Flu season hitting early and severely

By Warren King
Seattle Times medical reporter

E-mail this article Print this article Search archive

At least three deaths linked to influenza have occurred in Washington state this fall in one of the earliest flu seasons in memory, health officials say.

Three residents of two Yakima County nursing homes have died this month, and other indicators show influenza is widespread in the state, including King County.

"We're right in the middle of it. It's the earliest (flu-season start) I've ever seen," said Phyllis Shoemaker, an influenza epidemiologist for the state Department of Health for 20 years.

The concern in the state comes as national health officials brace for a severe flu season. In Colorado, at least three children have died from the flu in the past two weeks, and a fourth case is under review.

Nearly 4,000 cases have been reported in adults and children there so far this fall. Texas and Nevada also have been hit hard.

Information on flu vaccinations Flu symptoms The influenza virus attacks the respiratory tract but is different from a cold. Influenza usually comes on suddenly and may include these symptoms: • Fever • Headache • Tiredness (can be extreme) • Dry cough • Sore throat • Nasal congestion • Body aches A new vaccine, FluMist, is given in a nasal spray but is not recommended for certain groups because it contains a weakened, live virus. The groups include people younger than age 5 or older than 50, those with immune deficiency, asthma, chronic diseases of the heart, lung and other disorders, and pregnant women. Consult your physician about whether you can receive the vaccine. More information is available at the company's Web site: www.flumist.com Flu shots are available through private physicians and clinics, through the clinics of Public Health — Seattle & King County and the Snohomish Health District. For more information: Public Health — Seattle & King County: 206-296-4949 or www.metrokc.gov/health/sts_svs/immuniz.htm Snohomish Health District: 425-339-5224 or www.snohd.org Source: Centers for Disease Control and Prevention

In a typical year in the United States, about 36,000 people die from the flu, and 114,000 are hospitalized. Citing the early outbreaks this year, officials with the Centers for Disease Control and Prevention have repeatedly urged flu vaccinations.

No deaths or nursing-home outbreaks have been reported in King County.

But school absenteeism of more than 10 percent due to flulike illness was reported in 27 King County schools last week — nearly three times the previous week's count. A total of 59 schools in 19 counties statewide reported that level of absenteeism last week.

"There's a possibility we'll have a more severe season than usual," said Dr. Jeff Duchin, communicable-disease chief for Public Health — Seattle & King County.

Duchin and other health authorities are urging flu vaccinations, especially for older adults and others at risk of complications from the disease.

All three of the Yakima County nursing-home residents had other medical problems that probably were aggravated by flu, health officials said. A new, rapid test indicated the residents had influenza. The test also has revealed flu in three other Yakima County nursing homes.

No other information about the residents was available, said Marianne Patnode, coordinator for communicable-disease services for the Yakima Health District. State regulations don't require reporting of influenza cases.

Duchin and Dr. Jo Hofmann, state communicable-disease epidemiologist, said there is no way to know how long the season will last or how severe it might be. Authorities track the disease week to week by watching school absences, voluntary nursing-home reports, laboratory testing, physician surveys and respiratory illnesses in emergency rooms.

Authorities are concerned because the virus targeted by this year's vaccine has changed slightly since the vaccine was developed.

At the end of each flu season, the vaccine is designed for the following year based on the most recent viruses and other factors. Last summer, a slight variant of the major type A flu emerged in Australia and New Zealand. And now more than 70 percent of the flu-virus samples from around the country being tested by the CDC are the variant, H3N2 Fujian.

The CDC this week reported on the first three samples sent from Washington state in late October. All three were the variant and all three were from Washington State University students. Shoemaker said she plans to obtain samples from Western Washington counties next week, including King, Snohomish and Whatcom counties.

The CDC said the current vaccine won't work as well against the variant as it will against the major type A strain. But the agency said "it is expected that the current U.S. vaccine will offer some immunity against the (variant) and reduce the severity of the disease."

Health authorities recommend flu vaccinations for: • People age 50 and older. • Residents of long-term care facilities. • Women who will be more than 3 months pregnant during the flu season. • Adults and children age 6 months and older with chronic lung, heart or kidney conditions, diabetes or impaired immune systems. • Children who are receiving long-term aspirin therapy. • Health-care workers. • People who will be in close contact with those at high risk of flu complications. • Healthy children age 6 months to 2 years, their household contacts and out-of-home caretakers.

Influenza experts for several years have warned that a pandemic, or worldwide epidemic, could occur anytime, as they do every 20 to 50 years. It has been more than 30 years since the last pandemic, the Hong Kong flu in 1968-69.

But such outbreaks happen only when a major new strain of the virus, an "antigenic shift," emerges that is not covered at all by the existing vaccine. The current variant is only a "drift," or slight shift, in the structure of the virus that has circulated for years.

For the first time, vaccinations are offered in two forms this year: the traditional vaccine containing a dead flu virus and given by injection, and a nasal spray that contains a weakened, live virus.

Makers of the sprayed vaccine, FluMist, hoped it would be popular among those who do not like needles. But the company, MedImmune, has said it isn't selling well. It is not recommended for many people, including those younger than 5 and older than 50, those with respiratory problems, immune deficiency or certain metabolic diseases or pregnant women.

People who receive the mist may be contagious with the weakened virus for about eight days. So the CDC recommends the traditional vaccine for those in close contact with immune-suppressed people.

Flu season typically lasts into the spring, so health authorities emphasize that a vaccination is still recommended through winter. That is especially important, they say, in this flu season of uncertainty.

"If you don't get a shot, you're taking your chances," Shoemaker said.

Complications of influenza include pneumonia, bronchitis, and sinus and ear infections.

People age 65 and older, very young children and people with chronic medical conditions are most likely to have complications. For example, the flu aggravates asthma and congestive heart failure.

Material from the Associated Press was used in this report. Warren King: 206-464-2247 or wking@seattletimes.com

Copyright © 2003 The Seattle Times Company