tag:theconversation.com,2011:/us/topics/flu-season-52129/articlesFlu season – The Conversation2023-09-11T12:51:48Ztag:theconversation.com,2011:article/2079672023-09-11T12:51:48Z2023-09-11T12:51:48ZFlu season started early in Australia – countries in the northern hemisphere took note<p>Influenza is a seasonal virus that emerges and peaks in winter, so with evenings shortening in the UK, it’s time to think about flu again.</p>
<p>Countries in the northern hemisphere closely monitor flu trends in Australia, because this helps predict how winter flu season might play out there. Flu viruses are monitored to keep track of what’s circulating, the age groups most affected and how well the vaccines are working. </p>
<p>In 2020 and 2021, at the height of the COVID pandemic, flu rates <a href="https://www.ecdc.europa.eu/en/publications-data/infographic-influenza-europe-2019-2023">fell dramatically around the world</a>. This is probably because of the unprecedented change in human behaviour, with social distancing, hand hygiene, mask-wearing and travel restrictions. This changed in 2022, with Australia having an earlier-than-usual flu season, which peaked in June instead of August. </p>
<p>Based on their experience, countries in the northern hemisphere expected something similar. The 2022-23 flu season did indeed peak in the northern hemisphere in December 2022, <a href="https://www.ecdc.europa.eu/en/publications-data/influenza-virus-characterization-summary-europe-february-2023">two months earlier</a> than the usual (pre-pandemic) peak of flu activity. </p>
<p>This year, Australia experienced a peak of flu at the end of June, about two weeks later than <a href="https://www.health.gov.au/sites/default/files/2023-08/aisr-fortnightly-report-no-10---7-august-to-20-august-2023.pdf">last year</a>. When flu season will peak in the northern hemisphere, though, is hard to predict, and can’t be extrapolated from what happened in Australia. Human interactions and behaviour, including how many people opt to have the flu jab, can influence how flu spreads. </p>
<p>The scale of the Australian flu season, so far, looks similar to last year though cases are declining slower. Indicators such as hospital admission rates, admissions to intensive care units (ICU) and deaths are recognised markers of severity. Up to August 20 2023, the data looked similar to 2022. Among those hospitalised to date about <a href="https://www.health.gov.au/sites/default/files/2023-08/aisr-fortnightly-report-no-10---7-august-to-20-august-2023.pdf.">7% were admitted to an ICU</a>. </p>
<p>The death toll so far is just under 0.1% compared with 0.14% in 2022. Based on these figures, flu severity appears low overall, but it’s still too early to say for sure. </p>
<p>Australian surveillance reports also show that, similar to previous years, the highest number of cases are in children aged five to nine years, followed by younger and older children. </p>
<p>Among those hospitalised, those under 16 were the largest group (72%) based on reported data from key hospitals. This is concerning if this trend continues in 2023-24. However, it should be noted that the age distribution of hospital admissions in the Australian surveillance system may not reflect the age distribution of all flu admissions nationally. </p>
<h2>Get vaccinated</h2>
<p>The World Health Organization (WHO) recommends vaccination ahead of each flu season for certain groups, including <a href="https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)">older adults, children and healthcare workers</a>. The vaccine is safe and effective in preventing the flu and reducing hospitalisation or life-threatening complications like pneumonia. </p>
<p>One difficulty, and the reason why virus tracking is important, is that vaccine components must be updated so they’re well matched to the strains causing illness in a given year. </p>
<p>From surveillance data so far, <a href="https://www.health.gov.au/resources/publications/aisr-fortnightly-report-no-10-7-august-to-20-august-2023?language=en">59% of Australia’s circulating strains are type A and about 39% are type B</a>. Influenza A viruses are further divided into subtypes based on two proteins on their surface: haemagglutinin (H) and neuraminidase (N). These proteins are recognised by the immune system and can trigger an immune response. Several H and N subtypes exist, but A(H1N1) and A(H3N2) are most commonly responsible for seasonal flu in humans. </p>
<p>Influenza B is divided by lineages, with two lineages usually circulating (B-Victoria and B-Yamagata). </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/J5JTU0d2O2U?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Types of influenza virus explained.</span></figcaption>
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<p>Circulating influenza viruses change regularly because mutations in the virus genes happen over time. These make the H and N proteins highly variable, which may affect our immune response to the virus. These changes or “<a href="https://www.cdc.gov/flu/about/viruses/change.htm">antigenic drift</a>” are why new vaccines are needed each year. </p>
<p>For the body to make the right antibodies to protect people during the influenza season, the vaccines should contain H and N proteins (antigens) that match well to the circulating virus. </p>
<h2>Preparing vaccines for the coming season</h2>
<p>It takes several months to produce vaccines in the amounts needed for global distribution. That means the circulating strains are anticipated based on the previous season’s trends. For countries in the northern hemisphere, the WHO began consultations in February to recommend viruses for inclusion in flu vaccines for the 2023-24 flu season.</p>
<p>Tracking the effectiveness of vaccines during flu seasons can tell if recommendations for a given region were correct. Vaccine effectiveness turned out to be quite low (15%) <a href="https://www.gov.uk/government/news/flu-vaccine-effectiveness-in-2017-to-2018-season">in 2017-18</a>, and this resulted in a flu season with higher than usual levels of infection. </p>
<p>While it’s still too early to assess vaccine match and effectiveness, in Australia of the 2,678 flu virus samples sent to the WHO to date, 98% of influenza A(H1N1) isolates (samples taken from one person), 84% of influenza A(H3N2) isolates and 99% of influenza B/Victoria isolates <a href="https://www.health.gov.au/sites/default/files/2023-08/aisr-fortnightly-report-no-10---7-august-to-20-august-2023.pdf">had similar antigens to the corresponding vaccine components</a></p>
<p>Apart from vaccination, good habits and respiratory etiquette – learned during the COVID pandemic – can help us to avoid the flu and other respiratory illnesses. These include actions like covering coughs and sneezes, regularly washing hands and avoiding people who have symptoms.</p><img src="https://counter.theconversation.com/content/207967/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deirdre Fitzgerald Hughes receives funding from Science Foundation Ireland and the Irish Research Council. </span></em></p><p class="fine-print"><em><span>Eoghan O'Neill receives funding from Health Research Board Ireland. </span></em></p>The COVID pandemic made flu less severe. But now flu is back with a vengeance and all eyes are on Australia.Deirdre Fitzgerald Hughes, Senior Lecturer, Clinical Microbiology, RCSI University of Medicine and Health SciencesEoghan O'Neill, Associate Professor, Clinical Microbiology, RCSI University of Medicine and Health SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2078252023-06-25T20:04:25Z2023-06-25T20:04:25ZHeard of ‘kindy flu’? There’s no such thing. But kids are at risk this flu season for one simple reason<figure><img src="https://images.theconversation.com/files/533372/original/file-20230622-25-qj4y5m.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/small-sick-toddler-girl-indoors-home-1688033386">Shutterstock</a></span></figcaption></figure><p>The 2023 flu season may be one of Australia’s largest flu seasons on record, and doctors <a href="https://www.abc.net.au/news/2023-06-06/influenza-flu-season-affecting-kids-children-hospital-cases-up/102387982">are concerned</a> about the impact on children.</p>
<p>You may have seen <a href="https://www.9news.com.au/national/kindy-flu-warning-for-parents-highly-contagious-influenza-a-vaccination/bd4af754-2763-4b08-8b98-a2134ef29be5">headlines</a> warning parents about “<a href="https://www.kidspot.com.au/lifestyle/family-health/what-is-kindy-flu-and-do-parents-need-to-worry-about-it/news-story/1a229dd2d6dd55fa6b76b8b40ed7ea06">kindy flu</a>”. These can be misleading. This year’s flu virus does not “target” children. But during the 2023 flu season, children are particularly vulnerable for one important reason – low vaccination rates.</p>
<p>We are concerned that <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/national-influenza-vaccination-coverage-all-people">fewer children</a> have received their annual flu vaccine in 2023, compared to previous years. And it leaves them, and the wider community, at risk of flu and its complications.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-the-flu-13985">Explainer: what is the flu?</a>
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</em>
</p>
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<h2>How bad is it?</h2>
<p>In <a href="https://nindss.health.gov.au/pbi-dashboard/">2023</a>, we are on track for a similar influenza season <a href="https://www.health.gov.au/sites/default/files/documents/2022/10/aisr-2019-national-influenza-season-summary.pdf">to 2019</a> – the largest influenza season on record in Australia. That’s when there were more than 300,000 recorded influenza cases.</p>
<p>At the time of writing, we’ve had <a href="https://nindss.health.gov.au/pbi-dashboard/">107,941 recorded flu cases</a> so far in 2023, and the flu season still has months to go. Of these, 48,873 cases have been in children under 15 years and 22,365 in those aged five to nine years. </p>
<p>Since the flu season started in late April, children have made up almost <a href="https://www.health.gov.au/sites/default/files/2023-06/aisr-fortnightly-report-no-5-29-may-to-11-june-2023_0.pdf">80% of those admitted to hospital</a> across the country at sentinel surveillance sites. Many children’s hospitals are reporting high numbers of children <a href="https://www.schn.health.nsw.gov.au/news/articles/2023/06/protecting-children-through-flu-vaccine">hospitalised</a> with flu.</p>
<p>Sadly, one child has died of influenza, a <a href="https://7news.com.au/news/public-health/perth-familys-message-after-toddler-dies-from-flu-c-10895076">three year old</a> in Perth.</p>
<p>These large case numbers come after <a href="https://pubmed.ncbi.nlm.nih.gov/32986804/">low influenza case numbers</a> seen <a href="https://www.health.gov.au/resources/publications/aisr-2021-national-influenza-season-summary?language=en">earlier</a> in the <a href="https://www.health.gov.au/sites/default/files/documents/2022/10/aisr-2020-national-influenza-season-summary.pdf">pandemic</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kids-are-more-vulnerable-to-the-flu-heres-what-to-look-out-for-this-winter-117748">Kids are more vulnerable to the flu – here's what to look out for this winter</a>
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</em>
</p>
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<h2>Why is this happening?</h2>
<p>The 2023 flu strains do not seem to be any more severe than in other years, according to a number of measures.</p>
<p>In hospitals, the number of those admitted directly to intensive care (currently <a href="https://www.health.gov.au/sites/default/files/2023-06/aisr-fortnightly-report-no-5-29-may-to-11-june-2023_0.pdf">7%</a>) is similar to previous seasons. </p>
<p>In the community, the number of those with flu-like illnesses needing to take time off regular duties is <a href="https://info.flutracking.net/about/">also similar.</a></p>
<p>There is also no evidence the <a href="https://www.health.gov.au/sites/default/files/2023-06/aisr-fortnightly-report-no-5-29-may-to-11-june-2023_0.pdf">current strains</a> circulating are more likely to infect children, or for them to infect others, compared with strains circulating in previous years.</p>
<p>So something else must be going on.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man at home, sick with cold or flu, wiping nose" src="https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Home sick from work? You’re not alone.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sick-man-sits-home-on-gray-2223553363">Shutterstock</a></span>
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<h2>So what’s different in 2023?</h2>
<p>The single thing different to pre-pandemic years is the number of younger Australians not getting an influenza vaccine. </p>
<p>In 2020, at this stage of the season, nearly <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/national-influenza-vaccination-coverage-all-people">40% of children</a> aged from six months to under five years were vaccinated, compared with just 20% currently. In those aged five to under 15 years, 25% were vaccinated in 2020 compared with just 12% now.</p>
<p>This makes us worried. </p>
<p>Young children, particularly those <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4004f.htm">under five years</a>, are the group most likely to be hospitalised with flu.</p>
<p>Although children with underlying medical conditions – including chronic disorders of the heart, lungs, nervous and immune system – are most susceptible, <a href="https://academic.oup.com/cid/article/68/6/940/5077025">more than half of children</a> admitted to hospital each year with flu are otherwise healthy. While rare, <a href="https://publications.aap.org/pediatrics/article/132/5/796/31654/Influenza-Associated-Pediatric-Deaths-in-the">flu deaths</a> also occur in previously healthy children.</p>
<p>We are also worried about influenza making children more vulnerable to <a href="https://www.cdc.gov/flu/about/keyfacts.htm">secondary bacterial infections</a>. These include
<a href="https://www.9news.com.au/national/strep-a-australia-victorian-health-authorities-warning-strep-a-cases-are-rising-among-children/87989de5-94ca-4544-8cc1-d470f013c947">invasive group A streptococcus</a> and pneumococccal disease.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Strep A" src="https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=237&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=237&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=237&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=298&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=298&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=298&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Complications from flu can include invasive group A streptococcus infection.</span>
<span class="attribution"><a class="source" href="https://www.who.int/europe/news/item/12-12-2022-increase-in-invasive-group-a-streptococcal-infections-among-children-in-europe--including-fatalities">Meredith Newlove/CDC/WHO</a></span>
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<h2>Another reason to get vaccinated</h2>
<p>Children have large volumes of virus in their nasal secretions and, after infection, shed this for days. They also have poorer hygiene practices, often coughing and spluttering over those closest to them.</p>
<p>So children will quickly infect their parents, grandparents and younger siblings. Some will be at higher risk of getting unwell and being hospitalised, such as the elderly, the very young, First Nations people, and those with underlying medical issues <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu#people-at-risk-of-severe-disease-from-influenza">including</a> heart, lung, kidney and immune problems.</p>
<p>Primary school-age children are the group that <a href="https://pubmed.ncbi.nlm.nih.gov/24115913/">most frequently transmits flu</a> in the community. In
2023, we expect the largest number of cases in the community to be in five to nine-year-olds.</p>
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<strong>
Read more:
<a href="https://theconversation.com/should-i-get-a-flu-vaccine-this-year-heres-what-you-need-to-know-203406">Should I get a flu vaccine this year? Here's what you need to know</a>
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<h2>When to seek medical attention</h2>
<p>Flu in children commonly <a href="https://www.rch.org.au/kidsinfo/fact_sheets/influenza_the_flu/">causes</a> high temperatures, sore throats, miserable kids and a non-stop runny nose and cough. Most cases can be safely managed at home. </p>
<p>But if you’re worried about your child during the flu season, seek medical advice, particularly if your child:</p>
<ul>
<li><p>has difficulty breathing (breathing rapidly or drawing in chest or neck muscles)</p></li>
<li><p>is vomiting and refusing to drink</p></li>
<li><p>is more sleepy than normal</p></li>
<li><p>has pain that doesn’t get better with simple pain relief medication.</p></li>
</ul>
<p>And right now, before they get sick, book in your children for their annual flu vaccine. It prevents more than <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/irv.12939">half</a> of flu infections. And even if infected, vaccinated children are <a href="https://theconversation.com/thinking-about-getting-your-child-the-flu-vaccine-heres-what-you-need-to-know-94393">less likely</a> to be hospitalised with it.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-about-getting-your-child-the-flu-vaccine-heres-what-you-need-to-know-94393">Thinking about getting your child the flu vaccine? Here's what you need to know</a>
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<img src="https://counter.theconversation.com/content/207825/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Asha Bowen receives funding from National Health and Medical Research Council of Australia, and Medical Research Futures Fund of Australia. </span></em></p><p class="fine-print"><em><span>Christopher Blyth receives funding from the National Health and Medical Research Council of Australia, and Medical Research Futures Fund of Australia. He is a member of the COVID-19 Vaccines and Treatments for Australia – Science and Industry Technical Advisory Group and past member of the Australian Technical Advisory Group on Immunisation.</span></em></p>Rates of flu vaccination are down for children. That leaves them and us vulnerable to the flu and its complications.Asha Bowen, Program Head, Telethon Kids InstituteChristopher Blyth, Paediatrician, Infectious Diseases Physician and Clinical Microbiologist, Telethon Kids Institute, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2041192023-04-23T20:04:31Z2023-04-23T20:04:31ZFlu or COVID? You can now test for both at home with a single swab. Here’s what you need to know<figure><img src="https://images.theconversation.com/files/522244/original/file-20230421-22-d7zbfx.jpg?ixlib=rb-1.1.0&rect=2%2C5%2C995%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-sick-woman-home-african-lying-1631753728">Shutterstock</a></span></figcaption></figure><p>If you have respiratory symptoms as we head towards winter and flu season, could it be COVID or the flu? Or something else entirely?</p>
<p>Now, we have a <a href="https://www.sbs.com.au/news/article/combination-flu-and-covid-rapid-tests-have-hit-store-shelves-how-useful-are-they/pmh4bx4rk">range of home tests</a> that can distinguish between flu and COVID with one swab. They use technology you might be used to. They’re rapid antigen tests or RATs.</p>
<p>Here’s what you need to know about the tests, why they might be useful, and what they don’t tell us.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1646042955189481472"}"></div></p>
<h2>What’s new about these tests?</h2>
<p>Most people were introduced to RATs while testing at home for COVID.</p>
<p>But RATs to detect the flu have been available for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6156320/">years</a>, albeit used by health workers to test patients.</p>
<p>The latest RATs are different for two reasons. One, they detect both COVID and flu with one swab (a “combo” test). Two, they can be used at home.</p>
<p>The first of these combo home tests for flu/COVID was approved in <a href="https://www.tga.gov.au/news/media-releases/first-combination-covid-19-and-influenza-self-tests-approved-australia">September 2022</a>. Now several are on the market.</p>
<p>These tests let you check, with one test kit, if you are infected with two types of flu (influenza A and B) and SARS-CoV-2 (the virus that causes COVID).</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-flu-cases-already-100-times-higher-than-last-year-heres-what-we-really-know-about-the-2023-flu-season-201559">Are flu cases already 100 times higher than last year? Here's what we really know about the 2023 flu season</a>
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<h2>How do they work?</h2>
<p>These RATs contain antibodies that can detect influenza A, influenza B, and SARS-CoV-2.</p>
<p>Some kits have a test cassette with one well to add drops to and one window labelled: C (control), A (influenza A), B (influenza B) and T (test for COVID). </p>
<p>Some tests have two wells and two test windows. You view the influenza results in one window and the COVID results in the other.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/522242/original/file-20230421-14-aaner7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Test cassette of combined flu/COVID rapid antigen test" src="https://images.theconversation.com/files/522242/original/file-20230421-14-aaner7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/522242/original/file-20230421-14-aaner7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=603&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522242/original/file-20230421-14-aaner7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=603&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522242/original/file-20230421-14-aaner7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=603&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522242/original/file-20230421-14-aaner7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=757&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522242/original/file-20230421-14-aaner7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=757&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522242/original/file-20230421-14-aaner7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=757&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some test cassettes have two wells, like this one.</span>
<span class="attribution"><a class="source" href="https://www.tga.gov.au/sites/default/files/2023-02/covid-19-rapid-antigen-self-tests-are-approved-australia-ifu-404854_0.pdf">TGA</a></span>
</figcaption>
</figure>
<p>In the influenza window you will see markings C, A and B. If a line becomes visible at A (and C), you have tested positive for influenza A. If a line becomes visible at B (and C), you are positive for influenza B. If lines are visible at A, B and C you have tested positive for both influenza A and B. </p>
<p>If either A or B has a line but not C, or if none of them do, the test is invalid and you will need to take a new one. </p>
<p>The COVID window works the same way as in a standard RAT for COVID. If a line becomes visible at C and T, you are COVID-positive. If there is a line at C but not T, you are COVID-negative. If there is no line at C the test is invalid. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-my-rat-actually-working-how-to-tell-if-your-covid-test-can-detect-omicron-196210">Is my RAT actually working? How to tell if your COVID test can detect Omicron</a>
</strong>
</em>
</p>
<hr>
<h2>Why take the test? 3 reasons</h2>
<p>If you have respiratory symptoms, there are some practical reasons for knowing whether you are positive for COVID or flu. </p>
<p>One, if you know you have COVID, this will affect the timing of your booster vaccine. The Australian Technical Advisory Group on Immunisation recommends adults wait <a href="https://www.health.gov.au/news/atagi-2023-booster-advice">six months</a> after a COVID infection to get a booster to increase the time you have protective immunity. So it helps to know if you have been infected.</p>
<p>Two, if you need antiviral treatment, the medications differ depending on whether you have <a href="https://www.ncbi.nlm.nih.gov/books/NBK459363/">flu</a> or <a href="https://www.nps.org.au/radar/articles/nirmatrelvir-and-ritonavir-paxlovid-for-mild-to-moderate-covid-19">COVID</a>. </p>
<p>Three, knowing you have flu or COVID means you can take steps to protect others. This could mean working at home, avoiding contact with vulnerable people, and wearing a mask in company.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/522245/original/file-20230421-22-f0mwfd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman's holding Paxlovid pill in one hand, glass of water in other, Paxlovid, thermometer in background" src="https://images.theconversation.com/files/522245/original/file-20230421-22-f0mwfd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/522245/original/file-20230421-22-f0mwfd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522245/original/file-20230421-22-f0mwfd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522245/original/file-20230421-22-f0mwfd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522245/original/file-20230421-22-f0mwfd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522245/original/file-20230421-22-f0mwfd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522245/original/file-20230421-22-f0mwfd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you know you have COVID, you may be eligible for antiviral treatment.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-taking-paxlovid-prescription-treating-covid19-2161258693">MargJohnsonVA/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Which test to use? When to use it?</h2>
<p>The Therapeutic Goods Administration (TGA) lists <a href="https://www.tga.gov.au/products/covid-19/covid-19-tests/covid-19-rapid-antigen-self-tests-home-use/covid-19-rapid-antigen-self-tests-are-approved-australia">approved tests</a> on its website. Type the term “combination” in the search box. All combo tests currently listed use nasal swabs to collect the sample.</p>
<p>Most are listed as “very high sensitivity”. This means they get the same result in detecting positive cases as the gold standard PCR test 95% of the time. The others have “high sensitivity” (90% agreement with a PCR).</p>
<p>The <a href="https://www.tga.gov.au/qas-combination-rapid-antigen-self-tests">best time</a> to take the test is within four days of developing symptoms, as this is when it is easiest to detect both flu and COVID. The tests are more reliable if <a href="https://www.tga.gov.au/qas-combination-rapid-antigen-self-tests">you have symptoms</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/15-things-not-to-do-when-using-a-rapid-antigen-test-from-storing-in-the-freezer-to-sampling-snot-176364">15 things not to do when using a rapid antigen test, from storing in the freezer to sampling snot</a>
</strong>
</em>
</p>
<hr>
<h2>What if I have symptoms but the test is negative?</h2>
<p>One possibility is that your viral load was not high enough to be detected. You could take another test a day or so later to check again.</p>
<p>Another is you may have a different virus. Viruses that cause respiratory symptoms include <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553670/">rhinoviruses</a>, adenoviruses, <a href="https://www.health.gov.au/diseases/respiratory-syncytial-virus-rsv-infection">respiratory syncytial virus</a> and <a href="https://journals.lww.com/pidj/Fulltext/2022/03000/Proving_Etiologic_Relationships_to_Disease_.18.aspx">common cold coronaviruses</a>. </p>
<p>Other pathogens (disease-causing microorganisms) or health conditions can also cause respiratory symptoms. If you are concerned, consult your doctor for medical advice. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/havent-had-covid-or-a-vaccine-dose-in-the-past-six-months-consider-getting-a-booster-199096">Haven't had COVID or a vaccine dose in the past six months? Consider getting a booster</a>
</strong>
</em>
</p>
<hr>
<h2>What else should I know?</h2>
<p>As each test differs, make sure you <a href="https://theconversation.com/15-things-not-to-do-when-using-a-rapid-antigen-test-from-storing-in-the-freezer-to-sampling-snot-176364">follow the instructions</a> for that specific test.</p>
<p>The price of combo kits advertised online varies from A$8.95 to $59 (excluding delivery) so it pays to shop around.</p>
<p>It’s worth trying to avoid catching the flu rather than testing for it later. Flu vaccination reduces your chances of catching the flu by <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm">40-60%</a> when the vaccine is well matched to circulating strains. Flu vaccines for the 2023 flu season are available now.</p><img src="https://counter.theconversation.com/content/204119/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thea van de Mortel teaches into the Master of Infection Prevention and Control program at Grififth University. </span></em></p>Knowing if you have COVID or the flu can affect when you get vaccinated, need a particular antiviral, or if you need to work from home. But these combination tests can be expensive.Thea van de Mortel, Professor, Nursing, School of Nursing and Midwifery, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1951672023-04-21T12:41:02Z2023-04-21T12:41:02ZWatch out for dangerous combinations of over-the-counter cold medicine and prescription drugs – two pharmacoepidemiology experts explain the risks<figure><img src="https://images.theconversation.com/files/515976/original/file-20230317-1719-4fdiwl.jpg?ixlib=rb-1.1.0&rect=63%2C52%2C6974%2C4642&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Over-the-counter medications, even though they sell by the millions, are not risk-free.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/portrait-of-ill-woman-caught-cold-royalty-free-image/1061849382?phrase=cold%20and%20flu%20headache&adppopup=true">dragana991/iStock via Getty Images Plus</a></span></figcaption></figure><p>When colds, flus and allergies hit, many people automatically turn to over-the-counter medications to push through and treat their symptoms. These include decongestants, painkillers, cough or allergy medicines and combinations thereof. Nearly 70% of adults in the U.S. use over-the-counter medications as a first-line response for <a href="https://www.chpa.org/about-consumer-healthcare/research-data/otc-sales-statistics">treating cold and flu symptoms</a>. </p>
<p>Although these medications are easily accessible and widely used, it might come as a surprise to many people to learn that they are not risk-free. </p>
<p>We are a <a href="https://pharmacy.osu.edu/directory/macarius-donneyong">pharmacoepidemiologist</a> and pharmacist team and we investigate adherence to medications and potential harms of medications associated with drug-drug interactions. Pharmacoepidemiology is the study of medication use and treatment outcomes among large populations in real-world settings.</p>
<p>A 2021 study showed that from 2017 to 2019 in the U.S., approximately 6.1 of every 1,000 people <a href="https://doi.org/10.1001/jama.2021.13844">visited emergency rooms because of harms from medications</a>. Of these emergency room visits, 38.6% led to hospitalization. More of these cases occurred in patients 65 and older than in younger populations. </p>
<p>Another study estimated that every year, 26,735 people went to the emergency room for <a href="https://doi.org/10.1002/pds.5384">adverse events related to over-the-counter cold and cough medications</a>. And more than 60% used the medications for reasons other than the medication’s intended use.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/aDsW8tx1KsY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Combining medications, herbs and even certain kinds of foods can cause harm.</span></figcaption>
</figure>
<h2>The dangers of mixing medications</h2>
<p>When two or more drugs are used together, their interactions can sometimes <a href="https://www.fda.gov/drugs/resources-you-drugs/drug-interactions-what-you-should-know">produce unexpected harmful effects</a>. Pharmacists and physicians are typically knowledgeable about potential drug interactions, so it is very important for patients to ask their health care providers which over-the-counter medications are safe for them to use. </p>
<p>It is important to read the package ingredients of over-the-counter medications closely to avoid duplication of doses. Cold medications are typically made up of multiple ingredients, including pain relievers, nasal decongestants and cough suppressants or expectorants. A person who also takes a single-ingredient medication paired with one of these multi-ingredient formulations can receive an unsafe dose of that ingredient.</p>
<p>For example, acetaminophen, also known by its brand name Tylenol, is commonly taken as a single active ingredient in an acetaminophen pill. But acetominophen is often added to multi-ingredient over-the-counter drugs as well. For instance, certain formulations of DayQuil, an over-the-counter medication for relief from cold and flu symptoms, contain acetaminophen along with a cough suppressant and a nasal decongestant. Doctors typically do not recommend using both single-ingredient Tylenol and DayQuil at the same time, as it increases the risk of adverse events like liver damage due to accidental overdoses. Signs and symptoms of an acetaminophen overdose include nausea, vomiting, abdominal pain and confusion.</p>
<p>It is also dangerous for patients who are using drugs called monoaminooxidase inhibitors – an early class of antidepressants that includes Marplan (isocarboxazid) and Nardil (phenelzine), among others – or tricyclic antidepressants in combination with <a href="https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/pseudoephedrine">pseudoephedrine</a>, <a href="https://doi.org/10.1111/j.1365-2125.2006.02833.x">phenylephrine</a> or ephedrine, which are used to treat congestion. <a href="https://www.drugtopics.com/view/otc-drug-interaction-considerations-in-the-cough-and-cold-aisle">Combining these decongestants</a> with monoaminooxidase inhibitors or tricyclic antidepressants could lead to very high blood pressure and heart rhythm problems. </p>
<p>Taking the opioid oxycodone at the same time as certain antidepressants <a href="https://theconversation.com/taking-certain-opioids-while-on-commonly-prescribed-antidepressants-may-increase-the-risk-of-overdose-178262">can also be dangerous</a>. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/7_G3UGYu3xc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The shortage of children’s medicine on the shelves is part of the problem.</span></figcaption>
</figure>
<h2>Each person responds to drugs differently</h2>
<p>In addition to the potential for drug-drug interactions or other adverse effects, these medications can <a href="https://theconversation.com/why-prescription-drugs-can-work-differently-for-different-people-168645">affect certain people differently</a> and may increase the risk of harm depending on a person’s characteristics and age group. As we age, our bodies begin to lose the ability to efficiently clear drugs, which increases the risk of adverse events and unintentional overdoses.</p>
<p>Some drugs can be dangerous for people who have particular health conditions. For example, pseudoephedrine, phenylephrine and ephedrine <a href="https://www.uspharmacist.com/article/challenges-when-recommending-nonprescription-products-for-patients-with-diabetes">could increase blood sugar levels</a>, so it is important that diabetic patients be careful when using them. In addition, since these drugs are associated with increased blood pressure, patients with hypertension, hyperthyroidism or heart disease should be careful when using them, or avoid them altogether. </p>
<p>While everyone could potentially experience adverse effects from cold and flu medications, some groups – including older adults, children and pregnant women – may be at greater risk.</p>
<p>Older people who are using prescribed drugs to treat multiple health conditions may have a higher risk of drug interactions because of the higher number of medications being used simultaneously to treat different conditions. The aging body is not as adept at absorbing, distributing and eliminating medications as younger bodies are. This can put older adults at higher risk for overdose and drug-to-drug interactions with some medications.</p>
<h2>Alternatives for children</h2>
<p>The Food and Drug Administration and the Centers for Disease Control and Prevention <a href="https://www.fda.gov/consumers/consumer-updates/should-you-give-kids-medicine-coughs-and-colds">do not recommend</a> <a href="https://www.cdc.gov/antibiotic-use/colds.html">giving cold medications to children under age 4</a>. Because of a variety of factors, young children have a <a href="https://doi.org/10.5863/1551-6776-14.3.127">higher risk of accidental overdose and adverse events</a> that could lead to death. </p>
<p>For one, <a href="https://theconversation.com/why-prescription-drugs-can-work-differently-for-different-people-168645">small bodies respond to dosages differently</a> – the same dose in a child can lead to higher blood concentration of a drug than it would in an adult. In addition, as the child develops, organs mature at their own pace, and changes in the body composition are observed. So in addition to a child’s size, prescribers need to take into consideration the developmental stage of the child. And <a href="https://doi.org/10.1111%2Fbcp.12267">some drugs are not even recommended for kids</a>, as they haven’t developed the necessary mechanisms to process the drug.</p>
<p>However, <a href="https://www.aafp.org/pubs/afp/issues/2019/0901/p281.html">there are some safer alternatives</a>. Research has shown that honey can be helpful for <a href="https://doi.org/10.1503/cmaj.121442">reducing cold and flu symptoms</a> in children older than age 1.</p>
<p>Nasal saline, a salt solution used to clean the nasal passages to improve nasal airflow, can help alleviate congestion and nasal drip. And certain creams and ointments containing the soothing compounds camphor, menthol or eucalyptus oils can sometimes be effective at <a href="https://doi.org/10.1503%2Fcmaj.121442">reducing cough, congestion and sleep difficulties</a>.</p>
<h2>Pregnancy best practices</h2>
<p>Some of the components commonly used in cold medicines are not recommended during pregnancy, as they can put not only the mother at risk but also the fetus. Acetaminophen is <a href="https://www.uspharmacist.com/article/pregnancy-and-otc-cough-cold-and-analgesic-preparations">the doctor-recommended over-the-counter medication</a> for management of pain and fever at any stage of pregnancy. But acetaminophen should be used only when needed and taken minimally, from <a href="https://theconversation.com/tylenol-could-be-risky-for-pregnant-women-a-new-review-of-25-years-of-research-finds-acetaminophen-may-contribute-to-adhd-and-other-developmental-disorders-in-children-168820">one-time use to a few days at the most</a>. </p>
<p>Any other pain relievers or anti-inflammatory medicine such as ibuprofen, ketoprofen, naproxen and aspirin <a href="https://www.aafp.org/pubs/afp/issues/2003/0615/p2517.html">should not be taken during pregnancy without a doctor’s approval</a>. These drugs, with the exception of aspirin, are known as nonsteroidal anti-inflammatories, or NSAIDs. They are associated with <a href="https://www.fda.gov/media/142967/download">various adverse effects in the unborn baby</a>, such as kidney failure and reduced amount of amniotic fluid.</p>
<p>For symptoms such as nasal congestion during pregnancy, a decongestant called oxymetazoline in its intranasal form is <a href="https://www.uptodate.com/contents/image?imageKey=OBGYN%2F62846%7EOBGYN%2F75622%7EOBGYN%2F51533%7EOBGYN%2F77865&topicKey=undefined">the drug of choice</a>. But it is also critically important to use this drug as recommended by a physician, because it is suspected that, in certain settings, it may have some adverse effects on placental and uterine blood flow. </p>
<p>For your safety, always ask your pharmacist or health care provider about the risks and dangers of taking multiple medications at the same time.</p><img src="https://counter.theconversation.com/content/195167/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Macarius Mwinisungee Donneyong receives funding from National Institute on Ageing/National Institutes of Health and American Foundation for Suicide Prevention. </span></em></p><p class="fine-print"><em><span>Ximena Oyarzún-González does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some of the prescription medications you’re taking may not mix with over-the-counter drugs.Macarius Mwinisungee Donneyong, Assistant Professor of Pharmacoepidemiology, The Ohio State UniversityXimena Oyarzún-González, Postdoctoral Researcher in Outcomes and Translational Sciences, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2015592023-03-17T03:34:49Z2023-03-17T03:34:49ZAre flu cases already 100 times higher than last year? Here’s what we really know about the 2023 flu season<figure><img src="https://images.theconversation.com/files/515943/original/file-20230316-2171-ewng07.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sick-boy-thermometer-laying-bed-mother-450568075">Shutterstock</a></span></figcaption></figure><p>Alarming <a href="https://www.9news.com.au/national/flu-cases-australia-update-warning-vulnerable-numbers-rise-100-fold-last-year/55ccbb1d-9613-4e45-85aa-43c905efc8e6">headlines</a> and media coverage <a href="https://www.sbs.com.au/news/article/the-flu-nearly-disappeared-during-the-pandemic-now-cases-are-soaring-in-australia/a98cybrj8">have said</a> we’ve had 100 times as many influenza cases in the first two months of 2023 compared with the same time the previous year.</p>
<p>The coverage suggested we’re in for a bumper flu season, starting early and your best protection was to get a flu vaccine, when available.</p>
<p>But that scary sounding 100 figure is misleading. Here’s what’s behind the figures and what we can really expect from the 2023 flu season.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/you-cant-get-influenza-from-a-flu-shot-heres-how-it-works-118916">You can't get influenza from a flu shot – here's how it works</a>
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</em>
</p>
<hr>
<h2>Comparing apples with oranges</h2>
<p>In the first two months of 2023, there were 8,474 laboratory-confirmed cases of influenza. In 2022, over the same period, there were 79 cases.</p>
<p>So it might seem this year’s figures are indeed more than 100 times higher than last year’s. But we shouldn’t be alarmed. That’s because in early 2022, influenza cases were artificially low.</p>
<p>Strict COVID measures <a href="https://www.bmj.com/content/379/bmj.o2998">almost eliminated</a> influenza outbreaks in 2020 and 2021. Shutting international borders, quarantining, social distancing and mask-wearing stopped influenza coming into the country and spreading.</p>
<p>Many COVID restrictions weren’t relaxed until late February/March 2022. So, in January and February of that year there were fewer opportunities for us to mingle and spread the influenza virus. It’s hardly surprising there were few cases then.</p>
<p>In fact, the rate of flu in 2023 is actually very similar to pre-COVID years (that is before 2020).</p>
<p>As always, the reported cases represent just a fraction of the actual influenza cases. That’s because many people do not seek medical care when infected with influenza or their GP doesn’t always test them for it.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-when-is-the-flu-really-a-cold-25150">Health Check: when is 'the flu' really a cold?</a>
</strong>
</em>
</p>
<hr>
<h2>How about an earlier flu season?</h2>
<p>Every year, it seems, influenza throws a new curve ball making predictions tricky.</p>
<p>Flu rates in the northern hemisphere <a href="https://www.cnet.com/health/medical/early-signs-point-to-this-years-flu-season-being-the-worst-one-in-years/">largely peaked</a> in December 2022, two months earlier than usual.</p>
<p>But there has been some late-season influenza B activity in the northern hemisphere this year. This is one type of influenza that causes seasonal flu. So travellers arriving/returning from the northern hemisphere have been bringing influenza to Australia for several months.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Travellers pulling roll-along luggage in busy airport" src="https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=415&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=415&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=415&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=522&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=522&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515953/original/file-20230316-18-tssgo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=522&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Travellers from the northern hemisphere may have been bringing the influenza virus with them.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/airport-349845530">Shutterstock</a></span>
</figcaption>
</figure>
<p>So we expect more cases of influenza. Australia may even have an autumn surge. This occurred <a href="https://www.bmj.com/content/379/bmj.o2998">last year</a>, where influenza cases rose sharply in May, and peaked by June. That’s two months earlier than the five-year average pre-COVID.</p>
<p>Before COVID, influenza cases usually began to rise in April/May. This progressed to a full epidemic from June to August, often extending into September, before waning in October.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flu-covid-and-flurona-what-we-can-and-cant-expect-this-winter-177826">Flu, COVID and flurona: what we can and can’t expect this winter</a>
</strong>
</em>
</p>
<hr>
<h2>So what can we expect in 2023?</h2>
<p>The start, length and severity of influenza seasons vary and are often unpredictable.</p>
<p>Community immunity will be less than in pre-COVID times. That’s because of fewer influenza infections during COVID restrictions plus <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/national-influenza-vaccination-coverage-all-people">lower influenza vaccine uptake</a> in recent years.</p>
<p>So the 2023 flu season may be at least moderately severe. This remains speculation. Flu routinely surprises us.</p>
<p>The severity of the coming Australian influenza season will be influenced by the types of influenza that circulate, when the surge starts and when the season peaks. The effectiveness, uptake and timing of vaccinations and the degree of remaining herd immunity will all be important. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-mrna-vaccines-researchers-are-working-on-that-arent-covid-157858">3 mRNA vaccines researchers are working on (that aren't COVID)</a>
</strong>
</em>
</p>
<hr>
<h2>Plan to get vaccinated</h2>
<p>Only about 40% of those eligible were vaccinated against influenza in 2022, according to the <a href="https://www.servicesaustralia.gov.au/australian-immunisation-register">Australian Immunisation Register</a> database. Rates <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/national-influenza-vaccination-coverage-all-people">were highest</a> in people aged 65 or older.</p>
<p>However, as we saw an early influenza season in 2022 (peaking in May/June) this meant many Australians were not vaccinated during the early stages of the epidemic.</p>
<p>With this knowledge, it’s important to be vaccinated in April/May before influenza becomes common.</p>
<p>Now is a good time to start preparing to get your flu vaccine. Ask your GP or pharmacist when you can book yourself in.</p>
<p>Vaccination is our best defence against influenza and is recommended from the age of <a href="https://www.health.gov.au/news/2023-national-immunisation-program-influenza-vaccination-early-advice-for-vaccination-providers">6 months</a>. Younger infants <a href="https://www.health.gov.au/influenza-vaccination-in-pregnancy">receive protection</a> if their mum was vaccinated during pregnancy.</p>
<p>The 2023 vaccine has been updated to protect against more recently circulating strains. There are also <a href="https://www.health.gov.au/sites/default/files/2023-03/atagi-advice-on-seasonal-influenza-vaccines-in-2023.pdf">different types</a> of influenza vaccine, some more effective in elderly people, some free under the <a href="https://www.health.gov.au/resources/publications/national-immunisation-program-schedule?language=en">National Immunisation Program</a>, some not. Other vaccines are available for people with egg allergies and for small children. It’s best to discuss the vaccine options with your GP or pharmacist.</p><img src="https://counter.theconversation.com/content/201559/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert Booy receives funding from and consults to various vaccine companies in Australia. He has been funded by the ARC, NHMRC and industry to do research on influenza. He is a long-standing director of the Immunisation Coalition.</span></em></p><p class="fine-print"><em><span>Ian Barr owns shares in an influenza vaccine producing company, and his centre receives funding from commercial groups for ongoing activities.</span></em></p>We may have an autumn surge in flu cases. So best start planning for your flu shot soon.Robert Booy, Hon Prof, Dept of Child & Adolescent Health, University of SydneyIan Barr, Deputy Director, WHO Collaborating Centre for Reference and Research on InfluenzaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1966352023-01-03T21:22:02Z2023-01-03T21:22:02ZFears about RSV, flu and winter viruses can cause parental stress. Try these 4 expert tips to balance mental wellness and health risks<figure><img src="https://images.theconversation.com/files/501941/original/file-20221219-20-dl1m5x.jpg?ixlib=rb-1.1.0&rect=422%2C17%2C5568%2C3970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Parents need practical strategies to balance the health risks and stressors of kids getting sick as we trudge through the virulent flu, RSV and COVID-19 winter season. </span> <span class="attribution"><span class="source">(Pexels)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/fears-about-rsv--flu-and-winter-viruses-can-cause-parental-stress--try-these-4-expert-tips-to-balance-mental-wellness-and-health-risks" width="100%" height="400"></iframe>
<p><a href="https://calgary.ctvnews.ca/alberta-children-s-hospital-in-calgary-to-open-heated-trailer-next-to-busy-er-1.6171151">Pediatric emergency departments and clinics have been overcrowded</a> with the dramatic <a href="https://doi.org/10.1038/d41586-022-04408-7">increase in child respiratory viruses</a>, leaving many families anxious about caring for sick kids. </p>
<p>Making decisions about what to do — or not do — can be exhausting, especially coming out of nearly three years of pandemic fears, social isolation and burnout. Parents need practical strategies to balance the health risks and stressors of kids getting sick as we trudge through the virulent flu, RSV and COVID-19 winter season.</p>
<p>As researchers of <a href="https://heartsandmindslab.com/research-projects/">family well-being interventions</a>, we provide four evidence-based stress-management strategies grounded in <a href="https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/">dialectical behaviour therapy</a> skills (DBT). </p>
<figure class="align-center ">
<img alt="A man seen from behind with two children wearing bright pink hats and large backpacks." src="https://images.theconversation.com/files/502575/original/file-20221222-16-d432yn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/502575/original/file-20221222-16-d432yn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/502575/original/file-20221222-16-d432yn.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/502575/original/file-20221222-16-d432yn.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/502575/original/file-20221222-16-d432yn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=512&fit=crop&dpr=1 754w, https://images.theconversation.com/files/502575/original/file-20221222-16-d432yn.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=512&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/502575/original/file-20221222-16-d432yn.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=512&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A father walks into a vaccination clinic with his two children in Montréal.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Paul Chiasson</span></span>
</figcaption>
</figure>
<p>In tough situations, DBT encourages a mindset that balances accepting reality as it currently is (even if this is very much a reality we never wanted!) while identifying actionable steps to change our ability to cope, like bringing in social support and understanding our emotional reactions in compassionate ways. </p>
<p>To bring you the most relevant information, we collaborated with pediatric emergency physicians to integrate their frontline expertise. </p>
<p>Try these tips to build confidence that you’re doing exactly what is needed for your kids this year. </p>
<h2>1) What are my most important values?</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Infographic featuring steps to reduce stress." src="https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1500&fit=crop&dpr=1 600w, https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1500&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1500&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1885&fit=crop&dpr=1 754w, https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1885&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1885&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Dialectical behaviour therapy (DBT) skills can help manage stress.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>For many families, kids’ activities are on the schedule again: fun with friends, time with relatives, celebrations. But having a cavalier attitude about including sick children at events — like in pre-pandemic times — might have costs down the road.</p>
<p>Consider your own values and identify the activities that are the most important, and consider what precautions you’re willing to take to keep your family and community healthy. Maybe it makes sense to attend a small house party with daycare friends, but not a larger gathering at the local arcade? </p>
<p>If limiting sick days matters to you, catching up on <a href="https://www.canada.ca/en/public-health/services/diseases/flu-influenza/get-your-flu-shot.html">COVID-19 boosters or flu shots</a> could save you weeks of sick kids at home. Now is also a great time to teach kids of any age about the basics of hand-washing, tissue use and the “<a href="https://www.nytimes.com/2020/03/17/arts/comic-books-coronavirus.html">batman cough</a>.” </p>
<p>Articles on the <a href="https://www.nytimes.com/2022/12/14/opinion/covid-symptoms.html">new etiquette of coughs</a> highlight the <a href="https://doi.org/10.3389/fpubh.2022.874693">value of masks</a> for residual symptoms, and rebuilding trust with our communities. </p>
<p>Finally, keeping kids home when sick <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/guidance-documents/summary-evidence-supporting-covid-19-public-health-measures.html">really matters</a>. It will also help you avoid the side-eye in public. </p>
<h2>2) How will I manage if they get sick?</h2>
<p>If you have young kids at home, odds are they’ve already been sick and they’ll get sick again. <a href="https://bayareadbtcc.com/cope-ahead-part-1/">Coping ahead</a> — anticipating and rehearsing responses to difficult situations — can reduce anxiety now and help you respond effectively in the future. </p>
<p>With the waves of child sickness, it’s common to find yourself with depleted resources, physically and emotionally. In anticipation of the next onset of illness, a little preparation can go a long way to reduce family stress and promote recovery. Consider replenishing essentials, reviewing the plan for seeking health care, planning for childcare difficulties and managing tough emotions. </p>
<h2>3) My child is sick. How worried should I be?</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Infographic with steps to take to manage a child's illness." src="https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1500&fit=crop&dpr=1 600w, https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1500&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1500&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1885&fit=crop&dpr=1 754w, https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1885&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1885&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Having a plan in place can help families manage when a child is sick.</span>
<span class="attribution"><a class="source" href="https://cdn.theconversation.com/static_files/files/2489/5_steps_to_reduce_stress_%282%29.pdf?1671477085">Click here to view</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Managing a sick child is tough when there is little to be done but wait and watch. DBT helps you ask “what is the problem to be solved?” This might be as “simple” as tolerating family physical and emotional discomfort with compassion and care. </p>
<p>Staying present and focusing on <a href="https://centerforcbt.org/2021/11/02/improvemoment/#:%7E:text=The%20DBT%20concept%20of%20improving,mind%20in%20an%20effective%20way.">improving the moment</a> can help reduce distress when nothing else can be done. </p>
<p>Alternatively, more change-based action is needed. When faced with an ill child, consider looking from every angle of the situation. Remember there is no absolute truth and we can’t predict the future. Be open to alternative options, check your assumptions and avoid using extreme language (“always” and “never”). </p>
<p>It’s key to critically assess the validity of information sources and prioritize those that are evidence-based, including <a href="https://www.canada.ca/en/public-health/services/publications/healthy-living/caring-for-sick-child-nobodys-perfect.html">governmental or health board websites</a>. Diving down the rabbit hole of googling symptoms will typically increase stress without offering meaningful benefits. </p>
<p>Fortunately, the <a href="https://cps.ca/en/media/canadian-study-confirms-children-and-youth-at-low-risk-of-severe-covid-19-during-first-part-of-pandemic">odds of serious illness or death are small</a> in Canada for most children. Ask a health-care provider if you’re concerned your child may be at <a href="https://www.cdc.gov/rsv/high-risk/infants-young-children.html">greater risk</a> of serious illness (for example, if they were premature, have underlying heart or lung conditions, neuromuscular disorders, immune problems or take medication that suppresses the immune system).</p>
<h2>4) Back to basics</h2>
<p>You may already be well versed in the importance of “basics” when it comes to serving your emotions. There is a reason why “hangry” is such a common concept! Small steps can go a long way to helping the household stay healthy, recover quickly and keep family moods up. </p>
<p>As a family, try to <a href="https://www.behavioralhealthflorida.com/blog/please-skill-how-can-it-help/">prioritize plenty of sleep, nutritious foods and getting outside once a day</a>. And while this is true for the whole family, parents should also keep in mind the airplane rule: we must <a href="https://www.forbes.com/sites/forbescoachescouncil/2020/06/09/leaders-put-your-own-oxygen-mask-on-first/?sh=4109d4c977ad">put our own masks on before we help those around us</a>. </p>
<p>Lastly, <a href="https://doi.org/10.1111/famp.12618">social connection</a> offers a buffer to stress. Find ways to be creative with scheduling quality social connections consistent with your comfort level such as connecting with friends over FaceTime or only meeting outdoors.</p>
<p>During really tough moments, acknowledge the difficulty of the situation and remind yourself that you’re doing your best in a really challenging time.</p>
<p>It’s normal to be on edge and exhausted managing so much, particularly after three years of pandemic disruptions to family life. We hope these tips may provide even a small amount of relief this winter.</p><img src="https://counter.theconversation.com/content/196635/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily E. Cameron receives funding from the Canadian Institutes of Health Research, Social Sciences and Humanities Research Council of Canada, Children's Hospital Research Institute of Manitoba, and Research Manitoba.
</span></em></p><p class="fine-print"><em><span>Leslie E. Roos receives funding from the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, Research Manitoba, the Canadian Foundation for Innovation, and the Children's Hospital Research Institute of Manitoba.</span></em></p><p class="fine-print"><em><span>Tasmia Hai receives funding from Research Manitoba.</span></em></p><p class="fine-print"><em><span>Darcy Beer, Elisabete Doyle, Karen Gripp, and Merilee Brockway do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Evidence-based tools for dialectical behaviour therapy can help us manage family stressors during the virulent respiratory virus season.Emily E. Cameron, Associate Postdoctoral Fellow, Department of Psychology, University of ManitobaDarcy Beer, Assistant Professor Pediatrics/Pediatric Emergency Medicine, Department of Pediatrics and Child Health, University of ManitobaElisabete Doyle, Section head and Medical Director of Pediatric Emergency, Winnipeg Children's Hospital, Assistant Professor of Pediatrics and Child Health, University of ManitobaKaren Gripp, Section Head, Pediatric Emergency Medicine and Associate Professor, Rady Faculty of Health Sciences, University of ManitobaLeslie E. Roos, Assistant Professor, Department of Psychology, University of ManitobaMerilee Brockway, Assistant Professor, Faculty of Nursing, University of CalgaryTasmia Hai, Postdoctoral fellow, Department of Psychology, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1957882022-12-14T13:13:59Z2022-12-14T13:13:59ZAs viral infections skyrocket, masks are still a tried-and-true way to help keep yourself and others safe<figure><img src="https://images.theconversation.com/files/499681/original/file-20221207-12-ly6akr.jpg?ixlib=rb-1.1.0&rect=147%2C61%2C8032%2C5346&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Masks are an easy and low-cost way to reduce the amount of virus entering the air and spreading to others.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/multiracial-people-in-the-city-wearing-face-mask-royalty-free-image/1369532854?phrase=masks%20&adppopup=true">william87/iStock via Getty Images Plus</a></span></figcaption></figure><p>The cold and flu season of 2022 has begun with a vengeance. Viruses that have been unusually scarce over the past three years are <a href="https://www.cdc.gov/surveillance/nrevss/rsv/index.html">reappearing at remarkably high levels</a>, <a href="https://www.washingtonpost.com/wellness/2022/12/07/face-masks-tripledemic-flu-covid-rsv/">sparking a “tripledemic”</a> of COVID-19, the flu and respiratory syncytial virus, or RSV. This November’s national hospitalization levels for influenza were the <a href="https://www.cdc.gov/flu/weekly/index.htm">highest in 10 years</a>. </p>
<p>We are <a href="https://sph.umich.edu/faculty-profiles/martin-emily.html">infectious disease epidemiologists</a> and <a href="https://sph.umich.edu/faculty-profiles/eisenberg-marisa.html">researchers</a>, and we have spent our careers focused on understanding how viruses spread and how best to stop them. </p>
<p>To respond to the COVID-19 pandemic, we and our public health colleagues have had to quickly revive and apply decades of evidence on respiratory virus transmission to chart a path forward. Over the course of the pandemic, epidemiologists have <a href="https://doi.org/10.1073/pnas.2014564118">established with new certainty</a> the fact that one of our oldest methods for controlling respiratory viruses, the face mask, remains one of the <a href="https://theconversation.com/evidence-shows-that-yes-masks-prevent-covid-19-and-surgical-masks-are-the-way-to-go-167963">most effective tools</a> in a pandemic. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/wg8HmJ0i-H4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Day care centers, college dorms and public gatherings can promote superspreader events.</span></figcaption>
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<h2>A slew of circulating viruses</h2>
<p>Unlike the many past waves of COVID-19 since the spring of 2020, this fall’s surge of respiratory disease is not due to a single novel virus. Rather, now that masks and other measures have gone by the wayside, the U.S. has returned to the classic cold and flu season pattern. In a typical year, many viruses cocirculate and cause similar symptoms, leading to a wave of illness that includes ever-shifting combinations of <a href="https://doi.org/10.1093/infdis/jiu327">more than 15 types and subtypes of viruses</a>. </p>
<p>Nowhere is this pattern more obvious than in young children. Our research has shown <a href="https://doi.org/10.1093/infdis/jiy232">that classrooms house many viruses at once</a>, and that individual kids can be infected with <a href="https://doi.org/10.1093/infdis/jis934">two or three viruses</a> even during a single illness. </p>
<p>While mere inconveniences for most people, respiratory viruses like the seasonal flu are responsible <a href="https://doi.org/10.1097/JOM.0000000000001120">for missed work</a> and school. In some cases they can lead to severe illnesses, especially in very young children and older adults. After years of fighting one virus, parents are now exhausted by the reality of battling many, many more.</p>
<p>But there is a straightforward way to cut down on the risk for ourselves and others. When it comes to individual decisions, masks are among the most low-cost and most effective steps that can be taken to broadly reduce transmission of a multitude of viruses. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/XBU8QpnC9Zc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">As of early December 2022, the Centers for Disease Control and Prevention is now recommending that people wear masks indoors in five New York counties.</span></figcaption>
</figure>
<h2>The latest research</h2>
<p>Long before the COVID-19 pandemic, researchers were studying the effectiveness of masks at reducing transmission of other respiratory viruses. Meta-analyses of viral spread during the <a href="https://doi.org/10.1056/NEJMoa030685">original SARS epidemic in 2002-2003</a> showed that one infection <a href="https://doi.org/10.1136/bmj.39393.510347.BE">was averted for every six people wearing a mask</a>, and for every three people who were <a href="https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-face-masks-and-barrier-face-coverings">wearing an N95 mask</a>. </p>
<p>Mask-wearing by health care workers has long been considered a primary strategy for <a href="https://doi.org/10.1086/313960">protecting young at-risk infants</a> from RSV infection transmitted in hospital settings. Scientific evaluation of the effectiveness of masks has historically been clouded by the fact that mask-wearing is often used in conjunction with other strategies, such as hand-washing. Nonetheless, the use of personal protective equipment, including masks, as well as gowns, gloves and possibly goggles in the health care setting, has been commonly <a href="https://doi.org/10.1111/irv.12379">associated with reduced transmission of RSV</a>. </p>
<p>Similarly, one of the largest pre-COVID-19 randomized studies of mask-wearing, conducted with over a thousand University of Michigan residence hall students in 2006 to 2007, found that symptomatic respiratory illness was reduced among mask-wearers. This was especially true when <a href="https://doi.org/10.1086/650396">masks were combined with hand hygiene</a>. </p>
<p>More recently, researchers measured the amount of virus present in exhaled breath from people with respiratory symptoms to study how well masks blocked the release of virus particles. Those who were randomly selected to wear a mask had lower levels of respiratory shedding for influenza, rhinovirus – which causes the common cold – and non-SARS coronaviruses, <a href="https://doi.org/10.1038/s41591-020-0843-2">than those with no mask</a>.</p>
<p>Now, three years into the pandemic, evidence around masks and our experience using them has grown enormously. Laboratory studies and outbreak investigations have shown that masks <a href="https://doi.org/10.1126/science.abc6197">lower the amount of virus that enters the air</a> and reduce the quantity of viruses <a href="https://doi.org/10.1126/science.abd9149">that enter our airways when we breathe</a>. Recent studies have shown that wearing a surgical mask in an indoor public setting <a href="http://dx.doi.org/10.15585/mmwr.mm7106e1">reduces the odds of testing positive for COVID-19</a> by 66%, and wearing an N95/KN95 type of mask lowers the odds of testing positive by 83%. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Chart showing the relative odds of testing positive for COVID-19 depending on mask-wearing and mask type." src="https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A study of mask-wearing in public indoor settings found that people who wore surgical masks were 66% less likely to contract COVID-19 than those who wore none.</span>
<span class="attribution"><span class="source">Centers for Disease Control and Prevention</span></span>
</figcaption>
</figure>
<h2>Infections drop when schoolchildren are masked</h2>
<p>Our own research has shown the major impact of mask-wearing on transmission of SARS-CoV-2 – the virus that causes COVID-19 – and other viruses. During the circulation of the <a href="https://theconversation.com/delta-variant-makes-it-even-more-important-to-get-a-covid-19-vaccine-even-if-youve-already-had-the-coronavirus-164203">highly transmissible delta variant</a> in the fall of 2021, we found that schoolwide mask requirements were <a href="https://www.michigan.gov/-/media/Project/Websites/coronavirus/Folder21/20211109_Data_and_modeling_update_vFINAL.pdf?rev=7559c12956754727abe039594f179c25">linked to a reduction in COVID-19 infections</a>. School-age children living in districts without mask requirements were infected at a higher rate that increased faster in the early weeks of the school year than their counterparts in districts with complete or partial mask requirements. Similar patterns occurred in other states coinciding with the <a href="https://doi.org/10.1056/NEJMoa2211029">lifting of school mask requirements</a> in spring 2022.</p>
<p>Our preliminary work in a community with frequent mask-wearing behavior has found that the <a href="https://doi.org/10.1101/2022.12.08.22283268">rate of non-COVID respiratory illness in families fell by 50%</a> during 2020 and 2021 compared with earlier years. In our study, as participants reported the relaxing of mask-wearing and other mitigation behaviors in early 2022, the viruses that are now gripping the U.S. began to return. This resurgence started, curiously enough, with a reappearance of the four “common cold” seasonal coronaviruses.</p>
<figure class="align-center ">
<img alt="A graph showing that COVID-19 infection rates were significantly higher in school districts without mask requirements." src="https://images.theconversation.com/files/500487/original/file-20221212-116135-2cfnvi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500487/original/file-20221212-116135-2cfnvi.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=287&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500487/original/file-20221212-116135-2cfnvi.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=287&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500487/original/file-20221212-116135-2cfnvi.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=287&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500487/original/file-20221212-116135-2cfnvi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=361&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500487/original/file-20221212-116135-2cfnvi.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=361&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500487/original/file-20221212-116135-2cfnvi.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=361&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Michigan school districts without mask requirements experienced higher COVID-19 case rates in fall 2021 during the two months after back-to-school.</span>
<span class="attribution"><span class="source">Michigan.gov Data and Modeling Updates, Eisenberg and Martin Research Groups, University of Michigan, Ann Arbor</span></span>
</figcaption>
</figure>
<p>Unfortunately, vaccines are only available for two of the major causes of respiratory illness: <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html">SARS-CoV-2</a> and <a href="https://www.cdc.gov/flu/prevent/flushot.htm">influenza</a>. Likewise, antiviral treatments are also more commonly available for SARS-CoV-2 and influenza than for RSV. RSV vaccines, which have been in development for many years, are expected to <a href="https://www.path.org/resources/rsv-vaccine-and-mab-snapshot/">become available soon</a>, but not in time to stem the current wave of illness. </p>
<p>In contrast, masks can reduce transmission for all respiratory viruses, with no need to tailor the intervention to the specific virus that is circulating. Masks remain a low-cost, low-tech way to keep people healthier throughout the holiday season so that more of us can be free of illness for the time that we value with our family and friends.</p><img src="https://counter.theconversation.com/content/195788/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Toth Martin receives funding from the National Institutes of Health, the Centers for Disease Control and Prevention, and Flu Lab.</span></em></p><p class="fine-print"><em><span>Marisa Eisenberg receives funding from the National Institutes of Health, National Science Foundation, Michigan Department of Health and Human Services, and the Centers for Disease Control and Prevention. </span></em></p>Decades of research show that respiratory illnesses are dramatically reduced when people wear face masks.Emily Toth Martin, Assistant Professor of Epidemiology, University of MichiganMarisa Eisenberg, Associate Professor of Complex Systems, Epidemiology and Mathematics, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1942422022-11-18T13:33:47Z2022-11-18T13:33:47ZCOVID-19, RSV and the flu are straining health care systems – two epidemiologists explain what the ‘triple threat’ means for children<figure><img src="https://images.theconversation.com/files/495979/original/file-20221117-11-mwkz5y.jpg?ixlib=rb-1.1.0&rect=97%2C64%2C5302%2C3497&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pediatric emergency rooms in some states are at or over capacity due to the surging number of respiratory infections. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/toddler-boy-using-nebulizer-to-cure-asthma-or-royalty-free-image/1146454661?phrase=kids%20hospital%20RSV&adppopup=true">GOLFX/iStock via Getty Images Plus</a></span></figcaption></figure><p>Every fall and winter, viral respiratory illnesses like the common cold and seasonal flu keep kids out of school and social activities. But this year, more children than usual are <a href="https://www.washingtonpost.com/health/2022/11/04/flu-rsv-covid-cases-surge/">ending up at emergency departments and hospitals</a>. </p>
<p>In California, the Orange County health department declared a state of emergency in early November 2022 due to record numbers of <a href="https://www.msn.com/en-us/health/medical/oc-declares-health-emergency-due-to-viral-infections-causing-rise-in-pediatric-hospitalizations/ar-AA13Cs2k">pediatric hospitalizations for respiratory infections</a>. In Maryland, <a href="https://www.wbaltv.com/article/rsv-maryland-hospitals-at-capacity-transfer-patients-out-of-state/41858233">emergency rooms have run out of beds</a> because of the <a href="https://theconversation.com/rsv-a-pediatric-disease-expert-answers-5-questions-about-the-surging-outbreak-of-respiratory-syncytial-virus-193275">unusually high number</a> of severe <a href="https://www.cdc.gov/rsv/index.html">respiratory syncytial virus</a>, or RSV, infections. So emergency departments there are having to refer patients across state lines for care. </p>
<p>In the U.S., the winter respiratory virus season started earlier than usual this year. Since peak infections usually occur in late December or January, this uncharacteristic early wave suggests that the situation could get much worse for people of all ages, particularly children.</p>
<p>We are epidemiologists with <a href="https://public-health.tamu.edu/directory/fischer.html">expertise in epidemic analysis</a> for <a href="https://www.usfca.edu/faculty/annette-regan">emerging disease threats</a>, including respiratory infections. We watch patterns in these infections closely, and we pay particular attention when the patterns are unusual. We’ve grown increasingly concerned about the amount of pediatric hospitalizations over the last few months and the pattern that is emerging.</p>
<h2>The ‘triple threat’</h2>
<p>In early November, the Centers for Disease Control and Prevention <a href="https://emergency.cdc.gov/han/2022/han00479.asp">issued a health advisory</a> about increased activity in respiratory infections – especially among children. The CDC and other health experts are warning of the so-called “triple threat” of respiratory illness from <a href="https://www.cdc.gov/rsv/index.html">RSV</a>, <a href="https://www.cdc.gov/flu/about/keyfacts.htm">influenza</a> – or the seasonal flu – and <a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/about-covid-19/basics-covid-19.html">COVID-19</a>.</p>
<p>The underlying reasons for the convergence of these viruses and the increase in infections so early in the season are not yet clear. But health experts have some clues about contributing factors and what it could mean for the coming months.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/gzkZeb-wW8k?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">As of mid-November 2022, a children’s hospital in Buffalo, N.Y., had already admitted more than double the number of respiratory syncytial virus patients than in the entire 2019-2020 respiratory season.</span></figcaption>
</figure>
<p>When it comes to COVID-19, 2022 is expected to usher in another <a href="https://doi.org/10.1038/d41586-022-03157-x">winter wave of infections</a>, similar to patterns seen in 2020 <a href="https://www.politico.com/news/2021/11/22/covid-surge-winter-523109">and 2021</a>. Previous winter surges stemmed from a combination of factors, including the emergence and spread of new viral variants, more people gathering indoors rather than distanced outside, and people coming together for the holidays.</p>
<p>But unlike previous pandemic winters, most COVID-19 precautions – such as using masks in public areas or avoiding group activities – are more relaxed than ever. Together with the <a href="https://www.nbcnews.com/health/health-news/new-coronavirus-subvariants-surpass-ba5-dominance-rcna57294">looming threat of new variants</a>, it is difficult to predict how big the next COVID-19 wave could be.</p>
<p>And while the seasonal flu has proved somewhat unpredictable during the COVID-19 pandemic, it nearly always hits during late October. Flu season also arrived about a month early and in greater numbers than in recent history. By <a href="https://gis.cdc.gov/grasp/fluview/FluHospRates.html">our read of the data</a>, pediatric flu hospitalizations are nearing 10 times what has been seen for this time of year for more than a decade. </p>
<p>RSV infections tend to follow a similar seasonal pattern as the flu, peaking in winter months. But this year, there was an unexpected <a href="https://www.cdc.gov/surveillance/nrevss/rsv/natl-trend.html">summer wave</a>, well before the start of the typical fall respiratory virus season.</p>
<p>In typical years, RSV garners little media attention. It’s incredibly common and usually causes only mild illness. In fact, most children <a href="https://www.cdc.gov/rsv/high-risk/infants-young-children.html">encounter the virus before age 2</a>. </p>
<p>But RSV can be a formidable respiratory infection with serious <a href="https://www.cdc.gov/rsv/high-risk/index.html">consequences for children</a> under 5, especially infants. It is the <a href="https://doi.org/10.1016/S0140-6736(22)00478-0">most common cause of lower respiratory infections</a> in young children, and more severe illnesses can lead to pneumonia and other complications, often requiring hospitalization. </p>
<h2>Why children are particularly at risk</h2>
<p><a href="https://www.cdc.gov/flu/about/keyfacts.htm">Children</a>, especially young children, tend to get <a href="https://doi.org/10.1093/cid/cix1060">sicker from flu</a> and <a href="https://www.cdc.gov/rsv/high-risk/index.html">RSV</a> than other age groups. But infants younger than 6 months old <a href="https://doi.org/10.1542/peds.2012-1255">stand to suffer the most</a>, with nearly double the <a href="https://doi.org/10.1016/S0140-6736(22)00478-0">risk of RSV-related death</a> compared to other children younger than 5. COVID-19 hospitalization rates are also <a href="https://covid.cdc.gov/covid-data-tracker/#covidnet-hospitalization-network">four to five times higher for infants</a> than older children.</p>
<p>One reason the youngest children are at greater risk is that their immune systems are not yet fully developed and don’t produce the robust immune response seen in most adults. What’s more, infants younger than 6 months – who are most at risk of severe disease – are still too young to be vaccinated against influenza or COVID-19. </p>
<p>These viruses present challenges on their own, but their co-circulation and coinciding surges in infections create a perfect storm for multiple viruses to infect the same person at once. Viruses might even <a href="https://doi.org/10.1038/s41564-022-01242-5">act together</a> to evade immunity and cause damage to the respiratory tract. </p>
<p>Such co-infections are <a href="https://doi.org/10.1016/j.ajem.2016.12.001">typically uncommon</a>. However, the likelihood of co-infection is <a href="https://doi.org/10.1016/j.jcvp.2021.100036">substantially higher for children</a> than adults. Co-infections can be difficult to diagnose and treat, and can ultimately lead to <a href="https://doi.org/10.1016/S0140-6736(22)00383-X">greater disease severity</a>, complications, hospitalization and death. </p>
<h2>Factors behind the triple threat</h2>
<p>There are a few reasons why the U.S. may be seeing a surge in pediatric respiratory infections. First, COVID-19 protection strategies actually help prevent the <a href="https://doi.org/10.1038/s41579-022-00807-9">transmission of other respiratory pathogens</a>. School and daycare closures likely also minimized exposures children normally have to various respiratory viruses. </p>
<p>These and other efforts to prevent the spread of COVID-19 seem to have suppressed the broad circulation of other viruses, including influenza and RSV. As a result, the U.S. saw an overall <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7140a1.htm">drop in non-COVID respiratory infections</a> – and an <a href="https://www.cdc.gov/flu/about/season/flu-season.htm">almost nonexistent flu season</a> in the winter of 2020. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A young boy sits on an exam table with his mother soothing him while a doctor puts a Band Aid on his arm after giving him a shot." src="https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The early surge of respiratory infections underscores the need to get children up to date on flu and COVID-19 vaccinations.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/little-boy-getting-vaccinated-at-the-pediatricians-royalty-free-image/1266488183?phrase=flu%20shots%20kids&adppopup=true">Geber86/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>The decreased viral activity means that children missed out on some exposures to viruses and other pathogens that typically help build immunity, particularly during the first few years of life. The resulting so-called <a href="https://doi.org/10.1016/S1473-3099(22)00544-8">“immunity debt”</a> may contribute to an excess of pediatric respiratory infections as we continue into this season.</p>
<p>To further complicate the picture, the changing nature of viruses, including the<a href="https://www.cbsnews.com/news/cdc-now-tracking-bn-1-the-latest-new-covid-variant-on-the-rise/">emergence of new COVID-19 variants</a> and the natural evolution of seasonal influenza viruses, means that we could be seeing a unique combination of particularly transmissible strains or strains that cause more severe illness.</p>
<h2>Proactive steps people can take</h2>
<p>The early surge in respiratory infections with high rates of hospitalization highlights the importance of prevention. The best tool we have for prevention is vaccination. Vaccines that <a href="https://theconversation.com/when-should-you-get-the-new-covid-19-booster-and-the-flu-shot-now-is-the-right-time-for-both-190826">protect against COVID-19 and influenza</a> are available and <a href="https://www.cdc.gov/flu/prevent/vaccinations.htm">recommended for everyone over 6 months of age</a>.
They have been shown to be safe and effective, and they can and do save lives. </p>
<p>In particular, most recent data on the newly <a href="https://theconversation.com/will-omicron-specific-booster-shots-be-more-effective-at-combating-covid-19-5-questions-answered-189610">updated bivalent COVID-19 booster vaccine</a> suggests that it produces a <a href="https://doi.org/10.1056/NEJMoa2208343">more rigorous antibody response</a> against the current circulating omicron variants than the <a href="https://www.nytimes.com/2022/11/14/us/politics/moderna-booster.html">original COVID-19 vaccines</a>.</p>
<p>The best way to protect infants younger than 6 months old against flu and COVID-19 is by <a href="https://www.cdc.gov/vaccines/pregnancy/index.html">vaccination during pregnancy</a>. When a pregnant mother is vaccinated, <a href="https://doi.org/10.1093/cid/ciac793">maternal antibodies</a> cross the placenta to the baby, reducing the <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7107e3.htm?s_cid=mm7107e3_w">risk of COVID-19 hospitalization</a> in young infants by 61%. Vaccination of other caregivers, family and friends can also help protect infants. </p>
<p>Other preventive measures, like hand-washing, covering sneezes and coughs, staying at home and isolating when sick, can help to protect the community from these viruses and others. Paying attention to local public health advisers can also help people to have the most up-to-date information and make informed decisions to keep themselves and others – of all ages – safe.</p><img src="https://counter.theconversation.com/content/194242/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca S.B. Fischer receives funding from the Fogarty International Center at the U.S. National Institutes for Health and has previously received research funding from the National Institute for Allergy & Infectious Diseases. </span></em></p><p class="fine-print"><em><span>Annette Regan currently receives funding from the National Institutes for Health and the US Centers for Disease Control and Prevention. She has previously received research funding from the National Health and Medical Research Council (Australia), HRSA's Federal Office of Rural Health Policy, the Wesfarmers Center for Vaccines and Infectious Diseases, and the EuroQol Research Foundation.</span></em></p>Respiratory viruses are hitting young children and infants particularly hard this fall and winter season, and experts don’t yet know exactly why.Rebecca S.B. Fischer, Assistant Professor of Epidemiology, Texas A&M UniversityAnnette Regan, Assistant Professor of Epidemiology, University of San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1930762022-11-10T18:49:58Z2022-11-10T18:49:58ZInfluenza and COVID-19: What’s in store for the fall/winter respiratory virus season?<figure><img src="https://images.theconversation.com/files/493682/original/file-20221106-1597-j4udyc.jpg?ixlib=rb-1.1.0&rect=309%2C0%2C4264%2C3238&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Model of an influenza virus. Flu season is expected to make a big comeback this year.</span> <span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/influenza-and-covid-19--what-s-in-store-for-the-fall-winter-respiratory-virus-season" width="100%" height="400"></iframe>
<p>Public health experts in the Northern Hemisphere are <a href="https://www.cbc.ca/news/canada/hamilton/2022-flu-season-intense-1.6616707">predicting a fall/winter respiratory virus season</a> for the ages — one that highlights the importance of global surveillance efforts and vaccines as tools in the fight against influenza (flu) and COVID-19. </p>
<h2>Making sense of COVID-19’s impact on seasonal flu</h2>
<p>Prior to the COVID-19 pandemic, the annual respiratory virus season in northern and southern climates was an epidemic of sorts, one that was characterized by a rapid uptick in the rate of influenza (flu) and of influenza-like illness beginning in mid-fall, peaking in mid-winter and winding down in mid-spring. </p>
<p>The previously predictable pattern of influenza activity in the global North and South has become somewhat unpredictable in post-pandemic seasons. In the United States, approximately 36 million infections, 390,000 hospitalizations and 25,000 deaths due to flu were <a href="https://www.cdc.gov/flu/about/burden/past-seasons.html">reported during the 2019-20 season</a>. </p>
<p>In contrast, minimal influenza activity was noted in 2020-21 while the 2021-22 season saw a four-fold decline in activity compared to pre-pandemic seasons.</p>
<p>Implementation of strict public health measures during the COVID-19 pandemic was instrumental in reducing the incidence of flu and flu-like illnesses during the past two respiratory virus seasons in both hemispheres. However, the <a href="https://doi.org/10.1016/S2214-109X(22)00358-8">relaxation of these measures</a> is expected to promote a tidal wave of respiratory virus infections in the weeks to come. </p>
<p>These infections include <a href="https://doi.org/10.1016%2Fj.ijid.2022.08.002">influenza</a>, <a href="https://covid19.healthdata.org/global?view=cumulative-deaths&tab=trend">SARS-CoV-2</a> and <a href="https://www.cdc.gov/surveillance/nrevss/rsv/natl-trend.html">Respiratory Syncytial Virus (RSV)</a>, which often <a href="https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/palivizumab-respiratory-syncitial-virus-infection-infants.html">affects children</a>.</p>
<h2>Influenza in the Southern Hemisphere</h2>
<figure class="align-center ">
<img alt="Four red circular spots on a blue background." src="https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=495&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=495&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=495&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=622&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=622&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=622&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microscopic view of influenza B virus particles.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Despite the impact of COVID-19 on global health and the almost negligible level of seasonal influenza activity over the past two years, the Southern Hemisphere experienced a major shift in influenza activity during the 2022 respiratory virus season. </p>
<p>In <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7143a1.htm?s_cid=mm7143a1_w">Chile</a>, the season began with a burst of influenza B activity in January, followed by a relative lull in March and April, and then a surge in influenza A that peaked in June. In contrast, <a href="https://www.health.gov.au/sites/default/files/documents/2022/10/aisr-fortnightly-report-no-7-20-june-to-3-july-2022.pdf">Australia’s flu season</a> started in March, had a record peak in June, and was dominated throughout by influenza A.</p>
<h2>What’s in store for fall and winter?</h2>
<p>Unlike seasonal influenza, COVID-19 primarily behaves as a pandemic virus, with simultaneous, high-level viral transmission in all parts of the globe. COVID-19 activity may be “seasonal” in some respects, with higher rates of transmission during the fall and winter months when people are indoors more often than not and, consequentially, less socially-distanced. </p>
<p>The 2022 Southern Hemisphere experience serves as a harbinger for what to expect during the 2022-23 respiratory virus season in northern climates. </p>
<p>In the North, the respiratory virus season is already off to an early and blazing start, particularly in the <a href="https://www.cdc.gov/flu/weekly/index.htm">U.S.</a> and <a href="https://www.canada.ca/en/public-health/services/diseases/flu-influenza/influenza-surveillance/weekly-influenza-reports.html">Canada</a>, and appears destined to wreak havoc on <a href="https://www.thestar.com/news/canada/2022/11/04/doctors-nurses-advocates-call-on-governments-to-address-health-care-crisis.html">health-care systems that are already struggling</a> from the impact of COVID-19. </p>
<h2>The importance of influenza vaccination</h2>
<figure class="align-right ">
<img alt="Green circular spots with black markings on a blue background." src="https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microscopic view of H1N1 influenza virus particles.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Vaccination is one of the most effective public health interventions in our battle against influenza and COVID-19. Recommendations on the composition of flu vaccines are made biannually by the World Health Organization (WHO) several months in advance of the forthcoming respiratory virus season in each respective hemisphere. </p>
<p>However, licensing of influenza vaccines generally falls under national jurisdictions. Similar vaccine formulations are approved for use in the <a href="https://www.cdc.gov/flu/professionals/acip/2022-2023/acip-table.htm">U.S.</a>, <a href="https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2022-2023.html">Canada</a>, <a href="https://www.gov.uk/government/publications/flu-vaccines-for-the-current-season/flu-vaccines-for-the-2022-to-2023-season">United Kingdom</a> and other northern countries, and are now widely available. </p>
<p><a href="https://www.who.int/news/item/25-02-2022-recommendations-announced-for-influenza-vaccine-composition-for-the-2022-2023-northern-hemisphere-influenza-season">Flu vaccine composition</a> for the 2022-23 respiratory virus season in northern latitudes is based on surveillance of circulating influenza virus strains during the most recent respiratory virus season in the Southern Hemisphere. The WHO has recommended both quadrivalent vaccines (containing four strains) and trivalent vaccines (containing three strains), with no preference given to either formulation. </p>
<p>The quadrivalent vaccine contains two <a href="https://www.mcgill.ca/oss/article/health/what-does-it-mean-when-vaccine-contains-inactivated-virus">inactivated strains</a> of influenza A (H1N1 and H3N2) and two inactivated strains of influenza B. The trivalent vaccine is similar with the exception of having a single inactivated strain of influenza B.</p>
<h2>How effective are flu shots?</h2>
<figure class="align-center ">
<img alt="Gloved hands giving an injection in someone's shoulder" src="https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">You can get the flu jab concurrently with COVID-19 vaccine.</span>
<span class="attribution"><span class="source">(AP Photo/Rogelio V. Solis)</span></span>
</figcaption>
</figure>
<p>Vaccine-mediated protection against influenza infection, severe illness and death has immense public health ramifications, yet is often misunderstood. <a href="http://doi.org/10.1183/16000617.0258-2020">Vaccine effectiveness</a> varies from one respiratory virus season to another and <a href="https://www.cdc.gov/flu/vaccines-work/effectivenessqa.htm#:%7E:text=In%20addition%20to%20virus%20factors,the%20benefits%20received%20from%20vaccination.">hinges on several factors</a>, including the degree of vaccine mismatch with circulating strains, the use of high-dose versus standard-dose vaccines, prior influenza illness or vaccination, age, general health status, and public health measures such as social distancing, medical mask use, and travel restrictions.</p>
<p>Flu vaccines tend to confer a <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm">greater degree of protection against influenza B and influenza A H1N1 subtypes</a>, with a lower degree of effectiveness against the influenza A H3N2 subtype. </p>
<p><a href="https://doi.org/10.1093/cid/ciab462">Research</a> has shown that the effectiveness of standard-dose flu vaccines in preventing severe influenza illness during the 2019-20 U.S. respiratory virus season was highest in young adults (60 per cent), relatively low in middle-aged adults (20 per cent) and modest or negligible in the elderly. </p>
<p>High-dose vaccines improve effectiveness to 30 per cent in the elderly. Therefore, people 65 years of age or older should receive a high-dose quadrivalent vaccine. Flu shots should be complemented by other infection control precautions including social distancing, indoor masking and frequent handwashing.</p>
<h2>Do I really need a flu shot?</h2>
<p>You can get a <a href="https://www.cdc.gov/flu/prevent/coadministration.htm">flu shot concurrently with a COVID-19 shot</a>. </p>
<p>Influenza vaccines are considered safe and effective in virtually all individuals, despite the <a href="https://www.scientificamerican.com/article/flu-shots-may-not-protect-the-elderly-or-the-very-young/">lack of robust evidence of protection in very young children and the elderly</a>. Their use is akin to protection from wearing seatbelts; you may not necessarily be involved in an accident but if you are, the chances of survival and protection from serious injury are higher with their use than without. </p>
<p>During the <a href="https://www.cdc.gov/flu/prevent/flushot.htm">2019-20 respiratory virus season in the U.S</a>, influenza vaccination prevented over 100,000 hospitalizations and over 6,000 deaths. Given the expected burden of influenza illness and the ongoing COVID-19 pandemic, the benefits of vaccination will likely be greater during the current respiratory viral season compared to those in the past few years.</p>
<h2>What is the role of COVID-19 boosters?</h2>
<figure class="align-right ">
<img alt="Orange masses studded with small green dots." src="https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=515&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=515&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=515&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=647&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=647&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=647&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microscopic view of the Omicron strain of SARS-CoV-2 virus particles (coloured green) on a human cell.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>For COVID-19, the <a href="https://doi.org/10.1136/bmj-2022-072141">effectiveness of a two-dose primary vaccine series plus a single booster</a> in preventing hospitalization is close to 90 per cent but gradually drops to around 65 per cent over the course of four to five months after the last vaccine dose. Bivalent vaccine boosters may serve as a means of <a href="https://doi.org/10.1016/S1473-3099(22)00692-2">preserving vaccine-induced immunity</a> against newer variants of SARS-CoV-2. </p>
<p>COVID-19 vaccines remain part of an effective strategy to counter the next wave of infection. The latest <a href="https://secure.medicalletter.org/TML-article-1660c">bivalent vaccines</a> manufactured by Pfizer and Moderna are recommended as boosters for individuals with at least two primary COVID-19 vaccinations. </p>
<p>The bivalent vaccines are believed to be more effective against the dominant BA.4 and BA.5 Omicron subvariants of SARS-CoV-2 than the original mRNA vaccines, but <a href="https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/summary-national-advisory-committee-immunization-november-3-2022-recommendations-use-moderna-spikevax-bivalent-mrna-50-mcg-covid-19-booster-vaccine-adults.html">equal in effectiveness to first-generation bivalent vaccines</a> that target the original strain and the BA.1 Omicron subvariant. The <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-and-pfizer-biontech-bivalent-covid-19-vaccines">U.S.</a>, <a href="https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/summary-national-advisory-committee-immunization-november-3-2022-recommendations-use-moderna-spikevax-bivalent-mrna-50-mcg-covid-19-booster-vaccine-adults.html">Canada</a> and <a href="https://www.ema.europa.eu/en/news/comirnaty-spikevax-ema-recommendations-extra-doses-boosters">Europe</a> have slightly different age-based and time-based eligibility criteria for these boosters. </p>
<p>Influenza and COVID-19 are expected to make headway during the current respiratory virus season in northern climates. Vaccination in conjunction with personal protective measures are the best means of staying healthy.</p><img src="https://counter.theconversation.com/content/193076/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sameer Elsayed does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Flu and COVID-19 are expected to make headway during the current respiratory virus season. The best way to stay healthy is vaccination in conjunction with personal protective measures.Sameer Elsayed, Professor of Medicine, Pathology & Laboratory Medicine, and Epidemiology & Biostatistics, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1915202022-10-07T14:51:13Z2022-10-07T14:51:13ZFlu is set for a big comeback now COVID restrictions are lifted – here’s what you need to know<figure><img src="https://images.theconversation.com/files/488124/original/file-20221004-13-ed03x8.jpg?ixlib=rb-1.1.0&rect=0%2C15%2C5189%2C3438&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/shot-human-hands-making-injection-syringe-448816702">TT THAILAND/Shutterstock</a></span></figcaption></figure><p>The flu seasons of 2020 and 2021 were mild, mostly thanks to measures people took against COVID, such as wearing masks, social distancing and using copious amounts of hand gel. 2022, however, looks like a whole different kettle of fish. </p>
<p>The southern hemisphere – where flu season starts – has been hit hard. Australia, for example, has had the <a href="https://edition.cnn.com/2022/09/06/health/flu-covid-winter-us/index.html">worst flu season in five years</a>, and it has been <a href="https://www.reuters.com/world/asia-pacific/australias-winter-covid-wave-may-have-peaked-early-health-minister-says-2022-08-04/">hammered by COVID, too</a>. This year has been the <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00503-5/fulltext">first real opportunity</a> for both viruses to circulate freely as all COVID restrictions have now been lifted.</p>
<p>It’s strongly advised that people in the UK get the flu vaccine and ensure they are up to date with their COVID vaccine boosters. Scientists aren’t sure how these viruses will dovetail, but evidence suggests that being <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135706/">infected with both viruses simultaneously</a> greatly increases the risk of severe disease and death.</p>
<p>About <a href="https://www.bbc.co.uk/news/health-63045190">33 million people</a> in the UK are eligible for a free flu vaccine, including those aged 50 or older, pregnant women, people in residential care, and frontline healthcare workers. There is also a nasal-spray vaccine for <a href="https://www.nhs.uk/conditions/vaccinations/child-flu-vaccine/">children aged two years and older</a>, with many vaccine rollouts delivered in schools.</p>
<h2>Great pressure on the NHS</h2>
<p>Flu usually has an “R number” <a href="https://www.vdh.virginia.gov/coronavirus/2022/01/07/covid-19-and-influenza-surveillance/">between one and two</a>, meaning that, on average, each infected person will infect one or two people. This level of flu transmission is significant. </p>
<p>In the UK, across the winters of 2017-18 and 2018-19, there were 46,215 and 39,670 <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09553-0">flu-related hospital admissions</a> respectively. And, as of early September 2022, there were 590 daily hospital admissions with COVID, with those numbers on the rise. </p>
<p>NHS trusts are usually under greater pressure during the winter. Yet already in the autumn, several health services report that their capacities are limited. Derriford Hospital in Plymouth had waits of up to <a href="https://twitter.com/ShaunLintern/status/1577000794603167745">72 hours</a> for admission from A&E, while the <a href="https://www.bbc.co.uk/news/uk-england-cambridgeshire-63115121">East of England Ambulance Service</a> recently came close to declaring a “major incident”. </p>
<p>Nottingham Hospitals Trust declared a “<a href="https://twitter.com/ShaunLintern/status/1575584700696887296">critical incident</a>” on September 29. The legacy of <a href="https://theconversation.com/boris-johnsons-pandemic-legacy-where-he-went-wrong-managing-covid-and-some-things-he-got-right-189666">Boris Johnson’s pandemic governance</a>, with higher case and death rates than most comparable countries, has created further pressures across the health service, including hospitals and primary care. This does not bode well heading into a winter when there is a risk of high levels of both flu and COVID.</p>
<p>Despite the continuous circulating of new variants and sub-variants, the COVID vaccine continues to provide <a href="https://www.gov.uk/guidance/monitoring-reports-of-the-effectiveness-of-covid-19-vaccination">high protection</a> against severe disease and death. The strains of flu also change each winter and are, to some extent, unpredictable. So flu vaccine effectiveness is variable, but typically between 40% and 60%. </p>
<p>Data from <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm">Australia</a> provides an early estimate of around 40% effectiveness from their 2022 flu season. However, this is still an important level of protection, with <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm">hospitalisation rates</a> among vaccinated people typically much lower than in unvaccinated populations.</p>
<p>The Australian data is important for people in the UK and elsewhere in the northern hemisphere. Surveillance agencies <a href="https://www.nbcnews.com/health/health-news/australia-flu-season-warning-sign-us-this-year-rcna40123">look at circulating virus types</a> in the southern hemisphere, and use that data to decide the likely impact in their own countries, including the manufacturing of the flu vaccine. Australian virology reports show the <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm">vast majority</a> of their laboratory-confirmed cases were a strain of influenza called H3N2.</p>
<p>The UK Health Security Agency says this year’s flu jab is a good match for this strain.</p>
<h2>Other measures</h2>
<p>With the added pressures already on the NHS, a high vaccine uptake will be important. But wearing a mask can also help reduce the spread of flu and COVID. Meeting outdoors or opening a window to improve ventilation can also help to prevent new chains of transmission and lessen the likelihood of infecting vulnerable people.</p>
<p>The UK winter of 2022-23 will be a very good time to try to stay well, leaving some healthcare capacity for emergencies and vulnerable people.</p><img src="https://counter.theconversation.com/content/191520/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Head has previously received funding from the Bill & Melinda Gates Foundation and the UK Department for International Development.</span></em></p>People are strongly urged to get a flu shot and a COVID booster shot ahead of the potential ‘twindemic’ expected this winter.Michael Head, Senior Research Fellow in Global Health, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1908262022-09-22T12:40:17Z2022-09-22T12:40:17ZWhen should you get the new COVID-19 booster and the flu shot? Now is the right time for both<figure><img src="https://images.theconversation.com/files/485731/original/file-20220920-16871-cf9dvv.jpg?ixlib=rb-1.1.0&rect=140%2C60%2C6569%2C4386&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It is safe to get the newly formulated COVID-19 booster shot and the flu shot at the same time.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/close-up-photo-female-nurse-giving-vaccine-to-woman-royalty-free-image/1361778753?adppopup=true">SDI Productions/ E+ via Getty Images</a></span></figcaption></figure><p>At this point in the COVID-19 pandemic, nearly everyone has experienced the panic and uncertainty that come with having mild COVID-like symptoms – such as a cough and sore throat – only to test negative day after day. With cold and flu season just around the corner, that state of frustrating uncertainty is likely to strike most of us again. </p>
<p>Both COVID-19 and the flu are contagious respiratory illnesses that have <a href="https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm">similar symptoms</a>, making it difficult to distinguish between the two viral infections without a lab test. Testing is the only way to know which virus is causing your symptoms. In fact, labs are working to create one test that can detect <a href="https://doi.org/10.1001/jama.2022.11031">both COVID-19 and the flu</a>. </p>
<p>As a <a href="https://hhs.purdue.edu/directory/elizabeth-libby-richards/">nursing professor</a> with <a href="https://scholar.google.com/citations?user=Pdh4gSgAAAAJ&hl=en&oi=ao">experience in public health promotion</a>, I am often asked about the differences between the flu and COVID-19. This year I am fielding many questions about the timing of getting the new COVID-19 booster and the flu shot and whether they can be given together.</p>
<h2>Parsing the symptoms</h2>
<p>Symptoms of both COVID-19 and the flu can range from mild – or no noticeable symptoms at all – to severe. While flu infection does not typically affect one’s ability to taste or smell, <a href="https://my.clevelandclinic.org/health/symptoms/16708-loss-of-taste-and-smell">loss of taste or smell</a> has been a common symptom associated with COVID-19 infection. Both infections can cause fevers, chills, body aches and fatigue. More severe symptoms of either infection include difficulty breathing and subsequent infections like pneumonia. </p>
<p>During the 2021-2022 flu season, <a href="https://www.washingtonpost.com/health/2022/01/05/flurona-coronavirus-flu-symptoms/">the term “flurona”</a> made its way into the COVID-19 vernacular. Flurona refers to a simultaneous infection with both the flu and COVID-19. While only a few cases of co-infections <a href="https://doi.org/10.3389/fmed.2021.681469">have been reported</a>, it would not be surprising to see more of them this coming flu season. Vaccination for both the flu and COVID-19 is your best protection against both.</p>
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<figcaption><span class="caption">What flurona is – and isn’t.</span></figcaption>
</figure>
<h2>Timing the shots</h2>
<p>With the <a href="https://theconversation.com/will-omicron-specific-booster-shots-be-more-effective-at-combating-covid-19-5-questions-answered-189610">newly formulated COVID-19 booster shot</a> now available and flu season just around the corner, a natural question is whether there is an optimal timing for the two shots.</p>
<p>The answer to that question is to get both as soon as possible. It is important to consider that it takes approximately two weeks after vaccination for the body to develop antibodies from both the <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/how-they-work.html">COVID-19 vaccines</a> and the <a href="https://www.cdc.gov/flu/prevent/keyfacts.htm">flu vaccine</a>. </p>
<p>As long as you have completed your primary COVID-19 vaccine series and it has been at least eight weeks since your last COVID-19 booster, now is the time to <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html?">get the updated COVID-19 vaccine</a> that targets both the original strain of SARS-CoV-2 – the virus that causes COVID-19 – and the most recent omicron subvariants. The original COVID-19 vaccines and booster series have dramatically reduced the <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7023e2.htm">number of COVID-19 infection and death rates</a>, as well as <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7112e1.htm">cases of severe COVID-19</a> that lead to hospitalization. </p>
<p>While everyone 6 months of age and older are recommended to receive both the COVID-19 and flu vaccines, certain populations have a higher risk for severe infection, such as <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html">pregnant women</a>, and should be extra vigilant about getting vaccinated. </p>
<p>Further, among those vaccinated against COVID-19, symptoms during an infection <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/breakthrough-infections-coronavirus-after-vaccination#">tend to be milder</a>. However, due in part to the quickly evolving nature of the virus, it’s become clear that immune protection from COVID-19 vaccination or infection does not last forever. While studies show that the primary COVID-19 series maintains efficacy against severe disease and death six months after vaccination, protection against infection decreases by between <a href="https://doi.org/10.1016/S0140-6736(22)00152-0">20% to 30% by six months</a> after vaccination. </p>
<p>This decline in immune protection is exactly <a href="https://www.yalemedicine.org/news/covid-19-booster">why booster shots are so critical</a>. Without a large uptake of <a href="https://theconversation.com/low-vaccine-booster-rates-are-now-a-key-factor-in-covid-19-deaths-and-racial-disparities-in-booster-rates-persist-187272">booster shots in the population</a>, COVID-19 infection rates could surge again.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/UyheqSbbZGA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The updated COVID-19 booster shots are now available.</span></figcaption>
</figure>
<p>Timing is also important with the flu vaccine. Flu cases typically begin to rise in October and peak between December and February, <a href="https://www.cdc.gov/flu/about/season/flu-season.htm">but can last through May</a>. Ideally, people should get vaccinated before flu begins to spread, making <a href="https://www.cdc.gov/flu/season/faq-flu-season-2022-2023.htm">September or early October</a> the ideal flu vaccination time. </p>
<h2>A difficult flu season ahead</h2>
<p>Due to lockdowns, reduced travel, school closures and mask mandates in the first and second years of the pandemic, both the <a href="https://www.cdc.gov/flu/about/burden/past-seasons.html">2020-2021 and 2021-2022 flu seasons</a> were estimated to have fewer hospitalizations and deaths from the flu compared to many of the pre-pandemic years. </p>
<p>In the fall of 2021, experts became concerned about the potential for a <a href="https://theconversation.com/flu-season-paired-with-covid-19-presents-the-threat-of-a-twindemic-making-the-need-for-vaccination-all-the-more-urgent-169011">COVID-19 and flu “twindemic,”</a> especially as COVID-19 restrictions were lifting and masks were coming off. Fortunately, the worst didn’t bear out – flu numbers in the 2021-2022 season did not return to pre-pandemic levels. However, the possibility of a “twindemic” is not out of the picture for the coming flu season.</p>
<p>Flu seasons are <a href="https://www.cdc.gov/flu/about/burden/faq.htm">inherently difficult to predict</a>. With most people traveling again, schools open, mask mandates lifted and workers headed back to the office, people are undoubtedly going to be exposed to germs that they have been more protected from for the last two and a half years. </p>
<p>To further compound this, flu vaccine rates <a href="https://www.cdc.gov/flu/fluvaxview/dashboard/vaccination-dashboard.html#">have been lower during the pandemic</a>, suggesting that Americans may be out of the habit of getting their annual flu shot. </p>
<h2>Pairing the shots</h2>
<p>Many are also wondering whether they can or should get both the updated COVID-19 booster and the flu shot at the same time. The good news is, <a href="https://www.cdc.gov/flu/season/faq-flu-season-2022-2023.htm">yes, it is safe</a> for both adults and children 12 years of age and up who are eligible for the updated COVID-19 booster to get these vaccines simultaneously. </p>
<p>A recent study found that common vaccine side effects such as pain at the injection site <a href="https://doi.org/10.1001/jamanetworkopen.2022.22241">occurred at slightly higher rates</a> when someone received the flu vaccine and a COVID-19 vaccine at the same time, as opposed to receiving only a COVID-19 booster. However, those reactions, including fatigue and headache, were mild and resolved within a day or two.</p>
<p>You don’t need to make two separate vaccine visits as long as you are due for your next COVID-19 shot. However, I don’t recommend waiting to get your flu shot if you are not yet due for a COVID-19 booster. The Centers for Disease Control and Prevention suggests everyone receive their flu vaccine by <a href="https://www.cdc.gov/flu/season/faq-flu-season-2022-2023.htm">the end of October</a>. But if you miss that deadline, it is absolutely better to get vaccinated later in the season than not at all.</p>
<h2>Community matters too</h2>
<p>Getting the flu and COVID-19 vaccines isn’t just about your own health, it’s about family and community health too. Communities with higher vaccination rates have <a href="https://theconversation.com/what-is-herd-immunity-a-public-health-expert-and-a-medical-laboratory-scientist-explain-170520">fewer opportunities to spread the virus</a>. </p>
<p>Keep in mind <a href="https://www.cdc.gov/flu/prevent/whoshouldvax.htm">that many people cannot be vaccinated</a> because they have weakened immune systems or are undergoing treatments. They depend on those around them for protection. While one person may experience mild symptoms if they contract the flu or COVID-19, they could spread the virus to others who could become severely ill. Because it’s impossible to predict how people will react if they get sick, getting the flu and COVID-19 vaccines is the best prevention strategy.</p><img src="https://counter.theconversation.com/content/190826/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Libby Richards has received funding from the National Institutes of Health. She is is affiliated with the American Public Health Association. </span></em></p>When COVID-19 and the flu co-infect, it’s ‘flurona.’ But such cases are rare, and there are effective ways to protect yourself from both viruses.Libby Richards, Associate Professor of Nursing, Purdue UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1856022022-07-13T20:38:15Z2022-07-13T20:38:15ZRATs for flu exist – should we be self-testing for that too?<figure><img src="https://images.theconversation.com/files/472938/original/file-20220707-24-nhxgd0.jpg?ixlib=rb-1.1.0&rect=24%2C12%2C8218%2C5475&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Flu season has begun uncharacteristically early this year, and so far <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm">we’ve seen</a> around 187,000 laboratory-confirmed cases, 1,323 hospitalisations, and 113 deaths. </p>
<p>The risk of infection from either COVID or influenza this winter will be very high. The risk of being infected with both at the same time will also be significant, and will likely put a huge strain on our already overburdened health system.</p>
<p>A large number of people who get the flu do not get tested, unless the symptoms are severe. Early detection of flu can improve treatment to prevent significant illness, particularly in the young, elderly and immunocompromised.</p>
<p>A simple RAT test, the same as the ones we’ve become accustomed to using for COVID, could potentially help in detecting the virus early, and stopping the spread of flu.</p>
<h2>How do flu RATs work?</h2>
<p>RATs are short for rapid antigen tests and they can quickly test whether a person has Influenza A or B – two of the most common strains of flu virus.</p>
<p>The test is designed to pick up the presence of specific antigens of the flu virus, which when detected produce a coloured band to indicate a positive test result, similar to the line you’ve seen on your COVID RATs.</p>
<p>At the moment, RAT tests for flu are not widely available, are expensive compared to the COVID tests, and most <a href="https://www.cdc.gov/flu/professionals/diagnosis/clinician_guidance_ridt.htm">suffer problems</a> with sensitivity and/or specificity (their ability to detect positive cases) that need further work and testing. However, this could change if there was more demand for flu RATs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/472939/original/file-20220707-14-nxsno8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman in hospital bed with mask on" src="https://images.theconversation.com/files/472939/original/file-20220707-14-nxsno8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472939/original/file-20220707-14-nxsno8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472939/original/file-20220707-14-nxsno8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472939/original/file-20220707-14-nxsno8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472939/original/file-20220707-14-nxsno8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472939/original/file-20220707-14-nxsno8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472939/original/file-20220707-14-nxsno8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Antivirals reduce the risk of hospitalisation in flu patients.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Could flu RATs make a different to rates of flu and illness from flu?</h2>
<p>Influenza and COVID cause similar symptoms, however, the drugs we have to manage these diseases require a precise identification. This is critical, as it governs what type of antiviral drug is given. </p>
<p>Current flu RATs are <a href="https://www.cdc.gov/flu/professionals/diagnosis/rapidlab.htm">most sensitive</a> up to four days after symptom onset. A positive detection during this period can facilitate a quicker treatment strategy with antivirals, as these drugs have a narrow window of therapeutic opportunity. </p>
<p>If a patient tests positive for flu, they can then receive <a href="https://www.health.nsw.gov.au/Infectious/Influenza/Pages/info_for_prescribers.aspx">Tamiflu</a>, the <a href="https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#:%7E:text=Early%20treatment%20of%20hospitalized%20adult,of%20hospitalization%20in%20observational%20studies">antiviral</a> recommended for flu cases, which reduces the risk of hospitalisation. </p>
<p>However this must be taken within two days of infection (when symptoms emerge) for it to be effective. Everyone can get Tamiflu but they require a prescription, which makes it difficult to get the drug within the two-day window needed to be effective.</p>
<p>Tamiflu would not work against COVID, which requires a different antiviral for elderly and otherwise unwell patients, such as Paxlovid.</p>
<p>A flu RAT would benefit people at risk of severe illness such as babies, young children, the elderly and the immunocompromised. This would increase the chance of early detection to enable treatment, and it could also give us more accurate figures of the number of people with flu each season. </p>
<p>Flu RATs could also help in the management of outbreaks in high-risk communities such as aged care, nursing homes, schools and day care. A quick detection of flu could assist in measures to reduce the chances of transmission by antiviral treatment and isolation, as we’ve seen with COVID.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-ad-urges-us-to-take-on-winter-by-getting-covid-and-flu-vaccines-but-it-misses-some-key-things-185600">New ad urges us to 'take on winter' by getting COVID and flu vaccines. But it misses some key things</a>
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<h2>Are flu RATs available in Australia?</h2>
<p>There are currently no flu RATs approved by the Therapeutic Goods Administration (TGA) in Australia, for public use at home. The TGA has approved eight tests that are used only in a clinical setting, and these are designed to detect both flu and COVID.</p>
<p>We need to lobby the government to action TGA approval of home flu RATs, as public demand will help drive this process. The TGA will require time and money to test and develop the RATs to a high standard. </p>
<p>Therefore we can’t expect Australian-based RATs for this flu season, but given we are now all so comfortable with at-home antigen testing, testing for flu is the logical next step.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flu-may-be-back-but-covid-is-far-from-over-how-do-they-compare-184551">Flu may be back, but COVID is far from over. How do they compare?</a>
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<img src="https://counter.theconversation.com/content/185602/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stavros Selemidis receives funding from National Health and Medical Research Council of Australia. </span></em></p><p class="fine-print"><em><span>Doug Brooks receives funding from National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>John O’Leary receives funding from National Health and Medical Research Council. </span></em></p>Now we’re all accustomed to self-testing at home, we should consider using rapid antigen tests for flu as well.Stavros Selemidis, Professor of Pharmacology, RMIT UniversityDoug Brooks, Professor, University of South AustraliaJohn O’Leary, Chair professor, Trinity College DublinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1835362022-05-31T19:04:07Z2022-05-31T19:04:07ZResurgent COVID-19, flu and other viruses are pushing New Zealand’s health system to the limit – and now winter is coming<figure><img src="https://images.theconversation.com/files/466127/original/file-20220530-18-gw1tmv.jpg?ixlib=rb-1.1.0&rect=40%2C20%2C3312%2C2211&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>As Aotearoa New Zealand heads into the colder winter months, the <a href="https://www.nzdoctor.co.nz/article/undoctored/case-change-health-system">pressures</a> on our health system and staff are growing significantly.</p>
<p>On top of the ongoing <a href="https://thespinoff.co.nz/science/19-05-2022/we-cant-pretend-its-gone-covid-19-impacts-will-be-felt-for-years-new-studies-find">impact of COVID-19</a>, flu cases have <a href="https://www.rnz.co.nz/news/world/467793/flu-cases-are-spiking-so-how-do-i-know-if-i-have-covid-19-or-influenza">begun to spike</a>. </p>
<p>Conditions are also primed for potential outbreaks of other illnesses including <a href="https://www.1news.co.nz/2022/05/01/fears-measles-could-go-off-like-firecracker-if-it-takes-hold-in-nz/">measles</a>, <a href="https://www.sciencemediacentre.co.nz/2022/05/13/covid-19-cases-going-undetected-as-winter-approaches-expert-reaction/">whooping cough</a> and <a href="https://www.nature.com/articles/s41467-022-30485-3">respiratory syncytial virus</a> (RSV). </p>
<p>If we are to weather the coming storm, there will need to be a recommitment to public health measures that slow the spread of respiratory infections, as well as a renewed drive for widespread vaccination.</p>
<p>The first wave of <a href="https://www.rnz.co.nz/news/in-depth/450874/covid-19-data-visualisations-nz-in-numbers">Omicron</a> swept through Aotearoa New Zealand in late February and March. </p>
<p>Unfortunately, as seen in many other countries, the fall in case numbers has been much slower than the rise, with infections <a href="https://www.stuff.co.nz/national/health/128596199/covid19-influenza-hits-south-as-long-tail-continues">reaching a plateau</a> in all age groups. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/466119/original/file-20220530-14-nsrifv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466119/original/file-20220530-14-nsrifv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466119/original/file-20220530-14-nsrifv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466119/original/file-20220530-14-nsrifv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466119/original/file-20220530-14-nsrifv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466119/original/file-20220530-14-nsrifv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466119/original/file-20220530-14-nsrifv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Hospitalisations for or with COVID-19 are starting to rise towards their previous peak in younger age groups.</span>
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</figure>
<p>Case numbers have been driven by a high number of infections in young people between the ages of 10 and 29 years old. But the elderly have borne the brunt of hospitalisations, largely due to the higher risk of <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09826-8">severe outcomes</a> for older adults. </p>
<p>Age stratification aside, persistent inequities have also left Māori and Pasifika at the sharp end of the outbreak both in terms of cases and <a href="https://www.nzherald.co.nz/kahu/covid-19-omicron-outbreak-vaccine-inequity-and-western-travel-main-risks-for-poor-countries-and-indigenous-communities/VMQNWMHE57JVQB64RHI4TH6UKU/">severe outcomes</a>. </p>
<p>Hospitalisation rates and <a href="https://www.health.govt.nz/news-media/news-items/avoid-covid-reinfection-winter">reinfections</a> are rising in many age groups, mirroring trends <a href="https://www.abc.net.au/news/2022-05-14/experts-weigh-in-as-victorias-covid-rate-rises/101057072">seen elsewhere</a>. </p>
<h2>An unwanted COVID-19 resurgence</h2>
<p>New Zealand can expect <a href="https://www.rnz.co.nz/news/national/467013/nz-likely-to-be-hit-with-second-wave-during-winter-covid-19-modeller">another resurgence of COVID-19</a> this winter.</p>
<p>While 95% of New Zealand has received the second dose of the vaccine, one of the highest rates <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=People+vaccinated+%28by+dose%29&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=USA%7EGBR%7ECAN%7EDEU%7EITA%7EIND%7EAUS%7EESP%7EKOR%7ENZL">in the world</a>, fewer have received a <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2021-11-22..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Vaccine+booster+doses&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=USA%7EGBR%7ECAN%7EDEU%7EITA%7EIND%7EAUS%7EESP%7EKOR%7ENZL">booster</a>. We also have lower than optimal levels of childhood vaccination.</p>
<p><a href="https://theconversation.com/au/topics/long-covid-97731">Long COVID</a> will add a layer of complication for our medical services. </p>
<p>A recent <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7121e1.htm">report by the US Center for Disease Control</a> (CDC) suggests one in five COVID-19 survivors aged 18 to 64 years old, and one in four survivors aged 65 years and above, experienced at least one condition that might be attributable to previous COVID-19 infection. </p>
<p>Despite being labelled as one of this <a href="https://www.stuff.co.nz/national/health/300596869/long-covid-will-be-one-of-this-generations-disability-challenges--commissioner">generation’s disability challenges</a>, there is currently no test for long COVID. </p>
<p>Worryingly, <a href="https://theconversation.com/cases-are-high-and-winter-is-coming-we-need-to-stop-ignoring-covid-183218">COVID-19 deaths</a> in Australia have started to trend upwards. Evidence from <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-30-april-2022">Australia</a> has shown that the overwhelming majority of people are dying from, not with, COVID-19. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/464886/original/file-20220523-26-lkeeg5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464886/original/file-20220523-26-lkeeg5.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464886/original/file-20220523-26-lkeeg5.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464886/original/file-20220523-26-lkeeg5.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464886/original/file-20220523-26-lkeeg5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464886/original/file-20220523-26-lkeeg5.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464886/original/file-20220523-26-lkeeg5.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There has been a recent increase in COVID-19 related deaths in Australia.</span>
<span class="attribution"><span class="source">Our world in data</span></span>
</figcaption>
</figure>
<h2>Winter will bring more than COVID-19</h2>
<p>Health professionals are not just worried about COVID-19. The flu and other viruses are also expected to hit hard this year. </p>
<p>Thanks to closed borders, managed isolation and quarantine, and lockdowns, the last time New Zealand experienced a <a href="https://www.esr.cri.nz/assets/Uploads/Influenza-Surveillance-Intelligence-Report-4August19.pdf">flu season</a> was in 2019. </p>
<p>We are now more vulnerable to the virus. There has already been a reported <a href="https://www.stuff.co.nz/national/health/128624970/influenza-hotspot-potentially-emerges-in-the-south">surge</a> in Dunedin. </p>
<p>In response, the government has made two million vaccines available and has the widened eligibility for people to get vaccinated for <a href="https://www.beehive.govt.nz/release/two-million-flu-shots-covid-winter-plan">free</a>.</p>
<p>Unfortunately, there is growing concern that part of the population may not get vaccinated due to <a href="https://www.nursinginpractice.com/clinical/vaccinations-and-infections/vaccination-fatigue-leads-to-decline-in-children-getting-jabs/">immunisation fatigue</a>, or may be unable to due to <a href="https://journal.nzma.org.nz/journal-articles/structural-disadvantage-for-priority-populations-the-spatial-inequity-of-covid-19-vaccination-services-in-aotearoa-open-access">structural inequities in access to vaccines</a>. </p>
<p>As with COVID-19, looking across the Tasman can help us understand what is likely to happen in New Zealand. </p>
<p>Much like New Zealand, <a href="https://www.abc.net.au/news/2022-05-23/qld-free-flu-jabs-for-everyone/101091914">flu rates in Australia</a> have, until now, been very low due to closed borders. </p>
<p>The latest Australian national surveillance for <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm#current">influenza</a> shows a steep rise in rates of the flu, as well as rising hospital and ICU admissions. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/466120/original/file-20220530-16-aaebti.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466120/original/file-20220530-16-aaebti.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466120/original/file-20220530-16-aaebti.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466120/original/file-20220530-16-aaebti.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466120/original/file-20220530-16-aaebti.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=514&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466120/original/file-20220530-16-aaebti.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=514&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466120/original/file-20220530-16-aaebti.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=514&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Lab notifications in Australia for influenza show a steep pre-winter surge nationally, comparable to 2017 and 2019.</span>
</figcaption>
</figure>
<h2>Vaccination gaps exist for other diseases</h2>
<p>Before the COVID-19 pandemic even started, our research highlighted <a href="https://academic.oup.com/eurpub/article/31/3/561/6148900">declines in childhood immunisation</a> for vaccine-preventable diseases.</p>
<p>Public health officials are now noticing further <a href="https://covid.immune.org.nz/news-insights/maintaining-high-immunisation-coverage-current-covid-19-disease-circulating">significant declines</a> in routine childhood immunisations. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/466131/original/file-20220531-16-9q3awh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/466131/original/file-20220531-16-9q3awh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466131/original/file-20220531-16-9q3awh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=380&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466131/original/file-20220531-16-9q3awh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=380&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466131/original/file-20220531-16-9q3awh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=380&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466131/original/file-20220531-16-9q3awh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=478&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466131/original/file-20220531-16-9q3awh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=478&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466131/original/file-20220531-16-9q3awh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=478&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Maintaining high immunisation coverage in the current COVID-19 disease circulating environment.</span>
<span class="attribution"><span class="source">Dr Anna Howe, The Immunisation Advisory Centre, University of Auckland</span></span>
</figcaption>
</figure>
<p>In April, the World Health Organization <a href="https://www.who.int/news/item/27-04-2022-unicef-and-who-warn-of--perfect-storm--of-conditions-for-measles-outbreaks--affecting-children">reported</a> a 79% increase in <a href="https://www.1news.co.nz/2022/05/01/fears-measles-could-go-off-like-firecracker-if-it-takes-hold-in-nz/">measles cases</a> in the first two months of 2022. </p>
<p>Meaningfully addressing long-standing <a href="https://www.nzherald.co.nz/nz/childhood-vaccines-report-calls-for-urgent-changes-to-protect-maori-children-from-lethal-diseases/A5LBQEIVPL2AJZOM2SOKD2MDBU/">inequities</a> in childhood vaccination programmes takes on new urgency in the face of these vaccination gaps. </p>
<p>Lessons can also be learned from the COVID-19 vaccination programme regarding the success of handing <a href="https://www.newsroom.co.nz/ideasroom/eliminating-maori-inequities-in-covid-19-outcomes">leadership</a> to Māori and Pasifika community providers to improve vaccination rates. </p>
<h2>The health system is under unprecedented pressure</h2>
<p>We have long been warned that an <a href="https://www.stuff.co.nz/national/health/123707034/overstretched-underfunded-and-inequitable-incoming-health-minister-andrew-little-warned-system-is-under-immense-strain">underfunded health system</a> might struggle with a seasonal <a href="https://www.stuff.co.nz/national/health/124993556/we-are-worried--doctors-fear-patients-will-die-waiting-in-ambulances-this-winter-unable-to-access-overcrowded-emergency-departments?rm=a">surge in demand</a>. </p>
<p>Pressure points have appeared across the country. On May 23, <a href="https://www.odt.co.nz/news/dunedin/covid-ward-capacity">Dunedin Hospital’s COVID-19 ward</a> was at capacity. Two days later, Nelson Hospital also hit capacity limits, leading to temporary ambulance ramping at the <a href="https://www.stuff.co.nz/national/health/128738769/when-nelson-hospital-ran-out-of-beds-ed-patients-waited-in-a-tent#">emergency department</a>. </p>
<p><a href="https://www.stuff.co.nz/national/health/128808366/christchurch-ed-pleads-with-public-not-to-come-unless-urgent-as-winter-illness-bites">Canterbury District Health Board</a>, <a href="http://www.ourhealthhb.nz/news-and-events/latest-news/new-news-page-7/?fbclid=IwAR1zK_NB9T0X6slOwxgx5bOWEvsBFlazV5QYo19CAX2rGDo3zL3b-VTWkl4">Hawke’s Bay District Health Board</a>, and <a href="https://www.facebook.com/MidCentralDHB/posts/415367190596599">MidCentral District Health Board</a> have recently urged people to consider alternative care for minor conditions to help alleviate the pressure. </p>
<p>Community health providers are <a href="https://www.rnz.co.nz/news/national/462969/covid-19-increasing-wellington-cases-puts-pressure-on-gps-community-providers">also struggling</a> to meet demands. </p>
<h2>What can you do?</h2>
<p>During the winter, we spend more time in indoor spaces with <a href="https://www.rnz.co.nz/news/national/467839/rise-in-covid-19-cases-i-d-like-to-see-masks-mandated-in-schools">inadequate ventilation</a>. We are also becoming more complacent with our mask wearing as policies relax. </p>
<p>In the future, vaccines will need to <a href="https://www.theatlantic.com/health/archive/2022/05/covid-vaccine-effectiveness-severe-disease/629955/">improve</a>. </p>
<p>But for now, it’s important to remember that three doses of the COVID-19 vaccine remain effective against hospitalisation even for newer <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00309-7/fulltext">variants</a>, as well as lowering the risk of infection. </p>
<p>But there are things we can all do to avoid the worst this winter has to offer, including to:</p>
<ul>
<li>ventilate indoor spaces – especially in crowded rooms </li>
<li>wear <a href="https://covid19.govt.nz/prepare-and-stay-safe/keep-up-healthy-habits/wear-a-face-mask/types-of-face-masks/">appropriate masks</a> where social distancing is not possible, particularly indoors </li>
<li>get vaccinated against COVID-19, which helps to protect you from the most severe form of COVID-19, as well as protecting others by decreasing transmission. Other routine vaccinations for flu and measles will also be important to consider.</li>
</ul>
<p>Finally, workplaces should continue to support people to stay home and isolate if required.</p><img src="https://counter.theconversation.com/content/183536/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Matthew Hobbs receives funding from the New Zealand Health Research Council, Cure Kids/A Better Start National Science Challenge and IStar. He was also previously funded as a researcher by the New Zealand Ministry of Health. </span></em></p><p class="fine-print"><em><span>Lukas Marek has previously received funding from the Ministry of Health, New Zealand Health Research Council, Cure Kids and National Science Challenges.</span></em></p><p class="fine-print"><em><span>Alex Kazemi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The last time New Zealanders even had a flu season was in 2019. The flu, along with COVID-19 and other respiratory viruses, is expected to hit hard this winter.Matthew Hobbs, Senior Lecturer in Public Health and Co-Director of the GeoHealth Laboratory, University of CanterburyAlex Kazemi, Intensive Care specialist, turned Masters of Public Health, University of Auckland, Waipapa Taumata RauLukas Marek, Researcher and lecturer in Spatial Data Science, University of CanterburyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1731342022-02-01T13:14:34Z2022-02-01T13:14:34ZWhy taking fever-reducing meds and drinking fluids may not be the best way to treat flu and fever<figure><img src="https://images.theconversation.com/files/439010/original/file-20211226-36920-246w3v.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C5128%2C3426&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Using fever reducers or drinking too much fluid while battling the flu may upset the body's delicate balancing act. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sick-woman-taking-her-temperature-royalty-free-image/88689538?adppopup=true">Sam Edwards/OJO Images via Getty Images</a></span></figcaption></figure><p>As flu season progresses, so does the <a href="https://www.cdc.gov/flu/prevent/index.html">chorus of advice</a>, professional and otherwise, to drink plenty of fluids and take fever-reducing medications, like acetaminophen, ibuprofen or aspirin. </p>
<p>These recommendations, <a href="https://doi.org/10.1001/archpedi.1982.03970470017003">well-intentioned and firmly entrenched</a>, offer comfort to those sidelined with fever, flu or vaccine side effects. But you may be surprised to learn the science supporting these recommendations is speculative at best, harmful at worst and comes with caveats. </p>
<p><a href="https://education.wayne.edu/profile/gr7894">I am an exercise physiologist</a> who specializes in studying how the body regulates fluids and temperature. And based on a wide body of evidence, I can tell you that increased fluid intake and taking fever reducers, whether aspirin, acetaminophen or ibuprofen, may not always help in your recovery. In fact, in some cases, it could be harmful.</p>
<p>There’s a reason why people say fevers should be lowered when sick or after a vaccine. Both aspirin and acetaminophen, such as Tylenol, <a href="https://doi.org/10.1016/j.clinthera.2005.06.002">reduce fever, headaches and muscle aches</a>. But at the same time, <a href="https://doi.org/10.1093/infdis/162.6.1277">seminal</a> and <a href="https://doi.org/10.1098/rspb.2013.2570">newer studies</a>, including broad meta-analysis studies, show that <a href="https://doi.org/10.1258/jrsm.2010.090441">these medications</a> may weaken the immune response to infection or <a href="https://doi.org/10.1001/archinte.160.4.449">have unwanted side effects</a>.</p>
<h2>What is a fever?</h2>
<p>First, some background: Fevers are a regulated increase in core body temperature as a response to unwanted microbial invaders.
The more <a href="https://doi.org/10.1016/j.amjms.2021.01.004">severe the infection, the higher the fever</a>. </p>
<p>Having a fever is not all bad; it’s how the body has evolved to recuperate from an infection. For many species, <a href="https://www.racgp.org.au/afp/2015/januaryfebruary/a-is-for-aphorisms/">fevers are advantageous</a> and beneficial for survival. </p>
<p>But fever comes with a cost. A body temperature that’s too high can be deadly. For every increase of 1.8 degrees Fahrenheit, metabolism goes up 10%; the body begins to burn more calories than normal, temperature continues to rise and the <a href="https://doi.org/10.1111/j.1749-6632.2000.tb05376.x">body releases hormones</a> to keep fever under control. </p>
<p>Many studies demonstrate what can happen when fever reducers are thrust into this complex dance. It turns out aspirin or acetaminophen may cause infected people to feel better, but they also spread more virus while suppressing their own immune response to the infection. </p>
<p>In one double-blind, placebo-controlled study, healthy people infected with a cold virus <a href="https://doi.org/10.1093/infdis/162.6.1277">who took aspirin or acetaminophen</a> for a week had a reduced immune response and an increase in viral shedding – meaning producing and expelling virus particles from the nose. Another study showed that taking aspirin effectively reduced fever symptoms but <a href="https://doi.org/10.1001/jama.1975.03240240018017">increased shedding</a>.</p>
<p>Although some of those traditional studies took place decades ago, their results still hold up today. A recent study warned that if everyone took fever suppressants, there would be even <a href="https://doi.org/10.1098/rspb.2013.2570">more flu cases and flu-related deaths</a>. Furthermore, elevated body temperature – or fever – can help fight COVID-19 by reducing the <a href="https://doi.org/10.1371/journal.%20pbio.3001065">growth of the virus within the lungs</a>. In other words, fevers can help the body fight viruses while reducing the rate of death and disease.</p>
<h2>Drinking fluids</h2>
<p>To prevent dehydration, the Centers for Disease Control and Prevention recommends drinking more fluids when one <a href="https://www.cdc.gov/flu/pdf/freeresources/general/influenza_flu_homecare_guide.pdf?web=1&wdLOR=c20031A15-D755-4A4D-B1B2-40CE51B88D3A">has a fever or infection</a>, or has received <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/expect/after.html#relieve_side_effects">a COVID-19 vaccine</a>. But there is <a href="https://www.washingtonpost.com/lifestyle/2021/11/05/what-do-doctors-mean-when-they-say-drink-plenty-fluids/">scant scientific evidence</a> to support this recommendation. </p>
<figure class="align-center ">
<img alt="A teenage girl with flu drinks a glass of water." src="https://images.theconversation.com/files/439558/original/file-20220105-23-18gcely.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439558/original/file-20220105-23-18gcely.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439558/original/file-20220105-23-18gcely.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439558/original/file-20220105-23-18gcely.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439558/original/file-20220105-23-18gcely.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439558/original/file-20220105-23-18gcely.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439558/original/file-20220105-23-18gcely.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Drinking fluids to excess can lead to overhydration.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/teenager-drinks-water-from-a-glass-indoors-royalty-free-image/1314353664?adppopup=true">Dina Morozova/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p>It’s true that drinking fluids when dehydrated is <a href="https://doi.org/10.1001/archinte.1919.00090240119009">necessary to reduce fever</a>. But not everyone with a fever is dehydrated. For those who aren’t thirsty, forcing fluids <a href="https://doi.org/10.1073/pnas.1403382111">beyond thirst</a>, which is often unpleasant, may not be advisable. </p>
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<p>A study <a href="https://doi.org/10.1002/14651858.CD004419.pub3">that evaluated the advice</a> to “drink plenty of fluids” determined that increasing fluid intake when sick may not offer benefits, and that more high-quality studies are needed. Indeed, there was a potential <a href="https://www.webmd.com/diet/what-is-too-much-water-intake#1">risk from overhydration</a>. For some people, three liters, or about 12 eight-ounce glasses, is too much. Overhydration can cause nausea and vomiting, headaches and cramps; in severe cases, <a href="http://dx.doi.org/10.1136/bcr-2016-216882">excessive fluid intake</a> can cause seizures or coma. </p>
<p>Here’s why this happens. To stop dangerous escalations in fever, the body releases antidiuretic hormones. Urination is diminished, so <a href="https://doi.org/10.2165/11532070-000000000-00000">the body retains water</a> through the actions of the kidneys. So if someone with a fever drinks more water than necessary, water intoxication – or hyponatremia, a potentially fatal medical condition in which a patient’s blood sodium levels are too low – could follow. </p>
<p>One study found that nearly a quarter of patients who came to the hospital with COVID-19 had <a href="https://doi.org/10.1210/clinem/dgab107">hyponatremia upon admission</a>. In that study, hyponatremia increased the need for breathing support in the form of ventilation. And another study showed that the condition can lead to <a href="https://doi.org/10.1007/s40618-020-01301-w">poorer outcomes in COVID-19 patients</a>.</p>
<p>So maybe it’s time to rethink the conventional wisdom. If the fever is mild or moderate, stay warm, even use blankets, rather than try to actively reduce it. Rest, so your body can fight the fever. Conserve energy because your metabolism is already on overdrive. Use fever-reducing medications sparingly. Drink fluids, but only to tolerance, and preferably when thirsty.</p>
<p>And one final suggestion that should be soothing: When fighting a fever or vaccine side effects, consider sipping warm liquids that contain sodium. Broths containing sodium, like bullion, <a href="https://doi.org/10.1097/JSM.0000000000000221">may help avoid hyponatremia</a>. And although the actual scientific evidence is sparse and conflicting, <a href="https://doi.org/10.1016/j.chest.2020.06.062">chicken soup</a> may be a better antidote than water when fending off a fever or flu symptoms.</p><img src="https://counter.theconversation.com/content/173134/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tamara Hew-Butler does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In some cases, fever reducers and extra fluid intake can weaken the body’s response to infection.Tamara Hew-Butler, Associate Professor of Exercise and Sports Science, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1690112021-10-08T12:28:39Z2021-10-08T12:28:39ZFlu season paired with COVID-19 presents the threat of a ‘twindemic,’ making the need for vaccination all the more urgent<figure><img src="https://images.theconversation.com/files/425113/original/file-20211006-15-rrd6sc.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7292%2C5153&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A bad flu year on top of the pandemic could mean trouble for already-stressed hospitals.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/coping-with-a-winter-cold-royalty-free-image/1007965142">George Clerk/E+ Collection via Getty Images</a></span></figcaption></figure><p>As winter looms and hospitals across the U.S. <a href="https://www.npr.org/2021/08/19/1029378744/hospital-beds-shortage-covid-coronavirus-states">continue to be deluged</a> with severe cases of COVID-19, flu season presents a particularly ominous threat this year.</p>
<p>We are researchers with expertise in vaccination policy and <a href="https://scholar.google.com/citations?user=CFrZAVMAAAAJ&hl=en">mathematical modeling</a> of infectious disease. Our group, the <a href="https://www.phdl.pitt.edu/">Public Health Dynamics Laboratory</a> at the University of Pittsburgh, has been modeling influenza for over a decade. <a href="https://www.cvr.pitt.edu/people/richard-zimmerman-md-mph">One of us</a> has been a member of the Centers for Disease Control and Prevention’s <a href="https://www.cdc.gov/vaccines/acip/index.html">Advisory Committee on Immunization Practices</a> and the CDC’s <a href="https://www.cdc.gov/flu/vaccines-work/us-flu-ve-network.htm">Flu Vaccine Effectiveness Network</a>.</p>
<p>Our recent modeling work suggests that last year’s <a href="https://www.nytimes.com/interactive/2021/04/22/science/flu-season-coronavirus-pandemic.html">tamped-down influenza season</a> could lead to a surge in flu cases this coming season.</p>
<h2>Anti-COVID-19 strategies reduced flu too</h2>
<p>As a result of the numerous measures put in place in 2020 to curb transmission of COVID-19 – including limiting travel, wearing masks, social distancing, closing schools and other strategies – the U.S. saw a dramatic <a href="https://doi.org/10.1093/infdis/jiab485">decrease in influenza</a> and other infectious diseases during the last flu season.</p>
<p>Flu-related deaths in kids dropped from nearly 200 in the 2019-2020 season to <a href="https://www.washingtonpost.com/health/2021/03/02/children-flu-deaths/">one</a> in the 2020-2021 season. Overall, the 2020-2021 flu season had one of the <a href="https://www.cdc.gov/flu/about/burden/2019-2020.html">lowest recorded number of cases</a> in recent U.S. history.</p>
<p>While flu reduction is a good thing, it could mean that the flu will hit harder than normal this winter. This is because much of the natural immunity that people develop to disease comes from the spread of that disease through a population. Many other respiratory viruses demonstrated a similar drop during the pandemic, and some of those, <a href="https://emergency.cdc.gov/han/2021/han00443.asp">including interseasonal respiratory syncytial virus, or RSV</a>, have <a href="https://theconversation.com/a-pediatrician-explains-a-spike-in-ear-infections-this-summer-after-covid-19-restrictions-lifted-166461">increased dramatically</a> as schools have reopened and social distancing, masking and other measures have declined.</p>
<h2>Deciphering viral transmission</h2>
<p>Immunity to influenza involves multiple factors. <a href="https://www.cdc.gov/flu/about/viruses/types.htm">Influenza is caused by several strains of an RNA virus that mutate</a> at various rates each year, in a manner not unlike the mutations that are <a href="https://theconversation.com/massive-numbers-of-new-covid-19-infections-not-vaccines-are-the-main-driver-of-new-coronavirus-variants-166882">occurring in SARS-CoV-2</a>, the virus that causes COVID-19. </p>
<p>The level of a person’s existing immunity to the current year’s strain of flu depends on several variables. They include how similar the current strain is to the one that a child was first exposed to, whether circulating strains are similar to previously experienced strains and how recent those influenza infections were, if they occurred. </p>
<p>And of course human interactions, such as children crowding together in classrooms or people attending large gatherings – as well as the use of protective measures like wearing a mask – all affect whether a virus is transmitted between people. </p>
<p>There are also variables due to vaccination. Population immunity from vaccination depends on the proportion of people who get the flu vaccine in a given season and how effective - or well matched - that vaccine is against the <a href="https://www.cdc.gov/flu/vaccines-work/effectiveness-studies.htm">circulating influenza strains</a>. </p>
<figure class="align-center ">
<img alt="Health care workers attend to an unvaccinated COVID-19 patient at a medical center in Tarzana, California." src="https://images.theconversation.com/files/424841/original/file-20211005-22-18jw80q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/424841/original/file-20211005-22-18jw80q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424841/original/file-20211005-22-18jw80q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424841/original/file-20211005-22-18jw80q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424841/original/file-20211005-22-18jw80q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424841/original/file-20211005-22-18jw80q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424841/original/file-20211005-22-18jw80q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Health care workers treat a 45-year-old unvaccinated COVID-19 patient at a medical center in Tarzana, Calif. The ongoing pandemic, coupled with the looming flu season, could trigger what doctors call a ‘twindemic.’</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/health-care-workers-attend-to-a-patient-with-covid-19-as-news-photo/1235024685?adppopup=true">APU GOMES/AFP via Getty Images</a></span>
</figcaption>
</figure>
<h2>No precedent exists for a ‘twindemic’</h2>
<p>Given the limited spread of influenza in the general U.S. population last year, our research suggests that the U.S. could see a large epidemic of flu this season. Paired with the existing threat of the <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html">highly infectious delta variant</a>, this could result in a dangerous combination of infectious diseases, or a “twindemic.”</p>
<p><a href="https://covid19sim.org/">Models of COVID-19</a> and other infectious diseases have been at the forefront of predictions about the COVID-19 pandemic, and have often proved to be predictive of cases, hospitalizations and death.</p>
<p>But there are no historical examples of this type of dual and simultaneous epidemics. As a result, traditional epidemiological and statistical methods are not well suited to project what may occur this season. Therefore, models that incorporate the mechanisms of how a virus spreads are better able to make predictions.</p>
<p>We used two separate methods to forecast the potential impact from last year’s decrease in influenza cases on the current 2021-2022 flu season. </p>
<p>In recent research of ours <a href="https://doi.org/10.1101/2021.08.18.21262185">that has not yet been peer-reviewed</a>, we applied a <a href="https://doi.org/10.1186/1471-2458-13-940">modeling system</a> that simulates an actual population’s interactions at home and work, and in school and neighborhood settings. This model predicts that the U.S. could see a big spike in flu cases this season. </p>
<p>In <a href="https://doi.org/10.1101/2021.08.29.21262803">another preliminary study</a>, we used a traditional infectious disease modeling tool that divides the population into people who are susceptible to infection, those infected, those recovered and those who have been hospitalized or have died. Based on our mathematical model, we predict that the U.S. could see as many as 102,000 additional hospitalizations above the hundreds of thousands that <a href="https://www.cdc.gov/flu/about/burden/2019-2020.html">typically occur during flu season</a>. Those numbers assume that there is no change from the usual flu vaccine uptake and effectiveness starting this fall and lasting through the flu season.</p>
<p><iframe id="e5O9C" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/e5O9C/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Individual behaviors and vaccination matter</h2>
<p>A <a href="https://www.cdc.gov/flu/about/burden/past-seasons.html">typical flu season</a> usually produces 30 million to 40 million cases of symptomatic disease, between 400,000 and 800,000 hospitalizations and from 20,000 to 50,000 deaths. </p>
<p>This prospect, paired with the <a href="https://covid.cdc.gov/covid-data-tracker/#datatracker-home">ongoing battle against COVID-19</a>, raises the possibility of a twindemic overwhelming the health care system as hospitals and ICUs in <a href="https://www.nytimes.com/interactive/2021/09/14/us/covid-hospital-icu-south.html?searchResultPosition=4">some parts of the country overflow</a> with critically ill COVID-19 patients. </p>
<p>Our research also highlighted how young children could be particularly at risk since they have lower exposure to previous seasons of influenza and thus haven’t yet developed broad immunity, compared with adults. In addition to the burden on children, childhood influenza is an important driver of influenza in the elderly as kids pass it on to <a href="https://doi.org/10.1056/NEJM200103223441204">grandparents and other elderly people</a>. </p>
<p>However, there is reason for optimism, since people’s behaviors can change these outcomes considerably. </p>
<p>For instance, our <a href="https://doi.org/10.1101/2021.08.18.21262185">simulation study</a> incorporated people of all ages and found that increasing vaccination among children has the potential to cut infections in children by half. And we found that if only 25% more people than usual are vaccinated against influenza this year, that would be sufficient to reduce the infection rate to normal seasonal influenza levels. </p>
<p>Across the U.S., there is a lot of variability in vaccination rates, adherence to social distancing recommendations and mask-wearing. So it is likely that the flu season will experience substantial variation state to state, just as we have seen with <a href="https://www.npr.org/sections/health-shots/2021/07/09/1014512213/covid-is-surging-in-new-hotspots-driven-by-low-vaccination-rates">patterns of COVID-19 infection</a>. </p>
<p>All of this data suggests that although vaccination against influenza is important every year, it is of utmost importance this year to prevent a dramatic rise in influenza cases and to keep U.S. hospitals from becoming overwhelmed. </p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/169011/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark S Roberts receives funding from the Centers for Disease Control and the National Institutes of Health</span></em></p><p class="fine-print"><em><span>Richard K Zimmerman receives funding from Centers for Disease Control and Prevention, NIH, and Sanofi Pasteur. </span></em></p>Recent computer modeling shows the upcoming flu season might see a surge in cases. Coupled with COVID-19’s continued threat, doctors are again urging Americans to get their shots.Mark S Roberts, Distinguished Professor of Health Policy and Management, University of PittsburghRichard K Zimmerman, Professor of Family Medicine, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1390512020-05-20T14:31:46Z2020-05-20T14:31:46ZPasha 65: Busting myths around the flu vaccine<figure><img src="https://images.theconversation.com/files/336351/original/file-20200520-152302-o5l2eb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> </figcaption></figure><p>The flu vaccine will not stop you from getting the coronavirus but it’s still important to get it. It will help you fight off other respiratory viruses like the flu and you will avoid visits to the doctor, where there are sick people. Many people think the flu vaccine will make you sicker. There are also those who believe that it contains toxic mercury. </p>
<p>In today’s episode of Pasha, Marietjie Venter, head of the Zoonotic, Arbo and Respiratory Virus Programme and professor in the Department of Medical Virology, University of Pretoria, discusses – and busts – some common myths about the flu vaccine.</p>
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Read more:
<a href="https://theconversation.com/coronavirus-pandemic-why-a-flu-jab-is-a-good-idea-in-countries-heading-into-winter-136644">Coronavirus pandemic: why a flu jab is a good idea in countries heading into winter</a>
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<p><strong>Photo:</strong>
“A yield road sign with Flu Season Ahead” By ulegundo <a href="https://www.shutterstock.com/image-illustration/yield-road-sign-flu-season-ahead-136655441">Shutterstock</a></p>
<p><strong>Music</strong>
“Happy African Village” by John Bartmann, found on <a href="http://freemusicarchive.org/music/John_Bartmann/Public_Domain_Soundtrack_Music_Album_One/happy-african-village">FreeMusicArchive.org</a> licensed under <a href="https://creativecommons.org/publicdomain/zero/1.0/">CC0 1</a>.</p>
<p>“electronic-music-loop-001-Accurate time” by Frankum found on <a href="https://freesound.org/people/frankum/sounds/387440/">Freesound</a> licensed under <a href="http://creativecommons.org/publicdomain/zero/1.0/">Creative Commons</a></p><img src="https://counter.theconversation.com/content/139051/count.gif" alt="The Conversation" width="1" height="1" />
Thinking about getting the flu shot? This may help you decide.Ozayr Patel, Digital EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1362182020-04-15T22:30:38Z2020-04-15T22:30:38ZCoronavirus may wane this summer, but don’t count on any seasonal variation to end the pandemic<figure><img src="https://images.theconversation.com/files/328217/original/file-20200415-153308-kleblr.jpg?ixlib=rb-1.1.0&rect=187%2C113%2C3413%2C2411&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Plenty of warm and humid places – including Miami – are seeing the spread of SARS-CoV-2.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/miami-beach-lummus-park-closed-due-to-pandemic-sign-and-man-news-photo/1217550661">Jeff Greenberg/Universal Images Group via Getty Images</a></span></figcaption></figure><p>Will SARS-CoV-2, the virus that causes COVID-19, fade away on its own this summer?</p>
<p>After all, other viruses – including influenza and respiratory syncytial virus
<a href="https://www.cdc.gov/rsv/research/us-surveillance.html">(RSV)</a>, which causes bronchiolitis in little children – are <a href="https://www.cdc.gov/flu/about/season/flu-season.htm">mostly seen in the winter</a>.</p>
<p>The National Academies’ Standing Committee on <a href="https://www.nationalacademies.org/our-work/standing-committee-on-emerging-infectious-diseases-and-21st-century-health-threats#sectionCommittee">Emerging Infectious Diseases and 21st Century Health Threats</a> <a href="https://www.nap.edu/catalog/25771/rapid-expert-consultation-on-sars-cov-2-survival-in-relation-to-temperature-and-humidity-and-potential-for-seasonality-for-the-covid-19-pandemic-april-7-2020">recently addressed the question</a> of whether SARS-CoV-2 will follow the same pattern. The group of experts corralled the research that’s been done so far – much of it not yet peer-reviewed – to assess the evidence.</p>
<p>While there is some reason to hope that things may get better as the weather warms up, there is plenty of reason for the U.S. to keep its guard up.</p>
<h2>Are heat and humidity reason for hope?</h2>
<p>Although the U.S. is early in the course of the pandemic, there is evidence from other countries that SARS-CoV-2 spreads more rapidly in cold, dry weather.</p>
<p><a href="https://doi.org/10.1101/2020.03.30.20044099">One preprint study of 30 Chinese provinces</a> showed that the number of COVID-19 cases went down by between 36% and 57% for every 1.8 degree Fahrenheit increase in temperature. When temperatures held steady in the low 40s F, the number of cases went down between 11% and 22% with each 1% increase in relative humidity (how much water is in the air).</p>
<p><a href="https://doi.org/10.1101/2020.03.27.20045658">A larger preprint study looking at 310 regions in 116 countries</a> found that 11% more cases were reported when the temperature went down 9 degrees, the relative humidity went down 10% and when the wind speed went up. </p>
<p>Laboratory research also suggest that the virus survives longer in cold conditions. One study showed that SARS-CoV-2 lasts for 14 days at 40 F in lab media but <a href="https://doi.org/10.1016/S2666-5247(20)30003-3">is gone after one day at 98.6 F</a>.</p>
<p>These and other studies suggest that warm, humid weather may slow the spread of this virus, <a href="https://doi.org/10.1101/2020.02.12.20022467">although not all</a> <a href="https://doi.org/10.1101/2020.03.29.20046706">commentators agree</a>.</p>
<p>New research on this topic appears almost daily, and scientists are watching to see what happens as summer comes to the Northern Hemisphere. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/328218/original/file-20200415-153334-18rts5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/328218/original/file-20200415-153334-18rts5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/328218/original/file-20200415-153334-18rts5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=372&fit=crop&dpr=1 600w, https://images.theconversation.com/files/328218/original/file-20200415-153334-18rts5r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=372&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/328218/original/file-20200415-153334-18rts5r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=372&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/328218/original/file-20200415-153334-18rts5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=468&fit=crop&dpr=1 754w, https://images.theconversation.com/files/328218/original/file-20200415-153334-18rts5r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=468&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/328218/original/file-20200415-153334-18rts5r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=468&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Summer in the Southern Hemisphere hasn’t stopped SARS-CoV-2 from spreading in Australia.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/residents-of-sydney-keep-to-the-rules-of-social-distancing-news-photo/1218492661">James D. Morgan/Getty Images News via Getty Images</a></span>
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<h2>Which clues call for caution?</h2>
<p>COVID-19 is already spreading in many parts of the world where it’s hot, including Australia and South America, demonstrating that high temperatures are not enough to stop the disease.</p>
<p>The most important reason to be concerned about ongoing spread is the fact that this is a brand new virus for humans, so almost everyone is susceptible to being infected.</p>
<p>In fact, weather actually appears to <a href="https://doi.org/10.1101/2020.03.18.20036731">play a minor role</a> in the rate at which this virus spreads.</p>
<p><a href="https://www.nytimes.com/2020/04/13/opinion/coronavirus-what-we-know.html">Other influences on infection rates</a> include individual behaviors, cultural practices, geography, income and living conditions. <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html">Public health practices</a> such as social distancing, the intensity of testing for infection, contact tracing, quarantine of people who are exposed and isolation of people who are actually infected also play a big role in how the coronavirus spreads.</p>
<p>The news from other viral diseases <a href="https://www.nap.edu/catalog/25771/rapid-expert-consultation-on-sars-cov-2-survival-in-relation-to-temperature-and-humidity-and-potential-for-seasonality-for-the-covid-19-pandemic-april-7-2020">is not encouraging either</a>. The two most serious coronavirus diseases that are closely related to COVID-19, the first SARS outbreak and MERS, <a href="https://www.nap.edu/catalog/25771/rapid-expert-consultation-on-sars-cov-2-survival-in-relation-to-temperature-and-humidity-and-potential-for-seasonality-for-the-covid-19-pandemic-april-7-2020">did not vary with the seasons after they emerged</a>. In fact, MERS is still <a href="https://www.cdc.gov/coronavirus/mers/index.html">found year-round in the Middle East</a>, where it is hot and dry. Pandemic influenza infections have emerged at different times of the year as well.</p>
<h2>What should we do?</h2>
<p>The <a href="https://doi.org/10.1056/NEJMp2003762">long-term solution to SARS-CoV-2</a> will be to develop a <a href="https://blogs.scientificamerican.com/observations/can-we-really-develop-a-safe-effective-coronavirus-vaccine/">safe and effective vaccine</a>. This work is proceeding at unprecedented speed, but it will still take anywhere from months to a few years and will require trials involving thousands of people and massive international leadership and collaboration.</p>
<p>Until there’s a vaccine, prevention will require avoiding exposure to people who can spread the virus. Communities need to test people to find out who is contagious and engage in serious contact tracing, quarantine and isolation. Scientists need to learn more about how to determine if someone is immune and how long immunity lasts, <a href="https://www.nytimes.com/2020/04/13/opinion/coronavirus-immunity.html">a big open question at the moment</a>. As individuals, each of us will need to follow expert scientific advice about good hygiene practices and distancing.</p>
<p><a href="http://doi.org/10.1126/science.abb5793">SARS-CoV-2 is likely to keep circulating</a> until the human population has widespread immunity, which hopefully will come not from an unchecked pandemic but from developing and deploying a safe and effective vaccine.</p>
<p>[<em>You’re too busy to read everything. We get it. That’s why we’ve got a weekly newsletter.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybusy">Sign up for good Sunday reading.</a> ]</p><img src="https://counter.theconversation.com/content/136218/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ellen Wright Clayton reviewed the statement on seasonality by the NASEM Standing Committee.</span></em></p>Winter is flu season – could it be coronavirus season as well? The research is mixed, but other factors besides temperature and humidity have more to do with the spread of SARS-CoV-2.Ellen Wright Clayton, Professor of Pediatrics and Law and Health Policy, Vanderbilt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1153032019-04-17T19:49:59Z2019-04-17T19:49:59ZWe can’t predict how bad this year’s flu season will be but here’s what we know so far<figure><img src="https://images.theconversation.com/files/269716/original/file-20190417-139120-12zgr25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The flu comes on rapidly and symptoms get worse over the first few days.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com">Shutterstock</a></span></figcaption></figure><p>Influenza illness – or the flu – is a caused by the <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/flu-influenza">influenza virus</a>. It often comes on rapidly, with a high fever, chills, muscle aches, tiredness and a dry cough. These symptoms get worse over the first few days.</p>
<p>Most people will get better without medical care, but some people are at higher risk of dangerous complications. This includes pregnant women, children, those aged over 65, people with chronic diseases and Aboriginal and Torres Strait Island peoples. </p>
<p><a href="https://www.abc.net.au/news/2019-04-10/australian-flu-season-concerns-as-experts-urge-vaccinations/10987700">News reports have claimed</a> Australia is on track for a particularly bad flu season. But it’s too early to tell if that’s the case – and it’s impossible to predict. Here’s what we know so far. </p>
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Read more:
<a href="https://theconversation.com/whens-the-best-time-to-get-your-flu-shot-114978">When's the best time to get your flu shot?</a>
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<h2>What was last year’s flu season like?</h2>
<p>The World Health Organisation (WHO) classifies the severity of flu seasons based on how quickly the circulating viruses spread, the seriousness of the disease – which can be measured by the number of hospitalisations or deaths – and the impact of the illness, such as the strain on hospitals.</p>
<p>Based on these metrics, the 2018 influenza season was pretty mild. The season started late, comparatively few cases were seen in GP clinics and hospitals, it had a low impact on workplaces and hospitals, and it caused a moderate level of illness. </p>
<p>This contrasts with 2017, which saw an early start to the season, high activity in the eastern states, a great impact on GPs and hospitals, high levels of absenteeism, and <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2017%7EMain%20Features%7EDeaths%20due%20to%20influenza%7E5">at least 1,255 deaths</a>. </p>
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<img alt="" src="https://images.theconversation.com/files/269715/original/file-20190417-139097-16zk8y9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/269715/original/file-20190417-139097-16zk8y9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=347&fit=crop&dpr=1 600w, https://images.theconversation.com/files/269715/original/file-20190417-139097-16zk8y9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=347&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/269715/original/file-20190417-139097-16zk8y9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=347&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/269715/original/file-20190417-139097-16zk8y9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=436&fit=crop&dpr=1 754w, https://images.theconversation.com/files/269715/original/file-20190417-139097-16zk8y9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=436&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/269715/original/file-20190417-139097-16zk8y9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=436&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The 2017 flu season was particularly bad.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/104336624?src=5i3w5Yqi9HMkYbgYiSzapg-1-12&size=huge_jpg">VILevi/Shutterstock</a></span>
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<p>It’s too early to assess the 2019 season – this is usually done after the flu season ends. But GPs are <a href="https://aspren.dmac.adelaide.edu.au/documents/20714/292784/ASPREN+Update+06+2019/7188dc84-4cf1-4ac4-8aed-650547d880e8?version=1.0">seeing more flu-like illness</a> for this time of year than in previous ones. </p>
<p>Hospital surveillance doesn’t usually start until the end of April, so it’s difficult to assess activity and severity in hospitals, but emergency department presentations in both the Northern Territory and New South Wales have been high.</p>
<h2>Why is it so hard to predict?</h2>
<p>Part of the problem with predicting the influenza season is that we talk about one season, but four distinct influenza viruses cause clinically important illness in humans. </p>
<p>These viruses are categorised into two influenza types: A and B. Influenza type A is further subdivided into two subtypes: H1N1pdm09 and H3N2. Influenza type B is further subdivided into two lineages: B/Victoria and B/Yamagata. </p>
<p>All four of these viruses are covered by the four-strain influenza vaccine that is provided to Australians aged under 65 years. </p>
<p>For adults aged 65 years and older, an enhanced vaccine is available which contains the two influenza A subtypes and one influenza B. This year the B strain is a B/Yamagata lineage virus because in 2018, we saw many more B/Yamagata than B/Victoria viruses. </p>
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Read more:
<a href="https://theconversation.com/high-dose-immune-boosting-or-four-strain-a-guide-to-flu-vaccines-for-over-65s-112224">High-dose, immune-boosting or four-strain? A guide to flu vaccines for over-65s</a>
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<p>Flu viruses are continually mutating in nature, and so any immunity acquired from a previous infection or vaccine may provide little protection against the viruses that will circulate in the next season. </p>
<p>There is also little cross-immunity. Infection with A(H1N1)pdm09, for example, won’t necessarily protect you against A(H3N2). It’s even possible, though unlikely, to be infected with two viruses at the same time or in close succession.</p>
<p>All four of these influenza viruses rarely circulate with equal frequency during the winter months. Typically, one of the influenza A viruses will dominate. </p>
<p>In Australia, it’s rare for influenza B to dominate. It’s even rarer for both lineages to circulate at the same time, but it happened in 2015.</p>
<p>The burden of each of these viruses also varies. Children may be more susceptible to influenza B infections than adults, while the elderly are relatively less susceptible to infection with A(H1N1)pdm09 but are more vulnerable to A(H3N2) infections. </p>
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<img alt="" src="https://images.theconversation.com/files/269713/original/file-20190417-139104-t262gk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/269713/original/file-20190417-139104-t262gk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/269713/original/file-20190417-139104-t262gk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/269713/original/file-20190417-139104-t262gk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/269713/original/file-20190417-139104-t262gk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/269713/original/file-20190417-139104-t262gk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/269713/original/file-20190417-139104-t262gk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Children are more susceptible to influenza B infections.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/572401480?src=NPI5MX7JVyIA5BOekrVtjA-1-2&size=huge_jpg">Aslysun/Shutterstock</a></span>
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<p>Although deaths have been associated with all four viruses, A(H3N2) generally causes more deaths than the others, particularly among the elderly.</p>
<p>Unfortunately, our disease surveillance systems rarely collect information on the specific influenza viruses that patients present with in GP clinics and hospitals. That’s because influenza testing can be expensive, and knowing the strain – or if it is indeed influenza – wouldn’t necessarily alter the course of treatment. </p>
<p>Instead, we learn which virus dominated and its likely impact. While this is useful for monitoring overall trends, it isn’t sufficient to study specific virus circulation patterns that might enable us to predict the seasons better.</p>
<h2>What’s happening elsewhere in the world?</h2>
<p>Influenza viruses mutate quite rapidly and circulate the globe quite efficiently thanks, especially, to air travel. </p>
<p>That said, circulation of influenza viruses in Europe does not necessarily help us predict which viruses will circulate in Australia as there is no consistent pattern of one hemisphere leading the other in terms of virus circulation. </p>
<p>Even within hemispheres, variation occurs. During the <a href="https://www.who.int/influenza/vaccines/virus/recommendations/201802_recommendation.pdf?ua=1">2017-18 winter</a>, influenza B viruses dominated in Europe, while A(H3N2) viruses dominated in North America. </p>
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Read more:
<a href="https://theconversation.com/when-the-numbers-arent-enough-how-different-data-work-together-in-research-103907">When the numbers aren't enough: how different data work together in research</a>
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<p>In tropical and sub-tropical regions, where there is no “winter”, there may be more than one flu season per year, or a year-round season with low rates of one virus, usually influenza B. </p>
<p>The reasons why influenza viruses circulate at different times are unclear. They may be related to climatic factors, such as temperature and humidity and, in some locales, may be driven by tourism. But we don’t really understand the causal relationships between these factors. </p>
<p>The good news is that with increased computing power, greater availability of high-quality surveillance, more years of data and a greater understanding of influenza virology and immunology, our ability to forecast the season is improving.</p><img src="https://counter.theconversation.com/content/115303/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sheena Sullivan receives funding from the Australian Government Department of Health. She is a member of the Australasian Epidemiological Association, the International Epidemiological Association and the International Society for Influenza and Other Respiratory Viruses.
</span></em></p><p class="fine-print"><em><span>Rob Moss has received funding from the Australian Government Department of Health, the Department of Foreign Affairs and Trade, and the Defence Science Technology Group. </span></em></p>The 2018 flu season was mild, while 2017 was a particularly bad year. It’s impossible to predict what the 2019 flu season has in store, but we’ve seen more cases so far this year than usual.Sheena G. Sullivan, Epidemiologist, WHO Collaborating Centre for Reference and Research on InfluenzaRob Moss, Research Fellow, Mathematical Biology and Physiology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/976882018-06-05T10:44:54Z2018-06-05T10:44:54ZThe flu vaccine is being oversold – it’s not that effective<figure><img src="https://images.theconversation.com/files/221709/original/file-20180605-119875-oo518i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The protection of the flu vaccine is minimal, and may not be worth it.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Winter has started, and with it, flu season. Inevitably, all of us (young, old and sick) have been implored to be immunised against influenza, with <a href="http://immunise.health.gov.au/">some eligible</a> for a subsidised vaccine. And people are heeding the message, to the point that there is <a href="https://www.theage.com.au/national/victoria/flu-vaccine-800-000-new-doses-ordered-to-meet-national-shortage-20180525-p4zhlz.html">now a shortage</a> of available vaccines. </p>
<p>At the same time, findings from <a href="http://community.cochrane.org/news/why-have-three-long-running-cochrane-reviews-influenza-vaccines-been-stabilised">three important Cochrane reviews</a> on the effectiveness of the influenza vaccination aren’t consistent with the advice we’re been given.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1003191190731100160"}"></div></p>
<p>Cochrane reviews are independent systematic reviews, which are comprehensive analyses of most of the literature relevant to a research topic. Cochrane reviews summarise the results in a multitude of studies, and are regularly updated to absorb new research.</p>
<p>These three Cochrane reviews have been recently updated, as well as stabilised, which is what happens when it looks as if it seems unlikely new research would be published that would change the conclusions.</p>
<h2>What the reviews found</h2>
<p>The <a href="http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD001269.pub6/full">first Cochrane review</a> looked at the effects of the influenza vaccine in healthy adults from 25 studies conducted over single influenza seasons in North America, South America, and Europe between 1969 and 2009. It found the vaccine reduced the chance of getting laboratory confirmed influenza from 23 cases out of 1,000 to 9 cases out of 1,000. </p>
<p>While this seems to be a reduction of more than 50%, that seems less optimistic expressed in absolute terms.</p>
<p>The infection rate in adults drops from 2% per year to 1%. You could say that’s halved, but it effectively only drops by 1%. So this means that out of every 100 healthy adults vaccinated, 99 get no benefit against laboratory confirmed influenza.</p>
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Read more:
<a href="https://theconversation.com/what-you-need-to-know-to-understand-risk-estimates-67643">What you need to know to understand risk estimates</a>
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<p>The <a href="http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD004879.pub5/full">second Cochrane review</a> – which looked at trials in children over single influenza seasons in the US, Western Europe, Russia, and Bangladesh between 1984 and 2013 – found similar results.</p>
<p>The <a href="http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD004876.pub3/full">third Cochrane review</a> looked at vaccines for the elderly in nursing homes. It found much less good evidence, with only one randomised trial – considered the gold standard in clinical trials as it establishes causation rather than correlation.</p>
<p>While <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861778/">observational studies</a> (that draw inferences from a population to establish associations) have been done to show benefits of the vaccines, bias means we <a href="http://community.cochrane.org/news/why-have-three-long-running-cochrane-reviews-influenza-vaccines-been-stabilised">cannot rely</a> on their results.</p>
<p>There are also potential harms from influenza vaccines noted in the reviews. They range from serious (a neurological disease called Guillain Barre) through to moderate (fevers, in children especially – some of which will cause febrile convulsions), and trivial (a sore arm for a couple of days). </p>
<h2>Why are we so scared of the flu?</h2>
<p>There is a special concern about influenza from a public health point of view. This comes about from its potential to cause pandemics. The first in modern history was the Spanish influenza pandemic of 1918-19, when tens of millions of people died worldwide. </p>
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<a href="https://images.theconversation.com/files/221727/original/file-20180605-119860-80kn1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/221727/original/file-20180605-119860-80kn1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/221727/original/file-20180605-119860-80kn1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=451&fit=crop&dpr=1 600w, https://images.theconversation.com/files/221727/original/file-20180605-119860-80kn1n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=451&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/221727/original/file-20180605-119860-80kn1n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=451&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/221727/original/file-20180605-119860-80kn1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/221727/original/file-20180605-119860-80kn1n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/221727/original/file-20180605-119860-80kn1n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">There’s good evidence to show face masks protect against influenza.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>There have also been been several, less severe pandemics. These include the most recent swine flu that, although while affecting some (unexpected) groups of people (including pregnant women, those who were obese, and had asthma), caused <a href="https://www.mja.com.au/journal/2009/191/3/epidemiological-characteristics-pandemic-influenza-h1n1-2009-and-seasonal">little more effect</a> on the overall population than the usual seasonal influenza.</p>
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Read more:
<a href="https://theconversation.com/four-of-the-most-lethal-infectious-diseases-of-our-time-and-how-were-overcoming-them-78101">Four of the most lethal infectious diseases of our time and how we're overcoming them</a>
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<p>Public health experts worry about another pandemic that can be more harmful and contagious, which could be devastating. But it’s important to note the vast <a href="https://academic.oup.com/cid/article/49/9/1405/301441">majority of deaths from Spanish influenza</a> were from secondary bacterial infections and predated the antibiotic era.</p>
<p>The reasons influenza virus has this ability to cause new pandemics comes from its instability – it changes genetically easily, making it more difficult for our immune systems to recognise newer strains. The effect is that new vaccines must be prepared every year for a best-guess at next year’s virus, and we need vaccination every year. </p>
<p>Influenza can also undergo a more radical change, such as when a new form of the virus emerges from an animal host (wild or domesticated birds or pigs, for example). This moving target makes it more difficult to vaccinate against – especially with the genetic shifts of pandemics. Just when we need protection most, vaccines can provide it least.</p>
<h2>So what, if not the vaccine?</h2>
<p>There are <a href="http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD006207.pub4/full">physical barriers</a> that can prevent the spread of influenza. These are the masks (to reduce the spread of aerosol-borne virus particles), hand washing (to reduce the spread if virus from hands onto shared surfaces), and quarantine measures (isolating infected people to reduce their infectivity). </p>
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Read more:
<a href="https://theconversation.com/ive-always-wondered-why-many-people-in-asian-countries-wear-masks-and-whether-they-work-90178">I've always wondered: why many people in Asian countries wear masks, and whether they work</a>
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<p>There is now reasonable evidence such measures reduce infections considerably. It might take a bit of effort to change the psyche of Australians to make wearing a facemask acceptable if you have an acute respiratory infection. Even the heroic “soldiering on to work” (or school) with your virus needs to be reversed as a public health act.</p><img src="https://counter.theconversation.com/content/97688/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Del Mar receives funding from the NHMRC for the Cochrane Acute Respiratory Infections Group, which has hosted some of the publications mentioned in this article. . </span></em></p><p class="fine-print"><em><span>Peter Collignon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research shows for every 100 healthy adults vaccinated against influenza, 99 get no benefit.Chris Del Mar, Professor of Public Health, Bond UniversityPeter Collignon, Professor, infectious diseases and microbiology, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/943932018-04-09T07:02:34Z2018-04-09T07:02:34ZThinking about getting your child the flu vaccine? Here’s what you need to know<figure><img src="https://images.theconversation.com/files/213768/original/file-20180409-176974-13dgewy.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5742%2C3500&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Young children catch and spread the flu more than any other age group. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-vaccinating-little-baby-hospital-1020254464?src=YsuV47Ok5fbZ-Oxg4AwXOA-1-4">Africa Studio/Shutterstock</a></span></figcaption></figure><p>As we head toward winter, health professionals and the public are anxious about another influenza season like 2017, when record numbers of Australians were diagnosed with flu. </p>
<p>The flu is usually a mild illness that leaves us out of action for a few days. But for some, especially the <a href="https://www.pm.gov.au/media/ground-breaking-flu-vaccines-protect-millions-aussies">elderly</a> and children, the flu can be much more severe. In fact, influenza <a href="https://www.ombo.nsw.gov.au/__data/assets/pdf_file/0019/39412/NCIRS-child-deaths-from-infectious-diseases-report-2016-NSW-Ombudsman-final-1.pdf">kills more kids</a> than the feared meningococcal infection.</p>
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Read more:
<a href="https://theconversation.com/heres-why-the-2017-flu-season-was-so-bad-86605">Here's why the 2017 flu season was so bad</a>
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<p>This year, children aged between six months and four years will be eligible for free flu vaccines in <a href="http://www.health.nsw.gov.au/immunisation/Pages/kids-flu-shot.aspx">New South Wales</a>, <a href="https://www2.health.vic.gov.au/public-health/immunisation/vaccine-order-and-stock/seasonal-flu-vaccine">Victoria</a>, <a href="https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/immunisation/service-providers/influenza">Queensland</a>, <a href="http://www.examiner.com.au/story/5328677/free-flu-vaccinations-for-tasmanian-children-under-five">Tasmania</a>, the <a href="http://www.health.act.gov.au/sites/default/files//Influenza%20Immunisation%20-%20FAQs%20for%20parents_FINAL.pdf">Australian Capital Territory</a> and <a href="http://ww2.health.wa.gov.au/Articles/F_I/Influenza-immunisation-program">Western Australia</a>. </p>
<p>In addition, children aged six months to four years who are Aboriginal and Torres Strait Islander (who are hospitalised from flu at twice the rate of other Australian children) and children of all ages with specific medical conditions are also eligible for the funded vaccine under the <a href="https://beta.health.gov.au/resources/publications/atagi-advice-on-seasonal-influenza-vaccines-in-2018">National Immunisation Program</a>. </p>
<p>Other children in South Australia and the Northern Territory not covered under national programs can still access the vaccine from their GP at a small cost.</p>
<h2>Why should I vaccinate my child?</h2>
<p>Young children catch and spread the flu more than any other age group. Thousands of children are hospitalised every year; <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4004f.htm">hospitalisation rates</a> in children are much greater than in older people. </p>
<p>Being hospitalised is just the tip of the flu iceberg: many children will need emergency department or GP visits due to a high fever, cough, pneumonia and convulsions. Rare but severe complications such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/29017268">encephalitis</a> (life threatening brain inflammation) can also occur, and mostly in healthy children. </p>
<p>Vaccination is the most effective way to prevent flu. Those vaccinated are <a href="https://www.ncbi.nlm.nih.gov/pubmed/22032844">less likely to catch the virus</a> and develop serious complications compared with those who are unvaccinated. The risk of flu is reduced, on average, by <a href="https://www.ncbi.nlm.nih.gov/pubmed/27494798">50</a>-<a href="https://www.ncbi.nlm.nih.gov/pubmed/24753525">60</a>% in children receiving the vaccine. </p>
<p>Childhood flu vaccination programs have been shown to also <a href="https://www.ncbi.nlm.nih.gov/pubmed/28475770">protect others</a> in the household and the community by 22-60%. This is called “herd” or “community” immunity and particularly helps protect vulnerable people who may be at risk of becoming seriously ill with the flu.</p>
<p>The influenza virus continually mutates, seeking to evade the immune system. Even if you have had flu infection in the past, antibodies generated from that infection may not recognise and fight off a recently mutated virus. </p>
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Read more:
<a href="https://theconversation.com/mondays-medical-myth-the-flu-vaccine-will-give-you-influenza-5455">Monday's medical myth: the flu vaccine will give you influenza</a>
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<p><a href="https://www.tga.gov.au/aivc-recommendations-composition-influenza-vaccine-australia-2018">Every year</a>, flu experts predict which viruses are going to be circulating and adjust which strains are included in the vaccine. If unexpected or changed strains circulate, the vaccine is less effective than predicted. </p>
<p>Even with moderate effectiveness, if the vaccine is given to enough people, it protects them and helps drive down the spread of the virus in the community.</p>
<h2>Is it safe?</h2>
<p>Childhood influenza vaccination was temporarily <a href="https://www.ncbi.nlm.nih.gov/pubmed/22021725">suspended</a> in <a href="http://www.watoday.com.au/wa-news/flu-vaccination-ban-goes-national-after-fever-convulsions-in-children-20100422-tglp.html">2010</a> after an unexpectedly large number of children had high fevers. Some children also suffered seizures. </p>
<p>These events were due to a single of brand of vaccine, which was withdrawn from use in this age group and is no longer produced. All flu vaccines now used in children have extensive clinical trial data demonstrating their safety. </p>
<p>These events have been a catalyst for major changes in Australia’s approach to monitoring safety once vaccines are registered for use. Vaccine safety and side-effects are now tracked continuously through the <a href="http://www.ncirs.edu.au/vaccine-safety/ausvaxsafety/">AusVaxSafety</a> program.</p>
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Read more:
<a href="https://theconversation.com/flu-vaccine-wont-definitely-stop-you-from-getting-the-flu-but-its-more-important-than-you-think-75778">Flu vaccine won't definitely stop you from getting the flu, but it's more important than you think</a>
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<p>In 2017, only 6% of Australians receiving a flu vaccine reported side effects, with less than 0.5% concerned enough to contact a health professional. The side effects were well within the expected range, mostly mild and did not differ by vaccine brand. </p>
<p>The most common <a href="https://www.sciencedirect.com/science/article/pii/S0264410X17314998?via%3Dihub">side effects</a> in children are a mild fever, a sore arm and rash. </p>
<h2>How do I vaccinate my child?</h2>
<p>Flu vaccines are expected to be widely available from <a href="https://beta.health.gov.au/resources/publications/atagi-advice-on-seasonal-influenza-vaccines-in-2018">mid April</a> or early May. They are available at your GP surgery, community clinic and pharmacy, depending on your age and state or territory program. </p>
<p>Children aged under nine years who have not been vaccinated before require two doses in their first year. In young children previously vaccinated, only one dose is required. </p>
<p>Children less than six months are not recommended to receive the influenza vaccine: the most effective way to protect those too young to be vaccinated is by vaccinating <a href="https://www.nps.org.au/australian-prescriber/articles/immunisation-and-pregnancy-who-what-when-and-why">mothers</a> during pregnancy.</p><img src="https://counter.theconversation.com/content/94393/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Blyth receives funding from the National Health and Medical Research Council, Bill & Melinda Gates Foundation and Commonwealth and WA Departments of Health to undertake research into vaccine preventable diseases and childhood vaccination.</span></em></p><p class="fine-print"><em><span>Kristine Macartney is the Director of the National Centre for Immunisation Research and Surveillance (NCIRS) that receives funding from the Commonwealth and NSW Departments of Health, and the NHMRC.</span></em></p>The flu vaccine isn’t perfect but it’s the best way to protect against these potentially harmful viruses. Most children aged six months to five years are eligible for a free vaccine in 2018.Christopher Blyth, Paediatrician, Infectious Diseases Physician and Clinical Microbiologist, The University of Western AustraliaKristine Macartney, Professor, Discipline of Paediatrics and Child Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.