Influenza Activity Declining, Flu-related Deaths Persist

Mar 23, 2018

03/30/18

UPDATE: The total number of flu-related deaths has reached 293, that’s up four from last week.

 

For the first time this flu season Allen County reported zero influenza-related deaths.

 

Last year, Indiana ended its flu season with a total of 103 deaths.

Bar graph of flu-related deaths: 2017 compared to 2018. Numbers according to Indiana State Department of Health.
Credit Araceli Gomez-Aldana

Week 10 numbers reflected flu activity is on the decline.

Since December 16, 2017, Indiana has been categorized with high influenza activity but is now at a regular level. As a result, the hospital visitor restrictions have been lifted.

 

In a phone interview with WBOI, Dr. Deborah McMahan, Allen County Health Commissioner, shared her thoughts on this year’s flu activity.

Q: This year Indiana saw a big jump in flu related deaths compared to previous years. Are officials concerned?

“Yes. This has really been an intense flu season. Fortunately, we had a bit of a heads up because Australia in the southern hemisphere. Their flu season is prior to ours, so we had just a little bit of a heads up. We did know that at least in Australia the H3N2 influenza A virus was the dominant strain and was the particular varialent. Unfortunately, we saw the same thing here. H3N2 was the dominate strain and we had an increase of number of deaths up and above what we normally would have, yes.”

 

Map of Indiana counties most affected by the influenza virus. Numbers according to Indiana State Department of Health.
Credit Araceli Gomez-Aldana

Q: Are there any factors that have caused this flu season to be worse than previous years?

“What’s been particularly remarkable about this flu season is not only the variance of the strain but the fact that it has gone on for so long. It’s been since December, and this is one of the longest times, I think in fact it’s the longest time we ever had visitor restrictions in place. We had essentially three waves of influenza with the last one being more of influenza B than the H3N2 influenza A. So it’s just been really a remarkable year for the number of people that have been presenting to emergency rooms, presenting to their physicians office, being hospitalized and finally, unfortunately, succumbing to influenza, bad, bad year.”  

Q: When looking at age demographics, adults make up the largest hospitalization population, but deaths are disproportionately affecting adults 65 years or older. Why does that difference exists?

“What can often happen, unfortunately they can die at home or they die in the emergency room so they don't make it to the point of being hospitalized. Often times folks, that are elderly or older than 65, what they end up dying from is they start with influenza and they survive that but then they get hit, because their immune system is so overwhelmed with the influenza, that then what happens is they get a secondary bacterial infection. Then they can actually die from a bacterial pneumonia. A lot of times people put things off when they get older. It’s an ordeal for them to get to the emergency room or to get to the doctor’s office. They think they can tough it out and there just comes a point with infectious diseases, especially influenza or a bacterial pneumonia, that you miss the opportunity to make an intervention.”

Q: Does the Fort Wayne-Allen County Department of Health do anything to make sure older adults are receiving the flu shot?

“We really push that with everyone but especially with folks that are older. What we have pushed now for the last five years is not just getting a flu shot but talk to the pharmacists talk to your doctor. What other respiratory protections vaccines do you qualify or meet the criteria for? Most older people should have at least one pneumonia vaccine if not two. One thing that we really need to continue to push is the high antigen flu vaccine. It’s for older folks, where they get a little extra antigen to stimulate a little bit of an immune response. It’s for people whose immune system might not respond to a normal vaccine. Though, we push flu vaccine on everyone.”

 

Q: There have been 108 outbreaks in long term care facilities and six schools outbreaks this year. How do those numbers compare to previous years?

“They are greater. See that is one of the reasons why when we implement visitor restrictions for hospitals we really encourage our long term care facilities to do so as well. Again, what people have to remember about the flu that’s different about other diseases or infections is that you could be shedding the virus or contagious before you even have a symptom. So you think you are doing a good thing by visiting grandma in the nursing home but the reality is you may be contagious at that point and when grandma gets sick in the nursing home there are going to be other people that get sick as well. Typically infectious things like that go through a nursing home pretty quickly. So that’s why we are fortunate we have fewer outbreaks here because we do implement or at least recommend those visitor restrictions.”

Q: When do you think we will start seeing a decrease in flu-related deaths? The number of hospitalizations and emergency room visits are slowing down but flu-related deaths continue to increase, why is there that disconnect?  

“I think you should expect a lag because sometimes there are two things that are most likely going to be the cause of death in somebody with influenza A. It could be a secondary bacterial pneumonia and depending how long they had those secondary symptoms they might die fairly quickly. But another thing with the virus like H3N2 is it stimulates such an intense inflammatory response from the body that often times they develop something called ARDS, Acute Respiratory Distress Syndrome. Their lungs become very stiff. It can take awhile for the lungs to heal. So consequently, often times when people acquire the ARDS they may die two or three weeks after they acquire the initial infection. So sometimes there is that lag between the time someone is admitted and the time to which they actually succumb.”

Q: As we move forward what can we expect for the rest of this flu season?

“We have seen a decrease of flu activity in the ERs and hospitals but that doesn’t mean there isn’t flu out there. Don't be deceived by sunshine and warmer weather. We can still see flu activity. We will then start seeing West Nile Virus activity so it's important to remember that we live in a living environment. What you need to do is take those precautions. Get vaccinated when you can, wash your hands whenever you can, and again stay home when you are sick. If you follow those simple things I think you can really minimize the chances that you are going to get something. Even if you do get it you’ll have less of a negative outcome.”

 

Indiana State Department of Health