Posted in flu, Health, news

Flu Shot Found to be More Effective Than Nasal Mist Flu Vaccine

A new study published in Pediatrics reports the nasal FluMist vaccine to be less effective in treating the flu as compared to the traditional flu shot.

Study authors combined data from 5 US studies and found of the 17,173 children aged 2-17 reviewed, the flu shot was 67% effective where as the nasal spray (FluMist) was only 20% effective and protecting against the flu.

FluMist is a live attenuated vaccine that is not recommended in infants and pregnant women. It is indicated for those between the ages of 2-49 and introduces a live, weakened version of the flu virus to incite an immune response.  This differs from the injectable flu vaccine which uses killed versions of the flu strains to induce a flu response.

Children prefer the FluMist as the nasal spray offers a less painful option than an injection.

The US Centers for Disease Control and Prevention advisory committee voted last Fall to return the FluMist, nasal spray flu vaccine, to the recommended options for the 2018-2019 flu season.

In 2016 it was not recommended and discouraged as they found its effectiveness against seasonal flu to be approximately 46%, when 65% efficacy was touted by the injectable flu shot.  However during the 2017-2018 flu season, the current flu vaccine was found to be only 35% effective with one of the worst flu seasons in years taking the lives of healthy young adults and children.

Why was last season so severe? The H3N2 strain was the predominant one, notorious for bad flu seasons, and is crafty, able to mutate before the vaccine is finalized.  Hence our flu vaccine was not able to be as close a match as desired.

The panel voted 12-2 to include FluMist as an option for medical providers to recommend against the upcoming 2018-2019 flu season.

Why was FluMist removed?  Experts found it to be ineffective against one of the influenza A H1N1 strains. With its overall efficacy found to be lower than the flu shot it was deemed a less ideal option than the shot.

This year the H1N1 strain appears to be more prevalent.

The FluMist Quadrivalent nasal spray, manufactured by MedImmune of AstraZeneca PLC, offers protection against 4 strains of flu including H1N1, H3N2 and two influenza B strains.  According to FluMist’s prescribing information, the FluMist proved 90% effective against H3N2 as opposed to influenza B where it scored 44.3% effectiveness.   Another review found its efficacy against H3N2 to be 79%.

slide_25

Now that’s not to say the FluMist would have been immune to the vaccine issues experienced with last year’s flu shot as H3N2 is a highly virulent and mutable virus, and could have snowed the FluMist vaccine makers as well.

Yet we may need to consider that the FluMist may be more efficacious for some strains of the flu whereas the flu shot may better protect us against others.  More research needs to be done in this area. As of now choosing which flu shot to get for the next flu season may be a crap shoot.

For more on the study click here. 

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

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Posted in flu, Health, news

Flu Now Widespread in Multiple States

The CDC has reported an increase in flu activity during our 52nd week of the year ending on 12/29/18.

The CDC reports outpatient visits for influenza-like illness (ILI) jumped to 4.1%, above the national baseline of 2.2%.

 

cdc map.gif

The CDC states the following:

New York City and 19 states experienced high ILI activity; nine states experienced moderate ILI activity; the District of Columbia and 10 states experienced low ILI activity; and Puerto Rico and 12 states experienced minimal ILI activity.

States experiencing high ILI activity include:

  • Alabama
  • Arizona
  • Colorado
  • Georgia
  • Illinois
  • Indiana
  • Kansas
  • Kentucky
  • Louisiana
  • Massachusetts
  • Mississippi
  • Nevada
  • New Jersey
  • New Mexico
  • Oklahoma
  • South Carolina
  • Texas
  • Utah
  • Virginia

 

States experiencing moderate ILI activity include:

  • Arkansas
  • California
  • Michigan
  • Missouri
  • New York
  • North Carolina
  • Pennsylvania
  • Rhode Island
  • Vermont

 

Low and minimal activity (noted in yellow and green) has been reported in the remaining states as well as Puerto Rico.

flu-survey-map (1)

Image from CDC

 

Currently it appears the majority of flu cases are caused by the H1N1 Influenza A strain. Even though the H1N1 caused an epidemic in 2009, this may forbode a less severe flu season from last year’s H3N2 epidemic.

The Flu – Your Questions Answered

__________________________________________________________

When does flu season begin and how long does it last?

Flu season has begun already. It typically starts in the Fall, and ends late Spring.  So the range is described as October to May with it peaking December to March.

How bad will this flu season be?

It is difficult to predict, but already this early in the season we’ve had multiple flu related deaths reported by the CDC’s Flu View.

What is the flu?  How can one die from it?

The flu is caused by a virus. Multiple strains of virus’ can cause the flu.  The virus itself can be lethal, however the greatest risk comes with what it does to your immune system, thereby putting one at risk of secondary infections.  Pneumonia is the number one cause of flu-related deaths.  Secondly, it can exacerbate existing conditions such as asthma, seizures, even promote preterm birth, hence those who are pregnant or have preexisting medical conditions are urged to get vaccinated against the flu.  Moreover those who qualify should get the pneumonia vaccine as well.

 

h1n1-swine-flu-virus
h1n1 virus

 

What does this year’s flu vaccine cover?

According to the CDC, the trivalent vaccine covers for these three strains of flu virus:

  • A/Michigan/45/2015 (H1N1)pdm09–like virus
  • A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus
  • B/Colorado/06/2017–like virus (Victoria lineage)

Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).

These vaccines are aimed at providing protection against the Swine flu, and some influenza A and B strains.

What about older individuals?

This year, those over 65 will have three options for their flu vaccine.

Fluzone High-Dose – a higher dose flu vaccine that will hopefully allow their immunity to protect against the flu longer

FLUAD – the trivalent flu vaccine with an adjuvant to stimulate more of an immune response.

Flublock Quadrivalent – provides protection against 4 strains.

What about the nasal spray vaccine?

This year, the CDC allows use of the nasal spray vaccine as it has shown to have improved efficacy from  prior years. However it is only recommended for  those who are between the ages of 2 and 49 and cannot be given to those who are pregnancy or who have compromising medical conditions as outlined by the CDC.

Who should get the flu shot?

All individuals 6 months old and older unless specified by their medical provider.

What if I’m allergic to eggs?

Most individuals allergic to eggs can still get the flu vaccine, but if the allergy to eggs is severe (anaphylaxis, angioedema, difficulty breathing), the CDC recommends notifying your medical provider and being in a facility to monitor you if you do get the flu vaccine.

Will I get the flu from the flu shot?

No.  The flu vaccine has a “killed” version of the virus meaning it’s not an active virus (as opposed to a live attenuated vaccine, a weakened down version of it).   A “killed” or “inactivated” vaccine merely has the pathogen particles to induce an immune response.  Additionally, when one states they got the flu despite the flu shot it could be that the flu shot only protects against 3 – 4 strains and they were infected with a more rare strain not covered by the vaccine.

How effective is the flu vaccine?

The average effectiveness each year hovers around 60%.  Last year’s efficacy was much lower and this year’s has not been predicted as of yet. Australia is still reporting active cases on their Department of Health website.

I feel sick after the flu shot, why?

For some, the immune response that ensues can make one feel mildly ill, but should not resemble the flu. Those who state they got the flu “immediately” after receiving the shot, might have already been exposed and had not had a chance to produce immunity prior to their exposure.

sneezing

 

What are symptoms of the flu? How is it different from a cold?

A cold comes on slower and less severe.  Flu symptoms are more abrupt and can include:

  • Fever
  • Body Aches
  • Cough
  • Sneezing
  • Sore Throat
  • Shortness of Breath
  • Fatigue
  • Headache
  • Nausea
  • Vomiting

Are there medications to treat the flu? Will antibiotics work?

There are antiviral medications available, such as Tamiflu, to treat the flu.  Antibiotics, however, will not work since the flu is not caused by a bacteria but rather a virus. However if a secondary bacterial infection takes over, antibiotics may be used.

How can I prevent getting the flu?

Besides vaccination, avoid being around those who are sick, thorough hand washing, and take good care of yourself.  A balanced diet, exercise and sleep regimen can help boost your immune system.

Wishing you health this season!!

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in flu, Health, news

How to Soothe Your Sore Throat

It’s cough and cold season and with this may come the notorious sore throat.  But many who suffer don’t know when to see a medical provider or when to whisper prayers that it goes away on its own. Here are your questions answered.

What causes a sore throat?

The throat comprises the pharynx and the larynx (voice box).  For those of us who still own tonsils, they reside within the pharynx.

sore-throat-lg.jpg

If the throat becomes inflamed, pain and swelling can ensue.

Causes of sore throats include:

  • infection
  • post nasal drip
  • stomach acid from GERD (gastroesophageal reflux disease)
  • allergies
  • voice strain
  • pollution
  • smoke
  • environmental irritants
  • tumors
  • and more….

 

How can I tell if I need antibiotics for my sore throat?

If we have a virally-induced cold that starts off with the sniffles followed by a sore throat, then a cough, and doesn’t come with a fever, we watch the symptoms closely but hold off on antibiotics if we feel its viral in nature.

If however symptoms come on aggressively such as a fever persists, neck glands swell, pus/exudates cover the tonsils, and the sore throat gets worse each day, your medical provider may perform a strep screen to check for streptococcus bacteria, or perform a culture.  If positive, he/she may offer a prescription for antibiotics.

strep.JPG

 

What soothes a sore throat?

Assuming you don’t need antibiotics to treat a bacterial infection, any of the following may provide some temporary relief:

Gargling with salt water also offers relief as it introduces fluids and attracts more fluid to the area due to the salt content.

To help quell your cough, read below:

Winter Cold or Flu? How to Quell Your Cough

 

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

 

 

Posted in flu, Health, news

New Flu Medication May Save Lives This Flu Season

The FDA has approved a new drug, Xofluza (baloxavir marboxil), to help fight the flu this season.

The antiviral is a single dose and is taken within 48 hours of first signs of flu symptoms.

It is only indicated in those older than 12 years old.  The cost is approximately $150 for the single dose.

Current antiviral medications approved by the FDA to shorten the course of the flu include Relenza and Tamiflu.  These medications are in a class of neuraminidase inhibitors, which inhibit the release of new viral particles that have replicated in a host (patient).

09f1.jpeg

Xofluza, however, works sooner, by preventing the virus from replicating within the host cell in the first place.

Therefore this new drug can stop the spread of flu earlier than its predecessors.

NBC News reported the following:

A 2016-2017 study in 1,436 people in the U.S. and Japan showed the one-dose pill cut the time people were sick to 2.5 days, from about 3.3 days. It cut how long people had a fever from an average of 42 hours to just one day. It also reduced what’s called viral shedding from four days to just one day.

So the less time one is sick with the flu, the less risk of coming down with a secondary infection such as pneumonia, or other flu related illness.

Moreover if viral shedding is decreased, less family members and contacts can potentially become ill.

Now Xofluza may not prevent the flu in one who has not been exposed because it works by preventing virus that is present from replicating.

Flu symptoms may come abruptly and include:

  • Fever
  • Body Aches
  • Cough
  • Sneezing
  • Sore Throat
  • Shortness of Breath
  • Fatigue
  • Headache
  • Nausea
  • Vomiting

The most effective way to prevent the flu is avoidance of sick contacts, good hand washing and vaccination.

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

 

 

Posted in flu, Health, news

80,000 Americans Died From Flu-Related Illness Last Year

We knew last year’s flu season was deadly, but we didn’t expect this.    The CDC has this week revealed the following: over 80,000 Americans died last year from flu-related illness. This is double and even triple previous flu seasons.  Thus the 2017-2018 season was one the deadliest in decades, nearly matching the 1976-1977 swine flu outbreak.

Last year’s pandemic was most notably caused by H3N2.  This notorious strain can sneakily avoid being replicated in a vaccine, hence our flu shot efficacy last year was only 16%.

Flu Deaths: Are We Missing a Severe Pneumonia Season?

The most common cause of death was pneumonia.  Which makes us wonder if we are dealing with more severe pneumonia causing strains as well.

 

When does flu season begin and how long does it last?

Flu season has begun already. It typically starts in the Fall, and ends late Spring.  So the range is described as October to May with it peaking December to March.

How bad will this flu season be?

It is difficult to predict, but already this early in the season we’ve had multiple flu related deaths reported by the CDC’s Flu View.

What is the flu?  How can one die from it?

The flu is caused by a virus. Multiple strains of virus’ can cause the flu.  The virus itself can be lethal, however the greatest risk comes with what it does to your immune system, thereby putting one at risk of secondary infections.  Pneumonia is the number one cause of flu-related deaths.  Secondly, it can exacerbate existing conditions such as asthma, seizures, even promote preterm birth, hence those who are pregnant or have preexisting medical conditions are urged to get vaccinated against the flu.  Moreover those who qualify should get the pneumonia vaccine as well.

 

h1n1-swine-flu-virus
h1n1 virus

 

What does this year’s flu vaccine cover?

According to the CDC, the trivalent vaccine covers for these three strains of flu virus:

  • A/Michigan/45/2015 (H1N1)pdm09–like virus
  • A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus
  • B/Colorado/06/2017–like virus (Victoria lineage)

Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).

These vaccines are aimed at providing protection against the Swine flu, and some influenza A and B strains.

What about older individuals?

This year, those over 65 will have three options for their flu vaccine.

Fluzone High-Dose – a higher dose flu vaccine that will hopefully allow their immunity to protect against the flu longer

FLUAD – the trivalent flu vaccine with an adjuvant to stimulate more of an immune response.

Flublock Quadrivalent – provides protection against 4 strains.

What about the nasal spray vaccine?

This year, the CDC allows use of the nasal spray vaccine as it has shown to have improved efficacy from  prior years. However it is only recommended for  those who are between the ages of 2 and 49 and cannot be given to those who are pregnancy or who have compromising medical conditions as outlined by the CDC.

Who should get the flu shot?

All individuals 6 months old and older unless specified by their medical provider.

What if I’m allergic to eggs?

Most individuals allergic to eggs can still get the flu vaccine, but if the allergy to eggs is severe (anaphylaxis, angioedema, difficulty breathing), the CDC recommends notifying your medical provider and being in a facility to monitor you if you do get the flu vaccine.

Will I get the flu from the flu shot?

No.  The flu vaccine has a “killed” version of the virus meaning it’s not an active virus (as opposed to a live attenuated vaccine, a weakened down version of it).   A “killed” or “inactivated” vaccine merely has the pathogen particles to induce an immune response.  Additionally, when one states they got the flu despite the flu shot it could be that the flu shot only protects against 3 – 4 strains and they were infected with a more rare strain not covered by the vaccine.

How effective is the flu vaccine?

The average effectiveness each year hovers around 60%.  Last year’s efficacy was much lower and this year’s has not been predicted as of yet. Australia is still reporting active cases on their Department of Health website.

I feel sick after the flu shot, why?

For some, the immune response that ensues can make one feel mildly ill, but should not resemble the flu. Those who state they got the flu “immediately” after receiving the shot, might have already been exposed and had not had a chance to produce immunity prior to their exposure.

sneezing

 

What are symptoms of the flu? How is it different from a cold?

A cold comes on slower and less severe.  Flu symptoms are more abrupt and can include:

  • Fever
  • Body Aches
  • Cough
  • Sneezing
  • Sore Throat
  • Shortness of Breath
  • Fatigue
  • Headache
  • Nausea
  • Vomiting

Are there medications to treat the flu? Will antibiotics work?

There are antiviral medications available, such as Tamiflu, to treat the flu.  Antibiotics, however, will not work since the flu is not caused by a bacteria but rather a virus. However if a secondary bacterial infection takes over, antibiotics may be used.

How can I prevent getting the flu?

Besides vaccination, avoid being around those who are sick, thorough hand washing, and take good care of yourself.  A balanced diet, exercise and sleep regimen can help boost your immune system.

Wishing you health this season!!

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

 

Posted in flu, Health, news

This Year’s Flu Season Has Begun

Flu season has already begun, with three cases being reported in Western Massachusetts, and this year may be different from those past as the CDC has made multiple new recommendations and different options made available for the public.  Let’s answer your questions.

 

When does flu season begin and how long does it last?

Flu season has begun already. It typically starts in the Fall, and ends late Spring.  So the range is described as October to May with it peaking December to March.

How bad will this flu season be?

It is difficult to predict, but already this early in the season we’ve had multiple flu related deaths reported by the CDC’s Flu View.

What is the flu?  How can one die from it?

The flu is caused by a virus. Multiple strains of virus’ can cause the flu.  The virus itself can be lethal, however the greatest risk comes with what it does to your immune system, thereby putting one at risk of secondary infections.  Pneumonia is the number one cause of flu-related deaths.  Secondly, it can exacerbate existing conditions such as asthma, seizures, even promote preterm birth, hence those who are pregnant or have preexisting medical conditions are urged to get vaccinated against the flu.  Moreover those who qualify should get the pneumonia vaccine as well.

 

h1n1-swine-flu-virus
h1n1 virus

 

What does this year’s flu vaccine cover?

According to the CDC, the trivalent vaccine covers for these three strains of flu virus:

  • A/Michigan/45/2015 (H1N1)pdm09–like virus
  • A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus
  • B/Colorado/06/2017–like virus (Victoria lineage)

Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).

These vaccines are aimed at providing protection against the Swine flu, and some influenza A and B strains.

What about older individuals?

This year, those over 65 will have three options for their flu vaccine.

Fluzone High-Dose – a higher dose flu vaccine that will hopefully allow their immunity to protect against the flu longer

FLUAD – the trivalent flu vaccine with an adjuvant to stimulate more of an immune response.

Flublock Quadrivalent – provides protection against 4 strains.

What about the nasal spray vaccine?

This year, the CDC allows use of the nasal spray vaccine as it has shown to have improved efficacy from  prior years. However it is only recommended for  those who are between the ages of 2 and 49 and cannot be given to those who are pregnancy or who have compromising medical conditions as outlined by the CDC.

Who should get the flu shot?

All individuals 6 months old and older unless specified by their medical provider.

What if I’m allergic to eggs?

Most individuals allergic to eggs can still get the flu vaccine, but if the allergy to eggs is severe (anaphylaxis, angioedema, difficulty breathing), the CDC recommends notifying your medical provider and being in a facility to monitor you if you do get the flu vaccine.

Will I get the flu from the flu shot?

No.  The flu vaccine has a “killed” version of the virus meaning it’s not an active virus (as opposed to a live attenuated vaccine, a weakened down version of it).   A “killed” or “inactivated” vaccine merely has the pathogen particles to induce an immune response.  Additionally, when one states they got the flu despite the flu shot it could be that the flu shot only protects against 3 – 4 strains and they were infected with a more rare strain not covered by the vaccine.

How effective is the flu vaccine?

The average effectiveness each year hovers around 60%.  Last year’s efficacy was much lower and this year’s has not been predicted as of yet. Australia is still reporting active cases on their Department of Health website.

I feel sick after the flu shot, why?

For some, the immune response that ensues can make one feel mildly ill, but should not resemble the flu. Those who state they got the flu “immediately” after receiving the shot, might have already been exposed and had not had a chance to produce immunity prior to their exposure.

sneezing

 

What are symptoms of the flu? How is it different from a cold?

A cold comes on slower and less severe.  Flu symptoms are more abrupt and can include:

  • Fever
  • Body Aches
  • Cough
  • Sneezing
  • Sore Throat
  • Shortness of Breath
  • Fatigue
  • Headache
  • Nausea
  • Vomiting

Are there medications to treat the flu? Will antibiotics work?

There are antiviral medications available, such as Tamiflu, to treat the flu.  Antibiotics, however, will not work since the flu is not caused by a bacteria but rather a virus. However if a secondary bacterial infection takes over, antibiotics may be used.

How can I prevent getting the flu?

Besides vaccination, avoid being around those who are sick, thorough hand washing, and take good care of yourself.  A balanced diet, exercise and sleep regimen can help boost your immune system.

Wishing you health this season!!

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

 

Posted in flu, Health, news

Obese Flu Patients are More Contagious

A study published in the Journal of Infectious Diseases found if an individual with the flu is also obese, they may be more contagious.

Researchers from the University of Michigan School of Public Health looked at 1,800 people from 320 Nicaraguan households during the flu seasons of 2015-2017.

Drugs.com reported that obese adults with the flu shed the influenza A virus 42 percent longer than non-obese adults with the flu.  And those who had no symptoms, or were mildly ill, shed the influenza A virus 104% longer than non-obese adults with the flu.

There did not appear to be a correlation with obese children and flu transmission length.

Influenza A is more commonly involved in pandemics than Influenza B.

influenza.jpg

Now previous studies have demonstrated how obese individuals are more likely to incur complications from the flu, but this study is unique in that it looked at transmission of the virus.

Researchers believe that an obese individual may have a weakened immune system, thereby not only becoming more vulnerable to the flu but also unable to “clear” the virus, thus shedding it more.

What are the symptoms of the flu?

The most common symptoms of the flu include:

  • Fever
  • Body Aches
  • Cough
  • Sneezing
  • Sore Throat
  • Shortness of Breath
  • Rapid Breathing
  • Rapid Heart Rate
  • Fatigue
  • Headache
  • Nausea
  • Vomiting

As opposed to a cold, in which symptoms are less severe and come on more slowly, the flu seems to hit you within hours.   The fatigue may be the first symptom, followed by body aches, scratchy throat, cough, runny nose and then fever. The fever could range anywhere from 100 – 106 F.  The fever usually lasts 2 days and the majority of those affected by the flu will average symptoms from 3-5 days.

Vaccination is recommended for all persons aged ≥6 months who do not have contraindications, according to the CDC.

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada