Cold and Flu
Last year’s flu vaccine gave a lackluster performance — it prevented the flu in less than a quarter of the people who got immunized. Flu vaccines are created to protect against the three or four viruses most likely to cause the flu in a given season. Some years, the predictions are better than others. Scientists are now working on a universal flu vaccine that may make the guesswork unnecessary. And there are improved vaccines available for people with egg allergies, which would otherwise prohibit them from getting standard flu shots. The flu vaccine may be imperfect, but it’s still worth getting. It does lower your chances of getting the flu, and it reduces the risk for heart attack, stroke, and death as well.
Some years the flu vaccine works quite well. Other years it doesn’t. It has done a particularly poor job this year against the main flu virus. The CDC reported yesterday that this year’s flu vaccine has been just 18% effective. The estimate for children is even lower. And it looks like the nasal spray vaccine may not have worked at all among children. One reason for this year’s mismatch between virus and vaccine is that experts must decide months in advance which of the hundreds of flu viruses to include in the vaccine. What became the dominant flu virus this year, a new strain of H3N2 influenza A, wasn’t around last year when experts were determining this year’s vaccine.
Each year, only 40% of U.S. adults get vaccinated against the flu, even though the vaccine is available at doctors’ offices, pharmacies, workplaces, and other venues. Two common reasons people give for avoiding the flu shot are 1) it will give me the flu and 2) it won’t work. Neither are accurate. The virus in a flu shot or nose spray has been killed or made unable to replicate in the human lung. Because the most common strains of flu virus changes from year to year, experts have to predict a year in advance which ones will predominate. Some years the guesses are good and the vaccines are quite effective. Other years the guesses aren’t so good and the vaccines aren’t as protective as they could be. The flu vaccine may be imperfect, but it’s still worth getting. Who should be vaccinated? The Centers for Disease Control and Prevention recommend that everyone over the age of 6 months get vaccinated against the flu every year.
Getting a flu shot can help ward off the flu. It also works to prevent pneumonia, a leading cause of hospitalization (about one million a year) and death (about 50,000) in the United States. Pneumonia can be especially dangerous in young children and older people. For these groups, as well as others who face a high risk of pneumonia, two different vaccines can help prevent pneumonia caused by the bacterium known as Streptococcus pneumoniae. One, called PPSV23 or Pneumovax, is derived from 23 different types of pneumococcal bacteria. A newer vaccine, called PCV13, features parts of 13 different pneumococcal bacteria linked to a protein that helps the vaccine work better. PCV13 is recommended for all children younger than 5 years old, all adults 65 years or older, and anyone age 6 or older with risk factors for pneumonia. PPSV23 is recommended for all adults 65 years or older and anyone age 2 years through 64 years are at high risk of pneumonia.
Enterovirus D68 is a respiratory infection that has been spreading across the country and making some children quite ill. It is especially problematic for kids with asthma or other respiratory issues. Enterovirus D68 can start out looking like a garden variety cold but lead to serious trouble breathing. What’s a parent to do? The same things he or she would normally do during cold and flu season: hand washing, staying away from people who are sick, regularly cleaning common surfaces like doorknobs, not sharing cups and utensils, and coughing or sneezing into the elbow, not the hands. Those who have children with asthma need to be extra vigilant about their child’s asthma care routine. Most upper respiratory infections are the simple cold. Still, it’s important to stay alert for signs of breathing difficulties.
Getting the flu shot may do more than protect against the flu and its lingering aftermath. It also lowers a person’s odds of a having heart attack, stroke, heart failure, or other major cardiac event—including death—by about a third over the following year. What’s the connection between flu and cardiovascular problems? The body mounts an impressive immune response against the flu. That causes a lot of inflammation, which destabilizes cholesterol-filled plaque inside blood vessels. Plaque rupture can cause a heart attack or stroke. Experts recommend a flu shot for everyone six months of age and older. It is especially important for those who face the highest risk of complications: young children; adults over age 50; those of all ages with serious health conditions such as cardiovascular disease, asthma or other lung disease, liver or kidney disease, or diabetes; and those who care for young children or other individuals at high risk of flu complications.
Beginning in March, 2013, reports started to come out of Eastern China that a new “bird flu” virus was loose and causing infections in humans. The new virus is called H7N9. Should we in the U.S. be worried? Neither I nor anyone I know can give a confident answer to that question. So far the news is reassuring. A report from the U.S. Centers for Disease Control and Prevention (CDC), and another from a team from China in this week’s New England Journal of Medicine, indicate that so far the new H7N9 virus has not clearly spread from one person to another, and has not spread outside of Eastern China. Even so, every public health agency around the world is keeping a close eye on China. That’s because a virus that cannot spread easily from one person to another can change or swap genes—and suddenly be capable of spreading easily.
To get or stay healthy, many people focus on exercising more, eating better, or quitting smoking. Getting recommended vaccinations is another relatively simple strategy for health that an alarming number of Americans overlook. Vaccination isn’t just for kids. Adults should get immunized against infectious agents that cause the flu, pneumonia, whooping cough (pertussis), shingles (herpes zoster), and more. The latest schedule for adult immunization has been published in the Annals of Internal Medicine. It now recommends adding a second anti-pneumonia vaccine for people with compromised immune systems. It also says that all adults age 65 and older should get the tetanus, diphtheria, and pertussis (Tdap) vaccine, as should pregnant women with each pregnancy. When it comes to adult immunization, Americans aren’t doing very well. One-third of older Americans don’t get the pneumococcal vaccine, 84% don’t get the shingles vaccine, and 87% don’t get the tetanus, diphtheria, and pertussis vaccine. In addition to protecting yourself from an infectious disease, immunization also protects others.
It’s shaping up to be a banner year for the flu. The City of Boston just declared a public health emergency, with 700 cases of the flu reported so far this season, compared to just 70 cases last year. Four Boston residents, all elderly, have died. A similar spike in flu is happening all around the country. According to the federal Centers for Disease Control and Prevention, this year’s flu season is shaping up to be a bad one. By the end of December, the flu was widespread in 41 states. The CDC says that more than 2,000 people have been hospitalized so far; scores of adults have died, as well as 18 children. One way to keep from getting the flu is to get the flu vaccine. (Almost everyone age 6 months and older should be vaccinated.) If you haven’t already done this, it isn’t too late. For more information about the flu, visit Harvard Health Publication’s Flu Resource Center at www.health.harvard.edu/flu
The holiday season gets all the hype at this time of year, but the flu season needs your attention as well. It has come early this year—the earliest since 2003, according to the Centers for Disease Control and Prevention (CDC)—and is expected to be severe. In the last month, new cases of flu in the U.S. have gone from a few hundred a week to more than a thousand a week. Forty-eight states and Puerto Rico have already seen lab-confirmed cases of the virus, and five children have died from it. Getting vaccinated and washing your hands often are your best bets against getting flu. The vaccine isn’t an anti-flu guarantee, but it can reduce your risk by up to 80%. Yet barely one-third of Americans have been vaccinated against the flu so far this year. Why aren’t more people getting a flu shot?