Cold & Flu – Highlight HEALTH http://www.highlighthealth.com Discover the Science of Health Wed, 01 Nov 2017 19:47:26 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.3 Genetic Mutation May Explain Increase in U.S. Whooping Cough Cases http://www.highlighthealth.com/cold-and-flu/genetic-mutation-may-explain-increase-u-s-whooping-cough-cases/ Thu, 12 Sep 2013 03:56:49 +0000 http://www.highlighthealth.com/?p=12129 Whooping cough is making a comeback, possibly due to a mutation that helps the bacteria evade one part of the immune system.]]>

An old disease is making a comeback, possibly due to a bacterial mutation. Seventeen states and Washington D.C. are reporting an increase in whooping cough this year. It’s an epidemic in Texas, on pace to be the worst in half a century [1]. The very young are most at risk.

Whooping cough

Whooping cough

Whooping cough or pertussis is a bacterial infection caused by Bordetella pertussis. It’s a highly contagious disease that clogs the airways with mucus, causing severe bouts of coughing. Pertussis symptoms include uncontrollable, violent coughing which makes it hard for the patient to breath. The patient then needs to take deep breaths, which produces a whooping sound, hence the diseases’ nickname “whooping cough.”

Early symptoms, which last approximately one to two weeks, include a runny nose, low-grade fever, a mild, occasional cough and a pause in breathing called apnea. Later, patients can exhibit the rapid coughs and high pitched “whoops,” vomiting and exhaustion after coughing. People remain contagious up to two weeks.

Whooping cough is more common in infants and young children, and can be fatal especially for children under 1 year of age.

A series of five doses of pertussis vaccine (called DTaP, the child pertussis vaccine) begins at two months after birth and is completed by 4-6 years of age. Preteens going to the doctor for their regular check-up at age 11 or 12 years should get a booster vaccine, called Tdap.

Despite widespread vaccination, pertussis has persisted in vaccinated populations and is one of the most prevalent vaccine-preventable diseases.

Re-emergence of whooping cough

In 2012, the Centers for Disease Control and Prevention (CDC) declared it the worst year for whooping cough in nearly 60 years. More than 41,000 cases were reported in 2012. Compare that to the 9,771 cases reported ten years ago in 2002 [2]. In fact, between 2002 and 2012, there has been, on average, over 16,000 more cases every year than between 1970 and 2002, a 400% increase!

Number reported pertusis cases vs year

So far in 2013, 17 states are reporting an increase in cases of whooping cough compared with the same time during 2012, including Alaska, Arkansas, California, Colorado, Florida, Georgia, Louisiana, Montana, Nebraska, Nevada, North Carolina, Ohio, Oklahoma, Rhode Island, South Carolina, Tennessee, and Texas.

Chages in pertussis reporting by state from 2012 to 2013

Indeed, it’s an epidemic in the state of Texas; there have been more than 2,100 cases this year and 2 infants who were too young to receive the vaccine have died.

Texas isn’t the first pertussis epidemic in the United States. Last year, Washington state declared a pertussis epidemic.

Genetic mutation to blame?

Concerns about whooping cough outbreaks have focused chiefly on the loss of immunity associated with the acellular vaccine, which was licensed for use in 1996 to minimize the risk of adverse events associated with whole-cell pertussis vaccine [3].

However, the recent rise in whooping cough cases may be caused by a genetic mutation of the bacteria, according to new findings published earlier this year in the New England Journal of Medicine [4].

Researchers at St. Christopher’s Hospital for Children in Philadelphia, Pennsylvania collected bacterial samples from 12 patients with whooping cough. In 11 cases, they found that the pertussis bacteria was no longer producing a cell surface protein called perlactin — one of three elements the body’s immune system uses to identify and fight the disease.

According to senior author Alan Evangelista, Ph.D., Director of Microbiology at St. Christopher’s Hospital for Children [5], the organism has adapted to evade one part of the immune system:

This particular [pertussis strain] is missing a surface protein. There’s a mutation that stopped making one of the targets. Usually the vaccine has three targets it goes after and this new strain only has two of the targets.

While the current pertussis vaccine will still work, it may not be as effective. The scientists have called for studies of isolates from geographically distinct U.S. regions to determine whether the finding is a local event or represents a more widespread shift in pertussis strains.

The researchers write that “an understanding of the epidemiology and virulence of pertactin-negative variants is crucial to developing the next generation of pertussis vaccines.”

What should you do?

What can you do to protect your kids from whooping cough?

Make sure the kids are up-to-date with pertussis vaccinations. Even diminished vaccine protection is better than nothing, and typically those who are vaccinated have milder cases.

Protect yourself. Adults should get a whooping cough booster shot so they don’t spread the disease.

Keep your kids away from those who are sick. Pertussis is spread through coughing or sneezing.

Watch for symptoms. Whooping cough typically starts with cold-like symptoms that can include a runny nose, congestion, low-grade fever and a mild cough. Infants may have a pause in breathing, called apnea. If you think your child might be sick, see a doctor immediately. Whooping cough is treated with antibiotics, and the earlier they can be given, the better.

References

  1. Whooping cough reaches epidemic level in Texas: official. Reuters. 2013 Sept 5.
  2. Pertussis Cases by Year (1922-2012). Centers for Disease Control and Prevention (CDC). Accessed 2013 Sep 11.
  3. Pertussis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Young Children Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1997 Mar 28;46(RR-7):1-25.
    View abstract
  4. Queenan et al. Pertactin-Negative Variants of Bordetella pertussis in the United States. N Engl J Med. 2013 Feb 7;368(6):583-4. doi: 10.1056/NEJMc1209369.
    View abstract
  5. New Strain Of Whooping Cough Resistant Of Current Vaccine. CBS Philly. 2013 Feb 9.
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Flu During Pregnancy May Increase Child’s Risk for Bipolar Disorder http://www.highlighthealth.com/mental-health/flu-during-pregnancy-may-increase-childs-risk-for-bipolar-disorder/ Thu, 06 Jun 2013 03:41:44 +0000 http://www.highlighthealth.com/?p=11147 Pregnant with the fluA recent study found that pregnant mothers’ exposure to the flu was associated with a nearly fourfold increased risk that their child would develop bipolar disorder in adulthood.]]> Pregnant with the flu

Pregnant mothers’ exposure to the flu was associated with a nearly fourfold increased risk that their child would develop bipolar disorder in adulthood, in a study funded by the National Institutes of Health. The findings add to mounting evidence of possible shared underlying causes and illness processes with schizophrenia, which some studies have also linked to prenatal exposure to influenza.

Pregnant with the flu


Alan Brown, M.D., M.P.H, of Columbia University and New York State Psychiatric Institute, a grantee of the NIH’s National Institute of Mental Health (NIMH), said:

Prospective mothers should take common sense preventive measures, such as getting flu shots prior to and in the early stages of pregnancy and avoiding contact with people who are symptomatic. In spite of public health recommendations, only a relatively small fraction of such women get immunized. The weight of evidence now suggests that benefits of the vaccine likely outweigh any possible risk to the mother or newborn.

Brown and colleagues reported their findings online May 8, 2013 in the journal JAMA Psychiatry [1].

Although there have been hints of a maternal influenza/bipolar disorder connection, the new study is the first to prospectively follow families in the same HMO, using physician-based diagnoses and structured standardized psychiatric measures. Access to unique Kaiser-Permanente, county and Child Health and Development Study External Web Site Policy databases made it possible to include more cases with detailed maternal flu exposure information than in previous studies.

Among nearly a third of all children born in a northern California county during 1959-1966, researchers followed 92 who developed bipolar disorder, comparing rates of maternal flu diagnoses during pregnancy with 722 matched controls.

The nearly fourfold increased risk implicated influenza infection at any time during pregnancy, but there was evidence suggesting slightly higher risk if the flu occurred during the second or third trimesters. Moreover, the researchers linked flu exposure to a nearly sixfold increase in a subtype of bipolar disorder with psychotic features.

A previous study, by Brown and colleagues, in a related northern California sample, found a threefold increased risk for schizophrenia associated with maternal influenza during the first half of pregnancy. Autism has similarly been linked to first trimester maternal viral infections and to possibly related increases in inflammatory molecules.

Brown suggested:

Future research might investigate whether this same environmental risk factor might give rise to different disorders, depending on how the timing of the prenatal insult affects the developing fetal brain.

Bipolar disorder shares with schizophrenia a number of other suspected causes and illness features, the researchers note. For example, both share onset of symptoms in early adulthood, susceptibility genes, run in the same families, affect nearly one percent of the population, show psychotic behaviors and respond to antipsychotic medications.

Increasing evidence of such overlap between traditional diagnostic categories has led to the NIMH Research Domain Criteria (RDoC) project, which is laying the foundation for a new mental disorders classification system based on brain circuits and dimensional mechanisms that cut across traditional diagnostic categories.

The research was also funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

Source: NIH News

References

  1. Parboosing et al. Gestational Influenza and bipolar Disorder in Adult Offspring. JAMA Psychiatry. 2013 May 8:1-8. doi: 10.1001/jamapsychiatry.2013.896. [Epub ahead of print]
    View abstract
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CDC Reports Flu Widespread, Google Search Trends Alarming http://www.highlighthealth.com/cold-and-flu/cdc-reports-flu-widespread-google-search-trends-alarming/ Tue, 15 Jan 2013 05:57:52 +0000 http://www.highlighthealth.com/?p=10264 U.S. Influenza-like illness Activity - Jan 5, 2013While the CDC reports that this year's flu season is "moderately severe", Google Flu Trends says we're having an influenza outbreak that could be the most widespread in decades. ]]> U.S. Influenza-like illness Activity - Jan 5, 2013

According to new surveillance statistics released on Friday from the Centers for Disease Control and Prevention (CDC), forty-seven states in the U.S. are now reporting widespread influenza activity [1]. The virus, which first appeared in the Southeast, has reached epidemic levels.

U.S. Influenza-like illness Activity - Jan 5, 2013


Forty-seven states have reported widespread geographic influenza activity (i.e. incidence of flu) for the week between December 30, 2012 and January 5, 2013, and twenty-four states and New York City have reported high influenza-like illness (ILI) activity (i.e. the proportion of outpatient visits to healthcare providers for influenza-like illness; see map above) [2].

Earlier this month, Dr. Joe Bresee, Chief of the Epidemiology and Prevention Branch in CDC’s Influenza Division, said that “reports of influenza-like-illness are nearing what have been peak levels during moderately severe seasons” [3].

Flu deaths and the epidemic

Deaths from flu are much more common than many people think. Thousands of adults and hundreds of children die each year from the flu. Because flu seasons are unpredictable and often fluctuate in length and severity, a single estimate can’t be used to summarize seasonal flu-related deaths. Instead, the CDC uses a range of estimated deaths to represent the variability of flu.

From the 1976-1977 flu season to the 2006-2007 flu season, flu-associated deaths ranged from a low of ~3,000 to a high of ~49,000 people [4]. Death certificate data and weekly influenza virus surveillance information was used to estimate how many flu-related deaths occurred among people whose cause of death was listed as respiratory or circulatory disease on their death certificate.

For the flu to be an epidemic, it has to cause 7.2% or more of deaths as reported through the 122 Cities Mortality Reporting System in a given week. During the first week of January 2013, the percentage of deaths caused by flu was 7.3%, just above the epidemic threshold for the first time this season.

That in itself isn’t disconcerting: flu outbreaks normally reach epidemic level for one or two weeks every season.

Googling indicators of flu activity

What is alarming are search trends for the flu. Google Flu Trends, which uses aggregated Google search data to estimate current flu activity around the world in near real-time, suggests that this year’s outbreak is the worst in the last six years (see graph below).

In 2009, Google determined that there is a close relationship between how many people search for flu-related topics and how many people actually have flu symptoms [5]. The Flu Trends system counts how often Google sees a flu-related search and estimates how much flu is circulating in regions around the world.

Google flu trends 2012-2013

In comparison to the CDC’s numbers, which are based on after-the-fact reports from healthcare providers around the country, Google’s numbers are based on an algorithm that can detect outbreaks nearly two weeks before they show up in CDC reports. And if their model turns out to be accurate, this year could be the most widespread flu outbreak in decades.

Michael Jhung, a medical officer in the CDC’s influenza division, said that he wouldn’t be shocked if that was true [6]. Jhung’s models suggest that the virus hasn’t yet reached its peak. We will have a better idea this week Friday when the CDC releases data on the number of people that visited the doctor with respiratory symptoms during the week of December 30th.

Current influenza vaccine 62% effective

What about the influenza vaccine? Researchers have determined that the current influenza vaccine is 62% effective in reducing symptoms of the disease [7]. This means that vaccination has reduced the risk for influenza-associated medical visits by approximately 60%.

Dr. Joseph Bresee, chief of the Epidemiology and Prevention Branch in CDC’s Influenza Division, said that the number is consistent with what the CDC expected [8]:

Sixty-two percent effectiveness of the vaccine in a population that’s a broad population that includes both healthy people and a lot of elderly and sick people is what we’d expect from influenza vaccine in a year in which the circulating strains look like the strains that were included in the vaccine. If you look back over the last few years at the studies that CDC has done, this is in line with what we found and also in line with some recent reviews of vaccine trials that have been done over the last several years.

For the first week of January, scientists tested almost 13,000 respiratory specimens [1]. Thirty-two percent tested positive: 80% were positive for influenza A, primarily H3N2 (only 1% of samples tested positive for the 2009 influenza A H1N1 strain). Influenza B was found in 20% of samples that tested positive; two-thirds of specimens were positive for a B/Wisconsin/1/2010-like virus. A second B strain from the B/Victoria lineage was identified in 6.7% of specimens.

Dr. Tom Frieden, director of the CDC, told reporters on Friday that the current vaccine includes both influenza A strains and the predominant influenza B strain [8]:

About 90 percent of all of the strains circulating are included in [this year’s] vaccine. In fact, they’re the most — the three most common strains and the current vaccines have only three — have space for only three strains. So the pick of vaccine strains was as good as it could have been this year. The other close to 10 percent are a second influenza B.

The CDC expects vaccine manufacturers to have vaccines on the market within a year or two that have space for four different vaccines.

Protect yourself from the flu

There’s a lot you can do to protect yourself against the flu. First and foremost: get the flu vaccine. For the 2012-2013 flu season, based on the numbers above, you’re 60% less likely to get the flu. If you do contract the virus after being vaccinated, you’re likely to have less severe symptoms.

Besides the flu vaccine, washing your hands is the best way to stay healthy and avoid getting sick. Coughing and sneezing can spread cold and flu germs and hand washing is the single most important thing you can do to prevent the spread of infection. The trick is to wash your hands for at least 20 seconds.

If you have symptoms of the flu, stay home and limit contact with others. See your doctor. Early treatment with antivirals such as Tamiflu can reduce the severity of illness and keep you out of the hospital.

References

  1. Seasonal Influenza (Flu) – Weekly Report: Influenza Summary Update. Centers for Disease Control and Prevention. Accessed 2013 Jan 13.
  2. FluView: ILINet State Activity Indicator Map. Centers for Disease Control and Prevention. Accessed 2013 Jan 13.
  3. Flu Activity Picks Up Nationwide. Centers for Disease Control and Prevention. 2013 Jan 4.
  4. Ginsberg et al. Detecting influenza epidemics using search engine query data. Nature. 2009 Feb 19;457(7232):1012-4. doi: 10.1038/nature07634.
    View abstract
  5. Thompson et al. Updated Estimates of Mortality Associated with Seasonal Influenza through the 2006-2007 Influenza Season. MMWR 2010 Aug 27; 59(33):1057-1062.
    View abstract
  6. Going Viral. Slate. 2013 Jan 9.
  7. Early Estimates of Seasonal Influenza Vaccine Effectiveness — United States, January 2013. MMWR 203; 62(Early Release);1-4. 2013 Jan 11.
  8. Press Briefing Transcript — CDC Update: Flu Season and Vaccine Effectiveness. Centers for Disease Control and Prevention. 2013 Jan 11.
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Flu Shot During Pregnancy Improves Perinatal Outcomes http://www.highlighthealth.com/pediatrics/flu-shot-during-pregnancy-improves-perinatal-outcomes/ Thu, 31 May 2012 04:30:54 +0000 http://www.highlighthealth.com/?p=9601 Pregnant woman and doctor with vaccine syringeA new study demonstrates that the benefits associated with flu shot during pregnancy extend to the developing fetus as well as to the mother.]]> Pregnant woman and doctor with vaccine syringe

During pregnancy, women need to take special care to avoid becoming ill. There are several reasons for this. The first is that a pregnant woman’s immune system is not as strong during pregnancy as it generally is; this helps to prevent the mother’s body from attacking the developing fetus. Unfortunately, however, the weakened immune system also means that pregnant mothers are more susceptible to pathogens that they’d otherwise fight off relatively easily. Increased susceptibility aside, there’s also the concern that some illnesses — influenza included — can impact the developing fetus. Finally, there’s the simple fact that many of the medications used to treat illnesses and their accompanying symptoms aren’t appropriate for pregnant women.

Pregnant woman and doctor with vaccine syringe

Currently, the American College of Obstetrics and Gynecology recommends flu shots during the fall and winter months for all pregnant women. This is an expansion of the previous policy, which recommended shots during later — but not earlier — pregnancy. The vaccination is important for helping to prevent influenza, to which pregnant women are particularly susceptible [1], and which can become particularly severe in pregnant women and increase the risk of pregnancy complications [2].

Several studies have shown that the flu shot is quite effective at preventing flu in pregnant women [3-5], and that the rate of adverse reactions to the flu shot is quite small, and no greater in pregnant than in non-pregnant women [6-8]. Further, a new study demonstrates that the benefits associated with flu shot during pregnancy extend to the developing fetus as well as to the mother. In a very large study of more than 55,000 pregnant mothers, those who received the flu shot during pregnancy were less likely to experience a number of negative birth outcomes [9]. These women were 27% less likely give birth significantly preterm, 19% less likely to have a very-small-for-gestational-age neonate, and 34% less likely to have a baby who died prenatally or perinatally. The study looked specifically at vaccination for the H1N1 influenza during a pandemic.

The authors concluded on the basis of these results that, while more research is needed in order to examine the mechanism for the improved birth outcomes, there is nevertheless evidence that influenza vaccination during pregnancy is associated with improved infant outcomes. Coupled with the recommendation of the American College of Obstetrics and Gynecology and the evidence that the flu shot is safe and effective during pregnancy, this is a powerful suggestion for routine influenza vaccination in pregnant women.

References

  1. Jamieson et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet. 2009 Aug 8;374(9688):451-8. Epub 2009 Jul 28.
    View abstract
  2. Reader et al. Influenza virus infection in the second and third trimesters of pregnancy: a clinical and seroepidemiological study. BJOG. 2000 Oct;107(10):1282-9.
    View abstract
  3. Murray et al. Antibody response to monovalent A/New Jersey/8/76 influenza vaccine in pregnant women. J Clin Microbiol. 1979 Aug;10(2):184-7.
    View abstract
  4. Sumaya et al. Immunization of pregnant women with influenza A/New Jersey/76 virus vaccine: reactogenicity and immunogenicity in mother and infant. J Infect Dis. 1979 Aug;140(2):141-6.
    View abstract
  5. Zaman et al. Effectiveness of Maternal Influenza Immunization in Mothers and Infants. N Engl J Med. 2008 Oct 9;359(15):1555-64. Epub 2008 Sep 17.
    View abstract
  6. Mak et al. Influenza vaccination in pregnancy: current evidence and selected national policies. Lancet Infect Dis. 2008 Jan;8(1):44-52.
    View abstract
  7. Munoz et al. Safety of influenza vaccination during pregnancy. Am J Obstet Gynecol. 2005 Apr;192(4):1098-106.
    View abstract
  8. Tamma et al. Safety of influenza vaccination during pregnancy. Am J Obstet Gynecol. 2009 Dec;201(6):547-52. Epub 2009 Oct 21.
    View abstract
  9. Fell et al. H1N1 Influenza Vaccination During Pregnancy and Fetal and Neonatal Outcomes. Am J Public Health. 2012 Jun;102(6):e33-40. Epub 2012 Apr 19.
    View abstract
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Q&A: Can I Get the Flu From a Flu Shot? http://www.highlighthealth.com/cold-and-flu/qa-can-i-get-the-flu-from-a-flu-shot/ http://www.highlighthealth.com/cold-and-flu/qa-can-i-get-the-flu-from-a-flu-shot/#comments Mon, 09 Apr 2012 18:46:56 +0000 http://www.highlighthealth.com/?p=9321 Woman getting the flu shotQ&A is a biweekly series answering YOUR questions about the science of health.]]> Woman getting the flu shot

Question: I once got a flu shot and then came down with the flu afterward. Now I won’t get the shot anymore. Why did the shot give me the flu?

Woman getting the flu shot


Answer: First and foremost, it’s not possible to get the flu from a flu shot. There are two common forms of influenza vaccination. The first is an injection of inactivated virus, which is essentially virus that has been killed, and sometimes dismantled into pieces. Even though the virus has been inactivated, the immune system can still respond to it and “learns” the shape of the flu virus from the pieces present in the inoculation. This allows the immune system to respond rapidly upon subsequent exposure to the flu such that the virus will be eliminated before it can cause illness. Inactivated virus is incapable of causing illness, much the way the remains of a chicken dinner are incapable of laying an egg.

The second type of influenza vaccination is live, attenuated (meaning weakened) virus in the form of a nasal spray called FluMist. Despite the fact that the nasal spray contains live virus, the virus isn’t able to proliferate in the body and cause illness, because it’s been genetically modified to survive only at temperatures lower than core body temperature. As such, the virus can survive in the nose (such that the immune system can learn to recognize it and prevent future infection), but it can’t survive in the lungs or elsewhere in the body. The latter would be necessary for infection to occur.

There are a few possible reasons that an individual who’d been vaccinated for influenza could come down with “the flu.” The first, and most likely, is simply that the body reacts to the flu vaccine by generating an immune response to build immunity against a real attack. Because of this, people vaccinated against the flu feel kind of icky, tired, and may even come down with a headache or low grade fever. These symptoms are indicative of the body’s activated immune response to the flu vaccine, which is necessary to develop immunity against the live influenza virus.

Alternatively, what’s called “the flu” in common parlance is often a virus other than true influenza. The influenza vaccination can’t protect against colds or any of the many other respiratory viruses that are common during the winter months. As such, getting an upper respiratory infection after having been vaccinated for influenza isn’t an indication that the shot has failed to work. Influenza symptoms are characterized by fever (in most cases), muscle aches, headache and fatigue. It comes on much more rapidly — and is more severe in its presentation — than the common cold and many other seasonal respiratory viruses.

In the rare event that an individual is exposed to influenza shortly after vaccination, it is possible to come down with the flu. It takes the influenza vaccination approximately two weeks to take effect. During this time, the immune system is working on learning to recognize and respond to the virus, and an exposure soon after vaccination could result in illness. To preclude this, physicians generally recommend getting a flu shot well before the anticipated start of flu season.

Finally, there’s the outside chance that the flu shot could be ineffective against the flu in a particular year. Because the most common strains of influenza virus differ from year to year, health organizations must make educated predictions about which strains will likely be most prevalent. This creates a bit of a dilemma; the earlier predictions are made, the sooner the flu vaccine will be available, but the greater the chance the predictions won’t be completely accurate. Waiting until flu season starts to produce the vaccine would nearly guarantee the vaccine’s effectiveness, but would be unwise, because susceptible populations would be left unprotected for the beginning of the flu season.

In general, the flu shot is quite effective and the vast majority of vaccinated individuals do not get influenza. The flu can be quite serious — particularly in patients with respiratory disease, the elderly, and the immunocompromised. Approximately 200,000 hospitalizations and thousands to tens of thousands of deaths occur every year because of the flu [1]. Since it’s not possible to get the flu from a flu vaccine, and the virus hospitalizes and kills more people in this country than any other vaccine-preventable disease, the benefits of the flu vaccine clearly outweigh its riskss, even if it doesn’t 100% preclude the possibility of the flu.

Besides getting the flu shot, one of the best ways to avoid getting sick is to wash hands frequently. Remember that simply coughing or sneezing can spread cold and flu germs.

Q&A is a biweekly series answering YOUR questions about the science of health. Have a question? Use the contact form to ask us!

References

  1. Key Facts About Seasonal Influenza (Flu). Centers for Disease Control and Prevention. Updated 2007, Sep 17.
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Flu Vaccine for the 2011-2012 Season Approved http://www.highlighthealth.com/cold-and-flu/flu-vaccine-for-the-2011-2012-season-approved/ Thu, 21 Jul 2011 03:32:05 +0000 http://www.highlighthealth.com/?p=7777 Flu vaccineOn Monday, the FDA said it had approved the formulation for the 2011-2012 vaccine.]]> Flu vaccine

On Monday, the U.S. Food and Drug Administration (FDA) said it had approved the formulation for the 2011-2012 vaccine [1]. This year’s formulation is designed to protect against all three strains included in last years vaccine. Nevertheless, if you received a flu shot last year, you should still get vaccinated again this year: immunity to influenza viruses from vaccination declines over time and may be too low to provide protection after a year.

Flu vaccine


Each year, experts from the FDA, World Health Organization, CDC, and others in the public health community study virus samples and patterns collected worldwide to identify virus strains likely to cause the most illness during the upcoming influenza season. Currently, there are 136 national influenza centers in 106 countries that conduct year-round surveillance for influenza viruses and disease activity. Based on the information that’s been collected and the recommendations of the FDA’s Vaccines and Related Biological Products Advisory Committee, the strains selected for the Northern Hemisphere’s 2011-2012 influenza season are:

Six manufacturers are licensed to produce and distribute flu vaccines in the U.S. this year (brand names in parenthesis): CSL Limited (Afluria); GlaxoSmithKline Biologicals (Fluarix); ID Biomedical Corporation (FluLaval); MedImmune Vaccines Inc. (FluMist); Novartis Vaccines and Diagnostics Limited (Fluvirin); and Sanofi Pasteur Inc. (Fluzone, Fluzone High-Dose and Fluzone Intradermal).

For 2011, a new vaccine is also available. Sanofi’s Fluzone Intradermal was approved by the FDA in May [2]. It’s a shot that, unlike traditional flu shots, is injected under the skin instead of into the muscle. The company says the needle is 90% shorter than the kind used for intramuscular injection.

Cold and flu germs hide everywhere and everyone is at risk. Early last year, the CDC’s Advisory Committee on Influenza Practices recommended that everyone 6 months of age and older receive an annual influenza vaccination [3].

Flu season runs from November to April — most cases occur between late December and early March. Every winter, approximately 10-20% of people get the flu [4]. In children, the odds are even worse, with up to 40% of children becoming clinically ill due to the influenza virus. The most effective method to prevent infection, reduce symptom severity if you do get sick, and prevent the spread of virus to others is annual vaccination. Besides vaccination, one of the easiest ways to avoid getting sick is to wash your hands.

References

  1. FDA approves vaccines for the 2011-2012 influenza season. U.S. Food and Drug Administration News Release. 2011 Jul 18.
  2. FDA Licenses Sanofi Pasteur’s New Influenza Vaccine Delivered by Intradermal Microinjection. Sanofi Pasteur. 201 May 10.
  3. CDC’s Advisory Committee on Immunization Practices (ACIP) Recommends Universal Annual Influenza Vaccination. Centers for Disease Control and Prevention press release. 2010 Feb 24.
  4. Evans M. Flu shot. Can Fam Physician. 2005 Nov;51:1511-2, 1515-6.
    View abstract
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The Flu and Your Health http://www.highlighthealth.com/cold-and-flu/the-flu-and-your-health/ Mon, 13 Dec 2010 04:40:58 +0000 http://www.highlighthealth.com/?p=5678 It's the gift-giving season. However, there's one gift this time of year you don't want to give or get: the flu virus.]]>

It’s the gift-giving season. However, there’s one gift this time of year you don’t want to give or get: the flu virus. Flu season runs from November to April, with most cases occurring between late December and early March. About 10-20% of people get the flu every winter [1]. In children, the number is even higher with up to 40% of children becoming clinically ill due to the influenza virus.

Sick with the flu

What is influenza?

Influenza is a respiratory infection caused by a number of airborne RNA viruses that enter the body through the nose or mouth. Influenza viruses bind to epithelial cells in the nose, throat and lungs. Cells than absorb the virus. Once inside, the virus replicates using a cellular enzyme called an RNA-dependent RNA polymerase. The polymerase enzyme lacks proofreading capability and makes a spontaneous mutation at a rate of 1 per genome per replication [2]. Thus, essentially every influenza virus replicated contains a mutation. This is the reason why influenza viruses continually change over time and are able to evade the host immune system.

Symptoms of the flu present quickly and are worse than the common cold. Flu symptoms include body or muscle aches, chills, cough, high fever lasting 3-4 days, headache, sore throat, stuffy nose, extreme tiredness and stomach symptoms (more common in children), including nausea, vomiting and diarrhea. The incubation period between acquiring the infection and becoming ill is 1-4 days. Most heathy adults are able to infect other people 1 day before symptoms develop and up to 5 days after becoming sick [3]. Viral shedding, the period during which a person can infect others, usually peaks on the second day of symptoms. Children can infect others for several days prior to developing symptoms and can be infectious for more than 10 days. Since children can shed the greatest amounts of virus, they pose the greatest risk for viral transmission.

The flu vaccine: your options

The best way to prevent seasonal flu is to get vaccinated. Hospitalization and death from flu complications pose real risks; every year, on average, more than 200,000 people are hospitalized from flu complications and approximately 36,000 people die from the flu [3]. Immunizing children against influenza is perhaps the best method to reduce the occurrence of the flu in the community. If children receive the flu shot but the rest of the family abstains, the influenza attack rate drops by 40%; if parents also get the flu shot, the influenza attack rate drops by 80% [4].

The flu vaccine is available in two forms, a shot and a nasal spray (FluMist). The flu shot, which is approved for use in children 6 months and older, contains an inactivated flu virus. Although you may develop a slight reaction to the shot, including soreness at the injection site, muscle ache or fever, you won’t get the flu because the viruses in the vaccine have been inactivated. The nasal spray flu vaccine (FluMist), which is approved for use in children 2 years and older, contains a low dose of live but weakened flu virus. Similar to the flu shot, the nasal spray doesn’t cause the flu, but prompts an immune response so that your body develops antibodies necessary to fight influenza infection. A review of 48 reports on influenza vaccine efficacy over the past four decades found that the flu shot was 80% efficacious against influenza in healthy adults when the vaccine matched the circulating strain and the circulation was high [5]. If the circulating strain didn’t match the vaccine, efficacy was reduced to 50%. The flu vaccine was 30% effective against influenza-like illness. FluMist efficacy has been reported to be higher in both children and adults [6-8].

What else can you do?

In addition to the flu vaccine, one of the best ways to avoid getting sick and stay healthy is to simply wash your hands. Even something as simple as coughing or sneezing can spread cold and flu germs; hand washing is the single most important thing you can do to prevent the spread of infection and to stay healthy. Some scientists estimate that as much as 80% of all infections are transmitted by unwashed hands [9]. Nevertheless, a dab of soap and a quick rinse isn’t effective. The key is to wash your hands for at least 20 seconds to ensure that you’ve removed the microbes (here’s a trick: sing the ABC’s to yourself). By rubbing your hands with soapy water, you pull dirt and oil from your skin. The soap lather suspends any germs trapped inside and are then washed away when rinsing. If soap and water aren’t available, use an alcohol-based hand sanitizer. However, while alcohol-based hand sanitizers reduce the number of germs on skin, they aren’t necessarily more effective at reducing the flu virus on human hands. Studies have found that hand washing with soap and water is superior to all alcohol-based treatments.

References

  1. Evans M. Flu shot. Can Fam Physician. 2005 Nov;51:1511-2, 1515-6.
    View abstract
  2. Drake JW. Rates of spontaneous mutation among RNA viruses. Proc Natl Acad Sci U S A. 1993 May 1;90(9):4171-5.
    View abstract
  3. Key Facts About Seasonal Influenza (Flu). Centers for Disease Control and Prevention. Updated 2007, Sep 17.
  4. Hurwitz et al. Effectiveness of influenza vaccination of day care children in reducing influenza-related morbidity among household contacts. JAMA. 2000 Oct 4;284(13):1677-82.
    View abstract
  5. Jefferson et al. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD001269.
    View abstract
  6. Belshe et al. The efficacy of live attenuated, cold-adapted, trivalent, intranasal influenzavirus vaccine in children. N Engl J Med. 1998 May 14;338(20):1405-12.
    View abstract
  7. Belshe et al. Efficacy of vaccination with live attenuated, cold-adapted, trivalent, intranasal influenza virus vaccine against a variant (A/Sydney) not contained in the vaccine. J Pediatr. 2000 Feb;136(2):168-75.
    View abstract
  8. Treanor et al. Evaluation of trivalent, live, cold-adapted (CAIV-T) and inactivated (TIV) influenza vaccines in prevention of virus infection and illness following challenge of adults with wild-type influenza A (H1N1), A (H3N2), and B viruses. Vaccine. 1999 Dec 10;18(9-10):899-906.
    View abstract
  9. Put Your Hands Together. National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID) and National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED). 2008 Oct 13.
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NIAID Trial of 2009 H1N1 Influenza Vaccine Enrolling HIV-Positive Adults http://www.highlighthealth.com/cold-and-flu/niaid-trial-of-2009-h1n1-influenza-vaccine-enrolling-hiv-positive-adults/ Thu, 10 Dec 2009 19:15:00 +0000 HIV-infected adults currently are being recruited to participate in a clinical trial of 2009 H1N1 influenza vaccine. The study, sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health, will enroll approximately 240 men and women between the ages of 18 and 64.

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Safety and Distribution of the H1N1 Influenza Vaccine http://www.highlighthealth.com/cold-and-flu/safety-and-distribution-of-the-h1n1-influenza-vaccine/ Mon, 02 Nov 2009 21:31:22 +0000 http://www.highlighthealth.com/?p=3371 Know What to Do About the Flu is a webcast series launched by the U.S. Department of Health and Human Services (HHS) to hlep distribute timely and accurate information about the flu. Their goal is to distribute the latest facts and medical guidances so we can all be more effective in combating the spread of]]>

Know What to Do About the Flu is a webcast series launched by the U.S. Department of Health and Human Services (HHS) to hlep distribute timely and accurate information about the flu. Their goal is to distribute the latest facts and medical guidances so we can all be more effective in combating the spread of the flu and be better prepared should our families, our communities or our workplaces become affected.

In this edition, moderator Lark McCarthy discusses the level of testing prior to the H1N1 influenza A vaccine distribution and the subsequent monitoring that’s planned during and after the phases of distribution with Dr. Bruce Gellin, Director of the National Vaccine Program Office (NVPO) within the HHS, Dr. Jesse Goodman, acting chief scientist with the U.S. Food and Drug Administration (FDA), Dr. Harvey Fineberg, President of the Institute of Medicine (IOM) and Dr. Anne Schuchat, Director of the Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC).

This video was recorded on October 14, 2009.

H1N1 vaccine distribution

An article published earlier this week in the Washington Post questioned the shortage of H1N1 flu vaccine. Out of 80-120 million doses promised for mid-October by pharmaceutical companies, only ~16.5 millions doses have been delivered thus far [1]. According to the story, government officials relayed information on vaccine availability to the public as soon as manufacturers provided estimates. However, company representatives have said that the government was informed about production challenges are are on track for vaccine delivery.

injecting-a-virus-into-an-egg

Those production challenges included a slow growing vaccine. Flu vaccines are currently grown in eggs, a process that normally takes six months [2]. To reduce the production time, several biotech companies are working to develop large-scale cell culture methods that could potentially grow vaccines in several weeks as opposed to the six months required for egg-based production [2].

Nevertheless, according to a post earlier this week on The Patient Report (via the AP), 22 million more doses of H1N1 influenza vaccine are now available and the shortage should ease over the coming weeks. Per our list of what you need to know about the H1N1 vaccine, check with your doctor, you children’s school and/or your local health department regarding a list of locations where the H1N1 vaccine will be offered.

While you’re waiting for the vaccine to become available, remember to take these preventative measures against the H1N1 influenza virus:

  • Wash your hands often or use alcohol-based hand cleaner.
  • Cover your nose and mouth with a tissue when you cough or sneeze! Dispose of promptly.
  • Avoid touching your eyes, nose or mouth — these are areas where the virus can enter your body.
  • Make sure you’re getting enough sleep.
  • Eat well and drink plenty of fluids.
  • Avoid sick people.

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References

  1. Why such a shortage of swine flu vaccine? The Washington Post. 2009 Oct 27.
  2. Gerdil C. The annual production cycle for influenza vaccine. Vaccine. 2003 May 1;21(16):1776-9.
    View abstract
  3. Singer E. Pandemic fears hatch new methods in flu vaccine industry. Nat Med. 2005 Jan;11(1):4.
    View abstract
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Details of Critically Ill Patients with H1N1 in Mexico and Canada http://www.highlighthealth.com/cold-and-flu/details-of-critically-ill-patients-with-h1n1-in-mexico-and-canada/ Thu, 22 Oct 2009 04:14:29 +0000 http://www.highlighthealth.com/?p=3333 Two studies, which are available online as early release articles and will be published in the November edition of the Journal of the American Medical Association (JAMA), detail the characteristics, treatment and outcomes of critically ill patients with H1N1 in Mexico and Canada [1-2]. Although the death rate in each of the studies is quite]]>

Two studies, which are available online as early release articles and will be published in the November edition of the Journal of the American Medical Association (JAMA), detail the characteristics, treatment and outcomes of critically ill patients with H1N1 in Mexico and Canada [1-2].

respiratory-ventilation

Although the death rate in each of the studies is quite different, it nonetheless is as high or higher than that of seasonal flu. Furthermore, although seasonal flu typically affects people of older age — the average annual rate of influenza-associated hospitalizations over the last 20 years for people age 65 and older is 70% [3] — these studies show that H1N1 is striking many who are much younger. In both studies, the majority of critically ill patients with influenza A H1N1 had rapidly progressive respiratory failure and required mechanical ventilation.

Critically ill patients with influenza A H1N1 in Mexico

The first observational study was of 58 critically ill patients with H1N1 at 6 hospitals in Mexico [2]. These patients accounted for 6.5% of 899 admitted to the hospital with confirmed, probable or suspected influenza A H1N1 between the months of March 24, 2009 and June 1, 2009. The patients had a median age of 44, just over half were female (53%) and 2 were healthcare workers. Two patients were children (10 and 14 years old). Only two patients had received a seasonal influenza vaccination in 2008 or 2009.

Patients developed symptoms a median of 6 days prior to hospitalization. Symptoms included fever, respiratory issues (cough, shortness of breath or wheezing), generalized weakness, muscle pain, headache and gastrointestinal symptoms of nausea, vomiting, or diarrhea. Additional disorders the patients presented with included obesity (36.2%), a past history of smoking (34.5%), hypertension (25.9%), diabetes type 1 or 2 (17.2%) and gastrointestinal disease (10.3%). The time from hospitalization to intensive care unit (ICU) admission was between 0 and 3 days. Almost all patients were treated with antibiotics; 78% received antiviral drugs (neuraminidase inhibitors); 69% received corticosteroids. Fifty-four of the 58 patients (93%), including one child, required mechanical ventilation during the course of hospitalization.

After 60 days from the onset of critical illness, 24 of the 58 (41%) had died. Most died within the first 2 weeks. The median age of patients who died was 39. All deaths within 28 days were primarily related to respiratory failure, with only one late death primarily related to multisystem organ dysfunction. Both children survived.

Critically ill patients with influenza A H1N1 in Canada

The second observational study was of 215 critically ill patients with confirmed, probable or suspected influenza A H1N1 at 38 study intensive care units in Canada [3]. Since patients that had confirmed or probable H1N1 infection were significantly younger, had a longer duration of mechanical ventilation and ICU stay, and higher mortality than those with suspected disease, the analysis was restricted to the 168 patients that had confirmed or probable influenza A H1N1 infection. The patients had an average age of 32.3, 67.3% were female, and 30% were children. Only 10 of the 168 patients (6%) had received a seasonal influenza vaccination in the past two years.

Patients developed symptoms a median of 4 days prior to hospitalization. The most common symptoms included fever, respiratory issues, weakness and muscle pain. Possible bacterial pneumonia was present in just over 54 patients (30%). Additional disorders the patients presented with included chronic lung disease (including asthma, COPD and bronchopulmonary dysplasia; 41.1%), obesity (33.3%), hypertension (24.4%), a past history of smoking (22.6%) and diabetes type 1 or 2 (20.8%). The time from hospitalization to intensive care unit administration was between 0 and 2 days.

Almost all patients were treated with antibiotics; 90.5% received antiviral drugs (neuraminidase inhibitors); 50.6% received corticosteroids. Mechanical ventilation was used in 81% of patients on the first day of ICU admission. Clinical evidence for bacterial pneumonia following ICU admission was found in almost one-quarter of patients (41 of 168).

After 90 days from the onset of critical illness, 29 of the 168 (17.3%) had died. Eighteen patients died within the first 2 weeks and 24 died within 28 days from the onset of critical illness. The median age of patients who died was 42. The primary reported causes of death included severe respiratory failure, secondary infection and sepsis (generalized invasion of the body by pathogenic microorganisms or their toxins), and multiorgan dysfunction.

What to expect

An accompanying editorial in the JAMA issue said that although both studies have substantial epidemiological limitations, they nonetheless [4]:

… provide important signals about what clinicians and hospitals may confront in the coming months. H1N1 can produce a rapidly progressive respiratory failure that is refractory to conventional mechanical ventilation, often in young, healthy patients — a group who are not currently a priority group for H1N1 vaccination.

You can protect yourself from the H1N1 virus as well as the seasonal flu:

  • Get the H1N1 vaccine and the seasonal flu vaccine.
  • Wash your hands often or use alcohol-based hand cleaner.
  • Don’t cover your nose and mouth with you hand when you cough or sneeze! Use a tissue instead and throw it in the trash after use.
  • Avoid touching your eyes, nose or mouth — these are areas where the virus can enter your body.
  • Avoid sick people.
  • Get lost of rest, eat well and drink plenty of fluids.
  • If you do get sick, stay home.

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References

  1. Dominguez-Cherit et al. Critically Ill Patients With 2009 Influenza A(H1N1) in Mexico. JAMA. 2009 Oct 12. [Epub ahead of print]
    View abstract
  2. Kumar et al. Critically Ill Patients With 2009 Influenza A(H1N1) Infection in Canada. JAMA. 2009 Oct 12. [Epub ahead of print]
    View abstract
  3. Thompson et al. Influenza-associated hospitalizations in the United States. JAMA. 2004 Sep 15;292(11):1333-40.
    View abstract
  4. White and Angus. Preparing for the Sickest Patients With 2009 Influenza A(H1N1). JAMA. 2009 Oct 12. [Epub ahead of print]
    View abstract
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