Tuesday, September 15, 2015

#NatlPrep: Giving Preparedness A Shot In The Arm


Photo Credit PHIL


Note: This is day 15  of National Preparedness Month . Follow this year’s campaign on Twitter by searching for the #NatlPrep hash tag.

This month, as part of NPM15, I’ll be rerunning some edited and updated older preparedness essays, along with some new ones.


# 10,522


As I do every fall, yesterday I paid a visit to my local pharmacy (in this case, CVS) and got my yearly flu shot, skillfully and painlessly administered by Ibukun, one of their resident pharmacists.  I was in and out in less than 15 minutes, my insurance paid 100% of the cost, and I was quite happy to have crossed one more item off my fall `to do’ list.

This year, I opted to go with the quadrivalent shot.  One that contains 4 flu strains, not the 3 strains included in the traditional trivalent vaccine.  I’ll explain why.


Twice each year (in February for the Northern Hemisphere and September for the Southern Hemisphere), global flu experts meet to decide upon the formulation of the next seasonal flu vaccine.  It’s a dicey proposition, as the viruses in circulation can change radically over a period of months


In addition to picking two influenza A strains (H1N1 & H3N2), experts must also decide which of  two lineages of influenza B virus (Yamagata or Victoria) they believe will dominate the upcoming flu season.


This year, they selected the B/Phuket/3073/2013-like virus for the trivalent vaccine,  which is part of the Yamagata lineage of B viruses.  And so far, that appears to be a pretty good choice.   


But their record of success in picking the `right’ B strain over the years hasn’t exactly been sterling.  Which is why - in 2012 - the FDA approved the first Quadrivalent Flu vaccine; one containing both Victoria and Yamagata lineage B strains (see Two B's Or Not Two B's? That Is the Question).  Since then, the availability of the quadrivalent vaccine each year has increased steadily.


While influenza B doesn’t get as much respect as influenza A, B viruses are nonetheless capable of causing serious illness.  They often become the predominant strain late in the flu season, after influenza A has peaked, which puts even more time between the decision of what lineage to use, and its arrival. 


The past few months we’ve been watching an unusual level of influenza B activity in the Southern Hemisphere (see Dr. Ian Mackay’s  To (type) B or not to (type) B...),  including reports of a rising number of Victoria lineage infections  (see the ECDC’s report from last August Eurosurveillance: B/Victoria Prevalence In Early New South Wales Flu Season).   

In it, they write:  

During the early weeks of the 2015 Australian influenza season, influenza B accounted for 67% (821/1,234) of all positive influenza tests in New South Wales. Of 81 successive influenza B viruses characterised, 33 (41%) were from children aged < 16 years; 23/81 (28%) belonged to the B/Victoria lineage.

This lineage is not contained in the southern hemisphere's 2015 trivalent influenza vaccine. The significant B/Victoria lineage activity in the southern hemisphere suggests that the quadrivalent vaccine should be considered for the northern hemisphere.


Since I’m a bit of a belt and suspenders type guy, this year I’m hedging my bets and going with a vaccine that is formulated to include both B lineages.  


Despite last year’s high profile miss on the H3N2 component (see CDC: Updated Estimated Seasonal Flu Vaccine Effectiveness), most years the flu shot provides a moderate level of protection against catching the flu, and may reduce the severity of your illness even if you are sickened.


You might not have thought about it, but getting your seasonal flu shot each year should really be part of your overall preparedness plan. During a disaster or prolonged emergency you are going to be tired, stressed, and your immune systems likely weakened.


The last thing you need to be dealing with during a crisis is to be sick with the flu on top of it. 


According to the CDC, more than 40 million doses of this year’s flu vaccine have already been distributed, so finding a shot should be no trouble.  




September might seem a little early to be getting the flu shot, but we are already seeing scattered reports of influenza around the country, and it takes a couple of weeks after getting the shot for immunity to kick in.  


The CDC recommends getting it earlier, rather than later (see Should I wait to get vaccinated so that my immunity lasts through the end of the season?)


While the vaccine can’t promise 100% protection, it – along with practicing good flu hygiene (washing hands, covering coughs, & staying home if sick) – remains your best strategy for avoiding the flu and staying healthy this winter.

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