Influenza in the United States continued to strike hard at children, with 9 additional pediatric deaths last week, bringing the total for this season to 29.
The week of Jan. 6-12 was also hard on adults aged 65 and older. For this group, the influenza-related hospitalization rate was 82/100,000 population – strikingly higher than the national rate of 19/100,000 population, Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said in a press briefing.
"We are about halfway through this flu season, and it’s shaping up to be worse than average and particularly hard on the elderly" Dr. Frieden said. "Influenza always takes the heaviest toll on seniors, especially when H3N2 is the prevalent strain, as it is this year." Surveillance methods are available online.
Thirty states and New York City reported high levels of flu activity during the week ending on Jan. 12 – an increase from 24 states the week before. However, there is some small suggestion that the season, which started about a month earlier than usual, may be peaking, Dr. Frieden noted. Nationwide, the rate of influenza-like illness was 4.3% - a slight decreased from 4.8% last week. Rates are still rising in some western states, including California. A map of the outbreak is available online.
Dr. Frieden cautioned that the decreased infection rate won’t yet affect rates of hospitalizations, complications, and deaths. "We expect to see these in a phased response [to infection rates]. We expect to see the numbers of hospitalizations and deaths rise further in the next week or so, as people develop complications from the illness."
Some spot shortages of vaccine occurred last week. "We continue to hear reports of shortages. Some patients have not been able to find vaccine and some providers have not been able to order."
The five vaccine manufacturing companies initially projected a national supply of about 135 million doses, of which 129 million have already been distributed. The companies have agreed to make an additional 10 million doses available, much of which will be directed at the western states, where infections are still on the uptick. The total of 145 million doses is about double the amount of vaccine available several years ago.
"There is still vaccine out there," Dr. Frieden said." Some formulations might be temporarily out of stock, but providers who want to should be able to order more."
Providers can track vaccine availability at http://preventinfluenza.org/ivats/ivats_12_13.pdf. Patients can find vaccine near their home by entering their ZIP code on the www.preventinfluenza.org home page.
"Although it’s not perfect, vaccination is the best tool we have to protect from the flu," he said. "There is still time to vaccinate, especially in states where most of the season is still to come."
Although there’s still plenty of antiviral medication, the Food and Drug Administration is taking steps to avoid any problems. There are some spot shortages of oral suspension oseltamivir for children aged younger than 1 year. Pharmacists can compound a substitute using the 30-mg, 40-mg, and even 75-mg capsules, said FDA Commissioner Margaret Hamburg. Directions are included on the oseltamavir packaging insert.
The FDA has also approved the distribution of 2 million older – but still effective – 75-mg oseltamivir capsules. The medication is not expired, but is packaged in older material, with an insert that doesn’t include the compounding instructions, Ms. Hamburg said during the briefing.
Dr. Frieden reiterated the importance of early antiviral treatment.
"In studies of very sick patients, death rates were cut by 75% or more by prompt use. For high-risk patients it can mean the difference between mild diseases and the intensive care unit or death."
High-risk groups include the elderly, children, anyone with a compromised immune system, children with neurologic or developmental disorders, and those with asthma, diabetes, or heart disease
"Even if a rapid flu test is negative for a high-risk patient, they should be treated in the first 48 hours of developing symptoms, because the rapid flu test does give a number of false negatives," Dr Frieden said.
Older and high-risk adults should especially avoid being around children who may be infected. "This is not a good time to babysit the grandchildren," he said.