Tag Archives: flu

Would You Like the Real Flu or Fake Flu? Chances are Good Either Way.

outbreakSo…you, not me, but everyone else we know has gotten or had the flu this winter. But which flu? As King County Health explains, there’s a big difference between a stomach “flu” and influenza. The norovirus is the most common culprit in stomach bugs (salmonella is #2) that produce vomiting and diarrhea. There is some body ache overlap, but influenza is more likely to feel like a high fever and mean cold ganged up on you.

This winter, the nation has been beset by both. A new strain is now “accounting for about 60 percent of norovirus outbreaks,” reports the Associated Press. It’s responsible for 140 different outbreaks across the U.S. since last fall.

One trait that the norovirus shares with influenza is that its spread is fueled by close quarters — King County has seen long-term care facilities report 32 outbreaks of influenza since January 1 of this year, “compared to an average of 12 total outbreaks reported per season since 2007-2008 (peak, 21).” As of mid-January 2013, state officials have confirmed 12 influenza-related deaths, the majority of cases in senior citizens.

The only good news is at this particular moment, Washington’s pertussis outbreak has subsided a bit compared to the same time last year.

You can use Google Trends to explore “stomach flu” in Washington — if you drill down, you’ll discover that Enumclaw seems particularly hard hit, so now might not be a good time to do that restaurant tour. Real flu activity remains “intense,” Google says.

Washington’s department of health concurs: their weekly update (January 6 – 12: pdf) shows a slight increase from the preceding week: 160 confirmed cases from 144. About one-quarter of the people tested (you have to have a temperature of over 100 degrees and a sore throat or cough) are confirmed with influenza. With its more dense population, western Washington leads the eastern side of the state in total cases.

There’s not much to do about the norovirus, other than to stay hydrated, and to give yourself three days after symptoms have subsided before you think about preparing food for anyone. Cleaning up after the “symptoms” is a must: use bleach and water. Once you’ve got the flu, there’s not much to do about that, either. This year’s flu shot is turning out to be about 62-percent effective, which is better than even odds.

Nasal Spray is Tops for Flu Protection for Kids

(Image: FluMist)
(Image: FluMist)

The CDC’s reports show the flu widespread across much of the U.S., with the South feeling particularly feverish and congested. Here in Washington, it’s the western half the state that’s been hardest hit.

The last two weeks of 2012, as people gathered for holiday celebrations, the number of people complaining of the flu to western Washington ER doctors soared past the annual baseline percentage for such cases. That last week of 2012, a total of 20,821 people came into the ER feeling sick from something like the flu. (A little more than 22 percent of the cases were confirmed to be influenza by lab tests.)

If you haven’t caught the flu yet, you might be weighing a family trip to get a flu shot — by the way, King County has an online flu vaccine finder. Before you go, here’s some news: According to a 2011 study of studies conducted by infectious disease experts, the flu nasal sprays (or LAIVs) “consistently show highest efficacy in young children (aged 6 months to 7 years),” at 83 percent effectiveness.

That said, the sprays are known to cause wheezing in children under two years of age — FluMist has the relevant caveats on their home page. Probably you’re wondering if the live version of the flu isn’t exactly what you’re trying to avoid. The difference is that the spray version’s virus can only live in the cooler climes of your nose. It creates an immune response, but dies before it can colonize your lungs.

Adults up to 49 years of age can get a nasal spray, too, rather than a shot, but they don’t show the same immunological response to the live attenuated vaccine (LAIV) as kids do. The trivalent inactivated vaccine (TIV) that’s in a flu shot rings in at 59 percent effectiveness in adults 18 to 64. That average is misleading, in a way, since the vaccine (in the studies used, which covered flu seasons between 2004 and 2009) ranged from 16 to 76 percent effective.

“The effectiveness of the flu vaccine depends on a number of factors, including how well matched it is to the circulating virus, and the underlying age and health of the person vaccinated,” says Dr. Jeff Duchin, chief of King County Health’s Communicable Disease Control, Epidemiology & Immunization Section. But “[i]nterestingly, the CIDRAP study did not find a good correlation between antigenic match and effectiveness. In addition, the 2009 H1N1 outbreak had a very well matched vaccine yet VE was still about 59 percent.”

The variability seen in the studies, then, is something of a mystery. While the two worst years for vaccine effectiveness were indeed years when the vaccines mix of flu strains didn’t correspond to what Nature served up, in another year where the same thing happened, the vaccine was almost 70 percent effective.

“Although not perfect,” concludes Duchin, “flu vaccine is still recognized as the single most important step that we can take to decrease the risk for influenza infection, related complications, hospitalizations, and deaths.”

Washington State’s Flu Season is Now Open

“Early start may mean bad flu season ahead,” reads the headline in the Seattle Times, but so far the news in Washington is good — that’s a national wire story. The CDC’s flu map shows the worst outbreaks occurring on the East Coast — and Alaska. Here in Washington State, the flu is rated “sporadic,” below epidemic levels and tracking closely with the rate of the past two years at this time.

Still, the turning point may come as early as four to five weeks, as it did two years ago. Levels of immunity and good behavior (i.e., not passing the flu along to the office) can make all the difference.

On that note, more good news. The majority of confirmed cases, nationally and in Washington, are of the influenza A H3 variety, and the head of the CDC, Dr. Thomas Frieden, says this year’s flu shot is protecting well against those strains of the bug. (So far, the incidence of pertussis remains low, too.) Thanks to the state’s childhood vaccine program, a shot is free for anyone under 19 years old. (This map will list the vaccination providers near you.)

There’s still time to get a jump on the prevention; Accuweather’s flu forecast for Seattle claims this cool, rainy pattern doesn’t impact flu risk.

No Better Time for Your Flu Shot or Nasal Spray

Actor Chris O’Donnell got a Fluzone(R) Intradermal vaccine, and he seems just fine. Picture of health. (PRNewsFoto/Sanofi Pasteur)

Seattle is one of the five cities nationally chosen for the the Fluzone Intradermal Coop de Quill VacciNation Tour, and by Seattle, Sanofi Pasteur means Kirkland. Their Coop de Quill car, which features a “supersized rooftop 3D structure of the Fluzone Intradermal vaccine,” will pull up at a Kirkland Walgreen’s (12405 NE 85th St.) this Monday, September 24, from 1 p.m. to 7 p.m.

>>King County residents, go here to see who’s dispensing flu vaccines locally.

“Intradermal” is fancy medical term meaning “you won’t pass out when you see the needle we use.” It’s a mosquito-sized wisp of a thing that stops just under the skin, reducing the chance of muscle soreness. In fact, the most common after-effects are mosquito-bite-sounding: “redness, firmness, swelling, and itching.” (There’s also a nasal spray, if you’re between the ages of 2 and 49.)

The tour means to “educate adults 18 through 64 years of age about the seriousness of influenza and vaccine options available.” For instance, did you know that the majority of your neighbors are passively trying to infect you with the flu? During the 2010-11 flu season, only 36 percent of Washington adults 18-to-64 got immunized. (Maybe it’s time to break out the “I’m Immunized!” buttons, so you know who’s civic-minded, like the “I Gave Blood!” people.)

In King County, the flu immunization rate for all adults over 18 ( for latest year 2010) was 44 percent. 18-to-44-year-olds are the worst offenders; at about middle age, a more lively sense of mortality seems to have a salutary effect. But even so, only about 45 percent of the 45-to-64 age group bother to get a shot.

This despite the fact that, for the past two years, the flu vaccine has been right on the money when it comes to targeting the flu strains out there. It’s not perfect protection, by any means, but last flu season it was about 60-percent effective. (If you could walk into a casino and gamble 60-percent effectively, you would soon not be allowed into casinos.)

For the 3,000 to 49,000 people who die from it in the U.S. annually, the flu is no laughing matter. The 226,000 who are hospitalized because of its complications probably don’t chuckle over it, either. At Walgreen’s, the price locally is $31.99. Think of it as $16 for you, $16 for the good of everyone around.

More Reports of Salmon Virus Found in Canadian Waters

Salmon at the Ballard Locks (Photo: MvB)

It is not often, I think, that Canadian environmentalists have recourse to shaming their government by pointing to the U.S. being out in front on an issue, but that is the case with the study of infectious salmon anemia (the ISA virus, or the salmon “flu” as we’re calling it). Activist-biologist Alexandra Morton, who sent the initial fish suspects in for questioning, writes on her blog:

It is a big deal to Canada whether this virus is here or not because it has impact on barriers to trade. This is not an issue of simple biology, this affects companies owned by the Norwegian government and others.

While there has been no comment at all from Fisheries and Oceans in BC, the US is taking this seriously.

Now, reports Seattlepi.com: “the ISA virus was found in the fins of three adult salmon–a Chinook, a chum and a coho–taken out of the Harrison River in the Fraser Valley early last month.” However, they go on to say, “additional testing on the [first] sockeye smolts, done at the University of Bergen in Norway, was not able to confirm the findings.”

Only one of the tests showed a fish with ISAv, and that was at the limits of detectability, so it was not really a smoking fin. (Somewhat embarrassedly, Morton writes that storing the fish in a “home-type freezer was not optimal” in terms of potentially preserving the virus in pristine condition.)

With new reports of ISAv, the atmosphere becomes more tense. “[S]imilar to the sockeye from River’s Inlet, the Coho in the Fraser River was infected with the European strain of ISA virus. But we see from this report that a chinook salmon and a chum salmon also tested positive,” notes Morton.

In a way, it’s strange that the salmon farming industry in BC has been downplaying the chance of ISA making its way into their fish stocks. For one thing, farmed salmon are, because of their close quarters, most susceptible to the virus becoming epidemic. For another, so far it’s farmed Atlantic salmon who are symptomatic for ISAv–wild Pacific salmon can be carriers but tend not to die from it. The concern, is that as the virus mutates, that could change, and wreak havoc on salmon hatcheries. But with farmed Atlantic salmon, the danger is present from day one.

You’d think that, with the contagiousness of ISAv well established, you could expect Canadian authorities to be justifiably paranoid about it slipping in with hatchery eggs. But Morton claims that, contrary to the government’s insistence:

Surface disinfection is a guideline, not a regulation and DFO is not sure if the fish farmers were doing it and the DFO Director General of Science waived the Fish Health Protection Regulations in 2004 to allow eggs from a hatchery that does not meet these regulations.

Our U.S. salmon senators have banded together, Republican and Democrat alike, to proffer an amendment, since passed, that says the U.S. will not wait to see what Canada finds, but will move quickly to perform its own testing and prepare for the virus’s arrival. “The amendment requires a report be delivered to Congress within six months which outlines surveillance, susceptibility of species and populations, gaps in knowledge, and recommendations for action,” says Seattlepi.com.

UPDATE: From the Vancouver Sun:

“There are no confirmed cases of ISA in wild or farm salmon in B.C.,” said Con Kiley, the Canadian Food Inspection Agency’s national aquatic animal health program director. […]

However, questions remain because of the poor quality of the samples and federal officials agreed more testing is needed.

“The supplementary results must be considered inconclusive because of the poor quality of the samples,” Kiley said.

“Additional testing will continue and the results will be provided when we are ready.”

A commenter responds to the news. Given the back-and-forth up north, U.S. citizens may be happy that our own tests will be underway to keep an eye out for the virus’s appearance.

Why a Drug-Resistant Flu is Coming for You

The SunBreak’s Audrey has already made the link between Steven Soderbergh’s Contagion and the flu, and because news about the end of humanity is more relevant if it’s piggybacked on a recent film, we’re going to let the researchers at the Fred Hutchinson Cancer Center make the Contagion analogy yet again:

In the new movie Contagion, fictional health experts scramble to get ahead of a flu-like pandemic as a drug-resistant virus quickly spreads, killing millions of people within days after they contract the illness.

Although the film isn’t based entirely on reality, it’s not exactly science fiction, either.

(Okay, third time: This Thursday, 6:30 to 8:30 p.m., film-talking-guy Warren Etheredge discusses Contagion with Seattle infectious disease experts Ann Marie Kimball, MD, MPH, author of Risky Trade: Infectious Disease in the Era of Global Trade and a professor of epidemiology at the University of Washington; and David Sherman, PhD, a tuberculosis researcher at Seattle Biomed and adjunct associate professor at the UW School of Global Health. The panel will be held at the Seattle Biomedical Research Institute, 307 Westlake Avenue North, Suite 500.)

Dennis Chao, FHCRC researcher

Researchers Dennis Chao, Jesse D. Bloom, Beth F. Kochin, Rustom Antia, and Ira M. Longini, Jr., have published a paper on drug-resistant flu in the Royal Society journal Interface that illuminates–horrifically, if you’re inclined to see things this way–how quickly the flu has become resistant to Tamiflu, even though it shouldn’t have, given the “low overall level of the oseltamivir [i.e., Tamiflu] usage.”

We were not around for the 1918 flu epidemic, but we’re still very impressed by it, and regular readers of The SunBreak know that we like to keep close tabs on the efficacy of flu vaccines and antiviral treatments.

Luckily, we have the Fred Hutchinson Cancer Research Center nearby, where Chao, Bloom, and Longini put in time (when the last is not busy with being professor of biostatistics in the University of Florida College of Public Health and Health Professions and the UF College of Medicine and the UF Emerging Pathogens Institute).

The team studied the rise in resistance to Tamiflu between 2006 and 2009 (2009 was a banner year for flu locally), discovering that their computer models for the rise of resistance would not conform with observations unless the virus was doing something surprising:

The extreme speed with which the resistance spread in seasonal H1N1 suggests that the resistant strain had a transmission advantage in untreated hosts, and this could have arisen from genetic hitchhiking, or from the mutations responsible for resistance and compensation.

In slightly plainer English, it may come down to a single person with a doubly-mutant flu bug–one that is both Tamiflu-resistant and more contagious than usual.

Ira Longini

The models predict that it’s not a question of the larger Tamiflu-using population selecting for resistance, but of a Tamiflu-resistant mutant virus getting better, faster, stronger on its own. “If you see resistant strains in parts of the world where no one is taking antiviral drugs, that’s the smoking gun that the resistant strain must be transmitting,” Longini explains.

The hypothesis is that Tamiflu resistance somehow “hitchhiked” via other mutations for contagiousness. This mutant synergy is disturbing, given a) how big a problem drug resistance is already and b) that Tamiflu is stockpiled worldwide. As of the end of 2010, WHO had found about one-third of the flu strains it tested were resistant to Tamiflu (though to be fair, there are already concerns about how well Tamiflu works, under the best conditions).

All of which makes this a good year to get a flu shot. It can be wildly variable in effectiveness, depending on how well the mix of strains vaccinated against match up with what appears “in the wild,” but if you’ve ever bought a lottery ticket, you have no excuse for not taking these odds.