In Vermont, the rate of people seeking medical treatment for flu-like symptoms is more than double what it was at this time last year, with greater than 91% of the laboratory results confirming the presence of the H3N2 influenza subtype that has come to dominate seasonal flu statistics in recent years.
A genetic variation of the virus that caused a deadly pandemic and killed more than a million people in 1968, this year’s strain of H3N2 influenza has sickened more than 12,000 people across the U.S. according to the Centers for Disease Control and Prevention (CDC).
Dr. Louis DiNicola, who serves as director of primary care at Gifford Medical Center, said a series of mutations since first emerging in Australia last year, as well as a manufacturing glitch that caused this year’s flu vaccine to be considered roughly 30 percent effective, have lent to H3N2’s severity this year.
“H3N2 is particularly nasty,” said DiNicola. “That, itself, means that if you do get sick you are more likely to be sicker.”
Known as “antigenic drift,” the mutations in the virus that rendered it less responsive to the already-produced vaccine came about when the proteins hemagglutinin and neuraminidase—the “H” and “N” of H3N2—underwent minuscule changes on the surface of the virus. As a result, the newly re-configured virus is less likely to be recognized as an invader by a patient’s immune system.
All Ages Afflicted
A longtime pediatrician, DiNicola is particularly worried about the dangerous effect that H3N2 has had on young and school-aged children this year, citing numbers from the CDC that confirmed at least 37 pediatric deaths nationwide.
“Which is about double what we had last year at this point,” said DiNicola somberly. “In our worst years— for pediatrics—in 2014-2015, they hit 148 [pediatric deaths]. I think we’re going to bypass that.”
Locally, DiNicola is unable to conduct laboratory tests on every patient who presents with flu-like symptoms, but did say that this year’s flu season has been the busiest in years.
Of the kids who have shown up at the Gifford pediatric offices, “about a third … had classic influenza symptoms,” he said while emphasizing that this year’s patients spanned all ages, a fact that has prompted officials to close schools in 12 states due to high absenteeism.
“The 25-50 age group is getting hit pretty hard,” said DiNicola, speculating that, like the 1918 Spanish Flu pandemic, younger people simply haven’t had as much exposure to the newer strain of the H3N2 subtype as previous generations, making them susceptible to infection.
“Get the flu vaccine, get the flu vaccine, get the flu vaccine,” exclaimed DiNicola when asked about the best steps to avoid getting sick.
“The evidence is strong in Randolph, it’s strong nationally, if you get the flu vaccine,” he said, “the disease tends to be shorter and less severe.”
Whether or not you get the vaccine, DiNicola also recommends basic health precautions, such as covering your mouth and nose when sneezing or coughing, frequent hand washing with soap and hot water, and limiting contact with people exhibiting flu-like symptoms.
Parents should be quick to get their child to a doctor if they observe any flu-like symptoms, including fever, chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue.
“It traditionally hits suddenly,” said DiNicola, who described a condition called “viremia,” where pockets of the virus pour from a person’s mucus membranes into the bloodstream, causing a slew of severe symptoms to arrive all at once.
“What I hear from parents is that ‘she got up, she ate breakfast, she looked okay. And right before lunch she got flushed, red-hot, she didn’t move,” he said.
DiNicola also recommends a preventative course of the prescription antiviral drug Tamiflu in the event of sudden and obvious exposure to influenza, preferably within the first few hours after exposure.
“Tamiflu is extremely effective for all the strains that are out there right now,” said DiNicola, who also said Tamiflu helps to shorten the severity and duration of the flu, even in cases of H3N2. “If you get Tamiflu within 48 hours of coming down with symptoms, the likelihood of either dying from it or being hospitalized from it goes way down.”
In addition to antiviral medications, DiNicola stresses that, once infected with influenza of any strain, that patients, especially the elderly, get the correct balance of rest and mobility to increase their chances of making a full recovery.
“You need to rest because your body needs to recover, but don’t lay down for eight hours,” he said. “You need to be up, walking around, as best you can, around your house. Getting up, getting down, mobilizing your muscles, allowing yourself to breathe a little bit harder to clear your lungs,” he said. Several variations of pneumonia are a major risk for influenza patients.
Finally, DiNicola emphasizes that anybody experiencing flu-like symptoms take extra care to avoid dehydration, which can compound the effects of bacterial or viral pneumonia. “Drink plenty of fluids,” he said. “It’s much less important [that] you eat food, but drink fluids—and yes, chicken soup helps.”