Sunday, March 01, 2009

Influenza Marches On

Even as March begins and February is left in the dust, flu season shows no signs of abating. In the last week, two otherwise healthy teenage boys died from the complications of influenza infection in Maryland. It is unclear whether or not they had been vaccinated against the flu, but even the most optimistic prognosis tells us that this year's vaccination does not confer complete protection against some of the strains making their way around the country.

According to the Washington Post, 83 Americans under the age of 18 died from complications related to influenza last year. This year, 17 young Americans have died, not including the two Maryland teens.

Checking in on the CDC website devoted specifically to influenza, 24.6% of all specimens submitted to the CDC for testing have been positive for influenza, and the proportion of deaths is well below the "pandemic threshold".

In terms of the flu vaccine, it appears that several circulating B strains are indeed not covered by this year's vaccine, and several strains are also showing resistance to common antiviral drugs. Still, public health officials and the CDC recommend vaccination in order for susceptible members of the public to be afforded the most protection possible.

When checking on Google Flu Trends, one notes that high levels of flu activity can be seen in most regions of the country, although overall flu activity for the United States is still deemed as "moderate". This information mostly concurs with that of the CDC surveillance site, where widespread activity is seen throughout the northeastern, southeastern and southwestern US.

In terms of pandemic flu, resources have been mobilized by the federal government to prepare for such an eventuality, and public health officials like myself are regularly updated on how national preparations are developing. Unbeknownst to most Americans, enormous stockpiles of antiviral medications are currently stored in massive warehouses in every region of the country, and this Strategic National Stockpile (SNS) can be mobilized and delivered to local municipalities within 24-48 hours of its activation. Many of us public health officials have surveyed local schools and buildings as SNS sites for emergency dispensing of such medication, and plans have been submitted to the CDC so that we can quickly receive these deliveries from regional SNS sites.

The 1918 flu pandemic that killed anywhere from 20 to 100 million people worldwide does indeed seem like a long time ago, and protections against such an eventuality were at that time completely nonexistent. These days, the flu vaccine (which we realize can be woefully inadequate at times) and antiviral medications (to which some strains of the flu are resistant) do offer us some modicum of protection. Adding insult to injury, we are now seeing many secondary bacterial infections in patients with the flu, realizing that some of those infections are themselves antibiotic resistant organisms like MRSA (methycillin-resistant staph aureus), adding yet another layer of complication to the prevention and treatment of acute influenza.

Not to paint a picture of doom and gloom, I am simply pointing out that the surveillance, treatment and epidemiology of influenza has become increasingly complicated in the 21st century, and the likelihood of further resistant strains developing is rather high. Since most epidemiologists feel that a worldwide pandemic is indeed likely in the coming century, it seems that the judicious use of government resources to prepare for such an event is indeed quite prudent.

While I have not personally been touched by an influenza-related death, I feel deeply for the parents of children who have died during this flu season, and I hope that our collective efforts to thwart further unnecessary and tragic losses are widely successful. We've seen that influenza is no laughing matter, and being prepared for the worst often seems to be our best defense.
Post a Comment