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Repeat of Last Year or a ‘Twindemic?’

November 19, 2021 – Cases of the flu, the once-annual viral intruder that was regularly the nation’s worst annual health crisis, is showing signs of revival this fall.

But, according to experts, it is far too early to tell whether the country will have a normal – that is, bad – flu season or a repeat of last year, when the flu practically disappeared in the middle of the year. COVID-19 pandemic.

This flu season begins more like the seasons before the pandemic. About 2% of all visits to doctors and outpatient clinics through Nov. 13 were for flu or flu-like illnesses, up from about 1.4% a year ago, according to the CDC. The cases so far number in the hundreds – from 702 to 13 November.

Yet although the cases are low, they are increasing, according to the agency. The flu spread is already high in New Mexico and moderate in Georgia. The rest of the country sees little activity, according to the CDC.

Around the same time last year, influenza cases, hospitalizations and deaths dropped dramatically, despite fears that a drastic ‘twindemia’ could occur if COVID-19 and influenza cases increased significantly, and tandem. Comparisons of last year’s flu season statistics to previous years are surprising – in a good way.

During the 2019-2020 season, more than 22,000 people in the United States died from the flu; last year, deaths decreased to around 700 for the period 2020-2021 season.

So what could happen this year? Will the flu be a no-show again? Several top experts say it’s complicated:

Already, says Schaffner, “we are starting to hear about some epidemics. “

The University of Michigan, Ann Arbor, where 528 cases of the flu have been diagnosed at the University Health Service since October 6, is a cause of concern triggering an epidemic. The CDC sent a team to investigate the outbreak. Florida A&M University and Florida State University also experienced major epidemics this month.

The epidemics on college campuses are not surprising, Schaffner said. “It’s a population that is under-vaccinated,” he says, and students are often in close contact with many others. University of Michigan officials said 77% of cases are unvaccinated people.”

Predictions for this year’s flu season must also take into account the wearing of masks and social distancing that were common last year but have become less common or sometimes non-existent this year.

Despite the uncertainty as to how this year’s flu season will unfold, several changes and advancements in play for this year’s flu season are aimed at keeping the disease level low.

  • The composition of the vaccines has been updated – and each vaccine targets four viruses that are expected to circulate.
  • The flu vaccine and COVID vaccines can be given at the same time.
  • The CDC has updated guidelines for the timing of the flu shot for some people.
  • New dashboard tracks nationwide influenza vaccination rates, and CDC is leading education campaign, fearing the importance of the influenza vaccine has been sidelined with widespread attention focused on COVID and its vaccine since the start of the pandemic.

What’s in this year’s vaccine?

This year, all influenza vaccines in the United States are four-component (quadrivalent) vaccines, intended to protect against the four influenza viruses most likely to spread and cause disease this season.

The FDA’s Advisory Committee on Vaccines and Related Biologics (VRBPAC) selects the specific viruses that each year’s vaccine should target. To select, they take into account surveillance data with details of recent influenza cultures, previous year’s vaccine responses and other information.

Egg-based vaccines and cell-based or recombinant vaccines will target two strains of influenza A and two strains of influenza B. Options include injections or a nasal spray.

Several of the formulations are approved for use in people 65 years of age and older, including a high dose vaccine and the adjuvanted influenza vaccine. Everyone’s goal is to create a stronger immune response, as people’s immune systems weaken with age. However, the CDC is warning people not to delay vaccination while waiting for the high dose or adjuvant. According to experts, getting the vaccine available is the best thing to do.

Vaccination schedule

In general, September and October were good times for flu shots, according to the CDC. While it’s ideal to get the shot by the end of October, he always recommends getting the shot later than that rather than ignoring it.

Even if you’re not vaccinated in December or January, it’s still a good idea to do so then, Schaffner agrees. You would still have some protection, he said, because “for the most part in the United States, the flu peaks in February.”

While children can be vaccinated as soon as doses are available – even in July or August – adults, especially if they are 65 years of age and over, due to their weakened immune systems, should generally not be vaccinated. get vaccinated so early. This is because protection will decrease over time and they may not be protected throughout the flu season. But better early than not at all, according to the CDC.

Some children aged 6 months to 8 years may need two doses of the flu shot. Those who are vaccinated for the first time need two doses (4 weeks apart). Other people in this age group who have only received one dose before should receive 2 doses. season.

Early vaccination may also be considered for women in the third trimester of pregnancy, as vaccination can help protect their infants after birth. Infants cannot be vaccinated before the age of 6 month.

Two arms, two vaccines

With millions of Americans now lining up for their COVID-19 recalls, experts are urging them to get the flu shot at the same time. It’s okay to receive both vaccines on the same day, experts say.

“You can [even] make 2 in one arm, an inch apart, ”says LJ Tan, PhD, policy and partnership manager, Immunization Action Coalition, an organization dedicated to increasing immunization rates. “We co-administer vaccines to children every time.”

And, says Tan, ‘the flu shot won’t amplify any reaction you have to COVID. vaccine.”

Vaccination follow-up

According to the CDC National Flu Vaccination Dashboard, approximately 162 million doses of influenza vaccine have been distributed as of November 5.

He expects about 58.5% of the population to get the flu shot this season, up from about 54.8% last season.

Undo the thought “The flu is not bad”

A common misconception, especially from parents, is that “the flu is not serious, it does not cause serious problems,” says Flor M. Munoz, MD, MSc, medical director of the transplant department. infectious diseases at Texas Children’s Hospital in Houston.

“The flu itself can be serious,” she says. And now with COVID, she says, “we are worried. If someone gets both infections, they can get very sick. “

Potential complications in children, especially those under the age of 5, include pneumonia, dehydration, brain dysfunction, and sinus and ear infections.

The flu shot, like COVID, is not perfect, she also tells parents. “In a good year, that gives 60 to 70% protection. But it can also be a lot less protective than that. Even so, “if you get the vaccine and you still get the flu, your illness will be less severe.”

Antivirals to the rescue

When the flu symptoms – fever, cough, sore throat, runny nose, body aches, headaches, chills and fatigue – appear, antiviral treatments can reduce the duration of your illness by about a day, according to the CDC. They are only available with a prescription and work best when started within 2 days of the onset of the flu.

Four antiviral drugs for treating influenza are approved by the FDA, including:

  • Oseltamivir phosphate (generic or as Tamiflu)
  • Zanamivir (Relenza)
  • Peramivir (Rapivab)
  • Baloxavir marboxil (Xofluza)

Depending on the drug and how it is administered, the drugs are given for 1 to 5 days, usually, but sometimes more than 5 days.

Track local flu rates

Ray of Johns Hopkins suggests keeping an eye on the extent of the flu in your community, just as we’ve become accustomed to tracking COVID rates, and then taking precautions such as masking and social distancing. “Maybe we’re a little more nimble now to respond to risks,” he says, given the practice we have gained with COVID.

He says adapting these habits in response to flu outbreaks would be helpful and more natural for most people than in the past. “I don’t think it was usual 3 years ago to see people with masks when the flu rates were high. “

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