Flu is widespread in 47 states, the U.S. Centers for Disease Control and Prevention (CDC) said last week. That usually doesn't happen until late January or February. The good news is that the flu vaccine is a good match for the viruses that are around this year. But protection is not perfect -- about 62% on average so far, the CDC said January 11. A major type of virus circulating this year also tends to make people sicker than other types. As a result, hospitals from the Rocky Mountains to New England are crowded with flu cases. Boston declared a public health emergency last week. A hospital near Allentown, Pa., set up a tent outside its emergency room to handle the onslaught of cases. Health officials said the season seems severe because last year's was so mild. But it's too early to say whether this will turn out to be a bad year or just average. There are also other viruses circulating that mimic flu and outbreaks of a type of norovirus, often called "stomach flu." The Associated Press and USA Today wrote about the outbreak.

By Henry H. Bernstein, D.O.
Harvard Medical School

What Is the Doctor's Reaction?

Have you heard lots of people coughing and sniffling? Have you noticed more people calling in sick to work lately? Yes and yes! It is that time of year. The number of people sick with the flu is on the rise.

The Centers for Disease Control and Prevention (CDC) is reporting that:

• 47 states have widespread flu
• 3,710 people have been hospitalized because of flu
• 20 children have already died from the flu this season

Influenza A (H3N2), 2009 influenza A (H1N1), and influenza B viruses have all been seen in the United States this season. H3N2 is the main virus that is causing flu now. H1N1, the "swine flu" virus, has not been seen much so far.

The CDC estimates that the influenza vaccine is 62% effective this season. The study results were released early online in the Morbidity and Mortality Weekly Report. The estimates are based on data from children and adults who went to the doctor with respiratory illness in December. Data from 1,155 children and adults at 5 different sites were analyzed.

Experts calculated the vaccine effectiveness against flu that has been laboratory-confirmed. The current vaccine is moderately effective against all three strains of flu that are circulating now.

The CDC urges people who have not yet received the flu vaccine to get it right away. Even a moderately effective influenza vaccine has been shown to reduce:

• Illness
• Antibiotic use
• Doctor visits
• Time lost from work
• Hospital stays
• Deaths

Some people who received the vaccine this year can still get the flu. This should not be a surprise since this vaccine is not 100% effective.

Doctors also must think about treating people they suspect may have influenza with an antiviral medicine. This is important whether or not the patient has been vaccinated against the flu. An antiviral medicine, such as oseltamivir (Tamiflu), works best if taken within the first day or two after you show signs of the flu.

What Changes Can I Make Now?

Everyone 6 months of age and older needs influenza vaccine each year. The best way for your whole family to be protected is for everyone to get the vaccine. This includes parents, children, siblings, grandparents and caregivers.

It is not too late to get vaccinated! Every year, people get sick with the flu in the fall, winter and well into spring. So your child (and you) will be protected when you get the vaccine as late as March, April or even May.

Two types of vaccine are given.

• The inactivated influenza vaccine (IIV) is given as a shot. There are 2 kinds of shots. A shot that is given into the muscle is recommended for children 6 months and older and adults. This includes people with chronic medical conditions, such as diabetes and asthma. A high dose form of IIV is available for adults 65 and older. A new type of shot uses a smaller needle. The shot does not have to go into a muscle. It is licensed for use only in people ages 18 through 64.



• The live, attenuated influenza vaccine (LAIV) is sprayed into the nose. It is approved for healthy patients 2 through 49 years of age. People with a history of asthma or any chronic illness should not get the live vaccine.

IIV and LAIV are both very safe. Either type will help prevent flu. Check with your doctor to see which is best for each member of your family.

Getting a flu vaccine is easier (and quicker!) than ever. Besides doctors' offices, you can get the vaccine at flu clinics in:

• Pharmacies
• Supermarkets
• Department stores
• Workplaces
• Airports

The American Academy of Pediatrics (AAP) also offers these tips to help keep your child healthy this flu season:

• Encourage your whole family to wash their hands often. Use soap and warm water or an alcohol-based hand sanitizer.
• Teach your child to cover his mouth and nose while coughing or sneezing.
• Throw all tissues used for runny noses and sneezes in the trash right away.
• Wash dishes and utensils in hot, soapy water or the dishwasher.
• Teach your child to try not to touch her eyes, nose or mouth.
• Wash toys, doorknobs, counter tops and toilet knobs (anything that your child touches often) with hot, soapy water or a cleaner that kills germs.
• Do not let children share pacifiers, cups, spoons, forks, washcloths or towels without washing. Never share toothbrushes!

What Can I Expect Looking to the Future?

The CDC will continue to measure how well the vaccine is protecting against flu. It will provide updates throughout the flu season. Research will continue to develop influenza vaccines that are even more effective. Vaccination efforts will continue for as long as influenza viruses are circulating in communities.