Tag: hospitalization

Understanding Flu Season

Flu season starts.

A lot of folks get sick as flu season peaks.

Flu season eventually ends.

What’s to understand?

Understanding Flu Season

While we see flu activity at epidemic levels every year, some years are clearly much worse than others.

What kind of flu season will we have this year?
What kind of flu season will we have this year?

And while the severity of a flu season is easy to see after it is over, many of us could use a little help making sense of things when we are still in the middle of it.

  • Geographic Spread of Influenza Viruses – when you hear that there is widespread flu activity in a lot of states, this is what they are talking about. The only problem is that this doesn’t really tell you anything about the severity of a flu season. We get widespread flu activity in all states, or almost all states, each and every year as flu season peaks.
  • ILI Activity Indicator Map – like the maps showing the geographic spread of the flu, the ILI activity indicator map can help you tell where flu is spreading, but since it doesn’t necessarily represent the whole state, it can be misleading.
  • Influenza-like Illness Surveillance – the proportion of outpatient visits for influenza-like illness (ILI), or basically, how many people are going to the doctor with flu symptoms. Once we get above the national baseline of 2.2%, we know that flu season is starting in an area. How high can ILI get? Recently, it has peaked between 3.6% (2015-2016) and 7.5% (2017-2018). But that’s nationally. Because of wide variability in regional level data, you might see much higher ILI numbers in your state. For example, the regional baseline in Texas is 4%, while it is just 1.1% in Idaho. Still, widespread flu activity with a high ILI likely means a bad flu season.
  • Flu-Associated Hospitalizations – laboratory-confirmed influenza-associated hospitalizations. Overall, as flu season peaks, this can range from 4 to 5 per 100,000 population in a typical flu season, to 9 or 10 in a more severe flu season. This is also reported by age group. During a bad flu season, flu-associated hospitalizations will be high.
  • Mortality Surveillance – the proportion of deaths attributed to pneumonia and influenza. At some point in flu season, we get above an epidemic threshold and more people die with the flu, especially during a bad flu season.
  • Pediatric Deaths – pediatric influenza-associated deaths have been a nationally notifiable condition since the 2004 flu season and since then, on average, about 118 kids die with the flu each year. Last season was especially bad, with 185 pediatric flu deaths.

So how do you really know if it is a bad flu season?

Look for a high ILI%, high flu-associated hospitalizations, which will almost certainly be followed by a high mortality surveillance.

You also want to check viral surveillance data. Are the majority of influenza viruses being tested antigenically and genetically similar to the cell-grown reference viruses representing the 2018–2019 Northern Hemisphere influenza vaccine viruses? If not, that could mean a vaccine strain mismatch and a worse flu season.

And don’t be surprised by reports of widespread flu activity or rising ILI. That’s just flu season.

More on Understanding Flu Season

Is Surgery a Contraindication to Getting Vaccinated?

There are some situations in which it is very important to think about vaccines before your child has surgery.

“Pneumococcal conjugate vaccine (PCV13, Prevnar 13, Pfizer), Haemophilus influenzae type b vaccine (Hib), meningococcal conjugate vaccine (MenACWY), and meningococcal B vaccine should be given 14 days before splenectomy, if possible.”

Ask the Experts about Scheduling Vaccines

A splenectomy leaves your child at extra risk for many vaccine-preventable diseases, so it is a good idea to get vaccinated and protected well in advance of a planned splenectomy, if possible.

This doesn’t mean that these vaccines won’t work after the surgery, but just that you don’t want your child to be unprotected while he remains unvaccinated.

Is Surgery a Contraindication to Getting Vaccinated?

What about other surgeries?

Some kids are put on an aspirin regimen after cardiac surgery and it should be noted that taking aspirin is a contraindication for getting FluMist, the nasal spray flu vaccine, and is considered a precaution for getting the chicken pox vaccine.

“(j)No adverse events associated with the use of aspirin or aspirin-containing products after varicella vaccination have been reported; however, the vaccine manufacturer recommends that vaccine recipients avoid using aspirin or aspirin-containing products for 6 weeks after receiving varicella vaccines because of the association between aspirin use and Reye syndrome after varicella. Vaccination with subsequent close monitoring should be considered for children who have rheumatoid arthritis or other conditions requiring therapeutic aspirin. The risk for serious complications associated with aspirin is likely to be greater in children in whom natural varicella develops than it is in children who receive the vaccine containing attenuated VZV. No association has been documented between Reye syndrome and analgesics or antipyretics that do not contain aspirin.”

Vaccine Recommendations and Guidelines of the ACIP

In most other situations, not only is surgery not considered a contraindication to getting vaccinated, but “hospitalization should be used as an opportunity to provide recommended vaccinations.”

“Most studies that have explored the effect of surgery or anesthesia on the immune system were observational, included only infants and children, and were small and indirect, in that they did not look at the immune effect on the response to vaccination specifically. They do not provide convincing evidence that recent anesthesia or surgery significantly affect response to vaccines. Current, recent, or upcoming anesthesia/surgery/hospitalization is not a contraindication to vaccination. Efforts should be made to ensure vaccine administration during the hospitalization or at discharge.”

Vaccine Recommendations and Guidelines of the ACIP

The one possible argument that makes sense to delay a vaccine in few days or weeks before a planned surgery is that if your child has a reaction to the vaccine, even if it is a mild reaction, like a fever or irritability, then it might cause them to delay the surgery.

And you could make the same argument about delaying vaccines in the days or weeks after having surgery. Could mild reactions to a vaccine be confused with complications from the surgery?

Otherwise, your anesthesiologist’s preferences aside, a recent or upcoming surgery is not a true contraindication to getting vaccinated, especially if it is a vaccine that your child is already past due for or needs because of a local outbreak, etc.

nless they are giving these kids the oral polio vaccine or plan on them sharing a room with a bone marrow transplant patient, they don't need to worry about shedding. But that's only one of the reasons that this hospital's recommendations don't follow ACIP guidelines.
Unless they are giving these kids the oral polio vaccine or plan on them sharing a room with a bone marrow transplant patient, they don’t need to worry about shedding. But that’s only one of the reasons that this hospital’s recommendations don’t follow ACIP guidelines.

What happens if you delay getting your child vaccinated because of a planned surgery and they get exposed to someone with measles or chicken pox?

Fortunately, this isn’t usually an issue unless your child is already behind on their vaccines and needs to catch up. After all, there is a lot of flexibility built into the immunization schedule, so that your child could get all of their vaccines on time, even with a planned or unexpected surgery.

More on Surgery and Vaccines