It’s Fall in New England. The nights are cool. Every farm market has stacks of pumpkins by the door and garden shops are awash with yellow, purple, and orange mums. I keep pushing my grocery cart past the Halloween candy, but I can feel my will power weakening. Won’t the trick or treaters just love Reese’s Peanut Butter Cups and Milky Way minis? Newsflash: we never have trick or treaters, so my husband and I get to eat all the candy! That’s why I buy our favorites.
Have you been caught up in the fun and excitement of Halloween preparations and missed the start of the 2018-2019 Flu season, which officially launched in September? Flu season has entered like a lamb but based on last years’ experience we should be prepared for the lion. In a summary of the recent flu season, the Centers for Disease Control and Prevention (CDC) classified the 2017-2018 season as “high severity.” Influenza is a nationally reportable disease for children, but not for adults, so the CDC accesses various datasets, including death certificate data, and uses mathematical models to estimate deaths and hospitalizations attributable to influenza. Since reporting requirements started in 2004, last year had the largest number of pediatric deaths from flu except for the 2009 influenza pandemic year. The CDC summary includes graphs showing the rising incidence of influenza-like illness (ILI) in November 2017 with peak sustained high activity in January and February of 2018.
Note: In this graph showing multiple years of influenza surveillance, the black line represents the 2017-2018 season. Week 40 in this graph is early October with week 52 representing the end of December. The black line peaks in weeks 2 to 8 representing January and February.
The CDC also published national ILI hospitalization data, again showing greatest incidence in the early new year.
It is insightful to have data from last year about the impact of the flu, but real-time data during the flu season would improve early detection of flu outbreaks and enable early response to prevent spread. Flu Near You is a crowdsourcing app created by Harvard, Boston Children’s Hospital, and The Skoll Global Threats Fund to provide weekly national views of ILI. This app is designed to capture family health information volunteered from the general public. It’s pretty simple to open the app and answer “How are you feeling today?” by clicking either “Great, thanks!” or “Not feeling well”. The app then tracks when you are not feeling well and, if you have ILI symptoms, collects your zip code and adds your data to the flu activity map. The hope is that you will report on your family’s health weekly during flu season.
A recent BMC Infectious Disease article compared the effectiveness of 5 influenza surveillance systems including:
- Patient visit data for ILI collected from the CDC U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet), which collects data entered by more than 2,800 outpatient providers around the country documenting patient visits
- World Health Organization (WHO) viral data
- Emergency Department Syndrome Surveillance from Boston, MA
- EHR-collected data on ILI symptoms
- Flu Near You voluntary data
Results from this study suggest that with sufficient numbers of people in an area voluntarily reporting symptoms, crowdsourced data correlates well with government tracking. About 250 local crowdsourcing responses or more are needed to provide meaningful ILI tracking data.
While real-time data about ILI improves local response to outbreaks and reduces spread of the disease, it’s most desirable to prevent flu altogether. Currently the most effective way to protect yourself, your family, and your community from influenza and serious flu complications like hospitalization is to get the flu vaccine. There was a lot of scuttlebutt last year about the flu-vaccine being less effective than expected because it did not generate antibodies to the predominant circulating influenza strain. In the year before flu season begins, the Food and Drug Administration (FDA), World Health Organization (WHO), and the CDC review influenza virus strains circulating around the world. The group identifies the strains most likely to cause illness in the upcoming season in the U.S. Last year the committee identified the correct virus strain, but the FDA reports that “subtle changes” occurred in the “seed” virus that was used to create the vaccine such that the antibody response did not perfectly match the antigens on the circulating flu virus. Last year’s flu vaccine was 40% effective which according to the CDC means, “…the flu vaccine reduced a person’s overall risk of having to seek medical care at a doctor’s office for flu illness by 40%.”
A 40% reduction in needing medical care is pretty significant. The government has not published data on the cost of the 2017-2018 flu season, but data from 2016-2017 is known. In 2016-2017 the flu vaccine prevented:
- ~5.3 million illnesses
- ~2.6 million medical visits
- ~85,000 hospitalizations
That’s nothing to sneeze at!
The seasonal flu vaccine targets 3 (trivalent) or 4 (quadrivalent) virus types. It always covers 2 influenza A types and either 1 or 2 Influenza B types. According to the FDA, this year the Influenza A H3N2 strain used to create the 2018-2019 flu season vaccine has switched from A Hong Kong to A Singapore and one of the Influenza B strains has switched from B/Brisbane to B/Colorado.
CDC recommends that most people 6 months or older should get an annual flu vaccine, particularly people who are at high risk for serious flu complications including:
- Children younger than 5 and adults older than 65
- Pregnant women
- Long-term care facility residents
- American Indians and Alaska natives
- People with chronic medical conditions listed here, including those with chronic kidney disease, heart disease, and lung disease
Fresenius Kidney Care along with other dialysis providers is busy this time of year vaccinating staff and patients against influenza. The 2018-19 Fresenius Kidney Care Influenza Campaign was launched to all facilities in August as recommended by the CDC. In addition to vaccination, the dialysis facilities will also focus on hand and respiratory hygiene (e.g. handwashing, covering mouth and nose when coughing or sneezing) to prevent viral spread.
For many of you seeing patients in the outpatient setting, EHRs make it easier to offer and track vaccinations for patients. For example, Acumen 2.0 provides reminders for when vaccines are due, including influenza, pneumonia, and hepatitis, based on CDC guidelines and recommendations. The Acumen workflow offers “actionable best practice alerts” at the point of care prompting immunization, with the ability to order the vaccine directly from the alert. Acumen functionality also includes the ability to run reports on which patients are due for vaccines, and MyChart uses the patient portal to alert patients directly when vaccines are due. I hear from the Acumen development team that in the future eCube and Acumen integration will include shared data about vaccination status.
I’m a member of the Partners Healthcare system in the Boston area and just this week I had a patient portal message reminding me to get my flu vaccine. I’m scheduled to get vaccinated at my office vaccination event later this month.
It’s a good time of year to get into flu prevention mode. Consider being active by contributing crowd-sourcing data for you and your family and watch weekly data on the U.S. flu map. Your personal data in real-time may shorten community response time to early influenza outbreaks. Consider helping to protect yourself, your family, and your community by getting the flu vaccine. CDC survey data suggests that the most common reason that health care workers do not get the flu vaccine is fear of side effects or getting sick from the vaccine. Here are flu vaccine facts from CDC:
- The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season.Trivalent vaccines are made to protect against three flu viruses; an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. Quadrivalent vaccines protect against four viruses; the same viruses as the trivalent vaccine as well as an additional B virus.
- Flu vaccines CANNOT cause the flu.Flu vaccines are made with either killed or weakened viruses.
- Flu vaccines are safe.Serious problems from the flu vaccine are very rare. The most common side effect that a person is likely to experience is soreness where the injection was given. This is generally mild and usually goes away after a day or two.
Patients in the hospital and in the dialysis facility are at high risk for flu complications and they are part of your community. Consider getting vaccinated to protect yourself and others.
Dugan Maddux, MD, FACP, is the Vice President for CKD Initiatives for FMC-NA. Before her foray into the business side of medicine, Dr. Maddux spent 18 years practicing nephrology in Danville, Virginia. During this time, she and her husband, Dr. Frank Maddux, developed a nephrology-focused Electronic Health Record. She and Frank also developed Voice Expeditions, which features the Nephrology Oral History project, a collection of interviews of the early dialysis pioneers.
Image from www.canstockphoto.com