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,” explains 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.”
Necessary 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 says. “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,” says 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,” says 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 says.
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 adds.
Still, Miller says 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 worrying 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 says.
“It’s definitely different this year.”
This report by The Canadian Press was first published Oct. 12, 2022.
Young and old more likely to face severe flu. Here’s why doctors think it happens
Canadians have been getting sick enough with seasonal flu to land in hospital, say doctors with suggestions on who is most at risk and what it could mean for festive gatherings.
“We’re starting to now see the effect of flu on certain populations, particularly very young children and very older people, in making them sick enough that they need to come into hospital,” said Dr. Gerald Evans, chair of the division of infectious diseases at Queen’s University and Kingston Health Sciences Centre.
During the depths of the COVID-19 pandemic, air travel declined. It’s one of the suspected reasons that influenza all but disappeared, Evans said.
Flu viruses need human hosts travelling between the southern and northern hemispheres to gain a foothold during winter on both ends of the planet, according to influenza experts.
For about 100 years, doctors have known that the youngest and oldest are most at risk for serious flu. Why hasn’t been nailed down, but there are a few possible reasons — including what strains were circulating when you were first exposed.
Generational effects explored
Canadian and international research on humans as well as in animal models suggest that the first strain of flu virus you’re infected with tends to prime or shape the immune system. The result is that our immune system responds best to the original type of flu infection it faced.
“That’s why we believe that older people who are mostly primed with H1N1 don’t do very well during an H3N2 year like we’re having this year,” Evans said.
The 2009 H1N1 pandemic also continues to affect how younger ones do with flu.
Those aged 13 and under were probably primed to H1N1 after 2009, just as their grandparents were in their childhoods, Evans said.
If so, today’s kids could be more vulnerable to severe disease from flu now than their parents’ generation who first encountered an H3N2 strain.
Evans added it’s also thought that older people may have more severe outcomes from flu because of underlying problems such as heart disease, lung disease or treatments for cancer.
Youngest hadn’t been exposed
Another reason why young children are being hit hard by flu and RSV this year: recent pandemic public health measures meant those under two haven’t seen flu at all and preschoolers haven’t experienced it or another respiratory virus known as respiratory syncytial virus, or RSV, for a couple seasons.
“The boost of immunity they get from having had some prior exposures in the year before are missing and so they’re tending to get infected more,” Evans said.
Dr. Upton Allen, chief of infectious diseases at the Hospital for Sick Children in Toronto, pointed to a few other possibilities.
One is the strain of flu virus that’s mainly circulating. It’s officially called Influenza A H3N2, which Allen said might be associated with more severe disease.
Also, our immune system is considered weakest at the extremes of life.
“The overwhelming majority of kids who get the flu will get it mild, but some people can get it severe,” Allen said.
If a child is breathing very quickly, having trouble breathing, weak, doesn’t wake up or respond then those might indicate a more severe bout. “Call 911 or go to the nearest emergency department,” Allen said.
The Public Health Agency of Canada reports fewer than five influenza-associated deaths among those aged 16 and younger for the week ending Nov. 19.
“Each year the number of deaths generally are in single digits,” for that age group in Canada, Allen said.
Doctor’s holiday flu forecast
Marie Tarrant, a professor in the nursing school at the University of British Columbia Okanagan, is concerned about the uptick in hospitalizations from flu for patients and health-care systems.
“The other side of that is just the burden that is putting on a healthcare system that has been maximally strained for the last 2 ½ years.”
People with flu, RSV and other infections have a “compounding effect” of burdening hospitals, she said. Like Canada’s National Advisory Committee on Immunization, Tarrant recommends those aged six months and older who are eligible get a flu shot.
“Flu vaccines prevent about 40 to 60 per cent of serious illness and hospitalization,” she said. “They do work.”
Evans has similar advice.
“Get your flu shot,” he said. “It’s not going to be for everybody, but it’s going to prevent a lot of people getting infected and that’s going to help of course alleviate the stresses that we’re seeing in trying to provide care to everybody.”
It’s also not too late to get a flu shot, clinicians say.
Plus, flu season started earlier than it typically does this year, which could (eventually) offer a yuletide bright spot. Evans said seasonal flu usually disappears after a period of about six weeks. Canada is now about two weeks into a surge.
“By the time the holidays come around, we should be seeing a waning down of numbers of influenza infections, if it follows the pattern that we have seen now literally for decades.”
The good news? “As long as you’re feeling OK and you don’t have signs and symptoms of a cold, I think gathering together is fine.”
St. Joe's opens Hamilton Mountain flu, COVID and cold clinic – Hamilton Spectator
With the cold and flu season now in full swing, St. Joseph’s Healthcare Hamilton has opened a flu, COVID and cold clinic at their West 5th (and Fennell) campus.
St. Joe’s officials say the goal of the dedicated clinic is to provide both adults and children with timely care, while reducing the number of patients visiting emergency departments for respiratory illnesses commonly seen throughout the fall and winter.
Clinic visits are by appointment only.
See stjoes.ca/FluCOVIDCold to book an appointment.
Clinic hours are Monday to Friday 4:30 p.m. to 9 p.m., Saturday/Sunday 8 a.m. to 4 p.m.
The clinic is a collaborative effort between St. Joseph’s Healthcare Hamilton, Hamilton Health Sciences (HHS) and primary care doctors
St Joe’s official say adults and children experiencing flu, COVID or cold symptoms, who are unable to seek timely care from their family doctor or do not have a family doctor, should book an appointment if their symptoms are not improving after a few days, despite using common over-the-counter medications as indicated on the label, such as ibuprofen (Advil), acetaminophen (Tylenol), nasal rinses and cold/flu medications or if they are particularly worried about any of their symptoms.
Common symptoms include fever, cough, sore throat, runny or stuffy nose, chills, loss of taste or smell, headache, and muscle aches.
World AIDS Day: HIV activists hopeful for end to backsliding on infections, stigma – National | Globalnews.ca – Global News
HIV activists are marking World AIDS Day by urging Ottawa to help stop a global backslide in progress on stemming infections and stigma.
“It’s clear to us that this government is seized of the issue, but the truth of the matter is, no movement is happening quickly enough for people with HIV living in Canada,” says Janet Butler-McPhee, who co-leads the HIV Legal Network in Toronto.
The Public Health Agency of Canada estimated that 62,790 people in Canada were living with HIV in 2020, and that 10 per cent of them didn’t know they had the virus.
That represented a slight drop in overall cases from 2018, but an increase among the most vulnerable.
Indigenous people accounted for nearly one-fifth of new HIV infections in Canada in 2020, the data say. That year, women and people who inject drugs made up an increasing share of infections, while men who have sex with men made up a smaller share.
‘One pandemic cannot overshadow another,’ health minister says on HIV/AIDS
Advocates argue that the numbers reflect the uneven effects of the COVID-19 pandemic.
Butler-McPhee noted that the Harper and Trudeau governments both pledged funding for grassroots groups that serve people with HIV that hasn’t fully materialized, despite the added factors of a toxic drug crisis and the COVID-19 pandemic.
“You’re talking about organizations who have had to pivot pretty significantly and take on new work without funding that has been long-promised,” she said.
Meanwhile, Canada continues to trail its peers in criminalizing HIV non-disclosure. Canadians living with the virus can be prosecuted for not disclosing their status to sexual partners, even when prescription drugs make it impossible to transmit the virus.
“Criminalization can lead to the stigmatization of people living with HIV, which can often discourage individuals from being tested or seeking treatment,” the Department of Justice noted in October.
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The Liberals have been promising to fix the issue since 2016, but only launched a national consultation in October. They have also asked prosecutors to avoid criminalizing people with HIV in the territories, while suggesting provinces follow suit, with mixed success.
“For the last six years, there has been a recognition by this federal government that HIV criminalization is an issue in Canada, but there has been not as much movement as we’d like to see,” said India Annamanthadoo, a lawyer with the HIV Legal Network.
Specialty hospital for people living with, at risk of HIV
Abroad, the World Health Organization reported disruptions in HIV patients accessing treatments that suppress symptoms and stop the virus from progressing to AIDS, as countries targeted their health care systems at stemming COVID-19 infections.
That’s put a dent in progress toward the United Nations sustainable development goal of ending the epidemic of HIV-AIDS by 2030.
Before the pandemic, the UN’s joint program on AIDS reported that AIDS-related deaths had gone down by 68 per cent since the peak in 2004, and by 52 per cent since 2010.
Thursday marks World AIDS Day, which the United Nations has marked every year since 1988. The disease has killed roughly 40 million people, including 650,000 in 2021.
In a report this week, the agency said inequalities will make it impossible to reach global targets, whether it’s the presence of girls and women in school or continued stigma against men who have sex with men.
Girls and women in sub-Saharan Africa aged 15 to 24 are acquiring HIV at rates three times that of males in the same age group, the agency reported.
HIV advocate shares her journey of acceptance to help combat stigma
Gay men and people engaged in sex work are more likely to avoid HIV testing when the country they live in criminalizes their behaviour, the agency says.
In September, Canada was praised for pledging $1.2 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria, after months of concern that Ottawa would pull back its funding.
The move came after the Liberals cancelled a ministerial address to the International AIDS Conference in Montreal this summer, a summit clouded by controversy after African delegates were refused visas.
Back home, the Canadian Aboriginal AIDS Network argues that mainstream public-awareness campaigns and access to HIV-preventing drugs are not reaching Indigenous communities, particularly women.
Trevor Stratton, an Ojibwa activist with the group, told an online panel on Wednesday that Ottawa ought to launch an inquiry into the disproportionate rates of HIV among Indigenous peoples.
“It’s a national embarrassment; when I travel internationally I am actually embarrassed to be a citizen of Canada,” he said.
© 2022 The Canadian Press
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