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Repetition from last year or a ‘Twindemic?’

19 Nov. 2021 – Cases of the flu, that once-annual viral invader that has often been the country’s worst annual health crisis, show signs of waking up again this autumn.

But, say experts, it’s far too early to say whether the country will have a normal – ie bad – flu season or a recurrence of last year, when the flu almost disappeared amid the COVID-19 pandemic.

This flu season starts more like the seasons before the pandemic. About 2% of all visits to doctors and outpatient clinics up to November 13 were flu or flu-like illnesses, compared to about 1.4% a year ago, the CDC says. Cases are counted in the hundreds so far – 702 to 13 November.

Yet, while cases are low, they are increasing, the agency says. The spread of flu is already high in New Mexico and moderate in Georgia. The rest of the country sees little activity, according to the CDC.

This time last year, cases of influenza, hospitalizations and deaths have dropped dramatically, despite fears that a drastic “twindemy” could occur as cases of COVID-19 and flu greatly increased, and in tandem. The comparisons of last year’s flu season statistics with previous years are staggering – in a good way.

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

So, what could happen this year? Will flu be a no-show again? Several top experts say it is complicated:

  • “This is a hot question and I would like to give you a concrete answer. But everyone is struggling. predict. “- Stuart Ray, MD, Professor of Medicine and Specialist in Infectious Diseases at Johns Hopkins Medicine in Baltimore.
  • “It is very difficult 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 is unclear whether it will be a normal flu or not. season.“- Amesh Adalja, Managing Director, Senior Scholar at the Johns Hopkins Center for Health Security.
  • “There will be flu, but I can not tell you how bad it will be.” We do know that flu will be back. “- William Schaffner, MD, Specialist in Infectious Diseases and Professor of Preventive Medicine at Vanderbilt University Medical Center in Nashville.

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

One outbreak of 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 has sent a team to investigate the disease. outbreak. Florida A&M University and Florida State University also saw major outbreaks this month.

Outbreaks appearing on the university campus are not surprising, Schaffner said. “It’s a population that is under-vaccinated,” he says, and students are often in close proximity to many others. University of Michigan officials said 77% of cases were not vaccinated people.”

Predictions about this year’s flu season should also take into account that wearing a mask and social distancing which was common last year, but less common or sometimes non-existent this year.

Despite uncertainty about how this year’s flu season will play out, several changes and progress 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 that are expected to circulate.
  • The flu vaccine and the COVID vaccines can be given at the same time.
  • The CDC has updated guidelines for the timing of the flu vaccine for some people.
  • A new dashboard follows flu vaccination figures nationwide, and the CDC is launching an education campaign, fearing that the importance of the flu vaccine has taken a back seat, focusing heavily on COVID and its vaccine since the pandemic began.

What’s in this year’s vaccine?

This year, all the flu vaccines in the US, four component (quadrivalent) injections are meant to protect against the four flu viruses that are likely to spread and cause disease this season.

The FDA’s Advisory Committee on Vaccines and Related Biological Products (VRBPAC) selects the specific viruses to target each year’s vaccine. To choose, they take into account surveillance data with details on recent flu cultures, reactions to the previous year’s vaccines and other information.

Both the egg-based vaccines and the cell- or recombinant-based vaccines will target two influenza A strains and two influenza B strains. Options include injections or a nasal spray.

Several of the formulas are approved for use at age 65 and older, including a high-dose vaccine and the adjuvant flu vaccine. The goal of each is to create a stronger immune response as people’s immune systems weaken with age. However, the CDC warns people not to delay vaccination while waiting for the high dose or adjuvant. Getting the vaccine available is the best thing to do, experts say.

Vaccine Timing

Overall, September and October were good times for flu vaccinations, says the CDC. Although it is ideal to be vaccinated by the end of October, it still recommends vaccinating later than that rather than skipping it.

Even if you were unvaccinated in December or January, it’s still a good idea to get it then, Schaffner agrees. You will still get some protection, he says, as flu usually peaks in February. “But he emphasizes that earlier is better.

While children can be vaccinated as soon as doses are available – even July or August – adults, especially those aged 65 and over, should generally not be vaccinated as early due to their weakened immune systems. This is because protection will diminish over time and they may not be protected for the entire flu season. But early is better than not at all, says the CDC.

Some children from 6 months to 8 years may need two doses of flu vaccine. Those who are vaccinated for the first time need two doses (4 weeks apart). Others in this age group who have previously received only one dose should receive 2 doses of this season.

Early vaccination may also be considered for women in the third trimester of pregnancy, as the immunization may help provide protection to their babies after birth. Babies can not be vaccinated until the age of 6 months.

Two Arms, Two Vaccines

With millions of Americans now queuing up for their COVID-19 boosters, experts are encouraging them to get the flu vaccine at the same time. It is acceptable to get both vaccines the same day, experts agree.

“You can [even] do 2 in one arm, spaced with a thumb, “says LJ Tan, PhD, chief policy officer and partnership officer, Immunization Action Coalition, an organization dedicated to raising immunization rates.” We co-administer vaccines to children all the time.”

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

Follow vaccinations

According to the CDC National Influenza Vaccine Dashboard, about 162 million doses of flu vaccine have been distributed since November 5th.

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

Getting rid of the ‘Flu is not bad’ thinking

One common misconception, especially from parents, is that “the flu is not severe, it does not cause serious problems,” says Flor M. Munoz, MD, MSc, Medical Director of Transplant Infectious Diseases at Texas Children’s Hospital in Houston.

“Flu in itself can be serious,” she says. And now, with COVID, she says, ” we’m worried. If someone got both infections, they could get quite sick. ”

Among the possible complications in children, especially those under 5 years, are pneumonia, dehydration, brain dysfunction and sinus and ear infections.

The flu vaccine, as for COVID, is not perfect, she also tells parents. “In a good year, it gives 60 to 70% protection.” But it can also be much less protective than that. Nevertheless, “if you are vaccinated and still get the flu, you will have milder illness.”

Anti-viral to the rescue

When flu symptoms – fever, cough, sore throat, runny nose, body aches, headaches, chills and fatigue – occur, antiviral treatments can reduce the time you are sick by about a day, according to the CDC. They are only available by prescription and work best when started within 2 days of getting sick with the flu.

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

  • Oseltamivir phosphate (generies of as Tamiflu)
  • Zanamivir (Relenza)
  • Peramivir (Rapivab)
  • Baloxavir marboxil (Xofluza)

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

Follow local flu rates

Ray of Johns Hopkins suggests a eye about how widespread flu is in your community, just as we have become accustomed to tracking COVID rates, and then taking precautions such as masking and social distance. “Maybe we’re a little more agile now to respond to risk,” he says, given the practice gained with COVID.

He says adjusting these habits in response to flu outbreaks will be helpful – and more natural for most people than in the past. ” I do not think it was usually 3 years ago, to see people in masks when the flu rates were high.

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