Flu Near You

A vast swath of red across the U.S. indicates a high level of flu activity.

The nation’s early flu season continued to grow in the U.S. this week, with no sign yet of a peak in the spread of coughing, achy, feverish illness, health officials said Friday.

"I think we're still accelerating," said Tom Skinner, a CDC spokesman. 

Twenty-nine states and New York City reported high levels of flu activity, up from 16 states and NYC the previous week. Flu was widespread in 41 states, up from 31 states, according to the latest figures from the Centers for Disease Control and Prevention.

As of the week ending Dec. 29, 2,257 people had been hospitalized with flu, and 18 children had died from complications of the illness, CDC reported.

“It’s about five weeks ahead of the average flu season,” said Lyn Finelli, lead of the surveillance and response team that monitors influenza for the CDC’s National Center for Immunization and Respiratory Diseases. “We haven’t seen such an early season since 2003 to 2004.”

That’s the year that Joe Lastinger’s 3-year-old daughter, Emily, fell ill with the flu in late January and died five days later.

“That was the first really bad season for children in a while,” said Lastinger, 40, who lives near Dallas, Texas. “For whatever reason that’s not well understood, it affected her and it killed her.”

During that season, illnesses peaked in early to mid-December, followed by a peak in flu-related pneumonia and deaths in early January. It was over by mid-February and was considered a “moderately severe” season for flu, according to the CDC.  Finelli and other CDC officials say it’s too early to tell exactly how bad this year’s season will be.

But over at Google Flu Trends, which monitors flu activity in the U.S. and around the world based on internet search terms, this year’s season has already topped the bright-red “intense” category.

And at Flu Near You, a new real-time tracking tool that’s gaining about 100 participants each week, about 4 percent of the 10,000 users say they’ve come down with flu symptoms.

Joe Lastinger's 3-year-old daughter, Emily, fell ill with the flu in late January 2004 and died five days later.

“That’s huge,” says John Brownstein, an epidemiologist and assistant professor of pediatrics at Harvard Medical School and Children’s Hospital Boston. “Last year, we never got near this.”

Brownstein is one of the founders of the project coordinated by Children’s Hospital Boston, the Skoll Global Threats Fund and the American Public Health Association. Though it’s still in its early stages, it already has generated new, interesting and, most of all, immediate data about this year’s flu season.

“It’s what we call ‘nowcasting,’” Brownstein said. “It’s a more up-to-date view.”

CDC data, which is based on visits to doctors for influenza-like illness, can lag two weeks or more behind real-time activity.

By contrast, Flu Near You can paint an immediate picture of what’s new with flu.

For instance, Brownstein said his data show that cough is the most frequently reported flu symptom this season, at 19 percent. It’s been followed by sore throat, 16 percent; fatigue, 15 percent; headache, 14 percent; body ache, 10 percent and fever, just 7 percent.

More telling, for people who reported both flu symptoms and vaccination status, of those who got the flu, three out of four were not vaccinated, while a quarter had gotten their flu shots.

Brownstein cautioned that can’t be used as a true measure of this season’s vaccine efficacy because of variables in reporting. But the CDC says that in the 2010-2011 flu season, vaccine effectiveness was about 60 percent for all age groups combined.

The agency has received reports that people who were vaccinated still developed laboratory-confirmed strains of flu. CDC officials said it’s not possible to know whether that’s happening more this season than usual and that the agency is “watching the situation closely.”

Overall, this year’s vaccines appear to be well matched for the two strains of influenza A and one strain of influenza B that are circulating this year, CDC officials have said.

The dominant strain this year is the H3N2 strain, which can cause more serious illness. Flu seasons can vary widely, but some years are severe, with hospitalizations of up to 200,000 people and between 3,000 and 49,000 deaths during a season.

As of December 14, the latest CDC figures available, about 127 million doses of flu vaccine had been distributed, from about 135 million doses produced for this season.

Joe Lastinger was one of the first to sign up for the Flu Near You tracking program after its test phase. The health care executive and father of three surviving children said it gives participants information they can act on about flu in their communities.

“I’m always excited about getting ahead of it,” he said. “This is a tool you can use. If everybody starts reporting these symptoms, you’re ahead.”

Information about vaccination is particularly important, said Lastinger. Flu vaccinations weren’t routinely recommended for healthy children Emily’s age back then, and Lastinger and his wife weren’t worried about it.

“For us, vaccination was the thing we should have done, had we known,” he said. “Flu needed to be up there on our parent radar of things to worry about. We think it should be on every parent’s list.”
 

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There’s more evidence that this is shaping up to be a nasty flu season, with the number of states with high flu activity doubling in a week and reports of the achy, feverish illness spreading widely across the U.S.

Eight states are now reporting high levels of what’s known as influenza-like illness, according to the Centers for Disease Control. Eighteen states reported widespread flu activity for the week that ended Dec. 8, according to the agency’s FluView data.

"Today’s report confirms that the U.S. flu season is off to early start,” CDC Director Dr. Thomas Frieden said in a statement. “It’s too early to tell how severe our season might be. However, we know that thousands die and hundreds of thousands of people are hospitalized with flu each year. Vaccination is the single most important step we can take to protect ourselves and our families against infection. It's not too late to get vaccinated before the flu season peaks.”

Flu season typically peaks in January and February.

The strains of flu showing up this year include two types of influenza A, H3N2 and the H1N1 that caused the 2009 pandemic. Influenza B viruses also have been identified.

The good news, though, is that this year’s vaccines are well-matched to the viruses, CDC officials said.

The eight states with high levels of flu activity include Alabama, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas.

Flu seasons can vary widely, but some years are severe, with hospitalizations of up to 200,000 people and between 3,000 and 49,000 deaths during a season.

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• Flu shots still a hard sell, health experts find 

This year’s flu season has kicked in early, with activity up significantly across the nation, particularly in the south and southeast, federal health officials say.

"It looks like it's shaping up to be a bad flu season," said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

The percentage of aching, feverish folks who went to the doctor with influenza-like illness had reached the national baseline of 2.2 percent, the earliest that has happened in the regular flu season in nearly a decade, the 2003-2004 season. Flu season may start as early as October, but typically peaks in January or later.

Five states reported high levels of flu activity -- Alabama, Louisiana, Mississippi, Tennessee and Texas. Widespread activity was reported in four states, regional activity was seen in seven states and 19 states reported local flu activity, CDC officials said. That was up from eight states that reported local flu activity the previous week.

Michael Patrick / AP file

Linda Howard, 66, of Knoxville, Tenn., gets a flu shot from nursing student Elizabeth Wallace at free flu shot clinic in October.

By contrast, last year's flu season started late, with an uptick in cases not starting until February. 

Health officials are urging people to get their flu shots now, including babies older than six months, and all adults and children. Every year, about a quarter of the U.S. population gets the flu and an average of about 36,000 people die.

The strains making people sick are influenza A -- both H3N2 and the 2009 H1N1 or pandemic swine flu strain -- and influenza B. So far, the vaccines manufactured for this season appear to be a good match, health officials said. 

But the H3N2 virusmay  typically cause more severe symptoms than the other flu bugs, noted Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University. His staff has already started seeing flu patients in Tennessee. 

"We're all a bit antsy," he said. 

About 120 million doses of flu vaccine are available this year, Frieden said. About 112 million people have received their flu shots so far, officials said. 

The key to avoiding the flu is getting the shot, the experts emphasized. 

"We are particularly encouraging people who haven't gotten vaccinated to do it," said Dr. Melinda Wharton, acting director of the CDC's Center for Immunization and Respiratory Diseases.

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By Rachael Rettner
MyHealthNewsDaily

The vaccine against swine flu seems to offer broader protection against other flu viruses, compared with the seasonal flu vaccine, researchers say.

This vaccine, officially called the 2009 H1N1 vaccine, was administered in 2009 to protect against a new virus strain that caused a pandemic that year.

In the new study, people who received this vaccine developed antibodies against not only H1N1, but also several other flu strains, the researchers said. Such protection against multiple strains is rarely seen in people who receive the seasonal flu vaccine or are infected with seasonal flu, the researchers said.

The findings bring researchers closer to developing a universal flu vaccine — one that provides broad protection against flu viruses and lasts for years, said study researcher Rafi Ahmed, director of the Emory University's Vaccine Center. Currently, a new seasonal flu vaccine must be developed and administered every year because its protection is limited to certain strains, and wanes over time.

The study will be published this week in the journal Proceedings of the National Academy of Sciences.

Broad protection
Previously, Ahmed and colleagues found that people who became sick with the 2009 H1N1 flu virus produced antibodies against multiple flu viruses, but it was not known whether the vaccine could do this as well.

The new study involved 24 healthy adults who were immunized with the 2009 H1N1 vaccine. Seven days after they received the flu shot, the researchers analyzed their blood.

A universal vaccine for flu?
Flu viruses consist of a "head" region that changes over time and varies between strains, and a "stalk" region that remains fairly constant. Usually, antibodies against the flu bind to the head of the virus, and for this reason, the protection that seasonal flu vaccines offer is typically quite specific.

However, in the new study, participants produced some antibodies that could bind to the stalk of the flu virus — it's these antibodies that could be the basis for a universal flu vaccine, Ahmed said.

Antibodies are produced by cells called B cells. The researchers speculate that, because H1N1 was such a "new" strain of flu, it forced the body to activate a rare type of B cell, one that could produce antibodies that bind to the virus' stalk.

"The next step now is to design a vaccine to target these B cells," Ahmed said.

"The study is encouraging, that we're seeing antibodies generated against the conserved portions of the virus," said Dr. Bruce Lee, an associate professor at the University of Pittsburgh Graduate School of Public Health. "But it's just an initial step," Lee said, noting that much more work is needed before the results could be translated to a universal flu vaccine.

And while the production of antibodies against a virus suggests that people will be protected against it, it remains unclear whether they could avoid catching the disease, Lee said.

Participants had increases in antibodies against several flu strains, including H1N1, H5N1 and H3N2. Antibodies are immune system proteins that bind to harmful pathogens, such as viruses.

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The flu season may finally be picking up steam after the slowest start in nearly three decades, a new government report suggests. 

The Centers for Disease Control and Prevention reports an uptick in the number of samples testing positive for the virus -- 10.5 percent in the first week of February versus 7.6 percent the week before.

That suggests that the flu season is just off to a late start, CDC researchers say. Interestingly, it’s only the second time in 29 years that the percentage of respiratory samples testing positive remained under 10 percent through January.

"The peak of flu cases most commonly occurs in January or February, but the timing can vary significantly year to year," says Dr Otto Yang, professor of medicine, division of infectious diseases, at the David Geffen School of Medicine at the University of California, Los Angeles.

Flu season generally hits as early as October and can continue as late as May.

"It's difficult to predict if this will overall be lower than other years, because we have not yet reached the peak yet," Yang says.

Another of the CDC’s indicators that suggests that flu activity is starting to pick up in certain areas around the country is the count of people who show flu-like symptoms. Two regions -- Central and Northwestern U.S. -- are reporting a bump in influenza-like illnesses above baseline for the first time this year. And California is now reporting widespread influenza activity, while Missouri, Texas and Virginia have been reporting localized upticks.

Yang suggests the flu is peaking first in California because of its coastal location. "I can only speculate, but California is a state with lots of people traveling in and out, including people from areas where flu typically starts its spread each season," Yang says.

That may bode ill for the rest of the country, says Dr. Richard Zimmerman, a professor of family medicine at the University of Pittsburgh School of Medicine. “It’s fairly common for the west to precede the east,“ he explains. “But that’s not always true.”

If you still haven’t gotten your flu shot this year, get vaccinated right away, the CDC recommends, and Zimmerman agrees.

“This is really the last chance to get vaccinated,” he says.  “It takes anywhere from one to two weeks for the vaccine to become effective.”

Other than vaccination, stay at home when you're sick -- and cross your fingers that your colleagues or schoolmates do the same, Zimmerman says. (Although for those who don’t have any sick leave left -- or never had any in the first place -- that can be a tough call.)

The only other protection you have against the flu is regular hand-washing. But no matter how fastidious you are, hand washing can only do so much in face of a virus that is mostly spread through the air when people cough and sneeze.

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