more natural for most people than it was in the past. “I don’t believe it was common 3 years ago to see people in masks when flu cases were high. “

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