Relatively low circulation of the flu over the past two years puts young children at greater risk than usual of catching it this fall and winter, say experts who also fear fewer pandemic measures and reduced vaccination uptake will further spread.
To a lesser extent, adult resistance to influenza is also lower than it otherwise might be because fewer people received the immune boost of a recent winter infection, says infectious diseases specialist Dr. Susy Hota, stressing the added importance of flu shots this season.
“Our immune responses get boosted to some degree when we see these viruses more frequently,” said Hota, the medical director of infection prevention and control at the University Health Network.
“We haven’t really had that over the last two years. So people could get more symptomatic and pick up these infections and notice them more the next couple of years.”
Pandemic measures to limit COVID-19 spread led to just 69 confirmed flu cases during the 2020-2021 season and only sporadic cases in 2021-2022, according to a recent update from National Advisory Committee on Immunization, which advises the Public Health Agency of Canada on vaccine use.
The pool of potential flu patients this fall and winter is greater, just as masks and distancing rules have dropped, says immunologist Dawn Bowdish of Hamilton’s McMaster University.
“As a population we are ripe for influenza,” she said. “One of the reasons it seems to be spreading a little bit earlier than it would be in a sort of a pre-COVID year is because there’s just so many susceptible people who can harbour this infection.”
Like Hota, she says the potential rise in circulation in the coming months is “a really big problem” for children under two who are being exposed for the first time and are more susceptible to serious illness.
The same is likely true for kids aged three and four who otherwise might have gotten flu when they were babies or toddlers but were spared because of COVID-19 mitigation strategies, she adds.
“Because we are dealing with a whole bunch of kids who haven’t had a lot of stimulation … we can expect that it could be really problematic in young kids this year,” said Bowdish.
She notes a similar scenario played out last summer when a surge of respiratory syncytial virus, or RSV, sent infants, toddlers and preschoolers to hospital and strained pediatric health-care resources.
While myriad other pressures continue to strain the health-care system — including ongoing COVID-19 infections that many experts fear will also rise — it’s especially important to get the flu shot this year, Bowdish adds.
As far as flu risk to the population as a whole, infectious disease expert Matthew Miller does not expect one missing flu season will make us vastly more susceptible than previous years.
Miller, the director of the Michael G. DeGroote Institute for Infectious Disease Research at McMaster, says many adults can count on some level of immunity generated by a lifetime of exposure to seasonal influenza, including seniors who don’t generally mount as strong of an immune response as younger age groups.
That immunity can last years and even decades if someone encounters a flu strain that is closely related to something they’ve seen before.
“During the swine flu pandemic, seniors were disproportionately protected from dying because that virus looked a lot like the virus that caused the 1918 Spanish flu,” said Miller, also an associate professor of biochemistry and biomedical sciences at McMaster.
“People who were very old and were exposed to the 1918 Spanish flu and viruses that were similar to it that circulated in the year shortly thereafter actually still had protection all the way up in 2009.”
There have been occasions where the same strain will recirculate for several years but if it changes, that pre-existing immunity becomes a lot less effective, says Miller.
Thanks to pandemic measures that also shielded most people from flu infection, Bowdish says the types of influenza now circulating are quite different than before the COVID-19 outbreak.
“Because of all the social distancing (and) the masking, many lineages of the flu virus have actually gone extinct,” she said.
Clues to this season’s dominant strain can be found in what circulated in the Southern Hemisphere, says Miller, noting we can most often expect to see the same version emerge in Canada.
“But it’s not always what happens in practice, because, of course, between the Australian season and our season there are gaps and the dominant virus can change in the interim,” he said.
Still, Miller said it’s likely that someone who fell ill in 2019 will have some protections this season, believing any changes to this year’s flu will be “modest.”
While countries including Australia, New Zealand and South Africa were hit particularly hard, Bowdish says it’s not clear if that’s because the virus itself developed particularly problematic mutations, because vaccination rates fell short, or because the vaccine didn’t match the strain very well.
Danielle Paes of the Canadian Pharmacists Association points to a survey of 1,500 adults in August that found only 50 per cent of respondents said they would get a shot this year, down six points from a survey in 2021. The margin of error is plus or minus 2.53 percentage points, 19 times out of 20.
Paes says waning interest in the flu shot could also exacerbate the flu’s impact this season.
Hota points to the resumption of many pre-pandemic activities as a main factor driving flu infections this season, noting that mask mandates have dropped, people have resumed travel and are gathering again indoors.
“In previous years, we’ve had public health measures and some kind of restriction in the movement of people or socialization or the ability of people to congregate,” she said.
“It’s definitely different this year.”
HIV/AIDS progress in Brazil
December 1 is World AIDS Day, a time to raise awareness and show support for those living with AIDS or HIV, the virus that causes AIDS.
Treatment of HIV/AIDS has come a long way since the first cases became public in the 1980s.
And Brazil is one country that led the way; its pioneering programs to identify and treat patients recognized the world over.
In recent years, however, the country’s progress has shown to be slipping.
Early RSV season primarily impacts infants
Dear Doctors: What can I do to protect my baby from RSV? What are the symptoms? People are talking about a “tripledemic,” and it has my husband and me worried. We’re both vaccinated for the flu and COVID-19, and we are being super careful when we’re out and about. What else can we do?
Dear Reader: RSV is short for respiratory syncytial virus. It’s a common winter virus that can affect people of any age. In most cases, RSV infection causes mild symptoms similar to the common cold. However, infants and children younger than 2, whose immune systems are still developing, are at increased risk of becoming seriously ill.
RSV is the most common cause of pneumonia in infants and young children in the United States. It is also the leading cause of bronchiolitis in that age group. That’s a lung infection in which the smallest airways become inflamed and swollen, and an increase in mucus production impedes air flow into and out of the lungs.
This year, as with the flu, RSV season has arrived early. Hospitals throughout the U.S. are reporting a surge of serious infections among infants and younger children.
The virus enters the body through the airways and the mucous membranes. It can remain viable on hard surfaces — such as a doorknob, night table or dinnerware — for several hours. It can also persist on softer surfaces, such as a tissue or the skin. Someone can become infected by breathing in the viral particles that remain airborne following a cough or a sneeze, or by touching their mouth, nose or eyes after direct contact with contaminated droplets.
Someone who is sick with RSV typically remains contagious for between four and eight days. However, due to their still-developing immune systems, it’s possible for infants to continue to spread the virus for several weeks, even after symptoms of the disease have abated. There is no vaccine for this virus, and no targeted treatments. Prevention relies on the same precautions you use to avoid any respiratory illness. That is, keep your baby away from people who are ill, avoid close contact with people outside your home and be vigilant about hand hygiene.
Symptoms of RSV arise between three and six days after infection. They can include a runny nose, sneezing and coughing, fever, a decrease in appetite and lung congestion that can cause wheezing. These symptoms tend to be progressive, arriving in stages as the body mounts its attack against the virus. But in very young patients, the first, and sometimes only noticeable, symptoms of RSV can be increased fussiness, a decrease in activity and difficulty breathing.
Treatment for RSV consists of managing symptoms. The specific avenue of care depends on a child’s age, general health and symptoms. In infants, treating RSV includes a focus on adequate hydration and remaining alert for any signs of problems with breathing. The majority of RSV infections run their course in a week to 10 days. Parents of younger infants should check with their pediatricians for guidance on treatment, particularly medications. If your child has difficulty breathing, isn’t drinking enough fluids or has worsening symptoms, call your health care provider right away.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to firstname.lastname@example.org, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.
AIDS Memorial Quilt comes to Palm Beach County
PALM BEACH COUNTY, Fla. — The largest piece of community folk art in the world, a tribute to victims of AIDS, is on display in Palm Beach County.
Now through Dec. 15, three different panels of the NAMES Project AIDS Memorial Quilt, often known as the AIDS Quilt, will be on display at three different Palm Beach County Public Library locations.
The quilt is a giant tribute to the lives of people who have died due to AIDS or AIDS-related causes.
The quilt weighs around 54 tons and was started in the 1980s during the early years of the AIDS pandemic.
The AIDS Memorial Quilt is comprised of nearly 50,000 panels containing 91,000 names of the men, women and children who lost their lives to the immune system disease.
The blocks, which make up the panels, are stitched by individuals in communities across the nation, including one librarian right in Palm Beach County.
Katrina Brockway, a librarian at the Hagen Ranch Road Branch Library, said she feels it brings tragedy a bit closer to home.
“It becomes so much more personal when you see these quilt panels and all of these people who were loved and didn’t have the same opportunity to escape this,” Brockway said. “So you can remember them, what they went through, and what their loved ones have gone through.”
Visitors can see the quilt panels during normal library hours at the library’s main branch on Summit Boulevard at the Jupiter branch and at the west Boca Raton branch.
Click here for the library’s hours and more information on upcoming AIDS events at the library.
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