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Robert Finberg, MD |
Americans were taken aback by last year’s record-breaking flu season, which saw the highest number of deaths and hospitalizations from influenza in decades. As the new flu season arrives, many have questions about what to expect in the coming months.
Robert Finberg, MD, the Richard M. Haidack Professor of Medicine, chair and professor of medicine, researches how to better prevent and treat influenza. He answers some of the most frequently asked questions in this Expert’s Corner Q&A.
Q: What are we seeing for flu activity so far this season?
A: We have seen a few cases in Central Massachusetts, including three at UMass Memorial Medical Center [the medical school’s clinical partner] but have not seen much since then. Nationally, there’s not yet been a lot of flu reported. The season usually comes in December to January, so we were surprised to see cases so early.
Q: How effective do you anticipate this year’s vaccine will be?
A: The U.S. Centers for Disease Control and Prevention anticipate this year’s vaccine will be 40 percent effective, the same as last year’s. CDC estimates range from 10 to 60 percent. But vaccine efficacies are always underestimated because they’re looking at people who had the vaccine and still got the flu. Even though the CDC may rate it as not being a good match for the influenza strains that end up in circulation, a vaccine is still going to have some efficacy, thus the recommendation that all people take it. Even if it does not prevent disease, it will likely result in milder disease.
Q: Why did the CDC urge people to get vaccinated by the end of October? Is it too late now?
A: The CDC recommends getting the vaccine as soon as possible because we don’t know when we’ll see an uptick in cases and chances of contracting the contagious illness surge. But it is better to get it later than not at all.
Q: Several vaccine formulations are available this year. Which do you recommend?
A: There are several vaccine manufacturers, but most providers stock just one formulation. Depending on which one a provider stocks, people get either a trivalent vaccine or a quadrivalent vaccine. Both include the two A viruses, H1N1 and H3N2. The trivalent includes one B virus, the quadrivalent contains two. We have no data showing one is better than the other for the coming season.
A high-dose, or adjuvant, vaccine that has the same strains but at a higher dose, is available and recommended for adults over age 65, including those in good health.
Q: The nasal spray vaccine FluMist has again been approved for use this year. Would you recommend it to patients, and if not, why not?
A: There is controversy about the nasal vaccine because in past years it has not been as effective as the injectable vaccine. My recommendation is that everyone get the injected vaccine.
But it’s better to get the nasal vaccine than none at all, so if a child refuses the shot, the nasal should be offered. FluMist is approved for ages 1 to 49, so adults can also choose it.
Q: Even if it doesn’t prevent flu in some individuals, how may vaccination affect the course of their illness?
A: The vaccine will provide an antibody boost, though not necessarily as big for all strains. But the virus has a number of different proteins that the antibodies will recognize, and it’s bound to recognize some of them. This will likely result in less severe disease.
Q: Do antivirals like Tamiflu shorten the duration of the illness?
A: Antivirals do decrease illness. Tamiflu is available now and is what I’ll prescribe for sick patients who come in and test positive for influenza.
Q: Can you comment on the newly approved antiviral Xofluza? How would you compare it to Tamiflu?
A: Xofluza is a new drug that reduces the viral burden faster than Tamiflu. Also, being a single dose drug is a big advantage over taking two pills a day for five days.
Xofluza looks better than Tamiflu in the studies that have been done, but we don’t have a lot of experience with it, and it may become widely available in the very near future. The caveat is that if there are going to be side effects or lack of efficacy, we’ll find that out only after using the drug for some time.
Q: Why should healthy people get the vaccine?
A: It’s very important because healthy individuals who are not vaccinated can infect others they come in contact with who don’t respond as well to the vaccine even if they receive it. These include family members with health problems like suppressed immunity due to cancer treatment; frail elderly patients; and children. Healthy family members, health care workers and those who work with children should get vaccinated. Studies show that healthy people who get flu vaccine have fewer “colds” and fewer sick days than unvaccinated individuals.
Q: Where is the best place to get a flu vaccine?
A: It seems like the drugstores have gotten into the vaccination business. There’s no harm in that. I don’t have a preference. Patients can also get vaccinated in traditional medical settings. It’s fine to get the vaccine wherever is most convenient for the individual.
Q: Final words for those still hesitant to get a flu shot?
A: Flu vaccines do not give people the flu. The only thing a flu vaccine will give you is a sore arm. And protection for yourself and others against a potentially life-threatening illness.
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