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Influenza 2013-2014

Article By Christy Wilson, PA-C

Respiratory Therapists

As we come to the end of football season watching the Seattle Seahawks defeat the Denver Broncos in Super Bowl XLVIII, I realize sport seasons can be so unpredictable.  Who would have thought the Atlanta Falcons won their division in 2012 and yet didn’t even make the playoffs in 2013?  I would have never guessed Peyton Manning would claim the record for most touchdown passes in a regular season only to throw two interceptions in the Super Bowl.  Just like sports, medicine has shown its volatility this year.  Would you have wagered the flu season of 2013-2014 would result in younger/middle-aged Americans being hospitalized for influenza and 42 out of 50 states reporting widespread levels of influenza?  Did you order extra isolation masks and gowns for your hospitals and clinics in expectations of widespread flu pandemic?  Only time will tell what the final influenza season record will be for 2013-2014 but so far the statistics of this year’s flu season are just as surprising as Peyton Manning’s stats in the Super Bowl.

As a Physician Assistant specializing in pulmonary, over the past few months I have seen numerous cases of influenza in which most of the cases being influenza A/ H1N1 and those being affected include young and middle-aged adults.  According to the CDC (Center for Disease Control) in general the risk of severe disease is highest among elderly population and children under 5, however this season I personally have seen the most severe cases in those young/middle-aged American who commonly were obese, have past medical history of metabolic disorders, cardiovascular disease and/or asthma.  My findings are similar to others throughout the county.  These younger patients have required lengthy hospitalizations often in the ICU and several have even required mechanical ventilation due to complications from acute respiratory failure, septic shock and ARDS.  Although not all states report death totals from influenza, California alone has had 147 documented deaths from H1N1 so far during this season.

Who to Rx antiviral therapy????

As healthcare providers we need to continue to be on the lookout for influenza, keeping in mind antiviral medicine is best if given within 48 hrs. Of the onset of symptoms however in severe cases such as patients requiring hospitalization there might still be a benefit to prescribing antiviral therapy.

Does the flu vaccine prevent influenza????

No!  Just because your patient received their flu vaccine doesn’t mean they won’t get the flu.  Although the flu vaccine is the best way to prevent the flu one should always consider influenza in their differential diagnoses when evaluating an ill patient with s/sx compatible with the flu.

How good is the rapid Flu test???

Although rapid flu testing is quick and convenient it is not all knowing – it has limits so although it might be negative – if the patient shows signs and symptoms of influenza still consider it a possibility.

Why is the flu affecting the young/middle aged adults????

The CDC made a statement explaining more adults between the ages of 18-64 have been hospitalized for the flu this year compared to any other year.   Although no one knows for sure, people suspect the elderly population have a built in immunity to H1N1 which is why there haven’t been as many reported influenza cases in the “65 and over” age group.  However no one knows for sure at this time.  There is other speculation the elderly population is more compliant with their yearly flu shots compared to the young/middle age population.

In summary, although the influenza season of 2013-2014 is not over yet, it has certainly been keeping those of us in healthcare very busy.  I’m looking forward the Spring when the flu season is finally over I can hang up my isolation mask until next Fall.

Christy is a speaker for Skin, Bones, Hearts & Private Parts. See Christy speak this June in Walt Disney World, Florida.