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2013: The Worst Flu Outbreak in Over a Decade

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The 2013 outbreak of the potentially deadly influenza virus, better known in common parlance as “the flu” has been termed by experts to be one of the worst in 10 years. The virus has already been reported in 47 states; 29 of which are reporting high or “severe” levels. As incidences of the flu normally peak in January and February, now is the time to be on alert, according to physicians.

As a result of concerns that the flu outbreak will continue to spread, New York State Governor Andrew Cuomo declared a public health emergency on Saturday, January 12 and issued an executive order which allows pharmacists to administer flu vaccinations to patients between six months and 18 years of age. This order suspends for the next 30 days the section of state education law that limits the authority of pharmacists to administer immunizing agents only to individuals 18 years of age or older.

Thus far, 20 children have died nationwide, including one from central New York. Children and teens, plus the elderly, are most susceptible to this year’s H3N2 common strain.

“We are experiencing the worst flu season since at least 2009, and influenza activity in New York State is widespread, with cases reported in all 57 counties and all five boroughs of New York City,” Governor Cuomo said. “Therefore, I have directed my administration, the State Health Department and others to marshal all needed resources to address this public health emergency and remove all barriers to ensure that all New Yorkers, children and adults alike, have access to critically needed flu vaccines.”

The order comes as nearly 20,000 cases of influenza have been reported in the state so far this season. That’s more than four times the 4,400 positive laboratory tests reported all of last season. As of January 5, there have also been 2,884 people hospitalized, compared to 1,169 total hospitalizations in 2011. Nearly 7 percent of all visits to health care providers were flu or flu-like illnesses in the first week of the year, compared with a typical 2 percent, Health Department figures show.

“It’s a really bad year,” said Dr. Ken Steier, a lung specialist and clinical dean at Touro College of Osteopathic Medicine, who estimated he’s seeing five times as many cases as is typical for this time of year. “It’s really been knocking people out.” And it’s likely to spread more, said Dr. Paul Hamlin, a pulmonary disease specialist based on Long Island. “I would expect to see more of it in the next four weeks,” he said.

Typically, cases peak and then taper off, but it’s hard to predict if this is a normal cycle or the outbreak will last through late March, when the seasonal illness usually falls off.

Dr. Hong Choi at City MD Urgent Care warns the virus can spread just about anywhere — on public transportation, surfaces like ATM’s — even the handle at the gas pump. “All this leads to higher viral transmission rate. It’s easy enough to get it from surfaces people have coughed on or touched after coughing in their hands. So really the best preventive measure at any time is to perform good hand hygiene,” said Dr. Choi. He added that, “We are really approaching endemic numbers in the New York City area and there is no reason to leave yourself vulnerable without a vaccine.”

90 percent of flu deaths involve the elderly, however, the New York State Health Department only requires hospitals to report when a child or teenager dies of the flu.

Dr. Nirav Shah, New York State Health Commissioner said, “To date in New York, we have had two pediatric deaths from the flu. New York averages about 1,400 deaths per year from the flu and based on the cases so far, we expect that to be worse.”

“Don’t send your kids to school if they are sick. And get them vaccinated,” said Dr. Shulamite Kon, a Manhattan pediatrician, whose office has been swelling with flu patients. “The kids who have been immunized and still get the flu have lighter symptoms,” added Kon. “It seems to give protection.”

“Influenza activity in New York City is continuing to increase — and all New Yorkers should receive a flu shot this year,” said the New York City Health Department spokesman, Sam Miller.

There have also been reported cases of the H1N1 virus, which caused a pandemic in 2009, and influenza B, which can be treated with this year’s vaccine.

“As New Yorkers, we work close together, we ride together in the subways, we eat in restaurants and cafeterias together, and given such a large and dense population we can easily spread the influenza virus to one another,” said Dr. Seth Feltheimer, a physician in Manhattan. “It’s not too late to get a flu shot now.”

It takes about two weeks after you get a flu shot for full protection. When it does, current research shows it is about 62 percent effective against the flu virus.

The state has set up a website to help New Yorkers find locations to get a shot — you can find a local vaccine provider by visiting flushot.healthmap.org and entering your zip code. New Yorkers without internet access can call 1-800-522-5006 or through TTY access at 1-800-655-1789 to find a nearby provider.

With three more months to go, the season “is stacking up to be moderate to severe,” said Tom Skinner of the federal Centers for Disease Control and Prevention. “In the past 10 years we have seen just two or three like it.”

California, Mississippi, and Hawaii are actually reporting low or minimal levels of influenza.

On Wednesday, January 9, the City of Boston declared a public health emergency as they also grapple with an exceedingly high number of cases of this historic outbreak of the flu. The influenza-ravaged city has seen about 700 confirmed cases of the virus since October 1, the unofficial start of the flu season, according to the office of Boston Mayor Thomas Menino, who declared the state of emergency. By comparison, Boston saw 70 confirmed cases during last year’s flu season. The outbreak has so far killed four Boston residents, all elderly, since the season unofficially began.

“This is the worst flu season we’ve seen since 2009, and people should take the threat of flu seriously,” Menino said in a release. “This is not only a health concern,” he said, “but also an economic concern for families, and I’m urging residents to get vaccinated if they haven’t already. It’s the best thing you can do to protect yourself and your family. If you’re sick, please stay home from work or school.”

Flu cases are now accounting for more than 4 percent of all emergency department visits at Boston area hospitals, but they accounted for about 1 percent outside flu season, according to Menino’s office. About 25% of Boston residents with confirmed cases have been ill enough to require hospitalization. Menino said his office, along with the Boston Public Health Commission, is working with health centers and hospitals throughout the city to offer free vaccination clinics over the coming weekend. But Massachusetts is only one of nearly 30 states that have reported especially high levels of “influenza-like illness,” according to the most recent weekly flu advisory from the Centers for Disease Control and Prevention.

Obtaining the flu shot, however, may not be as simple as one would think. According to the manufacturers of Tamiflu, the most widely used flu vaccine, this year’s U.S. flu season has created shortages of the treatment.

On January 9, Roche Holding AG told Reuters that it had a shortage of the liquid form of Tamiflu, given to children who already have the flu to slow or stop symptoms. A spokeswoman for the U.S. Food and Drug Administration confirmed that there have been supply interruptions in some locations.

Roche said it told wholesalers and distributors in recent weeks that temporary delays in shipments were imminent. In the meantime, pharmacists can make a substitute by dissolving Tamiflu capsules in a sweet liquid, according to Tara Iannuccillo, spokeswoman for Roche’s Genentech unit, which makes Tamiflu.

Sanofi SA, the largest flu vaccine provider in the United States, said on Thursday, January 10, it had sold out of four of the six different dosages of Fluzone seasonal flu vaccine due to unanticipated late-season demand. The vaccine is made in different sized vials and pre-filled syringes. “At this point we are not able to make any more vaccine because we are gearing up for next year’s vaccine,” said Michael Szumera, a spokesman for Sanofi.

“We are hearing of spot shortages. Given the time in our flu season, it isn’t surprising. People who haven’t been vaccinated and want to get the vaccine may have to look in several places for it,” CDC spokesman Tom Skinner said on Thursday. It is not unusual to run out mid-season during a moderate to severe season, which is what this year looks like, he said. Manufacturers planned to produce 137 million doses of the vaccine and as of late last year, 112 million people had been vaccinated, the CDC added.

Sanofi produced 60 million of those doses and GlaxoSmithKline PLC had planned to make 25 million doses. A spokesman for GlaxoSmithKline said on Thursday, January 10, that it expected to have the vaccine available until mid-February.

Novartis, AstraZeneca Plc, ID Biomedical Corp of Quebec and CSL Biotherapies are also authorized to sell flu vaccines in the United States. ID Biomedical’s product is distributed by Glaxo, while Merck & Co distributes the CSL Biotherapies vaccine.

AstraZeneca’s MedImmune unit sells FluMist, an intranasal spray approved for people aged 2 to 49.

Karen Andersen, an analyst with Morningstar, said Tamiflu sales would likely more than double to about $750 million this year from about $350 million in the 2011-2012 flu season. Tamiflu demand could boost overall Roche revenue this year by about 1 percent, but she said that would be a “small positive impact” for the company.

Tamiflu sales peaked at $3 billion in 2009, when governments stockpiled the product in case of a global epidemic of avian flu that never materialized.

The Walgreens chain which provides flu shots in some of its pharmacy locations, said on January 9, that it had given 5.7 million doses so far this flu season, up from 5.3 million a year ago.

“We’ve kept our reimbursement rates the same, so we are making a consistent level of profitability on flu shots,” Walgreens President of Pharmacy, Health and Wellness Kermit Crawford said after the company’s annual shareholder meeting in Chicago. Walgreens is the largest distributor of flu vaccines in the United States other than the government

Walgreens is reimbursed by health insurers such as UnitedHealth Group, Wellpoint Inc and Aetna Inc, whose profitability can be hurt by the flu because of reimbursements to pharmacies, doctors and other providers for vaccines and treatments.

It is definitely not too late to receive the seasonal flu vaccine, said epidemiologist Craig Roberts, a physician assistant at University Health Services at the University of Wisconsin, Madison. The 42,000-student campus gave 10,000 flu shots before the holiday break in December and has 5,000 more in stock. “We’ll be offering walk-in shots” once the students return around January 22, he said, “which we haven’t done in January before. We also sent out a mass e-mail asking students to get the shot at home if they can.”

The vaccines that are available this year are a fairly good match to the strains of the flu that are circulating, Skinner said.

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