Expert: 'a severe year' for influenza could get worse

By Jenna Lookner | Jan 07, 2013

Maine Center for Disease Control and Prevention released an advisory regarding heightened reports of early influenza activity in the state and as students return to school and adults to work following the holidays, an already severe flu season may worsen, said Maine State Epidemiologist Stephen Sears.

While the term "flu" has become the household classification for a broad range of symptoms associated with common winter-season viruses, influenza is a serious — and for certain populations, deadly — disease.

"Every piece of information we have suggests that this is going to be a significant year," said Sears, referring to the 2012-2013 winter season.

According to the December CDC memo "influenza activity in Maine...increased steadily" in November and December 2012, 13 cases of influenza had been "followed-up on" by the Maine CDC as of Dec. 18. According to the same memo, influenza hospitalizations and even one pediatric death in Maine are indicative of the expected severity of the outbreak this winter.

At Pen Bay Medical Center in Rockport flu season has made an impact, however hospital staff said the number of patients sick with influenza — or influenza-like illness — has not been overwhelming.

“As of [Jan. 7], we had three confirmed influenza cases currently admitted to Pen Bay Medical Center. An additional nine patients were suspected cases, with final test results pending. Admissions to hospitals are of course the tip of the iceberg — many more suspected or confirmed cases are being seen in the emergency department or in outpatient practices, but few require hospitalization. Those that do need to be admitted remind us that influenza can become a very serious illness,” said Dr. Cheryl Liechty an infectious disease physician at Pen Bay Medical Center in a written statement.

According to Lietchy, the hospital has not had to call in additional physicians or close wards due to influenza.

Influenza is a contagious respiratory illness that is spread through contact with "droplets" of the virus, such as a those emitted by a sneeze, or by hand-transfer from an object or surface contaminated by the virus to one's mouth, eyes, or nose, according to the CDC website. While some symptoms are commonly thought gastrointestinal, the symptoms of influenza are more commonly concentrated in the respiratory system. Fatigue and aches can also be indications of a flu infection. Children are more likely to experience gastrointestinal symptoms then adults, according to the CDC.

While there are three primary strains of influenza, influenza types A and B are responsible for most of the outbreaks in the U.S. each winter, according to the Centers for Disease Control and prevention, and the influenza A strains H1N1and H3N2, and influenza B are covered by the common flu vaccine.

Influenza occurs primarily during the winter in the Northeast, though cases have been recorded as early as October, but the peak of flu activity can sometimes occur as late as January, according to the CDC.

Regional School Unit 40 Superintendent Susan Pratt said Jan. 8 the schools under her purview "do seem to be hit by illness." Pratt said the schools are following established protocols and are in daily contact with the Maine Center for Disease Control, as is required in circumstances where more than 15 percent of students are absent.

Sears said the first confirmed case of influenza this season occurred Nov. 9 in Penobscot County.

"That's early for Maine," he said.

Sears said "within days" of the initial report multiple cases of the disease had been reported in Cumberland County. Adult influenza deaths are not "reportable," Sears explained, noting many adult deaths occur in elderly people who have other complications exacerbated by influenza. Pediatric deaths — meaning the death of a child of any age — must be reported at both a state and federal level, he said.

In December, a child in Central Maine died of influenza, Sears said. He declined to provide the child's age or town of residence. As of Jan. 7, approximately 20 pediatric deaths had been recorded nationwide, said Sears.

"That gave us a pretty clear indication that [influenza] was present statewide," he said.

Sears noted it was evident early on Maine was in for a "severe year" of influenza infection. He said the trend is not isolated to Maine. According to Sears and an influenza  surveillance map provided on the CDC website — which was last updated Dec. 29 — all but eight U.S. states are experiencing widespread instances of influenza.

Sears said the past three or four years have been relatively mild for influenza patients in Maine. One of the exacerbating factors this season is that the influenza A strain H3N2 is present, and that particular strain has been rare in recent years, so people do not have the antibodies to fight it as well.

Sears said Norovirus Gastroenteritis is also going around the state. The virus can be confused with the flu and sometimes occurs simultaneously in susceptible people. According to a Jan. 3 release from the Maine CDC, 16 cases of Norovirus have been confirmed in Maine.

Sears said Norovirus is particularly common in long-term care facilities where populations are in close contact.

Scott Shott, vice president of Development and Community Relations at Miles Memorial Hospital in Damariscotta, said the flu season has been pretty standard at that hospital so far. On Jan. 8 Shott said a single influenza patient was presently hospitalized there.

"It's pretty much what you would expect this time of year," he said.

With schools across the state back in session after a long holiday break, Sears said the chance for an acute outbreak of the flu is heightened. He explained influenza has an incubation period of between one and seven days from the time of exposure to the onset of symptoms, and that anyone who traveled or had visitors during the holidays is at higher risk for contracting the flu.

"Airports are a great mixing bowl," he said.

Sears reiterated influenza vaccines are available and recommended. He said he does not foresee a shortage of the flu vaccine this season.

"It's not too late to vaccinate," he said.

Though the vaccine is about 70 percent effective according to Sears, he said it can greatly decrease the severity of influenza and the risk of death in elderly patients, even those who contract the disease.

Sears said Maine hospitals have been struggling to find room for the many patients suffering from influenza and related complications, such as pneumonia. He encouraged those who may be ill to take stock of the severity of their symptoms before going to the emergency room.

"Only go to the ER if you are really sick," he said. "We want to use our resources best."

Liechty echoed cautionary sentiment expressed by Sears. She encouraged people to exercise caution to discourage the spread of illness.

“If you are sick, whether it be with cough or 'cold' symptoms (with or without fever) or diarrhea, stay home if possible. In particular, do not visit hospitalized friends or relatives if you have these symptoms. Please avoid contact with others in the community who may be at similarly increased risk for serious flu or diarrheal illness due to extremes of age (the elderly and infants) or other chronic medical conditions. We would like to do everything possible to limit the spread of influenza and Norovirus infections, especially among those who may be more likely to become seriously ill with these viruses," she said in a written statement.

As opposed to other wintertime ailments, influenza causes serious fatigue and acute body aches.

"You're really pretty sick overall," Sears said.

He said severe cases of influenza are characterized by dehydration, labored breathing and any major change in the severity of the symptoms.

He added those experiencing "influenza-like illness" should always stay home.

Courier Publications reporter Jenna Lookner can be reached at 236-8511 or by email at jlookner@courierpublicationsllc.com.

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