About 675,000 Americans died during the flu pandemic of 1918–a toll 10 times greater than World War I. That’s one reason to fear the flu.
It’s unlikely that such a deadly flu attack will occur again. And one reason is that Americans–and their public health officials–fear the flu enough to take proper preventive action.
Influenza, commonly known as the flu, is a respiratory infection caused by one of several viruses. Symptoms are similar to those of the common cold, although usually more severe, including fever of 102 degrees or greater. The fever and the aches and pains usually subside a bit after the first few days, and the flu itself is usually not serious enough to require a visit to a doctor. Even in 1918, the majority of patients suffered through it and came out fine after a couple of weeks.
The danger comes primarily from serious complications such as pneumonia that sometimes occur in persons who are vulnerable. The other risk that was readily apparent in 1918 is that the virus spreads rapidly unless measures are taken to prevent or control it.
As in past years, the best thing you can do to protect yourself and others is to get a flu shot as early as possible. You should also wash your hands frequently, cover your coughs and sneezes and isolate yourself at home when you first note the symptoms. For your sake and those around you, stay home for 24 hours after your fever has returned to normal.
Get Vaccinated Soon
In many states, the flu vaccine has already been shipped out and should be readily available at doctors’ offices, pharmacies, workplaces, schools and other locations in your community.
Although the flu season typically peaks in mid-winter, the virus often starts showing up in early October. Last year’s shot isn’t going to do you any good this year, but there is no harm in getting this year’s vaccine as early as possible since it will protect you through the end of the season in May. From the time you get the shot, it will take two to three weeks for you to build up enough antibodies for full protection.
The Centers for Disease Control recommends vaccination for everyone six months of age and older. Getting a shot is particularly important for persons at high risk of developing serious complications such as pneumonia, a brain infection or meningitis should they become sick with the flu.
Those at risk include:
• persons with medical conditions such as asthma, diabetes and chronic lung disease;
• pregnant women;
• children younger than five;
• seniors age 65 and older;
• persons with compromised immunity; and
• caregivers of patients at risk of serious complications.
Although the vaccine is not safe for them, children younger than six months have a particularly high risk of serious complications. As a result, parents must take special precautions to see that they and all caregivers are properly protected.
An intranasal spray is recommended for children ages 2 to 8 because of its greater effectiveness. For a child getting vaccinated for the first time, two doses are necessary.
There is also a higher dose vaccine, primarily for persons age 65 and over and those with a weakened immune response. And, for individuals with an allergy to eggs, there is a vaccine grown without eggs.
Flu viruses circulating today are of three general types: A, B and C. C viruses usually cause milder illness; A viruses, which are constantly changing, are responsible for most large epidemics. The vaccine each year is designed to protect against the specific viruses that are expected to be the most prevalent that year based on international surveillance.
The traditional flu shot is trivalent, meaning that it protects against three different viruses. Some recently introduced shots and the FluMist spray are quadrivalent, protecting against four virus strains.
For 2014-2015, the trivalent vaccine will protect against
• a 2009 A (H1N1),
• a 2012 A (H3N2) and
• a 2012 B virus.
A second B strain is added to the quadrivalent vaccine.
The spread and severity of flu is determined largely by how closely the vaccine viruses match those in circulation. The percentage of Americans becoming ill from the flu each year ranges from 5 to 20 percent of the population. Over the past three decades, yearly deaths have been as low as 3,000 and as high as 49,000–a far cry from the 675,000 in 1918.
The flu is spread easily, primarily from droplets in the air from coughs or sneezes but also from touching objects such as door knobs. Anyone at any age can develop serious complications, but about 90 percent of deaths occur in persons age 65 and over.
Even if you’ve been vaccinated, it’s still possible to get the flu but symptoms will generally be less severe and the risk of complications is reduced. One study tracking flu outcomes over three seasons found that vaccination reduced the risk of hospitalization by 61 percent for persons age 50 and over.
With reversal of the seasons in the Southern Hemisphere, Australia experienced its peak flu season during August. And it was particularly severe, with more than twice as many infections reported compared to the previous year. About three quarters of infections are from an H1N1 virus similar to the one responsible for the pandemic of 2009. This was initially referred to as swine flu even though researchers eventually found that the origin and circulation came through humans rather than pigs.
Until a vaccine against this strain was developed, the H1N1 virus spread rapidly. Unlike other flu viruses, it tends to be more prevalent and have a greater effect on young, healthy persons rather than older ones. About 41 percent of hospitalizations were among older children and young adults.
By comparison, scientists believe that the virus responsible for the 1918 pandemic was making its first appearance in humans and, as a result, spread rapidly, aided in part by the movement of troops in World War I. Again, the effect on younger adults was much greater than to be expected. Nearly half the deaths were in young adults, 20 to 40 years of age and 92 percent in adults younger than 65.
Scientists know that it’s very difficult to predict what flu viruses will do in any given season. That’s reason enough to fear the flu and to take preventive action.
REFERENCES:
Blythe Bernhard, “The flu shot is available, and experts say get it now,” St. Louis Post Dispatch, August 2, 2014.
Centers for Disease Control, “Key facts about seasonal flu vaccine,” page last updated May 20, 2014.
Centers for Disease Control, “What you should know for the 2014-2015 influenza season,” last updated August 1, 2014.
Centers for Disease Control, “The 2009 H1N1 pandemic: summary highlights, April, 2009-April, 2010.”
Centers for Disease Control, “Reconstruction of the 1918 influenza pandemic virus,” last reviewed and updated July 17, 2014.
“Influenza overview,” New York Times Reference from ADAM.
Influenza Specialist Group, “2014-2015 northern hemisphere flu vaccine recommendation.”
Bridie Jabour, “Flu cases in Australia more than double last year’s number,” The Guardian, August 11, 2014.
Heath Kelly, “Worried about the flu season? Here’s the story behind the figures,” The Conversation, August 12, 2014.
“Swine flu returns as Australia suffers through severe flu season: experts,” ABC News, August 12, 2014.
Jeffery K. Taubenberger and David M. Morens, “1918 influenza: the mother of all pandemics,” Emerging Infectious Diseases, January, 2006.
“Types of flu,” WebMD Medical Reference, reviewed by David T. Demer, August 27, 2013,
Airlie Walsh, “Flu cases skyrocket as NSW faces outbreak,” 9 News, August 11, 2014.
09/19/2014
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