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Flu Update - Cold and Flu Season Update

2013-2014 Flu Season

By

Updated April 06, 2014

Fever is a typical flu symptom.

Fever is a typical flu symptom.

Photo (c) Melis Kameel

Each flu season seems to have some kind of surprise in store for parents and pediatricians.

Last year, the big surprise was that we had such an early and intense flu season, in which 171 children died. Experts described it as the worst start to flu season in a decade. Before that of course, there was the emergence of swine flu and the swine flu pandemic.

The other big surprise last year was the early, widespread availability of flu shots and the availability of over 166 million doses of seasonal flu vaccine.

As flu season ended last year, the new surprise was the emergence of a new strain of bird flu in China, H7N9, which got more than 132 people very sick in China and caused 44 deaths. Fortunately, "the increase in case counts has fallen off from the month of April, when multiple cases were being reported each day." And "there is still no evidence of sustained (ongoing) human-to-human transmission with this virus and no cases have been reported outside of China." Cases have started to pick up again recently though and are now surging once again in a second wave, with at least 151 confirmed cases since October 2013.

Another surprise is a health advisory from the CDC that they are receiving reports of "severe respiratory illness among young and middle-aged adults" who are infected with pH1N1 (the flu virus that caused the swine flu pandemic in 2009 and which has continued to circulate as a seasonal flu virus strain). This has lead to higher than usual rates of hospitalization for people between the ages of 18 and 49 years.

Fortunately, in a new report, "Interim Estimates of 2013-14 Seasonal Influenza Vaccine Effectiveness -- United States, February 2014," the CDC has estimated the effectiveness of this year's seasonal flu vaccine to prevent "influenza-associated, medically attended acute respiratory illness" at about 67% in children between the ages of 6 months and 17 years.

Flu Season

Especially with the bad flu season we faced last year, parents should take steps to help avoid the flu and to keep their family from getting sick. In addition to getting a flu vaccine, this can include frequent hand washing, avoiding close contact with people who are sick with the flu, disinfecting contaminated surfaces, including toys and kitchen counter-tops.

Flu vaccine recommendations for the 2013-14 flu season didn't change from last year. Experts still recommend the vaccination of all people who are at least six months old. The availability of 138 to 145 million doses should make that easy too.

Also remember that children who are less than nine years of age, still need two doses of the flu vaccine if this will be the first time that they are getting vaccinated. Your kids might also need two doses if they are less than nine years of age and haven't had at least two doses of seasonal flu vaccine since July 1, 2010.

If your own pediatrician doesn't have flu shots, you might check with your local health department, hospital, or pharmacies, and find a flu shot wherever you can.

Flu Season Activity Reports

The latest weekly flu report from the CDC states that flu activity "is declining nationally, though flu viruses continue to circulate and cause illness in the United States," including that there is:
  • widespread flu activity in just five states (Connecticut, Delaware, Massachusetts, New Jersey, and New York)
  • regional flu activity in just four states (Maine, New Hampshire, Rhode Island, and Utah)
  • local flu activity in 17 states (Arizona, Florida, Illinois, Iowa, Louisiana, Maryland, Michigan, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia) and the District of Columbia
  • sporadic flu activity in 23 states (Alabama, Alaska, Arkansas, California, Colorado, Georgia, Hawaii, Indiana, Kansas, Kentucky, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, North Dakota, South Dakota, Vermont, Washington, West Virginia, Wisconsin, and Wyoming) and Puerto Rico
  • no flu activity in just one state (Idaho)

Google's Flu Trends, which relates flu searches in an area to how many people are actually sick with the flu, continues to report a low level of flu activity in the United States, which is a step down from the moderate level of flu activity that they were reporting in early February. Google Flu Trends is supposed to 'estimate flu activity faster than traditional systems.' It is a good complement for the CDC surveillance system, but is by no means a replacement, as we saw during the 2013-14 flu season, in which Google's Flu Trends greatly overestimated peak flu levels.

Knowing where there is flu activity can be helpful though, because if you have classic flu symptoms in an area where there are a lot of flu infections, especially widespread or intense flu infections, then you likely have the flu and should see your doctor right away if your child is a candidate for one of the flu medications, such as Tamiflu (oseltamivir) or Relenza.

Keep in mind that the FDA  expanded the approved use of Tamiflu in 2012, at a dose of 3 milligrams per kilogram twice daily for five days, to treat children as young as 2 weeks old. As with older children and adults, Tamiflu is for those infants who have flu symptoms for no longer than two days. But unlike older children and adults, Tamiflu can not be used to prevent flu in infants.

Because of the increased demand for the oral suspension form of Tamiflu, as in past years, it is frequently on back order can be hard to find in many areas. Your pharmacist should be able to compound the 75mg Tamiflu capsules into a suspension for your child though in the event of a Tamiflu shortage, as we are now seeing. The CDC also states that "for those patients who cannot swallow capsules, the capsules can be opened and the contents may be mixed with chocolate syrup or some other thick, sweet liquid, as directed by a healthcare professional" who can figure out an age-appropriate dose for your child, perhaps by using the 30mg or 45mg Tamiflu capsules.

Flu Deaths

Each year, the flu is reported to be responsible for almost 36,000 deaths, including about 85 deaths in children. In the 2009-10 flu season, 281 deaths in children were reported to the National Notifiable Diseases Surveillance System.

There were 171 pediatric flu deaths during the 2012-2013 flu season.

There have already been 82 pediatric flu deaths during the 2013-2014 flu season, including 3 new deaths in children that were reported to the CDC this past week. Most of these children were eligible to get a flu vaccine, but few fully vaccinated against the flu.

The CDC has also reported that during last year's flu season:

  • 90% of pediatric flu deaths were in children who had not received a flu vaccine
  • 40% of the flu deaths were in children who had no underlying chronic health problems
  • 40% of children had received a flu vaccine by mid-November
  • flu vaccination prevented an estimated 6.6 million influenza illnesses, 3.2 million medically attended influenza illnesses, and 79,260 hospitalizations
 

Sources:

CDC. FluView. 2013-2014 Influenza Season Week 113 ending March 29, 2014

CDC. Early Estimates of Seasonal Influenza Vaccine Effectiveness — United States, January 2013. MMWR. January 11, 2013 / 62(Early Release);1-4.

CDC. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices – United States, 2013-14, MMWR 2013, September 20, 2013 / 62(RR07);1-43

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