Even before you get to talk about problems with flu vaccine effectiveness, it becomes clear that everyone wants a better flu vaccine.
One big problem with the current generation of flu vaccines?
You have to get them each and every year.
Developing a Better Flu Vaccine
So what would we all want in a new and better flu vaccine?
last longer, so you didn’t have to get a new vaccine every year
be more effective
cover more flu vaccine strains, so it wasn’t a “guess” about which flu strains to include in the flu vaccine each year and we didn’t have to worry about drifted flu vaccine strains or new and emerging strains for which there is no vaccine
A universal flu vaccine, which covers all possible flu strains, would be ideal.
So why haven’t we been working on developing a universal flu vaccine?
Well, we have.
It just isn’t that easy.
Many different research teams have been working on a universal flu vaccine for years and some have already had some success.
Does that mean we will see a universal flu vaccine soon?
Unfortunately, of the almost 40 organizations working on improved flu vaccines, including a universal flu vaccine, about 30 are still in preclinical or phase 1 trials. So the answer is no, we will not see a universal flu vaccine soon.
The Strategic Plan to Develop a Universal Influenza Vaccine
Maybe that will change now that more and more folks are pushing for a better flu vaccine and we see the effects of severe flu seasons without a good vaccine.
Of course, talk isn’t enough.
“A priority for the National Institute of Allergy and Infectious Diseases (NIAID) is development of an influenza vaccine providing durable protection against multiple influenza strains, including those that may cause a pandemic, i.e., a universal influenza vaccine. To invigorate research efforts, NIAID developed a strategic plan focused on knowledge gaps in three major research areas, as well as additional resources required to ensure progress towards a universal influenza vaccine. NIAID will use this plan as a foundation for future investments in influenza research and will support and coordinate a consortium of multidisciplinary scientists focused on accelerating progress towards this goal.”
Erbelding et al on A Universal Influenza Vaccine: The Strategic Plan for the National Institute of Allergy and Infectious Diseases
That’s why it is also encouraging that we have seen the:
the Pathway to a Universal Influenza Vaccine workshop convened by the National Institute of Allergy and Infectious Diseases (NIAID) in 2017
the Strategic Plan for Developing a Universal Influenza Vaccine by the NIAID that was announced in 2018
U.S. Sen. Ed Markey (D-MA) introduced the Flu Vaccine Act, which would invest $1 billion towards development of a universal flu vaccine
Knowing that developing a universal flu vaccine is a priority of the NIAID and that so many organizations are already working towards this goal is very reassuring.
Hopefully we are a lot closer than some folks thing.
encouraging your kids to not touch their eyes, nose, or mouth, or to bite their nails or put things in their mouth, like their pencil or pen
cleaning and disinfecting surfaces that your child will likely touch
encouraging others to stay home from school or work when they have the flu until they are fever free for at least 24 hours, although they might be contagious for even longer
While these techniques might not work, they are certainly better than doing nothing and simply letting your kids catch the flu.
What to Do If Your Child Is Exposed to the Flu
If your kids do anything outside the home, even if they don’t go to daycare or school, there might come a time during a long flu season when they get exposed to someone with the flu.
What do you do?
“Prevention (prophylaxis) is a term used when someone who does not have flu symptoms is given Tamiflu to help stop them from getting the flu because they are exposed to or come into close contact with someone (for example live with or take care of someone) who has the flu.”
FDA on Tamiflu: Consumer Questions and Answers
In addition to watching for classic flu symptoms to develop over the next one to four days, if your child is unvaccinated or it is a year during which the flu vaccine is not very effective, if your child is in a high risk group for severe complications from the flu (under age two to five years or any age with chronic medical problems), then you might ask your pediatrician about:
a once a day dose of Tamiflu (Oseltamivir), which is recommended as a preventative in infants as young as three months old
a once a day dose of Relenza (Zanamivir), which is recommended as a preventative in children as young as five years old, unless they have respiratory problems, like asthma
But that doesn’t mean that everyone should take these flu medicines every time they are exposed to someone with the flu. If these medicines are overused, flu viruses will develop resistance and they won’t work, just like happened to some of the older anti-viral flu medicines, amantadine and rimantadine.
Still, if your child with diabetes, uncontrolled asthma, muscular dystrophy, or healthy four month old is closely exposed to someone with the flu, then taking Tamiflu to prevent a potentially severe case of the flu is likely a good idea.
What to Do If Your Child Gets the Flu
And if your child gets the flu?
Believe it or not, most healthy school age kids with the flu don’t need to be seen by their pediatrician.
“When treatment is started within two days of becoming sick with flu symptoms, antiviral drugs can lessen symptoms and shorten the time you are sick by about one day. They may reduce the risk of complications such as ear infections in children, and pneumonia and hospitalizations in adults. For people at high risk of serious flu complications, early treatment with an antiviral drug can mean the difference between having milder illness instead of more severe illness that might require a hospital stay.”
CDC on What You Should Know About Flu Antiviral Drugs
You should see your pediatrician or other health care provider at the first sign of flu symptoms if they are at high risk for serious complications of the flu and they might benefit from Tamiflu, which includes those under two to five years old and children with any chronic medical problems.
And of course, seek medical attention if your child with the flu is showing signs of a severe case of the flu, such as trouble breathing, dehydration, or being inconsolable, etc.
You should also seek medical attention if your child with the flu was getting better, but then starts to get worse again, with a return of fever, worsening cough, or severe headache, etc.
When in doubt, call your pediatrician!
What to Know About Protecting Kids from the Flu
In addition to avoiding people who are sick with the flu, see your pediatrician as soon as possible if your younger, high risk child is gets sick after being exposed to someone with the flu.
Is this going to be the worst flu season in history?
That certainly seems to be how the media is playing it.
Have you read any of these articles?
California’s deadly flu season could be worst in a decade
Defending against this season’s deadly flu: 5 things to know
The CDC says this year’s flu may reach ‘epidemic’ proportions
Worst of deadly flu season may still be to come, Dallas County officials say
Texas Is Suffering Through its Worst Flu Outbreak in Decades
Hospital Overrun By Flu Cases Having To Turn Them Away
Get ready, some medical experts are predicting the worst flu season in history
Worst flu season in history? Really?
Flu Season Hazard
Flu season can be deadly.
That’s not hype.
That’s why every one should get a flu shot each year.
Early flu seasons can be bad.
Why? They overlap with RSV season. That means that everyone is sick at the same time with bronchiolitis, croup, colds, and the flu.
They are especially bad because many people haven’t taken the time to get their flu shot yet.
And an H3N2-predominant flu season can be especially bad. In addition to high levels of pediatric flu deaths, the CDC reports that the four flu seasons that were H3N2-predominant in recent years were “the four seasons with the highest flu-associated mortality levels in the past decade.” H3N2 virus strains drift easily, so that flu vaccines are less effective.
Flu Season Hype
Right off the bat, one big problem with most of these headlines, and the way that this year’s flu season is being hyped, is folks going out of their way to use the word “deadly” every chance they can.
Every flu season is deadly!
And guess what?
Flu season reaches “epidemic proportions” each and every year!
“The United States experiences epidemics of seasonal flu each year. This time of year is called flu season.”
CDC on Frequently Asked Flu Questions 2017-2018 Influenza Season
And we get to the point, in many cities, where a hospital fills up for a few days and has to turn away flu cases. It happens with RSV too. Its called a “code Yellow” in some hospitals.
The biggest problem with the current news coverage though, is that there hasn’t been much evidence that this is going to be the worst flu season that we have seen, although it is starting to live up to some of the hype.
“The Centers for Disease Control and Prevention says flu season runs from about September to May. Most years in Texas, a number called the ILI percentage — the number of patients doctors see with flu-like symptoms — checks in at about 2 percent or 3 percent during the offseason and crests to about 6 percent during the worst of the flu season. This year, according to a model developed by a Carnegie Mellon University team led by Roni Rosenfeld, Texas’ ILI percentage has already risen above 13 percent.”
“This is really record-breaking. In the last 20 years [the estimated number of people presenting flu symptoms] hasn’t reached that height,” Rosenfeld says. “It’s the highest it’s been this early in the season, and it’s the highest it’s been period.”
Dallas Observer on Texas Is Suffering Through its Worst Flu Outbreak in Decades
Do you know what is wrong with that report in the Dallas Observer?
It misses that the ILI percentage was above 14% in Texas during the 2014-15 flu season too! So no records were being broken.
The ILI percentage was actually between 10 to just over 14% for three out of four years recently.
Will hyping the flu to make it sound even more dangerous scare folks into getting a flu shot?
An important take away from their first story? It actually reported on a lower hospitalization rate (at the time, it has since increased) this year than the 2014-15 flu season.
Why is the 2014-15 flu season important?
For one thing, looking at real data and not just trying to scare folks, we can say that this year’s flu season has looked a lot like the 2014-15 flu season. That was also an H3N2-predominant flu season that got off to an early start, but tragically, ended up killing at least 148 children.
I’m sure that few people remember, but the 2014-15 flu season looked a lot like another H3N2-predominant flu season – the 2012-13 flu season. That year, we also got off to an early start and again, tragically, we ended up with 171 pediatric flu deaths.
So, is this going to be a bad flu season?
Is there ever a good flu season?
“This season now looking like the 2014-15 season where H3N2 predominated.”
Dan Jernigan, MD, MPH Director of the Influenza Division in the National Center for Immunization and Respiratory Diseases
It’s hard to predict, but the odds are strongly against this being the worst flu season in history.
This year’s flu season is starting to live up to some of the hype though.
“The overall hospitalization rate is higher than the overall hospitalization rate reported during the same week of the 2014-2015 season; the most severe season in recent years.”
CDC Influenza Situation Update
On the other hand, fewer pediatric flu deaths have been reported so far (84 pediatric deaths) this year than at the same point in the 2014-15 (86 pediatric deaths) flu season.
And ILI has finally peaked (hopefully).
At 7.5%, it is the highest we have seen since the 2009 pandemic.
“The majority of the influenza viruses collected from the United States during October 1, 2017 through February 10, 2018 were characterized antigenically and genetically as being similar to the cell-grown reference viruses representing the 2017–18 Northern Hemisphere influenza vaccine viruses.”
CDC Situation Update: Summary of Weekly FluView Report
And we don’t have a mismatched flu strain or a strain that has drifted to be concerned about.
That doesn’t mean that the flu vaccine is going to work perfectly, by any means, but initial reports are that this year’s flu vaccine is much more effective than expected.
The best news, besides a very good supply of flu vaccines and anti-viral medicines, like Tamiflu, this year?
We saw the same H3N2 strain in the United States last year. Although that might not guarantee immunity if you had the flu last year, it should offer some protection against severe disease.
Also, we have some new flu vaccines, including the cell-based vaccine, Flucelvax, and high dose flu shots and flu shots with adjuvants for adults 65 years of age and older.
Still, like most H3N2-predominant flu seasons, it will at best be a moderately severe flu season.
Worst ever? That’s doubtful.
Ignore the hype, but don’t ignore the advice to get vaccinated and protected against the flu. It’s never too late to get a flu shot. Even with an early start, flu season will continue into the spring.
What to Know About Flu Season Hype or Hazard
Like other H3N2-predominant flu seasons, this year’s flu season will be moderately-severe, but warnings that it could be the worst flu season ever are likely just hype.
“The vaccine effectiveness of seasonal influenza vaccines is a measure of how well the seasonal influenza vaccine prevents influenza virus infection in the general population during a given influenza season.”
WHO on Vaccine effectiveness estimates for seasonal influenza vaccines
Is the flu virus that is going around the same strain that was picked to be in the flu vaccine?
Has the flu virus drifted, even if it is the same strain that is in the flu vaccine, becoming different enough that your protective flu antibodies won’t recognize it?
Is the H3N2 strain of flu virus the predominate strain during the flu season? H3N2 predominant flu seasons are thought to be worse than others.
In general, the flu vaccine is going to be less effective in a season where there is a poor match between the circulating strain of flu virus that is getting people sick and the strain that is in the flu vaccine, especially if it is an H3N2 strain that has drifted.
Unfortunately, we usually don’t know the answer to that last question until this year’s flu season really gets going.
What about reports that the flu vaccine effectiveness will be as low as 10% this year?
It is important to note that those reports are not based on flu activity in the United States and it has been a long time since we have seen flu vaccine effectiveness that low – the 2004-05 flu season. That was the year that because of a drifted A(H3N2) virus, “only 5% of viruses from study participants were well matched to vaccine strains.”
The 10% number is instead based on reports of Australia’s flu season, in which early estimates found that the A(H3N2) component of the flu vaccine was only 10% effective. Importantly, the overall vaccine effectiveness was much higher. Including other strains, the flu vaccine in Australia was at least 33% effective this past year.
“In the temperate regions of the Southern Hemisphere, influenza activity typically occurs during April – September.”
CDC on Influenza Prevention: Information for Travelers
Couldn’t we see a drifted A(H3N2) virus this year?
Sure, especially since an A(H3N2) virus will likely be the dominant strain, but so far “data indicate that currently circulating viruses have not undergone significant antigenic drift.”
“It is difficult to predict which influenza viruses will predominate in the 2017–18 influenza season; however, in recent past seasons in which A(H3N2) viruses predominated, hospitalizations and deaths were more common, and the effectiveness of the vaccine was lower.”
CDC on Update: Influenza Activity — United States, October 1–November 25, 2017
Again, it is too early to predict how effective the flu vaccine will be, but based on an undrifted H3N2 virus that is matched to the vaccine, you might expect an effectiveness between 30 to 40%.
It might be less if theories about egg-adapted mutations are true and are a factor this year.
“…some currently circulating A(H3N2) viruses are less similar to egg-adapted viruses used for production of the majority of U.S. influenza vaccines.”
CDC on Update: Influenza Activity — United States, October 1–November 25, 2017
It is also important to keep in mind that vaccine effectiveness numbers from Australia and the United States don’t always match up.
For example, in 2009, Australia reported an interim flu vaccine effectiveness of just 9%, but in the United States, the flu vaccine ended up being 56% effective! On the other hand, in 2014, the flu vaccine worked fairly well in Australia, but vaccine effectiveness was found to be just 19% in the United States.
Vaccine Effectiveness by Year
What does all of this mean?
“This season’s flu vaccine includes the same H3N2 vaccine component as last season, and most circulating H3N2 viruses that have been tested in the United States this season are still similar to the H3N2 vaccine virus. Based on this data, CDC believes U.S. VE estimates from last season are likely to be a better predictor of the flu vaccine benefits to expect this season against circulating H3N2 viruses in the United States. This is assuming minimal change to circulating H3N2 viruses. However, because it is early in the season, CDC flu experts cannot predict which flu viruses will predominate. Estimates of the flu vaccine’s effectiveness against circulating flu viruses in the United States will be available later in the season.”
CDC on Frequently Asked Flu Questions 2017-2018 Influenza Season
The reports about what happened in Australia should not have made headlines beyond Australia.
Folks should have waited for the yearly report on flu vaccine effectiveness from the CDC, which usually comes out in the middle of February. This year, that report states that:
the overall adjusted vaccine effectiveness against influenza A and influenza B virus infection associated with medically attended acute respiratory illness was 36%
vaccine effectiveness was estimated to be 25% against illness caused by influenza A(H3N2) virus, 67% against A(H1N1)pdm09 viruses, and 42% against influenza B viruses
the flu vaccine offered statistically significant protection against medically attended influenza among adults aged 18–49 years with an adjusted vaccine effectiveness of 33%
What about kids?
“…among children aged 6 months through 8 years, the interim estimates against any influenza and A(H3N2) virus infection were higher; the risk for A(H3N2) associated medically-attended influenza illness was reduced by more than half (59%) among vaccinated children. Also, with interim VE estimates of 67% and 42% against influenza A(H1N1)pdm09 and B viruses, respectively, vaccination provided substantial protection against circulating A(H1N1)pdm09 viruses, as well as moderate protection against influenza B viruses predominantly belonging to the B/Yamagata lineage, the second influenza type B component included in quadrivalent vaccines.”
CDC on Interim Estimates of 2017–18 Seasonal Influenza Vaccine Effectiveness — United States, February 2018
So the flu vaccine ended up being a lot more effective than folks predicted, especially in younger, higher risk kids, although it is still far from perfect.
Unfortunately, this year’s flu vaccine was not effective at preventing medically-attended influenza illness (flu case that sends you to see a doctor) for the 9 to 17 year old age group for some reason. That’s still not a good reason to skip the flu vaccine if your child hasn’t had it though, as the flu vaccine might still work to help your child, even if doesn’t fully prevent a case of the flu.
And while it isn’t perfect, getting a flu vaccine is certainly better than remaining unprotected and simply taking your chances that you won’t get the flu and complications from the flu.
What to Know About Flu Vaccine Effectiveness
Although the effectiveness of the flu vaccine varies from year to year, depending on how well matched the vaccine is to circulating flu virus strains, which strains are dominant, and whether they have drifted, it is always a good idea to get vaccinated and protected.
Breaking News: Flu season is essentially over. (see below)
While flu season typically peaks in February, it is very important to understand that there are few things that are typical about the flu.
Since 1982, while we have been twice as likely to see a flu activity peak in February than other winter months, we have been just as likely to get that peak in December, January, or March. That makes it important to get your flu vaccine as soon as you can.
You really never know if it is going to be an early, average, or late flu season.
There will likely be some surprises this flu season – there always are – but there are some things that you can unfortunately count on.
Among these flu facts include that:
there have been over 1,600 pediatric flu deaths since the 2003-04 flu season, including 110 flu deaths last year
about 113 kids die of the flu each year – most of them unvaccinated
antiviral flu medicines, such as Tamiflu, while recommended to treat high-risk people, including kids under 2 to 5 years of age, have very modest benefits at best (they don’t do all that much, are expensive, don’t taste good, and can have side effects, etc.)
a flu vaccine is the best way to decrease your child’s chances of getting the flu
And even in a mild flu season, a lot of kids get sick with the flu.
What about reports that the flu shot will be only 10% effective?
In general, flu season starts when you begin to see people around you with signs and symptoms of the flu, including fever, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue, etc. To be more accurate, you can also look at reports for flu activity in your area, especially the weekly reports from the CDC. Those flu reports can also help you determine when flu season ends.
It is obvious now that this is an early flu season. And with an H3N2 predominant strain, everyone should understand that is going to be a severe season.
Worst season ever? Probably not. But this season is starting to live up to some of the hype, as influenza-like-illness (ILI) activity is at 7.5% and is approaching the 7.7 peak of the 2009 pandemic and the overall hospitalization rate is higher than the overall hospitalization rate reported during the same week of the 2014-2015 season.
That leaves the next big questions – when will flu season peak and when will it be over?
As of mid-June, the CDC reports that flu activity is low in most parts of the United States.
The CDC has also recently reported that:
between 151 to 166 million doses of flu vaccine will be available this year, including 130 million doses of thimerosal-free or preservative-free flu shots, so the great majority of flu shots will not contain mercury!
FluMist, the nasal spray flu vaccine, will return next year
there have already been 176 pediatricflu deaths this year, and like in other recent years, most pediatric flu deaths are in kids who are unvaccinated
Are you going to get your kids a flu vaccine next year?
“CDC recommends that everyone 6 months and older get an injectable flu vaccine as soon as possible.”
CDC Influenza Situation Update
Flu season is essentially over, although like many other flu seasons, we will likely continue to see some flu activity throughout the spring and summer months.
And remember that while this is certainly a very bad flu season, it is still comparable to other recent H3N2 seasons, especially the 2012-13 and 2014-15 seasons.
Recent Flu Seasons
Are H3N2 predominant flu seasons really worse than others?
2003-04 flu season – 152 pediatric flu deaths (H3N2-predominant)
2004-05 flu season – 47 pediatric flu deaths
2005-06 flu season – 46 pediatric flu deaths
2006-07 flu season – 77 pediatric flu deaths
2007-08 flu season – 88 pediatric flu deaths (H3N2-predominant)
2012-13 flu season – 171 pediatric flu deaths (H3N2-predominant)
2013-14 flu season – 111 pediatric flu deaths
2014-15 flu season – 148 pediatric flu deaths (H3N2-predominant)
2015-16 flu season – 93 pediatric flu deaths
2016-17 flu season – 110 pediatric flu deaths (H3N2-predominant)
In addition to high levels of pediatric flu deaths, the CDC reports that the four flu seasons that were H3N2-predominant in recent years were “the four seasons with the highest flu-associated mortality levels in the past decade.”