Flu Vaccine Misses This Year's Most Common Strain, But Protection Guidelines Hold Steady
Influenza, better known as the flu virus, has a branding problem. Despite its potent 8th-place rank as a leading cause of death in the United States, last year only 42 percent of adults got vaccinated — a rate just two percentage points higher than it was in 2009. But the problem isn’t how loud flu experts are talking; the public hears them. The flu just isn’t scary enough to make them care.
This doesn’t stop federal agencies from trying. The Centers for Disease Control and Prevention just released its latest health advisory warning, alerting the public of influenza A (H3N2). In seasons past, when H3N2 has been the predominant strain, more people have been hospitalized and have died from the flu than when influenza A (H1N1) or influenza B strains have predominated. The CDC also points out that 52 percent of the H3N2 virus is antigenically different from the 2014-2015 vaccine, which means a flu shot won’t get the whole job done.
This Year's Flu, Again
The challenge for the CDC, and other public health officials, is conveying risk. Too often, a genuine health alert gets twisted into a seasonal scare tactic, delivered to a public that’s tired of being told to feel afraid. Out of this mix-up emerges inaction.
“We need to help people understand why the flu should be taken seriously,” said epidemiologist Dr. Jonathan Epstein, of EcoHealth Alliance, to Medical Daily. “Even if we had a 100-percent effective vaccine, I still think the challenge would be to get people to think it’s important.”
One arm of a successful approach is to make people aware of the facts. In 2010, the latest year data is available, 53,826 died as a result from influenza and pneumonia. This may paint the virus as a single entity. But like most viruses, the flu is actually a family of viruses, which can change genetically over the course of a year and render last year’s shot less-effective to this year’s virus. Unlike other leading causes of death, like cancer (No. 2 killer) and Alzheimer’s disease (No. 6), the flu is unique in that infection is mostly preventable.
“Mostly” is the operative word, unfortunately. The 52 percent of the H3N2 virus not covered by the latest vaccine is known as “drift,” and the best the public can hope for is that the latest vaccine cross-protects against another virus’s drift. So while the latest shot might not cover all of H3N2, it might pick up the slack in the aggregate.
On the bright side, vaccination is only one of three modes of protection. The same precautions that generally apply to infectious disease also apply to the flu, Epstein says. “It's important for people to appreciate how effective personal hygiene and social etiquette when sick are as tools to reduce the risk of flu infection.” These include regular hand washing and avoiding public places when sick.
In addition, H3N2 has drifted enough for the CDC to re-emphasize the role antiviral medications play in treating current flu cases and preventing future ones. These include Tamiflu (oseltamivir) and Relenza (zanamivir), which have already been shown in past years, such as the 2009 H1N1 pandemic, to have clinical and public health benefits. People taking these meds gets sicker less often and don’t have to suffer through symptoms for as long.
In this sense, death may not be the best tool for officials to wield in convincing the public to get vaccinated. Death from the flu is decidedly rare. The eighth-place spot is alarming, but still one-tenth the deaths chalked up to the leading cause: heart disease. Perhaps the most compelling motivator is that based on the latest estimates, vaccination prevented as many as 6.6 million influenza illnesses and 3.2 million medically attended illnesses, or those you’d need to drive to the hospital for. So while it may be easy to think a flu shot isn’t necessary when everyone else is healthy, herd immunity isn’t a spectator sport. Everyone can contribute.
Respecting the Risk
Earlier this year, when seven people in the United States were infected with Ebola at the same time, in different parts of the country, not even the most sophisticated quarantine efforts could quell a sense of public fear. And that’s because the perception of risk was huge. Ebola was part of “the unknown,” its dangers revived on 24-hour news cycles.
But the flu is familiar, and we like to think — naively — that familiar things can’t hurt us. This, of course, is patently false. “Flu does present a risk,” Epstein said. “I think the challenge for public health is to impress upon people that it can be serious, that people die in significant numbers every year, and that these deaths are largely preventable.”