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Influenza: A Refresher on an Old Foe

By Scott James, MD

Flu season is here. Ho hum. No big deal, right? Been there done that, didn’t even have to take the Tamiflu.

fluWell even if you think you know all there is to know about this respiratory villain, hang with me for a few minutes on this quick tour through the wide world of influenza. As a community, we owe it to each other to stay informed about key public health issues, and the yearly influenza epidemic is certainly one of those issues.

That’s right, I said epidemic. Did you know that each “flu season” is technically a regularly occurring epidemic? Influenza viruses continue to circulate at very low levels throughout the year, with infection rates spiking every fall and winter, usually peaking in February.

It’s important to remember that even though many of us consider flu to be old hat, it can be a severe illness and can be associated with serious complications, most notably pneumonia or worsening of an underlying illness such as asthma or congestive heart failure. Certain groups of people are at higher risk for severe influenza infections, including young children, adults older than age 65, pregnant women, and obese persons. Each year more than 200,000 people are hospitalized for influenza related illnesses in the United States alone. And while each season varies in severity, an average of 36,000 people in the US die each year from influenza or its complications – 36,000! While we can be thankful that most of us who get the flu will recover fully, we need to be careful not to take that for granted, thereby dismissing the real impact that influenza can have on a community.

The good news is that there are some proven things that we can do to curb the severity of flu season. A lot of it is just common sense:
• practice good hand hygiene and good cough etiquette (my kids continue to vigorously boycott these methods)
• avoid close contact with those who are sick
• stay home yourself if you are sick

Even with all of these excellent and necessary preventative measures, the single most effective way to prevent seasonal influenza infection is to get your flu vaccine every year. Everyone who is at least 6 months old should get the flu vaccine.

Unfortunately last year, only 45 percent of Americans older than 6 months of age got their flu vaccine. Here in Alabama we barely made the average at 46 percent. Even we healthcare workers don’t have our act together, with a national rate of 63 percent (by the way, the next time you see a doctor, nurse, or other healthcare provider, please ask them if they’ve gotten their flu vaccine yet). I’m thankful that Children’s of Alabama recently rolled out a mandatory vaccination policy for our workers.

In the past few years, you may have noticed that there have been some changes afoot with the “flu shot”. First off, it isn’t only a shot anymore—there’s a nasal mist that is a fine alternative for certain low risk groups of people. If you’re afraid of a jab, check with your doctor to see if you qualify for the mist. Secondly, while flu vaccines have historically included protection against three different strains of influenza (trivalent), this year’s flu vaccines protect against four strains (quadrivalent). This is good news because it means there’s a better chance you’ll have immunity against the viruses being passed around your community. And for those of you who don’t get the flu vaccine “because you never get the flu”, I’d just like to say that I’ve never been in a head-on collision, but I still buckle up for good measure.

So far this season, surveillance has shown the predominantly circulating strains to be influenza A (H1N1) pdm09, influenza A (H3N2), and some influenza B. These circulating viruses are a good match to the strains chosen for the 2013-14 influenza vaccine, meaning that there is a high likelihood of overall vaccine efficacy. We hope that high vaccine rates (did I mention that you should get your flu vaccine?) combined with good health-conscious behavior will lead to a mild flu season this year.

So, the next time you’re tempted to dismiss flu season as an inconvenient blip on the screen, remember that it is responsible for nearly 36,000 deaths per year in our country. That is 36,000 preventable deaths, and many serious illnesses besides. Let’s all commit to one another to do what it takes to stay educated and to act responsibly in the best interests of our community. Do it for yourselves, for your friends and loved ones, and for that random guy who is going to touch the door handle after you at Starbucks next week.

Scott H. James, MD
Assistant Professor
Department of Pediatrics
Division of Infectious Diseases
University of Alabama at Birmingham

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