tag:theconversation.com,2011:/ca-fr/topics/influenza-415/articlesInfluenza – La Conversation2024-03-19T04:27:53Ztag:theconversation.com,2011:article/2258802024-03-19T04:27:53Z2024-03-19T04:27:53ZWhy scrapping the term ‘long COVID’ would be harmful for people with the condition<figure><img src="https://images.theconversation.com/files/582695/original/file-20240319-28-gsqe8u.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3988&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/lonely-young-woman-feeling-depressed-stressed-636183893">kitzcorner/Shutterstock</a></span></figcaption></figure><p>The assertion from Queensland’s chief health officer <a href="https://www.abc.net.au/news/2024-03-15/long-covid-symptoms-queensland-chief-health-officer-john-gerrard/103587836">John Gerrard</a> that it’s time to stop using the term “long COVID” has made waves in <a href="https://www.theaustralian.com.au/breaking-news/long-covid-should-be-scrapped-over-fears-its-probably-harmful-qld-chief-health-officer/news-story/61d3a2328dbfb0e3e0a79b02474bac3e">Australian</a> and <a href="https://nypost.com/2024/03/14/lifestyle/no-such-thing-as-long-covid-health-agency-says-in-shock-claim-unnecessary-fear/">international media</a> over recent days.</p>
<p>Gerrard’s comments were related to <a href="https://www.eurekalert.org/news-releases/1037611">new research</a> from his team finding long-term symptoms of COVID are similar to the ongoing symptoms following other viral infections.</p>
<p>But there are limitations in this research, and problems with Gerrard’s argument we should drop the term “long COVID”. Here’s why.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1768403811704750300"}"></div></p>
<h2>A bit about the research</h2>
<p>The study involved texting a survey to 5,112 Queensland adults who had experienced respiratory symptoms and had sought a PCR test in 2022. Respondents were contacted 12 months after the PCR test. Some had tested positive to COVID, while others had tested positive to influenza or had not tested positive to either disease. </p>
<p>Survey respondents were asked if they had experienced ongoing symptoms or any functional impairment over the previous year. </p>
<p>The study found people with respiratory symptoms can suffer long-term symptoms and impairment, regardless of whether they had COVID, influenza or another respiratory disease. These symptoms are often referred to as “post-viral”, as they linger after a viral infection. </p>
<p>Gerrard’s research will be presented in April at the European Congress of Clinical Microbiology and Infectious Diseases. It hasn’t been published in a peer-reviewed journal.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-have-covid-how-likely-am-i-to-get-long-covid-218808">I have COVID. How likely am I to get long COVID?</a>
</strong>
</em>
</p>
<hr>
<p>After the research was publicised last Friday, some experts highlighted flaws in the study design. For example, <a href="https://www.msn.com/en-au/news/australia/co-lead-of-long-covid-clinic-says-qld-study-on-covid-is-an-unusual-approach-to-public-health/vi-BB1jV5oA#details">Steven Faux</a>, a long COVID clinician interviewed on ABC’s television news, said the study excluded people who were hospitalised with COVID (therefore leaving out people who had the most severe symptoms). He also noted differing levels of vaccination against COVID and influenza may have influenced the findings. </p>
<p>In addition, Faux pointed out the survey would have excluded many older people who may not use smartphones.</p>
<p>The authors of the research have acknowledged some of these and other limitations in their study.</p>
<h2>Ditching the term ‘long COVID’</h2>
<p>Based on the research findings, <a href="https://www.eurekalert.org/news-releases/1037611">Gerrard said in a press release</a>: </p>
<blockquote>
<p>We believe it is time to stop using terms like ‘long COVID’. They wrongly imply there is something unique and exceptional about longer term symptoms associated with this virus. This terminology can cause unnecessary fear, and in some cases, hypervigilance to longer symptoms that can impede recovery.</p>
</blockquote>
<p>But Gerrard and his team’s findings cannot substantiate these assertions. Their survey only documented symptoms and impairment after respiratory infections. It didn’t ask people how fearful they were, or whether a term such as long COVID made them especially vigilant, for example.</p>
<figure class="align-center ">
<img alt="A man sits on a bed, appears exhausted." src="https://images.theconversation.com/files/582697/original/file-20240319-18-aci07e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582697/original/file-20240319-18-aci07e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582697/original/file-20240319-18-aci07e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582697/original/file-20240319-18-aci07e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582697/original/file-20240319-18-aci07e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582697/original/file-20240319-18-aci07e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582697/original/file-20240319-18-aci07e.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">Tens of thousands of Australians, and millions of people worldwide, have long COVID.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depressed-overweight-man-on-bed-home-1575723550">New Africa/Shutterstock</a></span>
</figcaption>
</figure>
<p>In discussing Gerrard’s conclusions about the terminology, Faux noted that even if only 3% of people develop long COVID (the survey found 3% of people had functional limitations after a year), this would equate to some 150,000 Queenslanders with the condition. He <a href="https://www.msn.com/en-au/news/australia/co-lead-of-long-covid-clinic-says-qld-study-on-covid-is-an-unusual-approach-to-public-health/vi-BB1jV5oA#details">said</a>:</p>
<blockquote>
<p>To suggest that by not calling it long COVID you would be […] somehow helping those people not to focus on their symptoms is a curious conclusion from that study.</p>
</blockquote>
<p>Another clinician and researcher, Philip Britton, <a href="https://www.scimex.org/newsfeed/expert-reaction-long-covid-may-be-no-different-to-other-long-term-virus-effects">criticised Gerrard’s conclusion</a> about the language as “overstated and potentially unhelpful”. He noted the term “long COVID” is recognised by the World Health Organization as a valid description of the condition.</p>
<h2>A cruel irony</h2>
<p>An <a href="https://www.science.org/doi/full/10.1126/science.adl0867">ever-growing body of research</a> continues to show how COVID can cause harm to the body across organ systems and cells. </p>
<p>We know from the experiences shared by people with long COVID that the condition can be highly disabling, preventing them from engaging in study <a href="https://www.sbs.com.au/news/article/daniel-has-long-covid-it-has-cost-him-more-than-100-000/j8e18pxji">or paid work</a>. It can also harm relationships with their friends, family members, and <a href="https://www.abc.net.au/news/2023-12-27/long-covid-mecfs-health-damaging-relationships-crisis/103205564">even their partners</a>.</p>
<p>Despite all this, people with long COVID have often felt gaslit and unheard. When seeking treatment from health-care professionals, many people with long COVID report they have been <a href="http://bmjopen.bmj.com/content/12/1/e050979.abstract">dismissed</a> or turned away. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/social-media-activism-trucker-caps-the-fascinating-story-behind-long-covid-168465">Social media, activism, trucker caps: the fascinating story behind long COVID</a>
</strong>
</em>
</p>
<hr>
<p>Last Friday – the day Gerrard’s comments were made public – was actually <a href="https://www.longcovidawareness.life/">International Long COVID Awareness Day</a>, organised by activists to draw attention to the condition. </p>
<p>The response from people with long COVID was immediate. They shared their anger <a href="https://twitter.com/SMpwrgr/status/1768456837861618005?s=20">on social media</a> about Gerrard’s comments, especially their timing, on a day designed to generate greater recognition for their illness.</p>
<p>Since the start of the COVID pandemic, patient communities have <a href="https://pubmed.ncbi.nlm.nih.gov/35307048/">fought for recognition</a> of the long-term symptoms many people faced. </p>
<p>The term “<a href="https://theconversation.com/social-media-activism-trucker-caps-the-fascinating-story-behind-long-covid-168465">long COVID</a>” was in fact coined by people suffering persistent symptoms after a COVID infection, who were seeking words to describe what they were going through. </p>
<p>The role people with long COVID have played in defining their condition and bringing medical and public attention to it demonstrates <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850205/">the possibilities of patient-led expertise</a>. For decades, people with invisible or “silent” conditions such as ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) have had to fight ignorance from health-care professionals and stigma from others in their lives. They have often been told their disabling symptoms are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10819994/">psychosomatic</a>.</p>
<p>Gerrard’s comments, and the media’s amplification of them, repudiates the term “long COVID” that community members have chosen to give their condition an identity and support each other. This is likely to cause distress and exacerbate feelings of abandonment.</p>
<h2>Terminology matters</h2>
<p>The words we use to describe illnesses and conditions are incredibly powerful. <a href="https://blogs.bmj.com/bmj/2020/10/01/why-we-need-to-keep-using-the-patient-made-term-long-covid/">Naming a new condition</a> is a step towards better recognition of people’s suffering, and hopefully, better diagnosis, health care, treatment and acceptance by others.</p>
<p>The term “long COVID” provides an easily understandable label to convey patients’ experiences to others. It is well known to the public. It has been routinely used in news media reporting and and in many reputable <a href="https://www.science.org/doi/10.1126/science.adl0867">medical journal articles</a>. </p>
<p>Most importantly, scrapping the label would further marginalise a large group of people with a chronic illness who have often been left to struggle behind closed doors.</p><img src="https://counter.theconversation.com/content/225880/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Lupton is affiliated with OzSAGE.</span></em></p>People with long COVID have already fought hard to become visible.Deborah Lupton, SHARP Professor, Vitalities Lab, Centre for Social Research in Health and Social Policy Centre, and the ARC Centre of Excellence for Automated Decision-Making and Society, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2209802024-01-15T20:46:57Z2024-01-15T20:46:57ZRSV, flu and COVID: demystifying the triple epidemic of respiratory viruses<figure><img src="https://images.theconversation.com/files/568892/original/file-20240110-27-k3w5hm.jpg?ixlib=rb-1.1.0&rect=0%2C2%2C995%2C663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The influenza virus, which causes seasonal flu, is back at its usual rate after a hiatus due to health measures.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Since 2022, a triple epidemic of respiratory viruses — RSV, influenza and SARS-CoV-2 — has been disrupting our daily lives. In addition, the media constantly reminds us of how this is straining emergency departments.</p>
<p>How does the present respiratory virus season differ from seasons during the pre-COVID era?</p>
<p>As a specialist in virus-host interaction, I would like to shed some light on the new dynamics of the respiratory virus season.</p>
<h2>The infamous SARS-CoV-2</h2>
<p>SARS-CoV-2, the instigator of the COVID-19 pandemic, is still with us. Despite limited access to screening tests, analysis of the number of hospital admissions shows that the virus is still going strong.</p>
<p>Québec’s Institut National de Santé Publique counted more than 33,000 hospitalizations in Québec in 2023 affecting all age categories, <a href="https://www.inspq.qc.ca/en/node/29197">including 648 children under the age of nine</a>.</p>
<p>The virus is not seasonal. It has a strikingly efficient capacity to spread through aerosols, especially as we take refuge indoors to escape the cold. The virus currently circulating is actually a mixture of different viruses, known as variants, each of which has the potential to partially evade the immunity an individual has acquired through a previous infection or vaccination.</p>
<h2>Resurgence of seasonal flu</h2>
<p>After a hiatus due to health measures, the influenza virus, which causes seasonal flu, has returned with the same force. It is once again circulating <a href="https://www.cdc.gov/flu/about/viruses/types.htm">in different variants belonging to Types (strains) A and B</a>, although scientists believe that one Type B strain, the <a href="http://doi.org/10.2807/1560-7917.ES.2022.27.39.2200753">Yamagata lineage, has disappeared</a>.</p>
<p>A variant of H1N1 Type A, different from the viruses that caused the 1918 and 2009 pandemics, is now dominant in North America where it is causing an increase in hospital admissions, <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/fluwatch/2023-2024/week-49-december-3-december-9-2023.html">especially among the elderly and young children</a>.</p>
<p>However, we must remain vigilant, as the strain may change within the same season. What could this mean? The target population could change, <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/fluwatch/2018-2019/annual-report.html">as it did in the 2018-2019 season</a>.</p>
<h2>And what about RSV?</h2>
<p>The respiratory syncytial virus (RSV) also appears to be <a href="https://www.canada.ca/en/public-health/services/surveillance/respiratory-virus-detections-canada/2023-2024/week-50-ending-december-16-2023.html">resuming its pre-pandemic transmission levels</a>.</p>
<p>RSV causes bronchiolitis and pneumonia. <a href="https://cps.ca/en/documents/position/bronchiolitis">Bronchiolitis is characterized by the obstruction of the small airways, which can progress to wheezing or respiratory distress</a>.</p>
<p>Virtually all children are infected with RSV before the age of 2, and RSV infection is one of the main causes of hospitalization in young children.</p>
<p>Before the COVID-19 pandemic, there was an average of 2,523 hospitalizations per year in Canada, <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2810133">half of them in children under six months of age and more than a quarter requiring admission to intensive care</a>.</p>
<p>But RSV also severely affects the elderly and adults who are immunocompromised or have existing chronic conditions. RSV shows high levels of severe illness, hospital admissions and in hospital deaths in adults, <a href="https://doi.org/10.1093/infdis/jiad559">figures which are comparable to those for influenza</a>.</p>
<p>Admittedly, although these three viruses are attracting attention, other less publicized respiratory viruses are also circulating, <a href="https://www.canada.ca/en/public-health/services/surveillance/respiratory-virus-detections-canada/2023-2024/week-50-ending-december-16-2023.html">demonstrating a diverse viral environment</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/568438/original/file-20240109-27-z61q6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman in hospital" src="https://images.theconversation.com/files/568438/original/file-20240109-27-z61q6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568438/original/file-20240109-27-z61q6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568438/original/file-20240109-27-z61q6c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568438/original/file-20240109-27-z61q6c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568438/original/file-20240109-27-z61q6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568438/original/file-20240109-27-z61q6c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568438/original/file-20240109-27-z61q6c.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 continued presence of SARS-CoV-2 means our hospitals can’t catch their breath.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>SARS-CoV-2 has turned everything upside down</h2>
<p>The presence of SARS-CoV-2 marks the principal difference from the pre-pandemic era, since it is augmenting the burden on an already weakened health-care system. The challenge is amplified by the extremely high transmission capacity of SARS-CoV-2 compared with influenza and RSV, which makes seasonal management much more complex.</p>
<p>Until the SARS-CoV-2 pandemic, the respiratory virus season had a fairly predictable beginning and end that was determined by virus surveillance over the years. Our systems were already struggling to absorb this seasonal increase in patients. But today, the picture has become even more complex with the continuing presence of SARS-CoV-2. And our hospitals, with no time to catch their breath, are struggling to keep up.</p>
<h2>Beyond infection</h2>
<p>The second major difference that should not be overlooked is SARS-CoV-2’s ability to cause widespread health problems well beyond the respiratory system. In addition, it causes long-term consequences after infection, such as post-COVID syndrome (also known as long COVID), which affects millions of people.</p>
<p>The extent of the consequences of infection and reinfection on human health remains uncertain, as does the effectiveness of vaccines in limiting these effects. The SARS-CoV-2 pandemic – with its exceptional transmission levels – has produced a large number of patients available for research. Coupled with unprecedented funding, this has made it possible to undertake research that has never been possible before on a post-viral syndrome.</p>
<p>Of course, the number of people infected with RSV or influenza globally each year does not even come close to the number infected with SARS-CoV-2, even at this stage of the pandemic. However, there is considerable evidence that, in addition to the acute symptoms and mortality associated with influenza and RSV, <a href="https://doi.org/10.1038/s41591-022-01810-6">post-viral conditions also exist</a>, as they do with SARS-CoV-2.</p>
<h2>The importance of vaccines</h2>
<p>The final distinction from the pre-pandemic period is the arrival of RSV vaccines. In Canada, the Arexvy vaccine has been approved for people over 60, and the Abrysvo vaccine was also approved for pregnant women, providing immunity to children from birth. However, these two vaccines have not yet been officially recommended. We are still waiting for a vaccine to be made available for children. The trio of vaccines against COVID-19, influenza and RSV will certainly help to reduce the severe symptoms associated with respiratory virus infections in the coming seasons.</p>
<p>However, our primary objective must be to reduce the incidence of respiratory virus infections. Despite vaccination, we can expect the mortality and morbidity associated with these infections to increase as the population ages.</p>
<p>All three viruses share a common trait — they spread through the air. Their transmission could be reduced by implementing passive strategies aimed at reducing the concentration of aerosols in indoor air.</p><img src="https://counter.theconversation.com/content/220980/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathalie Grandvaux received research funding from the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council of Canada (NSERC), the Fonds de recherche du Québec - Santé (FRQS), the Canada Foundation for Innovation (CFI), the Fondation du centre hospitalier de l'Université de Montréal, and the Ministère de l'économie et de l'innovation du Québec.</span></em></p>The current triple epidemic of respiratory viruses is affecting all age groups, prompting comparisons with the pre-COVID-19 era.Nathalie Grandvaux, Professeure en biochimie des interactions hôte-virus, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2206032024-01-15T17:11:42Z2024-01-15T17:11:42ZFirst polar bear to die of bird flu – what are the implications?<p>Climate change is a threat to polar bear’s survival. Now they have a new deadly challenge facing them: bird flu. It was <a href="https://www.cbsnews.com/news/bird-flu-kills-polar-bear-first-time/">recently confirmed</a> that a polar bear from northern Alaska has died from the disease. </p>
<p>The current strain of H5N1 influenza has affected a <a href="https://www.nature.scot/doc/naturescot-scientific-advisory-committee-sub-group-avian-influenza-report-h5n1-outbreak-wild-birds">far wider range of species</a> than any previously recorded strain. This has included <a href="https://www.gov.uk/government/publications/bird-flu-avian-influenza-findings-in-non-avian-wildlife">several mammal species</a>, such as foxes, otters, mink, sea lions and seals (including, for the first time, <a href="https://www.itv.com/news/2024-01-11/bird-flu-found-in-antarctic-seals-could-pose-threat-to-fragile-ecosystem">seals in Antarctica</a>). Cases have been detected in humans, too.</p>
<p>However, while some cases in mammals have been associated with large numbers of animal deaths, the few cases in humans have, so far, shown only mild symptoms or have been <a href="https://ukhsa.blog.gov.uk/2023/06/06/ukhsas-asymptomatic-avian-influenza-surveillance-programme/">asymptomatic</a>. So, why are there such differences between species, and what are the implications of this polar bear’s death for the wider polar bear population, as well as other large mammals and humans?</p>
<p>Influenza viruses are highly adaptable. Their relatively simple genetic code not only changes at random via mutation in the same way as truly living organisms, but also via <a href="https://doi.org/10.1371%2Fjournal.ppat.1004902">reassortment</a>. This is where closely related viruses that infect the same host cell exchange genetic material to produce novel genomes. This can lead to greater adaptation for invasion, survival and replication within that host species.</p>
<p>This is probably how the current H5N1 strain has come to affect such a variety of bird species, with devastating effects for some populations. </p>
<p>Normally, large numbers of deaths associated with a disease are considered to be caused by the spread of a disease between individuals within the population. However, very specific <a href="https://www.nature.com/articles/s41579-023-00943-w">genetic changes</a> are needed for avian influenza viruses to become adapted to mammalian hosts. </p>
<p>These changes have not yet been detected in the current strain of H5N1. Although individual-to-individual transmission cannot be ruled out for some mammalian species that have been affected by H5N1, neither can vertical transmission – the transfer of the virus via consumption.</p>
<p>If we look at the <a href="https://www.gov.uk/government/publications/bird-flu-avian-influenza-findings-in-non-avian-wildlife">list of mammals</a> that have been infected by the current H5N1 strain, we see carnivores – and particularly those that are known to scavenge. </p>
<p>Very large numbers of some seabird species have died rapidly with H5N1. The likelihood of a seal or a polar bear finding and eating at least one infected bird carcass at an arctic colony suffering an outbreak seems quite high. </p>
<p>It is easy to imagine a pod of seals finding a colony of seabirds suffering an outbreak of H5N1 and gorging on carcasses. Under these circumstances, each seal would probably ingest and inhale massive viral loads. Those massive viral loads may have overrun the seals’ immune systems, leading to rapid infection and death without infection being passed between seals. </p>
<p>Whether the polar bear encountered large numbers of dead seabirds, one or more seals that had become infected after eating dead seabirds or some other source of virus remains unknown. The answer may be uncovered via testing of the virus and comparison with viruses found in species that occupy the same landscape. This approach is being used to <a href="https://science.vla.gov.uk/fluglobalnet/publications/flumap-update-oct23.html">track the spread</a> of H5N1 between wild animals and poultry in the UK.</p>
<figure class="align-center ">
<img alt="An elephant seal in South George." src="https://images.theconversation.com/files/569199/original/file-20240114-23-g758ql.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569199/original/file-20240114-23-g758ql.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569199/original/file-20240114-23-g758ql.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569199/original/file-20240114-23-g758ql.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569199/original/file-20240114-23-g758ql.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569199/original/file-20240114-23-g758ql.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569199/original/file-20240114-23-g758ql.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">Bird flu was recently detected in elephant and fur seals in South Georgia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/elephant-seal-on-beach-south-georgia-781207378">Zaruba Ondrej/Shutterstock</a></span>
</figcaption>
</figure>
<h2>More to find out</h2>
<p>Much of this remains hypothetical – for now. The consequences of the polar bear’s death for the species’ populations and for other large mammals cannot be predicted with a high degree of certainty. But if genetic testing reveals that the polar bear’s H5N1 remains poorly adapted to mammalian hosts, we might expect few other cases in polar bears. </p>
<p>Any further cases might also be closely associated with outbreaks of H5N1 in a nearby seabird colony. It also seems likely that the list of affected mammals and their geographical distribution should continue to grow, but relatively slowly. This list is likely to continue to include only carnivores – and scavengers in particular. </p>
<p>On the other hand, because influenza viruses are highly adaptable, ongoing surveillance of the H5N1 strain remains critically important. This will prepare us in case a new variant emerges that is adapted to mammalian hosts, potentially including humans. </p>
<p>The consequences of H5N1 for populations of some seabirds have been devastating. The consequences of failure to respond appropriately to a mammal-adapted H5N1 could be severe for polar bears – and for us.</p><img src="https://counter.theconversation.com/content/220603/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alastair Ward receives funding from the BBSRC to investigate the ongoing H5N1 outbreak as part of the Flu:TrailMAP consortium. </span></em></p>Avian influenza has killed a polar bear and may have infected other bears.Alastair Ward, Associate Professor of Biodiversity and Ecosystem Management, University of LeedsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2167382023-12-22T00:08:48Z2023-12-22T00:08:48ZAvian influenza has killed millions of seabirds around the world: Antarctica could be next<p>Antarctica is often imagined as the last untouched wilderness. Unfortunately, <a href="https://www.woah.org/en/disease/avian-influenza/">avian influenza</a> (“bird flu”) is encroaching on the icy continent. The virus has already reached the <a href="https://maps.app.goo.gl/QvLgto7pq8ggDALd6">sub-Antarctic islands</a> between the Antarctic Peninsula and South America. It’s only a matter of time before it reaches the Antarctic continent. </p>
<p>So far avian influenza has been detected in several seabird species on <a href="https://www.bas.ac.uk/media-post/first-confirmed-cases-of-avian-influenza-in-the-antarctic-region/">South Georgia Island</a> and the <a href="https://falklands.gov.fk/agriculture/avian-influenza">Falkland (Malvinas) Islands</a>. These birds are known to travel to Antarctica. Researchers also suspect avian influenza caused mass deaths of southern elephant seals. </p>
<p>The arrival of avian influenza in Antarctica could have potentially catastrophic consequences for the wildlife, decimating large populations. </p>
<p>Antarctic avian influenza outbreaks may also disrupt tourism and research activities during the busy summer season. So what can we do during this challenging time? </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1726658388245811583"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/migrating-birds-could-bring-lethal-avian-flu-to-australias-vulnerable-birds-204793">Migrating birds could bring lethal avian flu to Australia's vulnerable birds</a>
</strong>
</em>
</p>
<hr>
<h2>The bird flu pandemic</h2>
<p>We are in the midst of a “panzootic” – a large-scale pandemic of <a href="https://www.woah.org/en/disease/avian-influenza/">avian influenza</a>, which is occurring across the world and has affected more than 200 species of wild birds.</p>
<p>While this strain of avian influenza (H5N1) <a href="https://www.nature.com/articles/s41586-023-06631-2">is an old foe</a>, the genetics and epidemiology of the virus have shifted. Once mostly found in poultry, it is now infecting large numbers of wild birds. Migrating birds have <a href="https://www.nature.com/articles/s41559-023-02182-x">spread the virus</a> with substantial outbreaks now occurring in Europe, Asia, Africa, North America and South America. </p>
<p>Avian influenza has devastated seabird populations around the world, including a 70% reduction of <a href="https://onlinelibrary.wiley.com/doi/10.1111/ibi.13275">northern gannets</a> on Bass Rock in the United Kingdom. Many birds are diseased, with signs including loss of coordination, watery eyes, head twisting, breathing distress or lethargy. </p>
<p>Beyond birds, this virus may have killed more than <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4611782">30,000 South American sea lions</a> and over <a href="https://www.lanacion.com.ar/sociedad/puerto-madryn-murieron-mas-de-200-crias-de-elefantes-marinos-en-las-ultimas-dos-semanas-nid27102023/">2,500 southern elephant seal</a> pups in South America. In South Georgia mass deaths have been observed in <a href="https://www.bas.ac.uk/media-post/additional-cases-of-avian-flu-hpai-confirmed-on-south-georgia/">elephant seal pups</a> but the virus was not detected in samples sent for laboratory tests.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/invasive-species-are-threatening-antarcticas-fragile-ecosystems-as-human-activity-grows-and-the-world-warms-172058">Invasive species are threatening Antarctica's fragile ecosystems as human activity grows and the world warms</a>
</strong>
</em>
</p>
<hr>
<h2>Bird flu moving further south</h2>
<p>The first detection of avian influenza near Antarctica occurred in early October on Bird Island, <a href="https://www.bas.ac.uk/media-post/additional-cases-of-avian-flu-hpai-confirmed-on-south-georgia/">South Georgia</a>, in brown skuas (seabirds similar to large gulls). </p>
<p>A case on the Falkland (Malvinas) Islands was confirmed a few weeks later in another seabird species, the southern fulmar. </p>
<p>Genetic analysis revealed the virus entered these regions on <a href="https://www.biorxiv.org/content/10.1101/2023.11.23.568045v1">two separate occasions</a>.</p>
<p>Skuas and kelp gulls were highlighted as species <a href="https://www.scar.org/library/science-4/life-sciences/antarctic-wildlife-health-network-awhn/5973-risk-assessment-avian-influenza/file/">most likely to spread the virus to the Antarctic continent</a> in a recent risk assessment, as they travel into the region from South America. They are also highly susceptible to avian influenza, with related species in the <a href="https://www.nature.scot/avian-flu-causes-another-challenging-summer-seabirds#:%7E:text=Pink%2Dfooted%20geese%2C%20herring%20gulls,breeding%20population%20of%20great%20skua">Northern Hemisphere suffering losses of more than 60%</a>. </p>
<h2>What does this mean for Antarctica?</h2>
<p>The Antarctic Peninsula, with its <a href="https://www.scar.org/research-features/climate-expansion-ice-free-habitat/">ice-free areas</a>, is an important breeding ground for many key Antarctic species. </p>
<p>Critically, those species – and others, including the iconic Emperor penguin – live in <a href="https://www.bas.ac.uk/about/antarctica/wildlife/penguins/">dense colonies</a> and are not found elsewhere in the world, making them particularly vulnerable to disease outbreaks.</p>
<p>Outbreaks on the Antarctic Peninsula will also be extremely disruptive to the tourism industry. More than <a href="https://iaato.org/information-resources/data-statistics/">104,000 people</a> visited as tourists in the 2022–23 season. People visit to see wildlife, make a continental landing, and enjoy the scenery.</p>
<p>Once avian influenza is confirmed at a particular location, sites will be <a href="https://iaato.org/iaato-2022-23-biosecurity-protocols-regarding-avian-influenza/">closed to tourists</a>. This will lead to a different experience for visitors, with land-based wildlife encounters pivoting to cruise-based activities. </p>
<h2>What are we doing?</h2>
<p>The <a href="https://www.scar.org/science/awhn/">Antarctic Wildlife Health Network</a> of the Scientific Committee on Antarctic Research has developed recommendations for the research and tourism communities. </p>
<p>These recommendations include information around biosecurity, testing and reporting of cases. The network’s <a href="https://scar.org/library-data/avian-flu">database</a> collates information on suspected and confirmed cases of the H5N1 avian influenza strain in the Antarctic region. This is central to rapid data sharing.</p>
<p>During the 2022–23 season, a <a href="https://www.biorxiv.org/content/10.1101/2023.10.24.563692v1.full.pdf">small number of researchers</a> tested suspected cases and conducted surveys, which excluded the presence of avian influenza. </p>
<p>This year, through the generosity of industry partners, we will dramatically expand this effort. The network will conduct surveys across the Antarctic and sub-Antarctic to monitor the presence and impact of the virus on wildlife. </p>
<p>Safety and biosecurity measures have been boosted across the <a href="https://www.comnap.aq/heightened-risk-of-hpai-in-antarctica">scientific community</a> and <a href="https://iaato.org/wp-content/uploads/2020/04/IAATO_Don_t_Pack_a_Pest.EN_190070.pdf">tourism industry</a> to reduce the risk of people spreading the virus. This should ensure essential scientific research and tourism activities can continue safely. </p>
<p>New measures now in place include:</p>
<ul>
<li>disinfection of boots and outer clothing</li>
<li>wearing of N95 masks, protective glasses and gloves when working with wildlife</li>
<li>restrictions on access to infected sites.</li>
</ul>
<p>Tourism can play an important role in detecting and monitoring the spread of the virus, alerting authorities to new cases in locations not visited by scientists. </p>
<p>The International Association of Antarctica Tour Operators is on high alert. Extra training for <a href="https://iaato.org/polar-stakeholders-response-to-avian-influenza-as-2023-24-antarctic-season-begins/">field staff</a> will help them identify wildlife illness quickly. </p>
<h2>Antarctica is connected</h2>
<p>Many threats to Antarctica – including climate change, pollution, and pathogens – originate elsewhere. Climate change is expected to <a href="https://www.who.int/europe/news/item/01-07-2022-new-report-highlights-the-impact-of-changes-in-environment-on-one-health#:%7E:text=Climate%20change%20and%20rising%20temperatures,of%20both%20pathogens%20and%20vectors.">increase the spread of infectious diseases in wildlife</a> and Antarctica is not immune.</p>
<p>Disease surveillance and information sharing between all those active in the far south are vital to help minimise the impacts of avian influenza and future disease threats. </p>
<p>The avian influenza example highlights the connectivity of our world, and why we need to care for the planet at home in order to protect the far south. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ancient-pathogens-released-from-melting-ice-could-wreak-havoc-on-the-world-new-analysis-reveals-209795">Ancient pathogens released from melting ice could wreak havoc on the world, new analysis reveals</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/216738/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hanne E F Nielsen receives funding from the Australian Research Council, Linkage partner organisation Intrepid Travel, the Dutch Research Council, and the Australian Antarctic Division. Hurtigruten Australia provides in-kind support for fieldwork.</span></em></p><p class="fine-print"><em><span>Michelle Wille has an honorary appointment with the WHO Collaborating Centre for Reference and Research on Influenza. </span></em></p><p class="fine-print"><em><span>Meagan Dewar 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>A deadly strain of bird flu is circulating in animals. So far the virus has been detected in seabirds on islands near Antarctica. What does this mean for wildlife, tourism and research?Hanne E F Nielsen, Senior lecturer, University of TasmaniaMeagan Dewar, Lecturer in the School of Science, Psychology and Sport, Federation University AustraliaMichelle Wille, Senior research fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168202023-11-10T01:03:36Z2023-11-10T01:03:36ZWe’re in a new COVID wave. What can we expect this time?<figure><img src="https://images.theconversation.com/files/558289/original/file-20231108-21-f5uskt.jpg?ixlib=rb-1.1.0&rect=65%2C139%2C5398%2C3497&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-woman-face-mask-walking-through-1685691631">Shutterstock</a></span></figcaption></figure><p>Australia is now into its <a href="https://www.abc.net.au/news/2023-11-02/nsw-sydney-covid-christmas-fresh-wave/103051190">next COVID wave</a>. We’ve seen hints of this for a while. Case numbers and indicators of severe disease began rising in Victoria in August. But it has taken several months for a consistent pattern to emerge across Australia. </p>
<p>Now we see evidence of this new wave via <a href="https://www.health.vic.gov.au/sites/default/files/2023-11/victorian-covid-19-surveillance-report-03-november-2023.pdf">wastewater surveillance</a> for traces of SARS-CoV-2, the virus that causes COVID. We also see <a href="https://www.health.gov.au/topics/covid-19/weekly-reporting">rises</a> in COVID-related hospital admissions and antiviral prescriptions. Compared to past waves, this one has built up slowly and over a longer period.</p>
<p>Here’s what we know about this new wave and what to expect over the coming weeks.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-covid-inquiry-has-been-announced-but-is-covid-still-a-thing-do-i-need-a-booster-213469">A COVID inquiry has been announced. But is COVID still a thing? Do I need a booster?</a>
</strong>
</em>
</p>
<hr>
<h2>How do we know we’re in a new COVID wave?</h2>
<p>In earlier waves, when more people were testing for COVID and reporting their results, we were more confident case numbers were a reasonable reflection of how COVID was tracking.</p>
<p>However, now, a more useful indicator for COVID nationally is to look at trends in the number of prescriptions for the antiviral medications ritonavir (Paxlovid) and molnupiravir (Lagevrio) on the Pharmaceutical Benefits Scheme (PBS). </p>
<p>In the graph below, which is drawn from <a href="https://www.health.gov.au/topics/covid-19/weekly-reporting">national prescribing data</a>, you can clearly see script numbers rising.</p>
<p><iframe id="3d26e" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/3d26e/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>When will we hit the peak?</h2>
<p>It has become more difficult to predict the size and timing of the peak. Reduced access to COVID testing and fewer requirements or opportunities to report test results, combined with the slow growth rate for this wave, give a wider range of possibilities. </p>
<p>The wave is also likely to differ between states and territories, as some got off to a later start. </p>
<p>However, given the wave’s slow growth rate and further increases in hybrid immunity (immunity from both vaccination and infection) over 2023, it’s reasonable to expect this to be the smallest Omicron wave so far. </p>
<p>We also expect it will be over by early in the summer holiday period. That’s when rates of community contact decline significantly, as work and school contacts are much reduced. That means fewer opportunities for the virus to spread between networks of family and friends.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ah-memories-of-2020-why-its-important-to-remember-our-covid-holidays-good-or-bad-150061">Ah, memories of 2020. Why it's important to remember our COVID holidays, good or bad</a>
</strong>
</em>
</p>
<hr>
<h2>Why now?</h2>
<p>It’s unlikely this latest COVID wave stems from changes in behaviour. People are generally out and about, fewer people are wearing masks in public. But we don’t see any dramatic shifts in this type of behaviour in 2023 compared with 2022.</p>
<p>It’s not a seasonal cause, given respiratory viruses tend to spread better in winter, when we’re cooped up indoors with others.</p>
<p>It’s unlikely it’s our <a href="https://www.medrxiv.org/content/10.1101/2023.08.26.23294679v1">waning immunity</a> from infection or vaccination that’s prompting these successive waves.</p>
<p>Instead, we’re seeing the result of a constantly mutating virus. Successful SARS-CoV-2 variants are gradually acquiring mutations. Some of these changes reduce the ability of existing antibodies to bind to and neutralise the virus. So it appears it’s still the “immune escape” variants that are behind these latest waves.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/with-a-covid-variant-soup-looming-new-zealand-urgently-needs-another-round-of-vaccine-boosters-193616">With a COVID 'variant soup' looming, New Zealand urgently needs another round of vaccine boosters</a>
</strong>
</em>
</p>
<hr>
<h2>Which variants are to blame?</h2>
<p>The primary viral lineage in Australia this year has been XBB. Over the past six months, its two most influential mutations have been:</p>
<ul>
<li><p>the F456L mutation that led to the rise of EG.5.1, also known as Eris</p></li>
<li><p>more recently, the paired “FLip” mutations F456L+L455F. We see these in offspring of Eris and in much-less closely related lineages. This is a clear sign these mutations help the virus spread better.</p></li>
</ul>
<p>Both the single and paired mutations make existing antibodies less effective at blocking SARS-CoV-2 from binding to critical receptors on our cells. This increases our susceptibility to infection.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1689763022573916169"}"></div></p>
<p>The novel BA.2.86 lineage – colloquially known as Pirola – was first reported in Denmark in August and has many unique mutations. It has not been influential so far in this wave in Australia. But it has continued to evolve. And we may see it play a much bigger role in Australia in 2024.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-evasive-and-transmissible-is-the-newest-omicron-offshoot-ba-2-86-that-causes-covid-19-4-questions-answered-212453">How evasive and transmissible is the newest omicron offshoot, BA.2.86, that causes COVID-19? 4 questions answered</a>
</strong>
</em>
</p>
<hr>
<h2>Who is most at risk during this COVID wave?</h2>
<p>Since the start of the pandemic, rates of COVID-related death and severe disease have greatly declined. That’s due to <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00801-5/fulltext">widespread</a> vaccination and hybrid immunity, and a major change in the Omicron variant that’s made the virus less-likely to <a href="https://pubmed.ncbi.nlm.nih.gov/35104837/">infect the lung</a>.</p>
<p>However, provisional statistics show there have been about <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/latest-release">3,000</a> registered COVID deaths in Australia from January to July 2023.</p>
<p>Older people and those with weaker immune systems are expected to remain at <a href="https://www.sciencedirect.com/science/article/pii/S2468266723000798">greatest risk</a> of developing severe COVID during this current wave.</p>
<p>This is the rationale for the Australian Technical Advisory Group on Immunisation’s (ATAGI) September <a href="https://www.health.gov.au/news/atagi-update-on-the-covid-19-vaccination-program">recommendation</a> for people aged 75 or older to get boosted if more than six months had passed since their last vaccine dose. </p>
<p>ATAGI also recommended people aged 65-74, and people 18 years and over with severe immunocompromising conditions, consider having another booster.</p>
<p>But, by the end of October 2023, <a href="https://www.health.gov.au/sites/default/files/2023-10/covid-19-vaccine-rollout-update-27-october-2023.pdf">it was estimated</a> only one-quarter of Australians aged 65-74, one-third of people aged 75 or over and fewer than half (45%) of people in aged care had received a COVID vaccine in the past six months.</p>
<figure class="align-center ">
<img alt="Woman receives vaccination" src="https://images.theconversation.com/files/558309/original/file-20231108-19-5fu6vv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558309/original/file-20231108-19-5fu6vv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=249&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558309/original/file-20231108-19-5fu6vv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=249&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558309/original/file-20231108-19-5fu6vv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=249&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558309/original/file-20231108-19-5fu6vv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=313&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558309/original/file-20231108-19-5fu6vv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=313&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558309/original/file-20231108-19-5fu6vv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=313&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with immunocompromising conditions should get boosted.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-wearing-protective-face-mask-getting-1966499908">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/millions-of-australians-still-havent-had-their-covid-boosters-what-message-could-convince-them-now-190482">Millions of Australians still haven't had their COVID boosters. What message could convince them now?</a>
</strong>
</em>
</p>
<hr>
<h2>Which vaccines are available?</h2>
<p>Currently available bivalent vaccines protect against the original ancestral strain of SARS-CoV-2 (now extinct) plus the newer BA.1 or BA.4/5 variants. These bivalent vaccines also protect us against <a href="https://assets.publishing.service.gov.uk/media/6527f0bfaea2d0000d219c69/vaccine-surveillance-report-2023-week-41.pdf">severe disease</a> from the Omicron variants circulating now, such as XBB.</p>
<p>But we can expect newer monovalent XBB.1.5 vaccines soon, now the Therapeutic Goods Administration has <a href="https://www.tga.gov.au/products/covid-19/covid-19-vaccines/covid-19-vaccines-regulatory-status">approved them</a>. These are expected to provide <a href="https://www.medrxiv.org/content/10.1101/2023.10.04.23296545v1.full.pdf">better protection</a> against newer Omicron variants than the currently available <a href="https://www.sciencedirect.com/science/article/pii/S2213260023003065">bivalent vaccines</a>.</p>
<p>In the meantime, boosting with any available COVID vaccine will provide <a href="https://assets.publishing.service.gov.uk/media/6527f0bfaea2d0000d219c69/vaccine-surveillance-report-2023-week-41.pdf">good protection</a> for vulnerable people.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cdc-greenlights-two-updated-covid-19-vaccines-but-how-will-they-fare-against-the-latest-variants-5-questions-answered-213341">CDC greenlights two updated COVID-19 vaccines, but how will they fare against the latest variants? 5 questions answered</a>
</strong>
</em>
</p>
<hr>
<h2>What might we expect from COVID in 2024?</h2>
<p>The Northern Hemisphere appears to have settled into an approximate seasonal pattern of COVID infections in 2023 and it’s plausible Australia will follow suit. </p>
<p>If so, we should plan for overlapping seasonal epidemics of our three most important respiratory viruses: SARS-CoV-2, influenza and respiratory syncytial virus (RSV). So hospitals may need to plan ahead for larger peaks in admissions.</p>
<p>Hopefully, new <a href="https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/rsv.html">vaccines for RSV</a>, and more broadly protective <a href="https://www.nih.gov/news-events/nih-research-matters/research-context-progress-toward-universal-vaccines">flu and COVID vaccines</a> to be developed over the next decade, should help.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rsv-is-everywhere-right-now-what-parents-need-to-know-about-respiratory-syncytial-virus-208855">RSV is everywhere right now. What parents need to know about respiratory syncytial virus</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/216820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Wood receives funding from NSW Health and the National Health and Medical Research Council for projects on COVID-19. He has previously received funding from the federal government as part of COVID responses in 2020-21 and from WHO Western Pacific Regional Office in 2020. He is a current member of the Australian Technical Advisory Committee on Immunisation.</span></em></p><p class="fine-print"><em><span>Bette Liu receives funding from the Australian National Health and Medical Research Council and Australian Government. </span></em></p><p class="fine-print"><em><span>Katie Flanagan receives funding from the National Health and Medical Research Council, Medical Research Future Fund, Bill and Melinda Gates Foundation and Clifford Craig Foundation. She is involved in research projects studying the impact of COVID-19 vaccine boosters. She is a member of the Australian Technical Advisory Group on Immunisation and President of the Australasian Society for Infectious Diseases.</span></em></p><p class="fine-print"><em><span>Stuart Turville receives funding from the Australian National Health and Medical Research Council, Medical Research Future Fund and Covid grants (Round 2 Covid grant and VIIM vaccine group) awarded from the NSW state government.</span></em></p>This is expected to be the smallest Omicron wave so far. But eligible older and vulnerable people are still recommended to have a booster.James Wood, Professor, epidemiological modelling of infectious diseases, UNSW SydneyBette Liu, Associate Professor and NHMRC Career Development Fellow, UNSW SydneyKatie Louise Flanagan, Infectious Diseases Specialist and Clinical Professor, University of TasmaniaStuart Turville, Associate Professor, Immunovirology and Pathogenesis Program, Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2156672023-10-19T11:57:12Z2023-10-19T11:57:12ZBird flu in South Africa: expert explains what’s behind the chicken crisis and what must be done about it<p><em>An outbreak of <a href="https://www.woah.org/en/disease/avian-influenza/">avian flu</a> – a highly contagious viral infection that affects wild birds as well as poultry – <a href="https://www.nicd.ac.za/avian-influenza-outbreak/">has hit poultry farms in South Africa</a>. Two different strains are causing outbreaks in the country – A(H5N1) and influenza A(H7N6). A specialist in poultry health, Shahn Bisschop, answers some questions put to him by The Conversation Africa.</em></p>
<h2>What strain has broken out in South Africa?</h2>
<p>The outbreak caused by a highly pathogenic (HPAI) strain of H7N6 avian influenza is causing the most concern at present. The strain was <a href="https://www.news24.com/fin24/companies/bird-flu-super-infectious-sa-strain-emerges-in-mpumalanga-20230627">first confirmed in chickens</a> near Delmas north of Johannesburg at the beginning of June 2023.</p>
<p>This virus is a novel mutation of a strain which originated from wild birds at or near the location of the original outbreak. </p>
<p>The strain is well-adapted to chickens – it infects them easily and replicates effectively in them, in preference to other avian species – and spreads very easily between birds and farms. An <a href="https://sapa.jshiny.com/jdata/sapa/outbreaklanding/">estimated</a> 10 million have become infected while 6 million died from the H7N6. A further 1.7 million died from H5N1 earlier in the year.</p>
<p>The conventional control measures (collectively known as biosecurity) have been less effective than usual in limiting the spread of the disease. The main measures taken on poultry farms include strictly limiting human and vehicle movement. People entering farms will typically take further measures to limit disease transmission such as showering, changing clothes and disinfecting footwear when moving between different parts of the farm. </p>
<p>Because wild birds are associated with the spread of avian flu, measures are taken to ensure they are completely excluded from all chicken sheds. </p>
<h2>What’s new this time?</h2>
<p>For at least the past nine years, HPAI H5 viruses of the 2.3.4.4 clade <a href="https://www.nature.com/articles/s41421-023-00571-x">have been spread across the globe</a> principally by wild bird migrations and infect a range of avian and mammalian species. The first recorded cases caused by viruses belonging to this clade were reported in South Africa in 2017. A second outbreak occurred in 2020. It was anticipated that the next outbreak would probably also be caused by these viruses and indeed the first reported cases of HPAI in 2023 in the coastal regions were associated with H5 strains.</p>
<p>Local experts are working on the theory that the present outbreak of H7N6 HPAI <a href="https://www.cdc.gov/flu/avianflu/avian-in-birds.htm">was created</a> when a low pathogenicity AI (LPAI) virus circulating without causing disease in wild birds underwent a mutation to become an HPAI strain adapted to causing serious disease in chickens. This mutation occurred locally. </p>
<p>Mutation from LPAI to HPAI has been described in poultry in various parts of the world but was considered less likely than the return of the H5 clade 2.3.4.4 viruses previously encountered.</p>
<h2>What’s in place and what’s missing</h2>
<p>Avian influenza is a “controlled disease”. That means it’s placed under strict government control with the aim of eradication as quickly as possible when outbreaks are detected. All outbreaks on farms are immediately reported to the state veterinary service, which takes responsibility for the disease. </p>
<p>The protocol for HPAI control is that all affected farms are placed under strict quarantine and all surviving birds are destroyed and disposed of as quickly as possible in order to limit the further spread of the disease.</p>
<p>But there are weaknesses in the system. </p>
<p>The biggest is that the state veterinary services don’t have sufficient resources to manage the outbreaks effectively.</p>
<p>Secondly, because the state doesn’t compensate farmers for their losses, they have difficulty getting farmers to comply with orders to cull. This has meant that outbreaks have spread out of control. Infected birds have been moved off infected farms for sale – taking the disease with them.</p>
<p>Farmers in the EU and US are compensated when culling happens. This used to be the case in South Africa but no longer happens.</p>
<p>As a result, South Africa has struggled to contain HPAI outbreaks. In<a href="https://www.nicd.ac.za/wp-content/uploads/2017/06/NICD-Avian-influenza-FAQ_final1-1.pdf"> 2017</a> and <a href="https://rr-africa.woah.org/en/immediate-notifications-in-africa/">2020/21</a> the outbreaks gradually slowed and eventually stopped. </p>
<p>HPAI outbreaks tend to be seasonal. In Europe, they occur principally in winter months. In South Africa, there is a similar but less clear trend to more cases in the winter and fewer in summer. This may be related to reduced viral survival in hotter summer weather.</p>
<h2>Are there new approaches to consider?</h2>
<p>New and innovative thinking is needed to deal with the reality on the ground in South Africa.</p>
<p>One possible solution is the introduction of appropriate vaccines. This would reduce the losses associated with outbreaks and would slow the spread of the disease between farms. Like all vaccines, they can’t prevent birds from becoming infected but they can manage the level of infection and spread. But they can’t eradicate the disease. </p>
<p>But there are limited options in terms of available vaccines. And South Africa would need to ensure that the vaccines registered for use in the country were effective against the local strain. If vaccines are poorly matched to outbreak strains, they won’t be effective.</p>
<p>All of this will take time, even with the best effort of government and industry. </p>
<h2>Does the strain pose a risk to people? What should consumers should be aware of?</h2>
<p>The South African Poultry Association <a href="http://www.poultrydiseases.co.za/750-2/">has made it clear</a> that poultry products are safe for consumption. It has been <a href="https://www.up.ac.za/research-matters/news/post_2991581-up-researchers-weigh-in-on-bird-flu-outbreak">collaborating with the University of Pretoria</a> to make sure poultry products are indeed safe. Together with leading scientists they have sequenced the current field strain of H7 avian influenza virus. In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10302261/">a recent paper </a> scientists reported that none of the amino acid markers were present that afford the virus the ability to bind to mammalian cells.</p>
<p>This shows that infection of humans with the current virus is highly unlikely.</p><img src="https://counter.theconversation.com/content/215667/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shahn Bisschop 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>New and innovative thinking is needed to deal with the reality on the ground in South Africa.Shahn Bisschop, Senior lecturer, specialist poultry veterinarian, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag: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>
<figure>
<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>
</figure>
<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/2104572023-08-29T02:25:36Z2023-08-29T02:25:36ZI think I have the flu. Should I ask my GP for antivirals?<figure><img src="https://images.theconversation.com/files/544456/original/file-20230824-29-51fiyz.jpg?ixlib=rb-1.1.0&rect=613%2C0%2C5497%2C4086&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-lying-on-bed-while-blowing-her-nose-3807629/">Andrea Piacquadio/Pexels</a></span></figcaption></figure><p>If you test positive for COVID and you’re eligible for antivirals, you’ll likely ask your GP for a script to protect you from severe disease. </p>
<p><a href="https://healthdispatch.com.au/news/immunisation-coalition-urging-people-with-flu-like-symptoms-to-g">Antivirals</a> are also available to fight influenza viruses, via a doctor’s prescription. But they have a mixed history, with their benefits at times <a href="https://theconversation.com/controversies-in-medicine-the-rise-and-fall-of-the-challenge-to-tamiflu-38287">overstated</a>. </p>
<p>It can be difficult to get an appointment to see your GP. So when should you make the effort to see a GP for a prescription for influenza antivirals? And how effective are they?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/controversies-in-medicine-the-rise-and-fall-of-the-challenge-to-tamiflu-38287">Controversies in medicine: the rise and fall of the challenge to Tamiflu</a>
</strong>
</em>
</p>
<hr>
<h2>What exactly is influenza?</h2>
<p>The flu is primarily a viral infection of the respiratory system that can spread through sneezing, coughing, or touching contaminated objects then touching your nose or mouth. </p>
<p>Common symptoms include headache, sore throat, fever, runny or blocked nose and body aches that last a week or more.</p>
<p>Influenza is actually a group of viruses, divided into several <a href="https://www.cdc.gov/flu/about/viruses/types.htm#:%7E:text=There%20are%20four%20types%20of,global%20epidemics%20of%20flu%20disease,%20https://www.cdc.gov/flu/professionals/acip/background-epidemiology.htm">sub-groups</a>. Flu A and B are the <a href="https://www.health.gov.au/resources/collections/aisr?language=en,%20https://www.health.gov.au/resources/collections/australian-influenza-surveillance-reports-2023?language=en">most common groups</a> that circulate in humans. </p>
<h2>What are flu antivirals?</h2>
<p>Influenza antivirals, target specific parts of the viral life cycle, which prevents the virus replicating and spreading. </p>
<p>Most flu antivirals <a href="https://www.nejm.org/doi/full/10.1056/NEJMra050740">target</a> neuraminidase, an important enzyme the virus uses to release itself from cells.</p>
<p>On the other hand, COVID antivirals work by inhibiting other parts of the viral life cycle involved in the <a href="https://www.tga.gov.au/news/media-releases/tga-provisionally-approves-two-oral-covid-19-treatments-molnupiravir-lagevrio-and-nirmatrelvir-ritonavir-paxlovid">virus replicating itself</a>.</p>
<p>Three influenza antivirals are <a href="https://australianprescriber.tg.org.au/articles/influenza-overview-on-prevention-and-therapy.html#r20">used in Australia</a>. Relenza (zanamivir) is an inhaled powder and Tamiflu (oseltamivir) is a capsule; both are five-day treatments. Rapivab (peramivir) is a single injection. </p>
<p>These antivirals may also come with <a href="https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm">side effects</a>, such as a headache, vomiting, cough, or <a href="https://www.immunisationcoalition.org.au/resources/antiviral-treatments-for-influenza/">fever</a>.</p>
<p>Tamiflu and Relenza generally cost A$40-50 in Australia, plus the cost of the consultation fee with your doctor, if applicable. </p>
<hr>
<p>
<em>
<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>
</strong>
</em>
</p>
<hr>
<h2>How effective are antivirals for the flu?</h2>
<p>Antivirals have the greatest effect if started 24-72 hours after symptoms. This is to prevent the virus from reaching <a href="https://www.mdpi.com/1660-4601/19/5/3018">high levels in the body</a>.</p>
<p>Among healthy adults, if Relenza or Tamiflu are started within 48 hours from your first symptoms, they can <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008965.pub4/full">reduce the duration</a> of symptoms such as cough, blocked nose, sore throat, fatigue, headache, muscle pain and fever by just under a day. </p>
<p>For people who have developed severe flu symptoms or who have existing health conditions such as heart disease or chronic obstructive pulmonary disease (COPD), antivirals that start later (but still before day five of symptoms) can still reduce the <a href="https://academic.oup.com/cid/article/52/4/457/378776?login=true">severity of infection</a> and reduce the <a href="https://thorax.bmj.com/content/thoraxjnl/65/6/510.full.pdf?frbrVersion=3">chance of</a> <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/215903">hospitalisation</a> and <a href="https://academic.oup.com/jac/article/72/11/2990/4091484?login=false">death</a>.</p>
<figure class="align-center ">
<img alt="Older man coughs, while his partner looks concerned" src="https://images.theconversation.com/files/544481/original/file-20230824-17-g9r2zk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544481/original/file-20230824-17-g9r2zk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544481/original/file-20230824-17-g9r2zk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544481/original/file-20230824-17-g9r2zk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544481/original/file-20230824-17-g9r2zk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544481/original/file-20230824-17-g9r2zk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544481/original/file-20230824-17-g9r2zk.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">Antivirals need to be started early.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/man-in-gray-sweater-sitting-beside-woman-5790716/">Vlada Karpovich/Pexels</a></span>
</figcaption>
</figure>
<p>In a study from the 2009 swine flu (H1N1) pandemic in the United States, treatment with antivirals (Tamiflu and Relenza) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358088/">reduced</a> the chance of needing to be hospitalised. Around 60% of hospitalisations prevented were among 18-64 years olds, around 20% in children 0-17 years, and 20% in adults aged over 65.</p>
<p>The research is less clear about whether antivirals prevent the development of flu complications such as secondary bacterial pneumonia. They might, but so far the data aren’t clear.</p>
<h2>Are flu antivirals becoming less effective?</h2>
<p>Antiviral resistance to Tamiflu has been <a href="https://link.springer.com/article/10.1007/s10096-020-03840-9">reported</a> around the world, mostly in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223162/">immunocompromised people</a>, as they <a href="https://link.springer.com/article/10.1007/s10096-020-03840-9">have</a> a weakened immune system that allows higher viral loads and prolonged viral shedding.</p>
<p>The impact of the antiviral resistance is unclear but there is evidence indicating resistant strains can uphold their ability to replicate effectively and spread. So far it’s not clear if these stains cause more severe disease.</p>
<p>However, government agencies and surveillance programs are constantly monitoring the spread of antiviral resistance. Currently there is <a href="https://www.cdc.gov/flu/treatment/antiviralresistance.htm">minimal concern</a> for strains that are resistant to Tamiflu or Relenza.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-there-so-many-drugs-to-kill-bacteria-but-so-few-to-tackle-viruses-137480">Why are there so many drugs to kill bacteria, but so few to tackle viruses?</a>
</strong>
</em>
</p>
<hr>
<h2>Antivirals can also prevent the flu if you’ve been exposed</h2>
<p>Tamiflu and Relenza can also be used to <a href="https://onlinelibrary.wiley.com/doi/10.1111/irv.12046">prevent flu infections</a>, if we’re exposed to the virus or come into contact with infected people.</p>
<p>Some studies suggest Tamiflu and Relenza can <a href="https://www.bmj.com/content/326/7401/1235.long">reduce the chance of developing symptomatic influenza</a> by 70-90%.</p>
<p>Many health agencies around the world <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165743/">recommend</a> “prophylactic” treatment for high-risk patients in hospitals or age care setting when people have been in contact with others infected with influenza. </p>
<figure class="align-center ">
<img alt="Woman at supermarket reaches for an orange" src="https://images.theconversation.com/files/544484/original/file-20230824-8994-y4fyo6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544484/original/file-20230824-8994-y4fyo6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544484/original/file-20230824-8994-y4fyo6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544484/original/file-20230824-8994-y4fyo6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544484/original/file-20230824-8994-y4fyo6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544484/original/file-20230824-8994-y4fyo6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544484/original/file-20230824-8994-y4fyo6.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">Antivirals can stop people who have been exposed to influenza from developing severe illness.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-wearing-mask-in-supermarket-3962289/">Anna Shvets/Pexels</a></span>
</figcaption>
</figure>
<h2>So who should talk to their GP about a prescription?</h2>
<p><a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/racf-antiviral-treatments-and-prophylaxis.aspx#:%7E:text=The%20Australian%20Therapeutic%20Guidelines*%20recommends,of%20severe%20disease%20from%20influenza.&text=people%20with%20chronic%20conditions%20including,heart%20disease">Australian guidelines recommend</a> doctors offer antivirals to people with influenza who have severe disease or complications. </p>
<p>Doctors can also consider treatment for people at higher risk of developing severe disease from influenza. This includes:</p>
<ul>
<li>adults aged 65 years or older</li>
<li>pregnant women</li>
<li>people with certain chronic conditions (heart disease, Down syndrome, obesity, chronic respiratory conditions, severe neurological conditions)</li>
<li>people with compromised immunity</li>
<li>Aboriginal and Torres Strait Islander people</li>
<li>children aged five years or younger</li>
<li>residents of long-term residential facilities</li>
<li>homeless people.</li>
</ul>
<p>Doctors can prescribe antivirals for the prevention of influenza <a href="https://australianprescriber.tg.org.au/articles/influenza-overview-on-prevention-and-therapy.html#r20">in</a> vulnerable people who have been exposed to the virus.</p>
<p>Antiviral treatment also can be <a href="https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#:%7E:text=Antiviral%20treatment%20also%20can%20be,48%20hours%20of%20illness%20onset">considered</a> for otherwise healthy symptomatic patients who have confirmed or suspected influenza, if they can start treatment within 48 hours of developing symptoms.</p>
<p>In some instances a doctors can make a clinical diagnosis of influenza based on the symptoms and known close flu positive contacts of the patient. However, it is preferred to have flu diagnosed by one of the approved diagnostic tests, such as a <a href="https://24-7medcare.com.au/influenza/australian-gp-influenza-2023-guide/">rapid antigen test</a> (RAT) or the more accurate <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/influenza_factsheet.aspx">PCR test</a>, similar to what is perfomed for COVID. There are also now combo tests that can <a href="https://www.tga.gov.au/news/media-releases/first-combination-covid-19-and-influenza-self-tests-approved-australia">distinguish between SARS-CoV-2 and influenza virus</a>.</p>
<p>Remember, the flu can cause <a href="https://www.abc.net.au/news/2023-07-23/flu-season-hitting-children-hard-antivirals-may-help/102633722">severe illness or death</a>, particularly among people from the high-risk groups. So if you think you might have the flu, wear a mask and stay away to avoid spreading the virus to others. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-happens-in-our-body-when-we-encounter-and-fight-off-a-virus-like-the-flu-sars-cov-2-or-rsv-207023">What happens in our body when we encounter and fight off a virus like the flu, SARS-CoV-2 or RSV?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/210457/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lara Herrero receives funding from NHMRC. </span></em></p><p class="fine-print"><em><span>Wesley Freppel and Yong Qian Koo 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>It can be difficult to an appointment to see your GP. So when should you make the effort to see a GP for a prescription for influenza antivirals? And how effective are they?Lara Herrero, Research Leader in Virology and Infectious Disease, Griffith UniversityWesley Freppel, Research Fellow, Institute for Glycomics, Griffith UniversityYong Qian Koo, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2070232023-07-28T02:14:53Z2023-07-28T02:14:53ZWhat happens in our body when we encounter and fight off a virus like the flu, SARS-CoV-2 or RSV?<figure><img src="https://images.theconversation.com/files/539186/original/file-20230725-25-dio99v.jpg?ixlib=rb-1.1.0&rect=188%2C32%2C5275%2C3514&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-man-coughing-covering-mouth-tissue-1424228762">Shutterstock</a></span></figcaption></figure><p><a href="https://www.labcorp.com/coronavirus-disease-covid-19/covid-news-education/covid-19-vs-flu-vs-rsv-how-tell-difference">Respiratory viruses</a> like influenza virus (flu), SARS-CoV-2 (which causes COVID) and respiratory syncytial virus (RSV) can make us sick by infecting our respiratory system, including the nose, upper airways and lungs. </p>
<p>They spread from person to person through respiratory droplets when someone coughs, sneezes, or talks and can cause death in serious cases. </p>
<p>But what happens in our body when we first encounter these viruses? Our immune system uses a number of strategies to fight off viral infections. Let’s look at how it does this. </p>
<h2>First line of defence</h2>
<p>When we encounter respiratory viruses, the <a href="https://www.sciencedirect.com/science/article/pii/S193131281600038X?via%3Dihub/">first line of defence</a> is the physical and chemical barriers in our nose, upper airways, and lungs. Barriers like the mucus lining and hair-like structures on the surface of cells, work together to trap and remove viruses before they can reach deeper into our respiratory system. </p>
<p>Our defence also includes our behaviours such as coughing or sneezing. When we blow our nose, the mucus, viruses, and any other pathogens that are caught within it are expelled. </p>
<p>But sometimes, viruses manage to evade these initial barriers and sneak into our respiratory system. This activates the cells of our innate immune system. </p>
<figure class="align-center ">
<img alt="Woman sits on a train holding a tissue" src="https://images.theconversation.com/files/539184/original/file-20230725-27-mqxwrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539184/original/file-20230725-27-mqxwrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539184/original/file-20230725-27-mqxwrk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539184/original/file-20230725-27-mqxwrk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539184/original/file-20230725-27-mqxwrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539184/original/file-20230725-27-mqxwrk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539184/original/file-20230725-27-mqxwrk.jpg?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">
<figcaption>
<span class="caption">Sneezing and blowing our nose can help expel the virus.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-young-attractive-woman-look-on-1644508063">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Patrolling for potential invaders</h2>
<p>While our acquired immune system develops over time, our innate immune system is present at birth. It generates “non-specific” immunity by identifying what’s foreign. The cells of innate immunity act like a patrol system, searching for any invaders. These innate cells patrol almost every part of our body, from our skin to our nose, lungs and even internal organs. </p>
<p>Our respiratory system has different type of innate cells such – as macrophages, neutrophils and natural killer cells – which patrol in our body looking for intruders. If they recognise anything foreign, in this case a virus, they will initiate an attack response. </p>
<p>Each cell type plays a slightly different role. Macrophages, for example, will not only engulf and digest viruses (phagocytosis) but also release a cocktail of different molecules (cytokines) that will warn and recruit other cells to <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/cmi.12580">fight against the danger</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-how-does-the-immune-system-learn-37285">Explainer: how does the immune system learn?</a>
</strong>
</em>
</p>
<hr>
<p>In the meantime, natural killer cells, aptly named, attack infected cells, and stop viruses from multiplying and <a href="https://www.nature.com/articles/s41577-021-00558-3">invading our body further</a>. </p>
<p>Natural killer cells also promote inflammation, a <a href="https://www.hindawi.com/journals/jir/2018/1467538/">crucial part of the immune response</a>. It helps to recruit more immune cells to the site of infection, enhances blood flow, and increases the permeability of blood vessels, allowing immune cells to reach the infected tissues.
At this stage, our immune system is fighting a war against viruses and the result can cause inflammation, fevers, coughs and congestion. </p>
<h2>Launching a specific attack</h2>
<p>As the innate immune response begins, another branch of the immune system called the adaptive immune system is <a href="https://www.ncbi.nlm.nih.gov/books/NBK21070/">activated</a>. </p>
<p>The adaptive immune system is more specific than the innate immune system, and it decides on the correct tools and strategy to fight off the viral invaders. This system plays a vital role in eliminating the virus and providing long-term protection against future infections. </p>
<p>Specialised cells called T cells and B cells are key players in acquired immunity. </p>
<p>T cells (specifically, helper T cells and cytotoxic T cells) recognise viral proteins on the surface of infected cells:</p>
<ul>
<li><p>helper T cells release molecules that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764486/">further activate immune cells</a></p></li>
<li><p>cytotoxic T cells directly kill infected cells with a very great precision, <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2018.00678/full">avoiding any healthy cells around</a>. </p></li>
</ul>
<p>B cells produce antibodies, which are proteins that can bind to viruses, neutralise them, and mark them for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247032/">destruction by other immune cells</a>. </p>
<p>B cells are a critical part of memory in our immune system. They will remember what happened and won’t forget for years. When the same virus attacks again, B cells will be ready to fight it off and will neutralise it faster and better. </p>
<p>Thanks to the adaptive immune system, vaccines for respiratory viruses such as the COVID mRNA vaccine keep us protected from <a href="https://www.health.gov.au/our-work/covid-19-vaccines/our-vaccines/how-they-work">being sick or severely ill</a>. However, if the same virus became mutated, our immune system will act as if it was a new virus and will have to fight in a war again. </p>
<figure class="align-center ">
<img alt="Nurse puts bandaid on patient's arm after a vaccination" src="https://images.theconversation.com/files/539187/original/file-20230725-16-bkrqq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539187/original/file-20230725-16-bkrqq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539187/original/file-20230725-16-bkrqq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539187/original/file-20230725-16-bkrqq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539187/original/file-20230725-16-bkrqq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539187/original/file-20230725-16-bkrqq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539187/original/file-20230725-16-bkrqq.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">Vaccines help us generate an immune response to viruses we’re immunised against.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/90ejoVTj2-M">CDC/Unsplash</a></span>
</figcaption>
</figure>
<h2>Neutralising the threat</h2>
<p>As the immune response progresses, the combined efforts of the innate and adaptive immune systems helps control the virus. Infected cells are cleared, and the virus is neutralised and eliminated from the body. </p>
<p>As the infection subsides, symptoms gradually improve, and we begin to feel better and to recover. </p>
<p>But recovery varies depending on the specific virus and us as individuals. Some respiratory viruses, like rhinoviruses which cause the common cold, may cause relatively mild symptoms and a quick recovery. Others, like the flu, SARS-CoV-2 or severe cases of RSV, may lead to more severe symptoms and a longer recovery time. </p>
<p>Some viruses are very strong and too fast sometimes so that our immune system does not have the time to develop a proper immune response to fight them off. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ive-had-covid-and-am-constantly-getting-colds-did-covid-harm-my-immune-system-am-i-now-at-risk-of-other-infectious-diseases-188899">I've had COVID and am constantly getting colds. Did COVID harm my immune system? Am I now at risk of other infectious diseases?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/207023/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lara Herrero receives funding from NHMRC</span></em></p><p class="fine-print"><em><span>Wesley Freppel 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>COVID, the flu and RSV spread from person to person through respiratory droplets when someone coughs, sneezes or talks. Here’s how our body fights them off.Lara Herrero, Research Leader in Virology and Infectious Disease, Griffith UniversityWesley Freppel, Research Fellow, Institute for Glycomics, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2072862023-07-12T12:38:49Z2023-07-12T12:38:49ZStrep throat can easily be confused with throat infections caused by viruses – here are a few ways to know the difference<figure><img src="https://images.theconversation.com/files/536374/original/file-20230707-23-bxbi1g.jpg?ixlib=rb-1.1.0&rect=0%2C9%2C6640%2C4220&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Strep is most common in children between the ages of 5 and 15.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/male-pediatrician-examining-little-child-patients-royalty-free-image/1306247195?phrase=doctor+checking+for+strep&adppopup=true">aquaArts studio/E+ via Getty Images</a></span></figcaption></figure><p>“My sore throats, you know, are always worse than anybody’s.”</p>
<p>So declares Mary to Anne in “<a href="https://jasna.org/austen/works/persuasion/">Persuasion</a>,” Jane Austen’s 1817 book. Most of us can relate to this feeling. There is no such thing as “just a sore throat.” The pain, headache, fever and aches associated with a sore throat can make you feel terrible.</p>
<p>While sore throats can occur at any time of year, strep throat is <a href="https://www.cdc.gov/groupastrep/surveillance.html#">more common in the fall, winter and early spring</a>.</p>
<p>I am a <a href="https://facultyprofiles.tufts.edu/allen-shaughnessy">professor of family medicine</a>, a pharmacist and an expert on evidence-based medicine. My work involves the evaluation of research performed by others, and I have been following and analyzing research findings on strep for the past 30 years. </p>
<p>Many people incorrectly assume that all sore throats are due to strep throat, a bacterial infection of the pharynx, the middle throat area behind the nose and mouth, and patients often come to our family medicine office wanting to be checked and treated for strep with antibiotics.</p>
<p>However, neither testing nor treatment is always needed for a sore throat. Regardless of the cause, rest and pain relievers form the cornerstone of sore throat treatment.</p>
<p>Here’s some guidance on whether and when testing is necessary.</p>
<h2>Bacterial versus viral sore throats</h2>
<p>Most <a href="https://www.cdc.gov/antibiotic-use/sore-throat.html">sudden-onset sore throats</a> are caused by viruses – the same ones that cause the common cold, the seasonal flu and COVID-19. There are <a href="https://www.nih.gov/news-events/nih-research-matters/understanding-common-cold-virus#">more than 200 viruses</a> that can cause sore throat and other symptoms related to the common cold. </p>
<p>But bacteria can also be the culprits behind a sore throat. One of the most common examples is <a href="https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html#">strep throat</a>, or <a href="https://www.cdc.gov/streplab/groupa-strep/index.html">group A pharyngitis</a>.</p>
<p>Strep is caused by certain strains of <em>Streptococcus pyogenes</em> bacteria.
There are many species of strep; other common forms of strep that cause different infections in humans include “<a href="https://www.cdc.gov/groupbstrep/index.html">group B strep</a>” and “<a href="https://www.icliniq.com/articles/infectious-diseases/group-d-streptococcus-infections">group D strep</a>.” Group A strep usually lives peacefully among the many other types of bacteria growing on our skin and doesn’t cause any problems, until we get a break in the skin such as a cut or a scrape. This allows it to overwhelm the immune system’s ability to keep it in check.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A teenage girl is lying on a sofa, feeling unwell and holding a thermometer in her mouth to check her temperature." src="https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.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">Fever, headache and confusion can be symptoms of a severe case of strep.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sick-teenager-resting-at-home-and-monitoring-royalty-free-image/1482421648?phrase=strep+throat&adppopup=true">RealPeopleGroup/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>Group A strep can also live in the back of the throat – up to 30% of people without any evidence of a sore throat will have <a href="https://doi.org/10.3389/fcimb.2019.00137">this strain in their throat</a>. <a href="https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html#">Up to 3 in 10 children and 1 in 10 adults</a> feeling sick with a sore throat due to a virus or other cause will test <a href="https://doi.org/10.1371/journal.pntd.0006335">positive for group A strep</a>. That means that people with a sore throat caused by a virus could also be positive for strep, even if it’s not causing the symptoms.</p>
<p>Not all group A strep bacteria are the same, though. Some varieties are better at evading the immune system than others and can grow quickly. Others produce byproducts that can cause a sore throat and sometimes lead to <a href="https://www.mayoclinic.org/diseases-conditions/tonsillitis/symptoms-causes/syc-20378479">tonsillitis</a>, an infection of the tonsils, or cause ear or <a href="https://www.cdc.gov/antibiotic-use/sinus-infection.html">sinus infections</a>. </p>
<p>Still other strep strains produce a toxin that can cause a characteristic <a href="https://www.cdc.gov/groupastrep/diseases-public/scarlet-fever.html">skin rash</a> or lead to effects on the <a href="https://www.cdc.gov/groupastrep/diseases-public/rheumatic-fever.html">heart</a>, <a href="https://www.cdc.gov/groupastrep/diseases-public/post-streptococcal.html">kidneys</a> or even the <a href="https://www.nimh.nih.gov/health/publications/pandas">brain</a>. </p>
<p>Rarer still, group A strep can enter the bloodstream and cause <a href="https://www.mayoclinic.org/diseases-conditions/toxic-shock-syndrome/symptoms-causes/syc-20355384">toxic shock syndrome</a>, a life-threatening, overwhelming infection. These latter conditions are examples of invasive strep, meaning that the infection is in parts of the body typically free from germs; they <a href="https://www.cdc.gov/groupastrep/igas-infections-investigation.html">seem to be on the rise</a> after a marked <a href="https://www.cdc.gov/groupastrep/igas-infections-investigation.html">reduction in their occurrence during the COVID-19 pandemic</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/W50S0dCCFPs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Like other illnesses that made a comeback after COVID-19 prevention measures were relaxed, strep cases have returned to pre-pandemic levels.</span></figcaption>
</figure>
<h2>To test or not to test</h2>
<p>Doctors or other clinicians can easily test for strep by using a swab to collect a bit of the fluid from the back of the throat. This sample can identify group A strep in about a minute. </p>
<p>While researchers have been studying group A strep <a href="https://www.ncbi.nlm.nih.gov/books/NBK333430/">for over 75 years</a> and there are thousands of research papers focused on infections caused by strep, there is still <a href="https://www.nice.org.uk/guidance/ng84/chapter/Summary-of-the-evidence">controversy</a> over whether it needs to be tested for and treated. </p>
<p>To decide whether to test for group A strep, clinicians use a set of criteria based on <a href="https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitis">five questions</a> that can help determine whether strep testing is needed. These are:</p>
<p>– How old is the patient? Strep throat is most common in children <a href="https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html#">between ages 5 and 15</a> and least common in <a href="https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html#">adults over age 45</a>. </p>
<p>– Are the tonsils swollen or do they have a white or yellow coating? Both conditions often accompany strep. However, this question alone isn’t definitive, since viruses can also affect the tonsils.</p>
<p>– Are the <a href="https://www.verywellhealth.com/cervical-lymph-nodes-2252142">cervical lymph nodes</a> swollen or tender? Normally these bumps, which are in the front of the neck along the sides of the windpipe, cannot be seen or felt, but are often palpable when strep is present.</p>
<p>– Does the person have a fever? Lack of a fever makes strep less likely.</p>
<p>– Does the person have a cough? A cough is indicative of a viral cause and makes strep the less likely cause of the sore throat.</p>
<p>While none of these questions alone can provide a clear answer, taken together they can tell your clinician whether strep is more or less likely. </p>
<p>Using this scoring tool, an adult with a sore throat but without changes to the tonsils or lymph nodes, without a fever and with a cough has only a <a href="https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitis">1 in 40 chance, or 2.5%, of having strep throat</a>. For such patients, a strep test is not necessary. </p>
<p>On the other hand, when a first grader meets all five of these criteria, there is a 50% chance that strep is causing his or her sore throat. Based on recent research I have reviewed, by using these questions <a href="https://doi.org/10.7326/0003-4819-159-9-201311050-00003">adults can determine</a> when strep is the likely cause of a sore throat. </p>
<p>In the <a href="https://www.nice.org.uk/guidance/ng84">United Kingdom</a> and <a href="https://doi.org/10.1370/afm.741">other European countries</a>, doctors do not routinely test for strep. Antibiotic treatment can at times <a href="https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/au_arent_always_the_answer_fs_508.pdf">cause allergic reactions, rash, diarrhea, stomach upset, yeast infections and other side effects</a>. Authorities in these countries feel any benefit of testing and treatment does not outweigh these risks.</p>
<h2>Treatments for strep</h2>
<p>Once group A strep is confirmed, doctors may prescribe an antibiotic treatment. </p>
<p>Penicillin or amoxicillin are the most commonly prescribed antibiotics for strep. These medicines will not reduce pain or tiredness but may help symptoms resolve earlier, typically by <a href="https://www.nice.org.uk/guidance/ng84/chapter/Summary-of-the-evidence">about a day</a>. Doctors may also suggest use of a pain reliever such as acetaminophen or ibuprofen to help relieve symptoms.</p>
<p>Antibiotic treatment does not seem to lower the likelihood of <a href="https://doi.org/10.1136/bmj.38503.706887.AE1">spread of the infection between children</a> – which is common in schools and dormitories – <a href="https://doi.org/10.1136/bmj.f6867">or adults</a>.</p>
<p>Health care practitioners recommend staying home until fever has subsided. They also recommend taking the full course of antibiotics, even if the symptoms have abated. </p>
<p>With sore throats causes by viruses – against which antibiotics are ineffective – few treatments exist aside from using pain relievers to help soothe immediate symptoms. For this reason and because <a href="https://www.cdc.gov/antibiotic-use/index.html">antibiotic overuse is a major problem in the U.S.</a>, it is best not to assume that your sore throat is caused by strep and to treat it accordingly.</p><img src="https://counter.theconversation.com/content/207286/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Allen Shaughnessy 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>Despite an abundance of research on strep, there is still a great deal of debate in the scientific community over whether and when people should get tested and treated for it.Allen Shaughnessy, Professor of Family Medicine, Tufts UniversityLicensed 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>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-the-flu-13985">Explainer: what is the flu?</a>
</strong>
</em>
</p>
<hr>
<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>
<hr>
<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>
</strong>
</em>
</p>
<hr>
<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>
</figcaption>
</figure>
<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>
<figcaption>
<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>
</figcaption>
</figure>
<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>
<hr>
<p>
<em>
<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>
</strong>
</em>
</p>
<hr>
<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>
<hr>
<p>
<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>
</strong>
</em>
</p>
<hr>
<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/2077242023-06-22T02:11:07Z2023-06-22T02:11:07ZDo I need a booster vaccine if I recently had COVID? What if I’m not sure what I had?<figure><img src="https://images.theconversation.com/files/533059/original/file-20230621-14332-ci9rr5.jpg?ixlib=rb-1.1.0&rect=38%2C7%2C5121%2C3435&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/officers-nurse-use-needles-suck-covid19-2090251705">Shutterstock</a></span></figcaption></figure><p>In early 2021, recommendations about COVID vaccines were pretty straightforward – get two doses, as soon as you are eligible. A year later, we knew getting a third dose <a href="https://www.nature.com/articles/s41591-022-01727-0">was important</a> for protection against the new Omicron variant. </p>
<p>Today, though, the situation is far more complex – new updated vaccines are available, the majority of Australians have <a href="https://kirby.unsw.edu.au/sites/default/files/COVID19-Blood-Donor-Report-Round3-Aug-Sep-2022.pdf">likely been infected</a> at least once with an Omicron strain, and waves of infection continue to occur. </p>
<p>So how should you manage and time your booster shots?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/over-half-of-eligible-aged-care-residents-are-yet-to-receive-their-covid-booster-and-winter-is-coming-205403">Over half of eligible aged care residents are yet to receive their COVID booster. And winter is coming</a>
</strong>
</em>
</p>
<hr>
<h2>Why do vaccines need boosters?</h2>
<p>Vaccines work by training our body’s immune system to react harder, faster, stronger and better when we get infected by a pathogenic virus or bacteria. </p>
<p>Unfortunately, this protective benefit is not permanent and immunity tends to “wane” over time. The extent to which vaccine protection wanes is a function of two main factors. </p>
<p>First, your <a href="https://www.youtube.com/watch?v=la6nXuAw-Oo">immune system</a> (in the form of antibodies, memory B cells and T cells) is not infinite, and the levels of vaccine-induced immune responses will gradually decline over time. Second, pathogens circulating in the community can mutate, which enables “escape” from being recognised by the immune system. The more the virus escapes, the less protection the vaccine can give you.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-does-my-back-get-so-sore-when-im-sick-the-connection-between-immunity-and-pain-207222">Why does my back get so sore when I'm sick? The connection between immunity and pain</a>
</strong>
</em>
</p>
<hr>
<h2>Some vaccines need frequent boosting, others last forever</h2>
<p>Not all pathogens have the same ability to create or tolerate mutations. For viruses that change little (such as measles), your childhood vaccines remain highly protective and you might never need a booster. </p>
<p>In contrast, some viruses can rapidly and dramatically change (looking at you, influenza), quickly rendering our vaccines outdated and making updates necessary.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-need-a-flu-shot-and-a-covid-booster-can-i-get-them-at-the-same-time-204027">I need a flu shot and a COVID booster. Can I get them at the same time?</a>
</strong>
</em>
</p>
<hr>
<h2>So, where does COVID fit in?</h2>
<p>SARS-CoV-2, the virus that causes COVID, has demonstrated an ability to rapidly change since emerging in 2019. Although the early pandemic in Australia featured vaccine supply constraints, we now lucky to have many different vaccine options. </p>
<p>Recommendations currently favour updated mRNA “bivalent” boosters from Pfizer or Moderna, each containing equal parts of the original virus strain and an Omicron strain. </p>
<p>But the virus continues to change (currently XBB strains are <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/weekly-covid-overview-20230610.pdf#page=9">dominant</a>, and further updates to the composition of the vaccine are to be expected in the future (<a href="https://www.fda.gov/vaccines-blood-biologics/updated-covid-19-vaccines-use-united-states-beginning-fall-2023">most likely to target XBB.1.5</a>).</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1668393515670175744"}"></div></p>
<h2>That’s great, but I recently had COVID, so …</h2>
<p>Are you sure? Queuing for a PCR test seems like a fever dream from the past. Now, many of the RATs stacked in our cupboards are rapidly expiring. Influenza and RSV are <a href="https://www.abc.net.au/news/2023-05-08/rsv-flu-outbreak-hits-queensland-hard-cases-5-times-higher/102272112">back with gusto</a> (and cause similar symptoms). </p>
<p>If you did have confirmed COVID, <a href="https://www.cell.com/immunity/fulltext/S1074-7613(22)00238-2">our research</a> shows the majority of people mount a <a href="https://www.cell.com/immunity/fulltext/S1074-7613(23)00091-2">strong immune response</a> following each infection. </p>
<p>This means that once you recover, your immunity has been “updated” to reflect the virus variant that caused your infection and you will have higher protective antibody levels in your blood.</p>
<h2>Well, I definitely had something. What does that mean for my COVID booster?</h2>
<p>There are a couple of things to consider here. </p>
<p>Firstly, there is no such thing as “too much” immunity. Beyond the regular <a href="https://www.health.gov.au/our-work/covid-19-vaccines/advice-for-providers/clinical-guidance/adverse-events">side-effects of a vaccine</a>, there are no known additional risks to being re-vaccinated soon after an infection. </p>
<p>On the other hand, getting vaccinated quickly after recovery will not do much to further boost your immunity. <a href="https://www.health.gov.au/our-work/covid-19-vaccines/getting-your-vaccination/booster-doses">Current recommendations</a> are to wait six months after infection or your last dose before seeking another booster. </p>
<p>This allows your immune system time to rest, so that it can be effectively re-activated by vaccination. If you’d prefer to minimise your risk of COVID, and you don’t know what caused a recent illness, “<a href="https://www.health.gov.au/top-up-covid-19-protection">topping up</a>” your immunity via a booster may be the way to go.</p>
<h2>How should we balance booster shots and infections in the community?</h2>
<p>The short answer is, we need more information and time to figure that out. </p>
<p>Our communities now have high immunity (from both vaccines and infections), so balancing the risks and rewards of COVID boosters is increasingly complex. </p>
<p>Ultimately, your personal health care provider is best placed to offer specific advice. Generally however, those who are vaccinated (with three or more doses), younger (64 and under), and otherwise healthy have the least to gain.</p>
<p>For those who are older (especially over 65s) or who have health complications, regular COVID boosters are likely to be an important tool for staying healthy, especially over the winter season. While we still need more data, <a href="https://jamanetwork.com/journals/jama/fullarticle/2794072">multiple studies</a> suggest booster vaccines can <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00354-6/fulltext">reduce the risk</a> of developing long COVID, providing another reason to keep up-to-date. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1642752884738768898"}"></div></p>
<h2>The bottom line</h2>
<p>Unfortunately, COVID is among us and likely here for good. But like old mate influenza, we now have effective tools to blunt the impacts of COVID, and even better options will come through the pipeline to unlock further health improvements (like the transformative <a href="https://www.nature.com/articles/d41586-023-01529-5">new vaccines for RSV</a>). </p>
<p>For now, stay tuned to the latest <a href="https://www.health.gov.au/news/atagi-2023-booster-advice">advice from the Australian Technical Advisory Group on Immunisation</a> (ATAGI) about additional vaccine boosters and rest assured scientists and public health officials are still working to better understand how best to maintain high levels of population immunity via regular immunisation.</p><img src="https://counter.theconversation.com/content/207724/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Wheatley receives funding from NHMRC, MRFF and ARC. </span></em></p><p class="fine-print"><em><span>Jennifer Juno receives funding from the NHMRC, MRFF and NIH.</span></em></p>Firstly, there is no such thing as ‘too much’ immunity. Beyond the regular side-effects of a vaccine, there are no known additional risks to being re-vaccinated soon after an infection.Adam Wheatley, Laboratory Head, Department of Microbiology and Immunology, The University of MelbourneJennifer Juno, Laboratory Head, The Peter Doherty Institute for Infection and ImmunityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2072222023-06-14T20:11:24Z2023-06-14T20:11:24ZWhy does my back get so sore when I’m sick? The connection between immunity and pain<figure><img src="https://images.theconversation.com/files/531054/original/file-20230609-14782-rgga2o.jpg?ixlib=rb-1.1.0&rect=66%2C0%2C7282%2C4902&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-woman-back-ache-she-sitting-1056416144">Shutterstock</a></span></figcaption></figure><p>Have you ever wondered why your back aches when you’re down with the flu or a cold? Or COVID?</p>
<p>This discomfort, common during many illnesses, is not just a random symptom. It’s a result of complex interactions between your immune system and your brain called the “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314453/">neuroimmune synapse</a>”. </p>
<p>A fascinating and yet-to-be-understood consequence of this conversation between the immune and brain systems during sickness is that it is particularly noticeable in the <a href="https://academic.oup.com/brain/article/145/3/1098/6370954">lower back</a>. This is thought to be one of the body’s most sensitive regions to neuroimmune threats.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/turning-down-the-volume-of-pain-how-to-retrain-your-brain-when-you-get-sensitised-202850">Turning down the volume of pain – how to retrain your brain when you get sensitised</a>
</strong>
</em>
</p>
<hr>
<h2>Immunology basics</h2>
<p>Our immune system is a double-edged sword. Yes, it fights off infections for us – but it also makes us acutely aware of the job it is doing. </p>
<p>When our body detects an infection, our immune system releases molecules including signalling proteins called <a href="https://www.researchgate.net/publication/227831648_The_functions_of_cytokines_and_their_uses_in_toxicology">cytokines</a>. These proteins coordinate our immune system to fight off the infection and talk to our brain and spinal cord to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740752/#:%7E:text=Production%20of%20proinflammatory%20cytokines%20induces,to%20depression%20in%20vulnerable%20individuals.">change our behaviour</a> and physiology. </p>
<p>This can result in symptoms like fatigue, loss of appetite, fever and increased sensitivity to pain. Classically, we think of this as a beneficial behavioural change to help us conserve energy to fight off the infection. It’s why we often feel the need to rest and withdraw from our usual activities when we’re sick – and also why we are grumpier than usual. </p>
<h2>Invisibly small changes</h2>
<p>Part of this self-protective response is a change in how we perceive threats, including sensory stimuli. </p>
<p>When we are sick, touch can become painful and muscles can ache. Many changes in behaviour and sensory systems are <a href="https://doi.org/10.1159/000521476">believed</a> to have origins at the nanoscale. When molecular changes occur in part of the brain linked to cognition or mood, we think and feel differently. If these neuroimmune synapse changes happen in the sensory processing regions of the brain and spinal cord, we feel more pain. </p>
<p>Such sensory changes, known as <a href="https://www.iasp-pain.org/resources/fact-sheets/allodynia-and-hyperalgesia-in-neuropathic-pain/#:%7E:text=Allodynia%20is%20pain%20due%20to,stimulus%20that%20normally%20provokes%20pain.">allodynia and hyperalgesia</a>, can lead to heightened pain sensitivity, even in areas not directly affected by the infection – <a href="https://www.sciencedirect.com/science/article/abs/pii/S0889159114001731?via%3Dihub">such as the lower back</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/531056/original/file-20230609-19-371k1k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="man in bed takes own temperature and holds head" src="https://images.theconversation.com/files/531056/original/file-20230609-19-371k1k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531056/original/file-20230609-19-371k1k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531056/original/file-20230609-19-371k1k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531056/original/file-20230609-19-371k1k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531056/original/file-20230609-19-371k1k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531056/original/file-20230609-19-371k1k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531056/original/file-20230609-19-371k1k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Being sick can make you feel more sensitive to pain and grumpier.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fever-seasonal-flu-sick-africanamerican-man-1452615326">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Immune memories</h2>
<p>This immune response happens with a range of bacterial infections and viruses like COVID or the flu. In fact, the sick feeling we sometimes get after a vaccination is the good work our immune system is doing to contribute to <a href="https://theconversation.com/you-cant-get-influenza-from-a-flu-shot-heres-how-it-works-118916">a protective immune memory</a>. </p>
<p>Some of that immune-cellular conversation also alerts our brains that we are sick, or makes us think we are. </p>
<p>After some viral infections, the sick feeling persists longer than the virus. We are seeing a long-term response to COVID in some people, termed <a href="https://theconversation.com/when-does-covid-become-long-covid-and-whats-happening-in-the-body-when-symptoms-persist-heres-what-weve-learnt-so-far-188976">long COVID</a>. </p>
<p>Women, who generally have a <a href="https://www.nature.com/articles/nri.2016.90">stronger immune response</a> than men, may be more likely to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937378/">experience pain symptoms</a>. Their heightened immune response (while beneficial in resisting infections) also predisposes women to a higher risk of inflammatory conditions like <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980266/">autoimmune diseases</a>. </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>
</strong>
</em>
</p>
<hr>
<h2>When to worry and what to do</h2>
<p>If the pain is severe, persistent, or accompanied by other concerning symptoms, seek medical attention. Mild to moderate pain is a common symptom during illness and we often notice this in the lower back. The good news is it usually subsides as the infection clears and the sickness resolves.</p>
<p>While treating the underlying infection is crucial, there are also ways to dial down sickness-induced neuroimmune pain. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/531057/original/file-20230609-29-npjpw0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="bowl of chicken and vegetable soup" src="https://images.theconversation.com/files/531057/original/file-20230609-29-npjpw0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531057/original/file-20230609-29-npjpw0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531057/original/file-20230609-29-npjpw0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531057/original/file-20230609-29-npjpw0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531057/original/file-20230609-29-npjpw0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=514&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531057/original/file-20230609-29-npjpw0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=514&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531057/original/file-20230609-29-npjpw0.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"></a>
<figcaption>
<span class="caption">Grandma was right. Eat your soup.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/homemade-chicken-soup-turquoise-bowl-antique-229272709">Shutterstock</a></span>
</figcaption>
</figure>
<p>Maintaining a diverse microbiome (the collection of microorganisms living in and on your body) by <a href="https://pubmed.ncbi.nlm.nih.gov/31704402/">eating well and getting outside</a> can help. Getting quality sleep, staying hydrated and minimising inflammation <a href="https://karger.com/bbe/article/97/3-4/197/821576/Sickness-and-the-Social-Brain-How-the-Immune">helps too</a>. </p>
<p>Amazingly, there is <a href="https://pubmed.ncbi.nlm.nih.gov/34404209/">research</a> suggesting your grandmother’s traditional chicken broth recipe decreases the immune signals at the neuroimmune synapse. </p>
<p>Scientists are also <a href="https://pubmed.ncbi.nlm.nih.gov/24799686/">showing</a> mindfulness meditation, cold water therapy and controlled breathing can drive profound cellular and molecular changes to help activate bodily systems like the autonomic nervous system and alter the immune response. These practices might not only help manage pain but also add an anti-inflammatory component to the immune response, reducing the severity and duration of sickness. </p>
<p>Heat treatment (with a pack or hot water bottle) might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8401625/">provide some relief</a> due to increased circulation. Over-the-counter pain relief maybe also be helpful but seek advice if you are taking other medications.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/man-flu-is-real-but-women-get-more-autoimmune-diseases-and-allergies-77248">Man flu is real, but women get more autoimmune diseases and allergies</a>
</strong>
</em>
</p>
<hr>
<h2>All in the mind?</h2>
<p>Is this all mind over matter? A little of yes and a lot of no. </p>
<p>The little of yes comes from <a href="https://pubmed.ncbi.nlm.nih.gov/26194270/">research</a> supporting the idea that if you expect your breathing, meditation and cold bath therapy to work, it may well make a difference at the cellular and molecular level. </p>
<p>But by understanding the mechanisms of back pain during illness and by using some simple strategies, there is hope to manage this pain effectively. Always remember to seek medical help if your symptoms are severe or persist longer than expected. Your health and comfort are paramount.</p><img src="https://counter.theconversation.com/content/207222/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joshua W Pate is the author of the pain science children's book series titled Zoe and Zak's Pain Hacks.</span></em></p><p class="fine-print"><em><span>Mark Hutchinson is president of Science and Technology Australia and the research laboratory he leads is supported by the Australian Research Council, USDA, AFOSR, Lateral Pharma, Alyra Biotech, Regeneus, DMTC, and Defence Science Technology Group. He is a scientific advisor to Alyra Biotech and has ministerial appointments on the ARC CEO Advisory Committee and ARC legislative review. He has previously received payments for teaching from the NoiGroup.</span></em></p>Our immune system fights infection and has a nifty way to letting our brain know we are sick and should take it easy – but that can also be a pain.Joshua Pate, Senior Lecturer in Physiotherapy, University of Technology SydneyMark Hutchinson, Professor, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2062182023-06-09T10:09:03Z2023-06-09T10:09:03ZShould I get the flu vaccine? South African experts say yes - here’s why<figure><img src="https://images.theconversation.com/files/528335/original/file-20230525-29-xlo9ut.jpg?ixlib=rb-1.1.0&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>The winter months are synonymous with the flu in South Africa. Similar to other countries in the southern hemisphere, South Africa has an annual influenza season stretching from April to August. </p>
<p>Influenza (flu) is an acute respiratory illness caused by an infection of the respiratory tract with the influenza virus. Influenza is spread through respiratory droplets which you breathe in or can pick up from contaminated surfaces. People infected with the influenza virus how a wide range of symptoms such as sudden onset of fever, muscle pains and body aches, cough, sore throat, blocked or runny nose and headache. For most people, recovering from flu involves a few days of mild symptoms which resolve with symptomatic treatment. But for some, the flu can be deadly. </p>
<p>The World Health Organization (WHO) <a href="https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)">estimates</a> that there are over 1 billion flu cases occur each year. These include between three and five million cases of severe flu illness with people requiring hospitalisation and between 290,000 and 650,000 deaths each year. In severe cases influenza can spread to the lungs or weaken your lungs so that you get a bacterial infection. An infection of the the lower respiratory tract including the lungs is called pneumonia. In people with underlying heart or lung disease influenza infection can also cause worsening of these conditions. </p>
<p>Treatment for flu is mainly symptomatic. This includes bed rest and over the counter medicines to reduce fever like paracetemol. The best way to avoid getting ill is to get vaccinated. South Africa is currently <a href="https://www.nicd.ac.za/increase-in-flu-cases-across-the-country5-june-2023/">seeing a spike</a> in flu cases. As epidemiologists who <a href="https://www.nicd.ac.za/centres/centre-for-respiratory-disease-and-meningitis/">research</a> respiratory diseases, we urge those who haven’t had a flu vaccine yet to do so. This will help protect the individual and those around them from severe illness. </p>
<h2>Getting vaccinated</h2>
<p>The first reason you should strongly consider getting vaccinated against the flu if you haven’t done so yet is to protect yourself. Results from a <a href="https://academic.oup.com/cid/article/69/6/1036/5225193?login=true">modelling study</a> we conducted using 2013-2015 data estimated an average of 10,737,847 influenza-associated illnesses and 11,536 deaths every year in South Africa. </p>
<p>Flu vaccines remain the most effective method available to prevent flu illness, especially severe illness. The main reason to get the flu vaccine is to lower your risk of being sick with flu. </p>
<p>Most individuals infected with the flu virus will have mild illness. But certain groups of people are at risk of having severe flu illness or having flu complications or death. The flu vaccine has been <a href="https://stacks.cdc.gov/view/cdc/77654">shown</a> to lower the risk of severe illness or complications. </p>
<p>The groups who have a high risk of severe illness or complications include:</p>
<ul>
<li><p>pregnant women at any stage of pregnancy, including postpartum</p></li>
<li><p>individuals with chronic medical conditions (such as cardiac diseases, chronic renal diseases, diabetes mellitus)</p></li>
<li><p>immunocompromised people (such as people living with HIV, cancer patients) </p></li>
<li><p>elderly individuals (over 65 years).</p></li>
</ul>
<p>Individuals who fall in the groups above are strongly encouraged to get vaccinated for influenza each year. </p>
<p>Flu vaccination also prevents chronic health conditions from getting worse. For example, flu vaccination has been <a href="https://pubmed.ncbi.nlm.nih.gov/24150467/">associated</a> with lower rates of some cardiac events among people with heart disease. </p>
<p>If many people are vaccinated, it will also decrease the spread of influenza in communities. Specifically, health workers are encouraged to vaccinate as they are at risk of getting infected with influenza from their patients. They are also more likely to transmit the virus to their patients, who may be at risk of severe flu illness if not vaccinated.</p>
<h2>Not too late</h2>
<p>Ideally, flu vaccines should be administered ahead of the flu season around March or April as it takes approximately 14 days for the body to build immune responses to protect against infection. </p>
<p>However, it is never too late to get the flu vaccine as long as the influenza virus is circulating. It is recommended that people get vaccinated every year (season) because circulating vaccine strains differ each year. The previous vaccination may not protect against the new strain circulating. And the individual immunity wanes over time. </p>
<p><em>Namhla Bhenxa, an epidemiologist at the National Institute for Communicable Diseases, is the main contributor on this article.</em></p><img src="https://counter.theconversation.com/content/206218/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cheryl Cohen receives funding from United States Centres for Disease Control and Prevention and Wellcome Trust UK.</span></em></p><p class="fine-print"><em><span>Jocelyn Moyes and Sibongile Walaza 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>Flu vaccines remain the most effective method available to prevent flu illness, especially severe illness.Jocelyn Moyes, Medical Epidemiologist, National Institute for Communicable DiseasesCheryl Cohen, Co-head of the Centre for Respiratory Disease and Meningitis, National Institute for Communicable DiseasesSibongile Walaza, Medical Epidemiologist at the National Institute of Communicable Diseases and Lecturer at the School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2040272023-06-01T20:00:40Z2023-06-01T20:00:40ZI need a flu shot and a COVID booster. Can I get them at the same time?<figure><img src="https://images.theconversation.com/files/529244/original/file-20230531-23-t3j8la.jpg?ixlib=rb-1.1.0&rect=55%2C66%2C7293%2C4836&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/uN8TV9Pw2ik">CDC/Unsplash</a></span></figcaption></figure><p>Cases of influenza (the flu) and COVID are set to rise over winter, with many Australians looking to protect themselves from both of these respiratory viruses. </p>
<p>For most adults, if it has been <a href="https://www.health.gov.au/our-work/covid-19-vaccines/advice-for-providers/clinical-guidance/clinical-recommendations#timing-of-administration-of-other-vaccines-including-influenza-vaccine">six months</a> since you had COVID or your last vaccination, you’re likely eligible to book in your next dose. </p>
<p>Meanwhile, the flu vaccine is <a href="https://www.health.gov.au/news/2023-national-immunisation-program-influenza-vaccination-early-advice-for-vaccination-providers">recommended</a> for everyone over the age of six months.</p>
<p>But can you get both at once? Yes, you can get your flu vaccine and COVID booster safely at the same time, saving you a trip to the GP, nurse or pharmacy. </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>Why has the advice changed?</h2>
<p>When COVID vaccines were first rolled out, a gap was recommended between COVID and flu vaccines. This is because we didn’t have adequate data of the individual and long-term effects of the new COVID vaccines.</p>
<p>After examining the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8952219/">latest available evidence</a> on safety and efficacy, the World Health Organization updated its <a href="https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-vaccines-SAGE_recommendation-coadministration-influenza-vaccines">interim guidelines</a>. It suggests getting an influenza vaccine and any dose of any approved COVID vaccine at the same time is a practical option.</p>
<p>However, until more data becomes available, the WHO advises <a href="https://www.who.int/news/item/14-10-2022-influenza-in-the-northern-hemisphere-is-back">using different arms</a> for vaccination. This is to prevent the ingredients of the vaccines mixing and to limit the initial immune response to a different group of lymph nodes. </p>
<p>The <a href="https://www.coronavirus.vic.gov.au/sites/default/files/2022-05/Appendix34_Guidance_on_co-administration.pdf">Australian Technical Advisory Group on Immunisation</a> updated its vaccination guidelines in <a href="https://www.health.gov.au/sites/default/files/documents/2022/02/atagi-advice-on-seasonal-influenza-vaccines-in-2022.pdf">March 2022</a>, advising that influenza and COVID vaccines can be <a href="https://www.health.gov.au/sites/default/files/2023-03/2023-influenza-vaccination-program-advice-for-vaccination-providers.pdf">administered on the same day</a>. </p>
<figure class="align-center ">
<img alt="Clinician vaccinates man" src="https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.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">It’s practical to get both at once.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-american-black-female-doctor-prepares-1897028242">Shutterstock</a></span>
</figcaption>
</figure>
<h2>What happens when you get two shots at once?</h2>
<p>Getting multiple vaccinations at once isn’t new. Childhood vaccinations are routinely and safely administered at the same time.</p>
<p>For COVID and flu vaccines, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8952219/">randomised controlled trials</a> show no significant difference in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9746457/">immune responses</a> of the people who had both vaccines at once compared to those who had them on different days. </p>
<p>Participants who had both vaccines at once reported the same types of side effects from the body’s inflammatory response to vaccination (injection-site pain, redness, swelling at the injection site) as well as general symptoms associated with both COVID and flu vaccines, such as fever, muscle pain and a headache. </p>
<p>These minor side-effects were of similar intensity and duration to those who had either vaccine administered alone. </p>
<figure class="align-center ">
<img alt="Person sick with COVID or the flu sits in the dark" src="https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.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">
<figcaption>
<span class="caption">Side effects are similar when you have the vaccines individually or at once.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/d_mzrEx6ytY">Annie Sprat/Unsplash</a></span>
</figcaption>
</figure>
<p>Getting both COVID and flu vaccines is also more cost-effective, the uptake is higher when people don’t have to make multiple trips, and it saves health practitioners’ time. </p>
<hr>
<p>
<em>
<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>
</strong>
</em>
</p>
<hr>
<h2>What about the viruses? Can you get COVID and the flu at the same time?</h2>
<p>Although simultaneous infections with two different viruses are common, SARS-CoV-2 has been infecting humans for a relatively short time. We therefore have limited data on how influenza strains and SARS-CoV-2 interact with the host at the same time, and if there is any interaction between the viruses. </p>
<p>However, one <a href="https://pubmed.ncbi.nlm.nih.gov/33942104/">large study in England</a> reported that people positive for influenza had lower odds of also testing positive for SARS-CoV-2. This was attributed to possible <a href="https://pubmed.ncbi.nlm.nih.gov/36134660/">cross-reactive immunity</a> between viruses. </p>
<p>It did, however, find people infected with both viruses at the same time had worse outcomes and were twice as likely to die as those who were only infected with SARS-CoV-2. </p>
<p>Some experimental evidence <a href="https://pubmed.ncbi.nlm.nih.gov/33603116/">suggested</a> prior infection with type A influenza virus promotes SARS-CoV-2 entry and infectiousness. This could be due to a unique feature of the influenza A virus which allows COVID to take hold more easily. </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>Where can I get vaccinated and how much will it cost?</h2>
<p><a href="https://www.health.gov.au/sites/default/files/2023-03/2023-influenza-vaccination-program-advice-for-vaccination-providers.pdf">Influenza</a> and <a href="https://www.health.gov.au/our-work/covid-19-vaccines/who-can-get-vaccinated">COVID</a> vaccines are available at GP clinics and pharmacies. </p>
<p>Australians aged five years and over are eligible for a free COVID vaccination. The flu vaccine is free for people at higher risk of complications, including:</p>
<ul>
<li>pregnant women</li>
<li>people six months and older with selected chronic conditions</li>
<li>Aboriginal and Torres Strait Islander people. </li>
</ul>
<p>For the rest of the population, the flu vaccine costs around A$20-30. Some practitioners also charge a consultation fee. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1540220689273192449"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/im-over-65-and-worried-about-the-flu-which-vaccine-should-i-have-204810">I'm over 65 and worried about the flu. Which vaccine should I have?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/204027/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors 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>Cases of the flu and COVID are set to rise over winter, with many people looking to get vaccinated against both viruses.Vasso Apostolopoulos, Professor of Immunology and Pro Vice-Chancellor, Research Partnerships, Victoria UniversityMaja Husaric, Senior Lecturer; MD, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2048102023-05-31T20:07:11Z2023-05-31T20:07:11ZI’m over 65 and worried about the flu. Which vaccine should I have?<figure><img src="https://images.theconversation.com/files/529223/original/file-20230531-22-s5vazx.jpg?ixlib=rb-1.1.0&rect=8%2C516%2C2748%2C1322&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/Y5VBtBgswLQ">Philippe Leone/Unsplash</a></span></figcaption></figure><p>Influenza, or the flu, is a virus transmitted by respiratory droplets from coughing and sneezing. It can cause the sudden onset of a fever, cough, runny nose, sore throat, headache, muscle and joint pain. </p>
<p>In Australia, the flu is responsible for <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4004f.htm">more than 5,000 hospitalisation and 100 deaths</a> a year. The highest rates are among those over 65, whose immune systems aren’t as effective as they used to be, and children under five, whose immune systems are yet to mature. </p>
<p>To combat the decline in immunity as we age, specific vaccines are available for people aged 65 and over. So how do they work, and why exactly are they needed? </p>
<hr>
<p>
<em>
<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>
</strong>
</em>
</p>
<hr>
<h2>Remind me, how does the immune system work?</h2>
<p>The immune system uses multiple mechanisms to fight viral infections, which can be divided into two major arms of the immune system, called innate and adaptive immunity. </p>
<p>Innate immunity involves multiple inflammatory cells and chemicals that are triggered immediately, or within hours of encountering an infection. They activate the immune system to clear the infection. </p>
<p>Adaptive immunity takes a little longer (weeks) to work and involves memory T cells and antibody-producing B cells, which can be reactivated when the body encounters a virus or other pathogen.</p>
<p>The combined innate and adaptive immune response determines how well we respond to an invading virus like influenza. </p>
<h2>Why are older people more at risk from the flu?</h2>
<p>Generally, as we age past 65, the innate cells become less effective at their job of clearing infections. They also start <a href="https://www.annualreviews.org/doi/full/10.1146/annurev-cellbio-100616-060718">producing more inflammation</a>. </p>
<p>New T and B cell numbers also decrease with increasing age and hence the adaptive immune response is also not as effective as when we are younger. This immune system decline is called immunosenescence, which leads to increased susceptibility, hospitalisation and death from influenza. </p>
<figure class="align-center ">
<img alt="Older woman wearing a beanie sorts papers in her living room" src="https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.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">As we age, our immune system can’t clear infections as effectively.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/aODtyhXEAjg">Mariia Chalaya/Unsplash</a></span>
</figcaption>
</figure>
<p>Certain medical conditions, such as cancer and heart and lung conditions, increase susceptibility to severe influenza, with older people being more likely to have additional medical conditions than younger people.</p>
<h2>What flu vaccines are available?</h2>
<p><a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">Annual flu vaccines</a> are recommended to protect against the common circulating strains of influenza, which can differ from year to year. </p>
<p>The standard flu vaccines offered to adults aged under 65 consist of surface proteins of the virus or inactivated (killed) virus from four influenza strains: two A strains (H1N1 and H3N2) and two B strains. </p>
<p>When you’re vaccinated, your immune system makes antibodies from B cells which protect you if you become exposed to these strains of the virus. </p>
<p>However, the standard influenza vaccine is less effective in older people. </p>
<figure class="align-center ">
<img alt="Older people look out over an ocean" src="https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.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">The standard flu vaccines aren’t as effective for older people.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/sRAWQyoUiVQ">Katarzyna Grabowska</a></span>
</figcaption>
</figure>
<p>Two stronger or augmented vaccines have been made targeting this age group. They contain the same components as the standard vaccine, but one vaccine – called <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2020-CMI-01074-1&d=20230529172310101">Fluad</a> – uses a strong adjuvant (an agent used to increase the immune response to vaccination) called MF59 to stimulate better immunity. </p>
<p>The other augmented vaccine, called <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2020-CMI-02062-1">Fluzone</a>, uses a four-fold higher dose of each influenza strain to increase immunity. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-can-you-still-get-influenza-if-youve-had-a-flu-shot-184327">Why can you still get influenza if you've had a flu shot?</a>
</strong>
</em>
</p>
<hr>
<h2>How do they compare?</h2>
<p><a href="https://academic.oup.com/cid/article/73/11/e4251/5992287?login=false">Studies comparing Fluad and Fluzone</a> show both vaccines stimulate stronger immunity against influenza than the standard flu vaccine and are therefore likely to provide better protection. </p>
<p>Studies directly testing for improved clinical outcomes with vaccines for over-65s show a small benefit of receiving either of the vaccines over the standard vaccine, including a modest decrease in lab-confirmed influenza, <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(17)30235-7/fulltext">hospitalisations</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563546/">emergency department visits</a> compared to the standard influenza vaccine. </p>
<p>They are however yet to show and impact on flu-related deaths.</p>
<figure class="align-right ">
<img alt="Woman pushes mother in a wheelchair" src="https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1067&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1067&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1067&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1341&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1341&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1341&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fluad and Fluzone provide better protection for older people against the flu than the regular vaccine.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/yk7F8bdD0eU">Raychan/Unsplash</a></span>
</figcaption>
</figure>
<p>In the few studies comparing <a href="https://academic.oup.com/cid/article/73/11/e4251/5992287?login=false">Fluad and Fluzone directly</a>, there is little evidence of a difference between them in reducing influenza and serious flu outcomes. <a href="https://www.health.gov.au/resources/publications/atagi-advice-on-seasonal-influenza-vaccines-in-2023">The Australian Technical Advisory Group on Immunisation therefore recommends</a> using either Fluad or Fluzone.</p>
<p>While both have been Therapeutic Goods Administration (TGA) approved since 2020, only Fluad is available for free on the National Immunisation Program for people aged 65 and over. </p>
<p>Fluzone is only available with a private prescription if you’re 60 years and over, at a cost of around A$65-70. </p>
<p>If neither augmented vaccine is available, a standard influenza vaccine is also acceptable for older people, since any influenza vaccine is preferable to receiving none. </p>
<p>Flu vaccines can also be given at the same time as COVID vaccines. </p>
<h2>How else can we protect against the flu?</h2>
<p>While influenza vaccination is the single most effective way of preventing influenza, other measures such as social distancing and wearing a mask or N95 respirator can also provide some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779801/">community protection</a>.</p>
<p>Wearing a mask or N95 respirator significantly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779801/">reduces the risk</a> of infecting others when infected.</p>
<p>The evidence for protecting oneself against infection is less conclusive, mainly because it’s linked to early, consistent and, importantly, the <a href="https://cdn.who.int/media/docs/default-source/influenza/advice-on-the-use-of-masks-in-the-community-setting-in-influenza-a-(h1n1)-outbreaks.pdf?sfvrsn=24a45a95_1&download=true">correct use of masks</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/over-half-of-eligible-aged-care-residents-are-yet-to-receive-their-covid-booster-and-winter-is-coming-205403">Over half of eligible aged care residents are yet to receive their COVID booster. And winter is coming</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/204810/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Magdalena Plebanski receives Grant funding from National Health and Medical Research Council (NHMRC) to conduct fundamental immunology research on Flu and DTP vaccines in older adults. She conducts research on ovarian cancer, including a Phase II human trial part funded by Astrazeneca and ANZGOG (Australia and New Zealand Gynecological and Oncological Group). </span></em></p><p class="fine-print"><em><span>Katie Louise Flanagan receives funding from NHMRC, MRFF, BMGF and Clifford Craig Foundation. She was previously on Vaccine Advisory Boards for Seqiris (2016-19) and Sanofi-Pasteur (2016-18). She is President of the Australasian Society for Infectious Diseases and a member of the Australian Technical Advisory Group on Immunisation. These are her own personal views. </span></em></p><p class="fine-print"><em><span>Jennifer Boer and Kirsty Wilson 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>To combat the decline in immunity as we age, specific boosters are available for people aged over 65. Here’s how they work, and why they are needed.Magdalena Plebanski, Professor of Immunology, RMIT UniversityJennifer Boer, Postdoctoral Research Fellow, RMIT UniversityKatie Louise Flanagan, Infectious Diseases Specialist and Clinical Professor, University of TasmaniaKirsty Wilson, Postdoctoral Research Fellow, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2034062023-05-16T20:09:39Z2023-05-16T20:09:39ZShould I get a flu vaccine this year? Here’s what you need to know<figure><img src="https://images.theconversation.com/files/525558/original/file-20230511-27-mu2hpj.jpg?ixlib=rb-1.1.0&rect=53%2C152%2C5937%2C3835&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/photo-of-woman-holding-her-head-4064177/">Pexels/Marcus Aurelius</a></span></figcaption></figure><p>After having low rates of influenza (flu) transmission in recent years thanks to our COVID control strategies, case numbers are now rising. </p>
<p>So far this year, Australia has had <a href="https://www.immunisationcoalition.org.au/news-data/influenza-statistics/">more than 32,000</a> lab-confirmed cases of the flu and 32 deaths. </p>
<p>Getting a flu vaccine is the best way to protect against getting the flu. These are reformulated each year to protect against the most widely circulating strains – if our predictions are right. </p>
<p>Below you’ll find everything you need to know about the 2023 flu vaccine. But first, some flu basics. </p>
<hr>
<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>
</strong>
</em>
</p>
<hr>
<h2>What are the different types of flu?</h2>
<p>There are two main types of influenza: influenza A and influenza B. On the surface of the influenza virus there are two main proteins, the hemagglutinin (HA or H) and neuraminidase (NA or N).</p>
<p>Different strains are named after their versions of the H and N proteins, as in H1N1 or “swine flu”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">HA is the yellow spike, while the NA is the green oval.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/structure-influenza-virus-infographics-vector-illustration-542924464?src=ixiW0w-59I3I17RpN4L3wQ-1-12">Shutterstock</a></span>
</figcaption>
</figure>
<p>Minor changes in the proteins (HA and NA) on the surface are common because the enzyme the virus uses to make copies of itself is prone to errors. </p>
<p>Sometimes the influenza virus can change more abruptly when it mixes up components from different influenza viruses – including influenza viruses that typically infect birds, pigs or bats – to create a virus that’s basically new. </p>
<p>The regular change in the virus is the reason the vaccine is updated every year. The <a href="https://www.tga.gov.au/about-tga/advisory-bodies-and-committees/australian-influenza-vaccine-committee-aivc">Australian Influenza Vaccine Committee</a> meets late in the year to plan what should be included in the vaccine for the following season, after considering what happened in our last flu season and in the Northern hemisphere winter. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flu-or-covid-you-can-now-test-for-both-at-home-with-a-single-swab-heres-what-you-need-to-know-204119">Flu or COVID? You can now test for both at home with a single swab. Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>What strains does this year’s flu shot protect against?</h2>
<p>Modern flu vaccines typically protect against four strains. For this year’s vaccine, the committee <a href="https://www.tga.gov.au/resources/publication/meeting-statements/aivc-recommendations-composition-influenza-vaccines-australia-2023">has recommended</a> it includes:</p>
<ul>
<li><p>an A/Sydney/5/2021 (H1N1)pdm09-like virus</p></li>
<li><p>an A/Darwin/9/2021 (H3N2)-like virus</p></li>
<li><p>a B/Austria/1359417/2021 (B/Victoria lineage)-like virus </p></li>
<li><p>a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.</p></li>
</ul>
<p>The naming of the viral components can sometimes be confusing. The name is <a href="https://www.cdc.gov/flu/about/viruses/types.htm">derived from</a> the virus type (A or B)/the place it was first isolated/strain number/year isolated (virus subtype).</p>
<p>This year’s vaccine therefore includes an influenza A virus similar to the 2009 pandemic-causing H1N1 isolated from Sydney in 2021 and a second influenza A virus (H3N2) isolated in Darwin in 2021. </p>
<p>Influenza B viruses are classified into 2 lineages: Victoria and Yamagata. This year’s vaccine includes an influenza B isolated from Austria in 2021 (Victoria lineage) and an influenza B isolated in Phuket in 2013 (Yamagata lineage).</p>
<figure class="align-center ">
<img alt="People on a beach in Darwin" src="https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This year’s flu vaccine protects against a strain isolated in Darwin.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sunset-over-mindil-beach-darwin-northern-494537734">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Who should get a flu shot?</h2>
<p>Health authorities <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">recommend</a> everyone aged six months of age or over should get the flu vaccine every year.</p>
<p><a href="https://www.health.gov.au/news/2023-national-immunisation-program-influenza-vaccination-early-advice-for-vaccination-providers">Some groups</a> are at greater risk of significant disease from the flu and can access the flu vaccine for free. This includes:</p>
<ul>
<li><p>Aboriginal and Torres Strait Islander people aged six months and over</p></li>
<li><p>children aged six months to five years</p></li>
<li><p>pregnant women at any stage of pregnancy</p></li>
<li><p>people aged 65 years or over</p></li>
<li><p>people aged five years to 65 years who have certain underlying health conditions affecting the heart, lungs, kidneys or immune system, and those with diabetes. </p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-the-flu-shot-if-im-pregnant-96408">Should I get the flu shot if I'm pregnant?</a>
</strong>
</em>
</p>
<hr>
<h2>How can I get it?</h2>
<p>You can get a flu shot from your local general practice or pharmacy. Or you may have an opportunity to get vaccinated at your workplace if your employer supplies it. </p>
<p>While the vaccine is free for those in the <a href="https://www.health.gov.au/sites/default/files/2023-02/fighting-flu-starts-with-you-consumer-fact-sheet.pdf">above groups</a>, there can be a consultation or administration fee, depending on where you get your vaccine. </p>
<p>If you aren’t eligible for a free vaccine, it usually costs around A$20-$30.</p>
<figure class="align-center ">
<img alt="Nurse vaccinates woman" src="https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.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">Some people can get the shot for free, while others pay $20 to $30.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-african-american-woman-getting-flu-1906058728">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Are there different options?</h2>
<p>For over 65s, whose immune systems may not work as well as when they were younger, a <a href="https://www.health.gov.au/sites/default/files/2023-03/atagi-advice-on-seasonal-influenza-vaccines-in-2023.pdf">specific vaccine</a> is available that includes an adjuvant which boosts the immune response. This is free for over-65s under the national immunisation program.</p>
<p>A high-dose vaccine is also available for people aged 60 and over. However this isn’t currently funded and costs around $70 on a private prescription. </p>
<p>People with egg allergies can safely get the egg-based flu vaccine. However there is also a cell-based immunisation for people who don’t want a vaccine made in eggs. When vaccines are grown in eggs, sometimes the virus can change and this might affect the level of protection. Cell-based vaccines aim to address this issue. </p>
<p>The cell-based vaccine isn’t funded so patients will pay around $40 for a private prescription. </p>
<h2>How well do they work?</h2>
<p>The vaccine’s effectiveness depends on how well the strains in the vaccine match those circulating. It generally <a href="https://www.health.gov.au/resources/publications/aisr-2022-national-influenza-season-summary">reduces</a> the chance of being admitted to hospital with influenza by <a href="https://www.health.gov.au/sites/default/files/documents/2022/08/influenza-vaccine-efficacy-effectiveness-and-impact-explained.docx">30-60%</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-can-you-still-get-influenza-if-youve-had-a-flu-shot-184327">Why can you still get influenza if you've had a flu shot?</a>
</strong>
</em>
</p>
<hr>
<h2>What are the side effects?</h2>
<p>You can’t get the flu from the vaccine as there’s no live virus in it. </p>
<p>When people get a flu-like illness after the vaccine, it can be due to mild effects we sometimes see after vaccination, such as headaches, tiredness or some aches and pains. These usually go away <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine#possible-side-effects-of-influenza-vaccination">within a day or two</a>.</p>
<p>Alternatively, symptoms after getting a flu shot may be due to another respiratory virus such as respiratory syncytial virus (RSV) that circulates in winter. </p>
<h2>When’s the best time to get your flu shot?</h2>
<p>The vaccine provides <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu#vaccine-information">peak protection</a> around three to four months <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine#when-to-get-the-influenza-vaccine">after</a> you get it. </p>
<p>The <a href="https://www.immunisationcoalition.org.au/news-data/influenza-statistics/">peak of the flu season</a> is usually between June and September, however this changes every year and can vary in different parts of the country.</p>
<p>Given this, the best time to get the vaccine is usually around late April or early May. So if you haven’t already, now would be a good time to get it.</p><img src="https://counter.theconversation.com/content/203406/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Griffin has been a Medical Advisory Board Member including for AstraZeneca, GSK, MSD, Moderna, Biocelect/Novavax, Seqirus and Pfizer and has received speaker honoraria including from Seqirus, Novartis, Gilead, Sanofi, MSD and Janssen.
Paul Griffin is also a Director and Scientific Advisory Board Member of the Immunisation Coalition. </span></em></p>As people flock back to offices and pack public transport, we’re seeing more cases of the flu than in recent years. The flu shot isn’t perfect but it cuts your chance of being hospitalised.Paul Griffin, Associate Professor, Infectious Diseases and Microbiology, The University of QueenslandLicensed 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>
<hr>
<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>
</strong>
</em>
</p>
<hr>
<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/2025942023-04-12T12:09:29Z2023-04-12T12:09:29ZHuman metapneumovirus, or HMPV, is filling ICUs this spring – a pediatric infectious disease specialist explains this little-known virus<figure><img src="https://images.theconversation.com/files/520067/original/file-20230410-5874-jymbdf.jpg?ixlib=rb-1.1.0&rect=34%2C22%2C7634%2C4207&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Human metapneumovirus, or HMPV, peaks in North America from February to May, just on the heels of flu season.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-visiting-young-mother-at-home-for-routine-royalty-free-image/1471832871?phrase=children%20lung%20infection&adppopup=true">martin-dm/E+ via Getty Images</a></span></figcaption></figure><p>In the year 2000, Dutch scientists went on a mission of exploration – not to discover lands or riches, but to identify unknown causes of acute respiratory infections. </p>
<p>These illnesses, from the common cold to pneumonia, have been a plague on mankind throughout history. Most are caused by viruses, so if you’ve ever been told “you probably have a virus” by a clinician, they were likely correct. However, respiratory illnesses can be much more severe than simple colds.</p>
<p>Respiratory infections are the <a href="https://doi.org/10.1016/S0140-6736(12)60560-1">leading cause of death in children under 5 globally</a> and a major reason for hospitalization of children in developed countries. They are also a major cause of disease and death among people at high risk for severe disease, such as premature infants, older adults and those with underlying conditions. </p>
<p>However, meticulous research studies by many groups over decades had failed to identify a virus or bacteria in every person with an acute respiratory illness. Did this failure to detect a microbe result from tests that weren’t good enough, or viruses that doctors and scientists didn’t know about? The answer was partly the first; modern molecular tests are much better, so doctors find more known viruses. </p>
<p>But the Dutch group discovered a new virus, <a href="https://doi.org/10.1038/89098">human metapneumovirus</a>, abbreviated HMPV or MPV, which turns out to be a leading cause of respiratory infections. HMPV often presents like other common respiratory viruses, with congestion, cough and fever.</p>
<p>As a <a href="https://www.pediatrics.pitt.edu/people/john-v-williams-md">pediatric infectious disease specialist and virologist</a>, I have led my team in <a href="https://scholar.google.com/citations?user=Bar0h_8AAAAJ&hl=en">HMPV research for over 20 years</a>, and I’ve personally cared for many children with this infection. I’ve received emails from colleagues, clinicians and parents all over the country and the world with questions about severe and tragically fatal cases. </p>
<p>The U.S. saw a <a href="https://www.cdc.gov/surveillance/nrevss/hmpv/natl-trend.html">spike in HMPV detections</a> during the first few months of 2023. This trend is similar to the <a href="https://theconversation.com/rsv-treatments-for-young-children-are-lacking-but-the-record-2022-cold-and-flu-season-highlights-the-urgency-for-vaccines-and-other-preventive-strategies-195700">higher-than-normal case rates</a> of <a href="https://www.cdc.gov/surveillance/nrevss/rsv/natl-trend.html">respiratory syncytial virus, or RSV</a>, and influenza in the fall of 2022 and winter of 2023, likely related to decreased population immunity after two years of wearing face masks and social distancing. </p>
<p>Still, I find that many people even in health care are unfamiliar with this virus.</p>
<p><iframe id="eIbPJ" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/eIbPJ/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Origins of human metapneumovirus</h2>
<p>The human metapneumovirus was isolated from people with acute respiratory infection and sequenced in 2001 using a combination of specialized culture and molecular techniques.</p>
<p>It is related to RSV, which is the <a href="https://doi.org/10.1136/thoraxjnl-2018-212212">leading cause of serious respiratory infection in children</a> and a major problem in adults. Both viruses are in the same large group with measles, mumps and parainfluenza viruses, all of which are <a href="https://doi.org/10.1128/CMR.00015-11">leading causes of childhood disease</a>. </p>
<p>However, abundant data shows that HMPV is distinct from its cousin RSV in many ways. First, the order of genes in its <a href="https://doi.org/10.1006/viro.2001.1355">genome is quite different</a>. In addition, HMPV is missing two genes that RSV uses to overcome the immune response that would normally target it; yet HMPV has its own ways to <a href="https://doi.org/10.3390/v10090505">block immunity</a>.</p>
<p>Third, genetic analysis by several different groups shows that the <a href="https://doi.org/10.1099/vir.0.2008/006957-0">closest recent ancestor of HMPV</a> is a bird virus, <a href="https://doi.org/10.1099/vir.0.19043-0">avian metapneumovirus</a>. This is an agricultural pathogen of chickens and turkeys. Evolutionary and genetic analysis suggests that the human virus diverged from the bird virus <a href="https://doi.org/10.1371/journal.pone.0152962">several hundred years ago</a>. This is an example of a zoonosis: an <a href="https://theconversation.com/what-is-spillover-bird-flu-outbreak-underscores-need-for-early-detection-to-prevent-the-next-big-pandemic-200494">animal virus that jumps to humans</a>. In this case, HMPV became established as a permanent pathogen of humans. </p>
<p>Understanding how HMPV successfully made the leap might help predict which other animal viruses could be capable of transforming into primary human pathogens. The <a href="https://theconversation.com/as-bird-flu-continues-to-spread-in-the-us-and-worldwide-whats-the-risk-that-it-could-start-a-human-pandemic-4-questions-answered-200204">recent H5N1 bird flu outbreak</a> – which has been transmitted to humans only to a limited extent – illustrates this risk.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/sbkeFJOQhO4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">HMPV is a common respiratory illness during the spring months that can cause a narrowing of the airways, a barking cough and other nasty symptoms, particularly in children and older adults.</span></figcaption>
</figure>
<h2>HMPV in children</h2>
<p>Despite its being recognized only two decades ago, many studies have confirmed that HMPV is a major cause of respiratory infection in humans. Initial research groups focused on children and quickly discovered that HMPV caused respiratory infections in children worldwide, including <a href="https://doi.org/10.3201/eid0906.030017">Canada</a>, <a href="https://doi.org/10.3201/eid1708.051239">Australia</a>, <a href="https://doi.org/10.1128/JCM.42.1.126-132.2004">Japan</a>, <a href="https://doi.org/10.3201/eid0906.030009">Hong Kong</a>, <a href="https://doi.org/10.1097/INF.0b013e3180621192">South Africa</a> and <a href="https://doi.org/10.1086/383350">Argentina</a>. </p>
<p>Indeed, HMPV is a common cause of acute respiratory disease in children in <a href="https://doi.org/10.1016/S2214-109X(20)30393-4">every country</a> examined, and most children get the infection <a href="https://doi.org/10.1128/JCM.43.3.1213-1219.2005">for the first time by age 5</a>. One study using samples collected over 25 years in the U.S. found that HMPV was the <a href="https://doi.org/10.1056/NEJMoa025472">second most common</a> cause of lung infection in children after RSV. Other studies of multiple children’s hospitals in U.S. cities found that HMPV was the second most common cause of respiratory infections, leading to <a href="https://doi.org/10.1056/NEJMoa1204630">hospitalization</a> and <a href="https://doi.org/10.1056/NEJMoa1405870">pneumonia</a>.</p>
<p>Children with underlying risk factors, such as <a href="https://doi.org/10.2147/RRN.S76270">those born prematurely</a> and those with conditions like <a href="https://doi.org/10.1097/INF.0000000000002038">asthma</a>,
or those who have compromised immune systems, such as organ transplant recipients or children being treated for cancer, are at <a href="https://doi.org/10.1093/jpids/piu100">higher risk for severe HMPV</a>. Most children who become hospitalized with HMPV are otherwise healthy before they acquire it, yet <a href="https://doi.org/10.1093/jpids/piv027">many require intensive care</a> from the illness. </p>
<h2>Not just for kids</h2>
<p>HMPV is also a common cause of <a href="https://doi.org/10.1097/INF.0b013e3181684dac">serious lung infections among adults</a>. This is especially true in adults over 65 years old, or those with underlying conditions. A New York study over four winters found that HMPV was as common in hospitalized older adults as RSV or influenza, <a href="https://doi.org/10.1001/archinte.168.22.2489">with similar rates of ICU care and death</a>. </p>
<p>Studies over three winters in Nashville of adults over age 50 detected <a href="https://doi.org/10.1093/infdis/jis309">rates of HMPV hospitalization</a> and <a href="https://doi.org/10.1111/irv.12234">emergency department visits</a> that were similar to RSV and influenza. HMPV and RSV were more common than the flu in people 65 and older, presumably because many were vaccinated against the flu.</p>
<p>Another national study of adults hospitalized for pneumonia showed that <a href="https://doi.org/10.1056/NEJMoa1500245">HMPV was as common as RSV</a>, and nearly as common as influenza. As in children, HMPV is a particular problem for adults with chronic conditions such as <a href="https://doi.org/10.1086/444392">asthma</a>, <a href="https://doi.org/10.1002/cncr.30599">cancer</a> or <a href="https://doi.org/10.1016/j.jinf.2005.11.010">chronic obstructive pulmonary disease, also called COPD</a>.</p>
<p>Similar to the dire effects of flu and <a href="https://www.politico.com/news/2023/02/15/pandemic-nursing-home-covid-00082913">COVID-19 in nursing homes</a>, HMPV has also caused numerous outbreaks among vulnerable older adults in <a href="https://doi.org/10.3201/eid2502.181298">long-term care facilities</a>.</p>
<h2>Why HMPV is still so underrecognized</h2>
<p>Despite being a common cause of serious respiratory disease, HMPV remains underdiagnosed by clinicians and little recognized by the general population. Most people with an acute respiratory illness don’t get any testing, and if they do, only complex molecular testing can detect HMPV. But this testing is usually done only for hospitalized patients under select circumstances. </p>
<p>People tend to believe what they see, and therefore even health care professionals are most aware of diseases they test for frequently. But HMPV circulates predictably every year, and in North America the <a href="https://doi.org/10.1056/NEJMoa025472">peak is typically February through May</a>. So if you’ve had a cold recently this winter or spring, <a href="https://www.cdc.gov/surveillance/nrevss/hmpv/natl-trend.html">HMPV was a likely culprit</a>. Children’s hospitals around the country are seeing an <a href="https://time.com/6264539/respiratory-virus-not-covid-spring-2023/">increased number of cases</a>, including many in the ICU. Based on past research, this is almost certainly happening in adults too – it’s just that usually only those patients with severe illness are tested for HMPV. </p>
<h2>A dearth of treatments</h2>
<p>Right now, there are no specific antiviral drugs to treat HMPV as there are for flu and COVID-19. As with the many other respiratory viruses that cause colds, most infected people will do just fine with rest and fluids. </p>
<p>But some may develop trouble breathing and need to seek medical attention. Children or adults with serious underlying conditions should be especially careful, and just as with COVID-19, using hand sanitizer and washing hands can <a href="https://theconversation.com/yes-we-should-be-keeping-the-healthier-hand-washing-habits-we-developed-at-the-start-of-the-pandemic-169892">reduce transmission</a>.</p>
<p>Preventive vaccines and antibodies for HMPV are <a href="https://doi.org/10.1128/CVI.00230-15">in development</a> but are still a way off. So, for the moment, wear a mask if you’re sick and avoid others who are sick. You may dodge a repeat engagement with this virus that you’ve had but hadn’t heard of.</p><img src="https://counter.theconversation.com/content/202594/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John V. Williams receives funding from the NIH and CDC. He previously served on a scientific advisory board for Quidel and an independent data monitoring committee for GlaxoSmithKline, neither related to the subject of the article. </span></em></p>Similar to the patterns seen with COVID-19, flu and RSV, HMPV is making a comeback after years of being repressed by people wearing masks and social distancing.John V. Williams, Professor of Pediatrics, Microbiology and Molecular Genetics, University of PittsburghLicensed 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>
</strong>
</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>
<hr>
<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/1993712023-02-13T16:50:52Z2023-02-13T16:50:52ZBird flu continues to spread in mammals – what this means for humans and wildlife<p>As bird flu continues to decimate poultry and wild bird populations <a href="https://www.france24.com/en/environment/20230113-largest-global-bird-flu-outbreak-in-history-shows-no-sign-of-slowing">around the world</a>, the virus – a deadly strain called H5N1 – appears to be spreading to mammals. The virus has already been confirmed in foxes and otters in the UK, and more recently in <a href="https://www.gov.uk/government/publications/bird-flu-avian-influenza-findings-in-non-avian-wildlife/confirmed-findings-of-influenza-of-avian-origin-in-non-avian-wildlife">four dead seals</a>.</p>
<p>Bird flu refers to influenza A viruses that mainly infect birds. These viruses naturally circulate in wild waterfowl, usually without causing any symptoms. </p>
<p>But when they spread into poultry, some subtypes of the virus can evolve into forms that are highly infectious and deadly (classified as “highly pathogenic”), and can rapidly spread and kill domestic birds. </p>
<p>The H5N1 virus causing the current outbreak is one such highly pathogenic virus. Since its emergence in 1996, scientists have feared it poses a <a href="https://www.theguardian.com/uk-news/2021/dec/29/uk-health-chiefs-expected-imminent-pandemic-in-1997">pandemic threat</a>. The virus has shown a propensity to jump to humans (called “spillover”) with a high mortality rate. </p>
<p>World Health Organization (WHO) <a href="https://www.who.int/docs/default-source/wpro---documents/emergency/surveillance/avian-influenza/ai_20230106.pdf?sfvrsn=5f006f99_108">figures</a> show that between January 2003 to November 2022, there have been 868 cases of human infection with H5N1, more than half of which were fatal.</p>
<p>The foxes and otters that died were probably exposed to the virus by scavenging infected dead birds. The bodies of these birds have very high amounts of virus. Exposure to such a large dose might explain how the virus was able to overcome the species barrier. </p>
<p>Given that these cases occurred seemingly singly in different locations and times, they are probably dead ends – that is, unlikely to have caused further transmission in mammals. Evidence in the cases of seals in the UK also points to spillover (the virus going from birds to seals) rather than spread (going from seal to seal).</p>
<p>In contrast, the outbreak reported in a <a href="https://www.science.org/content/article/incredibly-concerning-bird-flu-outbreak-spanish-mink-farm-triggers-pandemic-fears">Spanish mink farm in October 2022</a> is more worrying. It is more likely that it spread from mink to mink due to the cramped conditions in which the animals live. Over 50,000 mink had to be euthanised.</p>
<p>Viruses from the mink appear to have <a href="https://doi.org/10.2807/1560-7917.ES.2023.28.3.2300001">acquired several changes</a> in their genes, at least one of which may help it grow better in mammals. How the virus spread to mink is not clear, but it is known that farmed mink are often <a href="https://www.nytimes.com/2023/02/08/health/avian-flu-mink-h5n1.html">fed raw poultry</a>. They are also not completely isolated from contact with other animals, such as wild birds.</p>
<figure class="align-center ">
<img alt="Mink in a cage." src="https://images.theconversation.com/files/509458/original/file-20230210-26-t5exqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509458/original/file-20230210-26-t5exqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509458/original/file-20230210-26-t5exqi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509458/original/file-20230210-26-t5exqi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509458/original/file-20230210-26-t5exqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509458/original/file-20230210-26-t5exqi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509458/original/file-20230210-26-t5exqi.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">Bird flu spread among mink is more concerning.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/farmed-american-mink-383860660">Lynsey Grosfield/Shutterstock</a></span>
</figcaption>
</figure>
<p>In the wild, the virus has also recently been implicated in the <a href="https://www.cidrap.umn.edu/avian-influenza-bird-flu/peru-confirms-h5n1-avian-flu-marine-mammals-part-southward-spread#:%7E:text=In%20a%20follow%2Dup%2C%20SENASA,as%20the%20cause%20of%20death.">mass death of sea lions in Peru</a> in seven protected marine areas. And there are reports of the virus killing hundreds of seals in the <a href="https://inews.co.uk/news/politics/mass-death-of-seals-raises-fears-bird-flu-is-jumping-between-mammals-threatening-new-pandemic-2121376">Caspian Sea</a>, off the coast of Dagestan in Russia. If confirmed, the number of animals involved would suggest mammalian transmission.</p>
<p>All these infections do not mean that a virus capable of causing a pandemic will emerge. But the growing range of the virus gives more opportunities for it to evolve and for humans to come into contact with it.</p>
<p>H5N1 is a long-anticipated threat. Even so, having a clear idea of its evolution will help design more effective vaccines and treatments. Additionally, the virus is already having a devastating effect on wildlife and could spread to further endangered species. </p>
<p>Therefore, surveillance – testing for the virus and sequencing samples from animals and humans at high risk of exposure – is crucial. We also need to consider vaccinations in obvious sources such as poultry and shutting down mink farms entirely.</p>
<p>“Since H5N1 first emerged in 1996, we have only seen rare and non-sustained transmission of H5N1 to and between humans,” Tedros Adhanom Ghebreyesus, director general of the WHO, said in a <a href="https://www.who.int/news-room/speeches/item/who-director-general-s-opening-remarks-at-the-media-briefing---8-february-2023">press briefing</a> last week. “But we cannot assume that will remain the case, and we must prepare for any change in the status quo.”</p><img src="https://counter.theconversation.com/content/199371/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Divya Venkatesh receives funding from the Biotechnology and Biological Sciences Research Council (BBSRC). </span></em></p>Bird flu has been confirmed in four dead seals in Scotland.Divya Venkatesh, Research Fellow, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1958072023-02-07T13:33:23Z2023-02-07T13:33:23ZHow do you make a universal flu vaccine? A microbiologist explains the challenges, and how mRNA could offer a promising solution<figure><img src="https://images.theconversation.com/files/508472/original/file-20230206-31-mtkppf.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2309%2C1299&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Broad protection from a universal flu vaccine could replace seasonal flu shots.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/influenza-vaccine-vials-pattern-background-royalty-free-image/1365216790">Flavio Coelho/Moment via Getty Images</a></span></figcaption></figure><p>To everything there is a season, and for the flu, it’s wintertime. Flu cases <a href="https://www.cdc.gov/flu/about/season/flu-season.htm">peak between December and February</a>, and the flu vaccine is your best defense. Getting the vaccine means you <a href="https://www.cdc.gov/flu/prevent/keyfacts.htm">will be less sick</a> even if you get a breakthrough infection. </p>
<p>However, your immune system is in a constant race against the flu virus. Like the virus that causes COVID-19, influenza rapidly changes and mutates into new variants, so manufacturers have to update the flu shot to <a href="https://www.doi.org/10.1126/science.aaq0105">try to keep pace</a>. After identifying a new flu variant, it takes manufacturers about six months to update the vaccine – and in the meantime the virus can mutate again. This phenomenon is called <a href="https://doi.org/10.1146/annurev-virology-010320-044746">antigenic drift</a>, and can reduce the effectiveness of the flu vaccine for that season. </p>
<p>An ongoing threat is that a major change in the flu virus, or <a href="https://www.cdc.gov/flu/about/viruses/change.htm">antigenic shift</a>, could cause the next flu pandemic. This happens when a flu virus from animals, such as birds or swine, gains the ability to transmit between humans. Most people will have no immunity against this new animal-origin virus, so it could quickly spread into a pandemic. If that happens, the annual flu shot will not be effective and can’t be updated fast enough to stop a global spread.</p>
<p><a href="https://scholar.google.com/citations?user=eNprtJEAAAAJ&hl=en">I am a researcher</a> developing new vaccines to prevent future pandemics. Nearly 20 years ago, my lab and several others developed a vision of building a <a href="https://doi.org/10.1101%2Fcshperspect.a028845">universal influenza vaccine</a> that could give us the leading edge in the race against influenza and prevent the next flu pandemic by effectively combating any eventual flu strain. One potential way to do this is with messenger RNA, or mRNA.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/0k1Qg9OlfRs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A primary challenge in developing vaccines against influenza is how rapidly the virus mutates.</span></figcaption>
</figure>
<h2>What is a universal influenza vaccine?</h2>
<p>A universal influenza vaccine is one that does not need to be updated each year because it is designed to protect against all or most influenza variants. Scientists are exploring several ways to develop universal influenza vaccines. Most fall into <a href="https://doi.org/10.1093/infdis/jiy103">one of two buckets</a>. </p>
<p>The first includes vaccines that focus on conserved, or unchanging, parts of the virus. This strategy directs the immune system against parts of the virus, or antigens, that are shared among all variants and can’t mutate without weakening or killing the virus.</p>
<p>The second includes mosaic vaccines. These are like a cocktail of protein pieces taken from different variants. The blend is made up of versions of the protein hemagglutinin – essential to the influenza virus’s ability to infect cells – that is found in all flu variants circulating in animals and people. The goal is to induce immunity against nearly all variants so there will be fewer gaps in the immune system’s defenses for the virus to slip through.</p>
<h2>Using mRNA for a universal flu vaccine</h2>
<p>The recent success of mRNA vaccines for COVID-19 shows promise for their use in achieving the vision of an effective universal influenza vaccine. </p>
<p>There are 20 known subtypes of influenza. Prior to the development of mRNA vaccines, it wasn’t feasible to make a single flu vaccine against all 20 subtypes due to the complexities and costs in manufacturing. Unlike traditional vaccines, constructing and producing mRNA vaccines is rapid and simple because manufacturers don’t have to produce and purify the protein directly. Instead, mRNA vaccines provide the genetic sequence of the protein and then use the body’s own cells to generate that protein <a href="https://doi.org/10.1073/pnas.2123477119">in its natural structure</a>. This makes it relatively easy to incorporate any antigen or many antigens.</p>
<p>Recently, a team of researchers <a href="https://doi.org/10.1126/science.abm0271">designed a mosaic mRNA vaccine</a> with sequences from multiple versions of the hemagglutinin protein, each representing one of the 20 influenza subtypes. This vaccine induced broad immunity against each variant in mice and ferrets.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/z0kfdZ8o_j4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">mRNA vaccines circumvent some of the manufacturing challenges traditional vaccines face.</span></figcaption>
</figure>
<p>Several research groups are also exploring the conserved antigen approach with mRNA vaccines. Animal studies have shown that it’s possible to design mRNA vaccines that can both focus immune responses against highly conserved, vulnerable parts of the virus and <a href="https://doi.org/10.1126/sciadv.adc9937">induce</a> <a href="https://doi.org/10.1016/j.ymthe.2020.04.018">broad immunity</a> against a wide range of different influenza subtypes. These include <a href="https://doi.org/10.1073/pnas.2206333119">avian flu viruses</a> that share many genetic sequences with human influenza. </p>
<p>Another promising approach uses <a href="https://give.uwmedicine.org/stories/designing-a-pandemic-free-future/">computational modeling</a> to leverage both conserved and mosaic approaches. This strategy displays multiple hemagglutinins from different influenza subtypes <a href="https://doi.org/10.3389/fimmu.2019.00022">on a nanoparticle</a>. Nanoparticles are structures that give researchers more precise control over how the immune system sees the viral antigens, subsequently allowing them to induce stronger immune responses against multiple variants. Here, both conserved and variable regions of the virus are exposed to the immune system and can lead to <a href="https://doi.org/10.1038/s41586-021-03365-x">broad immunity</a>.</p>
<h2>Obstacles to a universal flu mRNA vaccine</h2>
<p>There are still several challenges before a universal influenza mRNA vaccine can be made available. </p>
<p>For one, it is not clear which conserved antigens provide the broadest protection, and some don’t naturally induce strong immune responses. So, mRNA vaccines may need improvements like additional components that help activate immune cells. One such addition could include <a href="https://doi.org/10.1073/pnas.2217533119">using mRNA to express nanoparticles</a> that stimulate stronger immune responses against the conserved antigens presented by the vaccine.</p>
<p>The mosaic approach is also limited by the <a href="https://doi.org/10.1056/NEJMoa2022483">maximum dose possible</a> for mRNA vaccines, because higher doses could cause increased adverse reactions to the vaccine. When that dose gets divided into 20 or more antigens, the dose of one or more of those antigens may drop below the threshold needed for protection.</p>
<p>Scientists are working on these challenges, including by developing <a href="https://doi.org/10.1126/science.abq6562">new mRNA technologies</a> that work with a much lower dose. If mRNA vaccines work for universal protection from influenza, the same strategies could also <a href="https://theconversation.com/how-mrna-and-dna-vaccines-could-soon-treat-cancers-hiv-autoimmune-disorders-and-genetic-diseases-170772">apply to other frequently mutating viruses</a>, such as the virus that causes COVID-19 and maybe even HIV.</p>
<p>In the meantime, mRNA vaccines may soon <a href="https://doi.org/10.1073/pnas.2217533119">usher in a new era</a> of more effective annual flu vaccines by providing a better match to each flu season’s new variants. <a href="https://www.clinicaltrialsarena.com/features/mrna-vaccine-trials-to-watch/">Two seasonal influenza mRNA vaccines</a> are currently in human clinical trials. If successful, they may offer more effective protection from the annual flu than our current flu vaccines. With mRNA vaccines, I believe that we are at the beginning of starting a new race against flu that we may finally win.</p><img src="https://counter.theconversation.com/content/195807/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Fuller is a co-founder of Orlance, Inc. a biotechnology company developing a needle-free delivery technology for DNA and RNA vaccine. She also serves as a consultant for HDT Bio, a biotechnology company developing nanoparticle-based formulations to deliver RNA vaccines and Abacus Inc., a therapeutic vaccine company developing B cell targeted therapies for chronic infectious diseases and cancer. She receives grant funding from the National Institutes of Health, the Washington Research Foundation and the Department of Defense.</span></em></p>Annual flu vaccines are in a constant race against a rapidly mutating virus that may one day cause the next pandemic. A one-time vaccine protecting against all variants could give humanity a leg up.Deborah Fuller, Professor of Microbiology, School of Medicine, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1957182022-12-16T13:13:54Z2022-12-16T13:13:54Z1918 flu pandemic upended long-standing social inequalities – at least for a time, new study finds<figure><img src="https://images.theconversation.com/files/499388/original/file-20221206-16-lo9q7q.jpg?ixlib=rb-1.1.0&rect=0%2C220%2C3000%2C1742&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In this November 1918 photo, a nurse tends to a patient in the influenza ward of the Walter Reed hospital in Bethesda, Md. </span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreak1918InfluenzaCOVID19/97d84472fcad44449444ae3b7cc5f539/photo?Query=1918%20flu&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=91&currentItemNo=29">AP Photo/Harris & Ewing via Library of Congress</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Racial disparities in <a href="https://doi.org/10.1215/00703370-10235825">influenza deaths shrunk by 74% in U.S. cities</a> during the <a href="https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html">1918 flu pandemic</a> due to an odd coincidence of virus and history. That’s the key finding of our recently published study in the journal Demography. </p>
<p>This conclusion contradicts the <a href="https://tidsskriftet.no/2017/05/global-helse/social-inequality-forgotten-factor-pandemic-influenza-preparedness">common claim</a> that crises like pandemics <a href="https://doi.org/10.1073/pnas.2020685118">make social inequalities worse</a>. The 1918 influenza pandemic was a surprising exception. </p>
<p>Prior to the 1918 pandemic, Black people in the U.S. died of respiratory diseases <a href="https://doi.org/10.1007/s13524-019-00789-z">at vastly higher rates</a> than white people. But our study found that urban white people in their 20s and 30s were especially vulnerable to the 1918 virus, dying at rates that were up to 20 times higher than normal. While the death rates of Black people in urban settings also spiked during the 1918 pandemic, they did so by a much smaller rate than in white populations. On average, across all age groups, white mortality increased fivefold, while Black mortality increased threefold.</p>
<p>Overall, Black people <a href="https://doi.org/10.7326/M20-2223">still died at higher rates</a> than white people during the 1918 pandemic, but the ratio of Black-to-white mortality – a measure of racial inequality – <a href="https://doi.org/10.3390/ijerph16142487">shrank dramatically</a> compared with other time periods. So while 1918 was wildly deadly across the world, the death rate among urban white young adults in the U.S. was truly unprecedented.</p>
<p><iframe id="i69Ni" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/i69Ni/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Why it matters</h2>
<p>One anomalous feature of the pandemic is well known: It <a href="https://doi.org/10.1371/journal.pone.0069586">killed many young adults</a> alongside children and elderly people, who are traditionally at risk from flu viruses.</p>
<p>But the unusually small racial inequality in flu deaths in the U.S. in 1918 is a little-known puzzle that contrasts with modern pandemics <a href="https://doi.org/10.1073/pnas.2205813119">like COVID-19</a> <a href="https://doi.org/10.2105/AJPH.2009.170241">and HIV</a>, which have hit Black communities especially hard. It also contrasts with a global tendency for <a href="https://doi.org/10.1186/s13643-018-0931-2">poorer populations to be more likely</a> to die from the flu.</p>
<p>Our study considered several hypotheses to explain the surprising patterns in the U.S. during the 1918 pandemic. One such potential explanation was that policies like school closures especially benefited Black populations because of their higher risk of dying from the flu in nonpandemic years when such measures were absent.</p>
<p>But only one explanation fits our evidence: Urban white young adults in the U.S. were deeply vulnerable in 1918 because of the way their immune systems had been programmed during childhood in the late 19th century. This is because the first flu people encounter as children is special: <a href="https://doi.org/10.1126/science.aag1322">It teaches the immune system</a> how to respond to future flu infections. However, research shows that this so-called immunological imprinting <a href="https://doi.org/10.1016/j.jaut.2017.04.008">can be harmful</a> when the virus someone later encounters is very different from the virus their immune system has been trained against.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/U6Ccdk5wPvk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The 1918 flu pandemic killed at least 50 million people worldwide.</span></figcaption>
</figure>
<p>The last flu pandemic to hit U.S. cities before 1918 was a <a href="https://doi.org/10.1073/pnas.1000886107">devastating global pandemic</a> that began in 1889. Exposure to that virus would have taught children’s immune systems to expect <a href="https://doi.org/10.1073/pnas.1324197111">what was probably an H3N8 flu</a>. But the devastation in 1918 was caused by the world’s first H1N1 pandemic. The two strains belong to two different groups of influenza viruses, and immune protection from H3N8 would not have conferred protection against H1N1. </p>
<p>To the contrary: People whose first flu exposure occurred in the 1890s would have likely had a compromised immune response to the 1918 pandemic because their immune system produced the wrong kind of antibodies that <a href="https://doi.org/10.1038/s41467-021-23977-1">crowded out more effective ones</a>.</p>
<p>In <a href="https://doi.org/10.1371/journal.pone.0069586">2013</a> and <a href="https://doi.org/10.1073/pnas.1324197111">2014</a> studies, two groups of virologists and demographers proposed and tested the hypothesis that 1890s imprinting explains the unusually high mortality of young adults during the 1918 pandemic. We adapted their argument to explain unusually small racial disparities as well. </p>
<p>This hypothesis suggests that the pattern of Black and white deaths in 1918 revolves around a historical coincidence. Black young adults were more often spared this fateful imprinting because they spent their childhoods in rural areas. As a result, though they often lived in deep poverty, they did not encounter some of the respiratory diseases that were rampant in cities. So while they were vulnerable to 1918’s novel flu, they were less so than people whose immune systems were primed to meet a virus like the one that circulated in the 1890s. </p>
<h2>What still isn’t known</h2>
<p>Immunologists are only beginning to understand the exact mechanisms through which imprinting affects long-term immune responses. Recent studies about the <a href="https://doi.org/10.3390/v11020122">early 20th century</a> and the <a href="https://doi.org/10.1038/s41467-021-23977-1">COVID-19 pandemic</a> support the idea that imprinting can significantly affect immune responses later in life. We all carry in our bodies the memories of our past disease exposures. </p>
<p>Those exposures <a href="https://doi.org/10.1007/s13524-019-00789-z">changed radically</a> during the 20th century, and the full consequences for population immunity in the COVID-19 era remain to be unraveled.</p><img src="https://counter.theconversation.com/content/195718/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Wrigley-Field receives funding from the Minnesota Population Center, which is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number P2C HD041023).</span></em></p><p class="fine-print"><em><span>Martin Eiermann 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>During the 1918 flu pandemic, white people died at similar rates to Black Americans, according to a new study – a very different pattern than what occurred during the COVID-19 pandemic.Elizabeth Wrigley-Field, Assistant Professor of Sociology, University of MinnesotaMartin Eiermann, Postdoctoral Fellow in Sociology, Duke UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1946022022-11-29T17:21:01Z2022-11-29T17:21:01ZFour tips to avoid your office Christmas party turning into a superspreader event<figure><img src="https://images.theconversation.com/files/496588/original/file-20221121-12-8lwthl.jpg?ixlib=rb-1.1.0&rect=0%2C9%2C3100%2C2055&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/friends-having-party-smiling-people-on-2227501327">Undrey/Shutterstock</a></span></figcaption></figure><p>With Christmas just a month away, the <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1116648/Weekly_Flu_and_COVID-19_report_w45.pdf">good news</a> is that COVID cases in the UK have been falling, and are now at the lowest we’ve seen them for some time. </p>
<p>Meanwhile, the number of new <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1116648/Weekly_Flu_and_COVID-19_report_w45.pdf">flu infections</a> remains stable. And people in their 20s and 30s have some of the lowest case numbers of both viruses – great if you’re planning your work Christmas party or just fancy getting together with your friends this festive season. </p>
<p>However, while flu rates are relatively stable, they are higher than they have been <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1116648/Weekly_Flu_and_COVID-19_report_w45.pdf">for the past few years</a>, and <a href="https://www.health.gov.au/resources/collections/aisr">data from Australia</a> suggests the UK could face an earlier and more severe flu season this year. Plus, last year, COVID cases <a href="https://www.theguardian.com/world/2021/dec/23/uk-records-119789-new-covid-cases-in-one-day-its-highest-total-ever">increased 139%</a> in the two weeks leading up to Christmas. </p>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?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"></span>
</figcaption>
</figure>
<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/how-to-disagree-without-making-enemies-in-the-age-of-the-pandemic-tips-from-a-psychologist-187826?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">How to disagree without making enemies in the age of the pandemic – tips from a psychologist</a></em></p>
<p><em><a href="https://theconversation.com/five-reasons-why-young-people-should-get-a-covid-booster-vaccine-189411?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Five reasons why young people should get a COVID booster vaccine</a></em></p>
<p><em><a href="https://theconversation.com/four-reasons-the-shift-to-hybrid-working-is-set-to-stay-for-young-professionals-186013?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Four reasons the shift to hybrid working is set to stay for young professionals</a></em></p>
<hr>
<p>Add in the fact that it looks <a href="https://www.biorxiv.org/content/10.1101/2022.09.15.507787v4">unlikely</a> that your past COVID infections or vaccinations will offer much protection against new omicron variants, and the Christmas sparkle is slightly dimmed.</p>
<p>But if you’re wanting to celebrate after two years of curtailed festivities, don’t despair. There are a few things you can do to minimise the risk of COVID or flu ruining your Christmas party. </p>
<h2>1. Location, location, location</h2>
<p>Thinking carefully about the location of your Christmas celebration can really help prevent the spread of influenza and COVID viruses. Both <a href="https://pubmed.ncbi.nlm.nih.gov/17283614/">flu</a> and <a href="https://www.nature.com/articles/d41586-022-00925-7">COVID</a> are spread by small liquid droplets when we breathe, speak, cough and sneeze.</p>
<p>Somewhere outdoors like an open-air ice rink or rooftop bar is the perfect choice. A <a href="https://www.medrxiv.org/content/10.1101/2020.02.28.20029272v2">preprint</a> (a study not yet peer-reviewed) based on contact tracing data found that the odds of transmitting COVID in a closed environment were 18.7 times greater compared with an open-air environment.</p>
<p>Large infection events or “superspreader” events happen <a href="https://www.nature.com/articles/d41586-021-00460-x">most often</a> in venues that are more densely occupied and where people spend a longer time. On a smaller scale, COVID infections have been found to develop in distinct clusters in <a href="https://wwwnc.cdc.gov/eid/article/26/8/20-1274_article">crowded indoor spaces</a>. So it might be worth rethinking if you were going to hold your Christmas party in a “cozy” basement bar and instead brave the winter chill <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164734/">outside</a>.</p>
<h2>2. The guest list</h2>
<p>Limiting the number of people who could meet was of course used as a way to limit the spread of COVID <a href="https://www.gov.uk/government/news/rule-of-six-comes-into-effect-to-tackle-coronavirus">earlier in the pandemic</a>. Even though these rules are no longer in place, it’s worth thinking twice about inviting the whole company to a single event. Instead, you might be able to hold a series of smaller events, for example by splitting into different departments.</p>
<p>On average, each person who contracts COVID will pass it on to between <a href="https://www.bmj.com/content/369/bmj.m1891">two and three others</a>. But that neat country or global level estimate, known as the reproduction number (R0), hides huge variation at the individual level. In reality, most COVID infections stem from just a handful of people. Infection analysis <a href="https://www.science.org/doi/10.1126/science.abe2424">estimates</a> that around 15% of cases cause 80% of secondary infections. </p>
<p>The reproduction number of seasonal flu varies, but on average one person with the flu will pass it on to <a href="https://pubmed.ncbi.nlm.nih.gov/25186370/">one or two</a> others. Flu is generally more uniform in its spread, meaning the R0 number is more representative. A highly infectious person with COVID is estimated to expel <a href="https://elifesciences.org/articles/65774">hundreds to thousands</a> of infectious virus particles per minute while talking, singing or coughing. People with flu expel the virus at lower rates.</p>
<figure class="align-center ">
<img alt="A group of young people having beers outside." src="https://images.theconversation.com/files/496596/original/file-20221121-15-fi70fy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496596/original/file-20221121-15-fi70fy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496596/original/file-20221121-15-fi70fy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496596/original/file-20221121-15-fi70fy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496596/original/file-20221121-15-fi70fy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496596/original/file-20221121-15-fi70fy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496596/original/file-20221121-15-fi70fy.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">Outdoor gatherings carry a much lower risk of virus spread.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/people-enjoying-beer-together-pub-brewery-1978488200">William Perugini/Shutterstock</a></span>
</figcaption>
</figure>
<h2>3. Get vaccinated</h2>
<p>A recent <a href="https://www.biorxiv.org/content/10.1101/2022.09.15.507787v4">preprint</a> suggests two of the newer COVID variants, BQ.1 and XBB, have mutations which make them very good at evading the immune system. This means that protection gained from previous vaccines and natural infections might not be as effective as against earlier variants of the virus. Precisely how these variants will respond to our existing immunity is unknown though, and the NHS has offered <a href="https://www.england.nhs.uk/2022/10/nhs-urges-six-million-people-to-get-their-covid-autumn-booster/">26 million people</a> in more vulnerable groups across England an autumn booster this year.</p>
<p>Also consider a flu vaccine, which can reduce the <a href="https://www.sciencedirect.com/science/article/pii/S0264410X18309976?via%3Dihub">severity of illness</a> or even stop you you from becoming <a href="https://www.cdc.gov/flu/about/burden-averted/2019-2020.htm">ill</a>. Flu vaccines are readily available in the UK at GPs and pharmacies, and cost between <a href="https://lloydspharmacy.com/pages/flu-vaccination">£12</a> and <a href="https://www.well.co.uk/vaccinations/flu-jabs">£15</a> if you’re not <a href="https://www.nhs.uk/conditions/vaccinations/flu-influenza-vaccine/">eligible</a> for a free one. Many workplaces will reimburse you for this cost.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/xbb-and-bq-1-what-we-know-about-these-two-omicron-cousins-193591">XBB and BQ.1: what we know about these two omicron 'cousins'</a>
</strong>
</em>
</p>
<hr>
<h2>4. Avoid karaoke</h2>
<p>What’s planned for the office Christmas party? A simple meal and a few drinks? Or is something a bit more interesting on the agenda? It seems that Christmas parties with activities (like escape rooms) and themes (such as casino) are <a href="https://www.squaremeal.co.uk/christmas-parties/christmas-party-ideas/christmas-party-trends_10261">on the rise</a>.</p>
<p>When it comes to having a COVID-safe Christmas party, I’m afraid karaoke is on the naughty list. One <a href="https://depositonce.tu-berlin.de/bitstreams/7180d12f-24ca-4e69-b39e-8699a6de8725/download">study</a> found that we produce higher rates of aerosols (tiny particles which can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293495/">contain infectious virus</a>) during singing compared with breathing and speaking. And <a href="https://www.vanityfair.com/news/2020/04/five-surprising-facts-about-the-novel-coronavirus">anecdotally</a>, singing has been linked to a few superspreader events. So maybe pick something else this year.</p><img src="https://counter.theconversation.com/content/194602/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Victoria Easton has previously received funding from the BBSRC, MRC, Wellcome Trust, Cancer Research UK and GCRF. She is affiliated with the University of Leeds and is a member of the Microbiology Society.</span></em></p>Nobody wants a case of COVID or flu as a take-home gift from their office Christmas party.Victoria Easton, Virology Research and Teaching Fellow, School of Molecular and Cellular Biology, University of LeedsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1950882022-11-22T20:41:18Z2022-11-22T20:41:18ZFlu, RSV and COVID-19: Advice from family doctors on how to get through this winter’s ‘tripledemic’<figure><img src="https://images.theconversation.com/files/496851/original/file-20221122-20-t10vgv.jpg?ixlib=rb-1.1.0&rect=8%2C24%2C5455%2C3612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Over the past month, clinics have seen a surge of sick children presenting with RSV, the flu and other viruses.</span> <span class="attribution"><span class="source">(Shutterstock)</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/flu--rsv-and-covid-19--advice-from-family-doctors-on-how-to-get-through-this-winter-s--tripledemic-" width="100%" height="400"></iframe>
<p>As community-based family doctors, we have been attending to patients who showed the early warning signs of the oncoming wave of our viral season. We are now in the middle of that wave: a “<a href="https://www.theatlantic.com/health/archive/2022/11/covid-flu-season-twindemic-tripledemic-2022/672041/">tripledemic</a>” of RSV, influenza and COVID-19. </p>
<p>While much of the news coverage of this viral surge has focused on overcrowded emergency rooms and intensive care units, family physicians are an important front line of protection against serious illness.</p>
<p>We should remember that this wave of viruses hits us every year around this time, even though this appears to be a particularly bad wave of RSV and the flu. <a href="https://www.cbc.ca/news/health/kids-respiratory-viruses-surge-1.6652391">We don’t yet know for sure</a> why this wave is so much worse than recent years.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/g7eQzf2pMtA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">CBC’s The National looks at how to prepare for the upcoming winter.</span></figcaption>
</figure>
<h2>Observations by family doctors</h2>
<p>Family doctors have learned important lessons through the COVID-19 pandemic that we need to apply during the current viral season.</p>
<p>First, the vast majority of viral infections will be mild to moderate in severity and can be managed by a family physician in an outpatient setting. Most children do not need to visit emergency rooms to seek care for viral infections. </p>
<p>Over the past month, our clinics have seen <a href="https://globalnews.ca/news/9274843/ontario-health-care-emergency-department-moore-masks/">a surge of sick children</a> presenting with RSV, the flu and other viruses. It has become more common to see fevers lasting longer than five days, ongoing coughs and superimposed lung and ear infections that require treatment.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1590874899111088128"}"></div></p>
<p>In most cases, these conditions can be managed by a family physician. In a small number of cases, we reach out to our pediatric emergency colleagues to let them know a child is on their way for assessment and further management.</p>
<p>Second, patients should continue to seek medical care from a family doctor if they have a health concern, despite the presence of new or returning viruses. Throughout the pandemic, we have seen countless numbers of patients who <a href="https://www.statcan.gc.ca/o1/en/plus/735-adults-canada-delayed-seeking-health-care-during-first-year-pandemic">delayed seeking care for serious health problems</a>. These patients missed crucial time needed to diagnose and treat their conditions in a timely manner. </p>
<p>Patients should continue to see their family doctors to seek advice or treatment for a health condition, including guidance on concerning viral symptoms.</p>
<p>Third, we are also observing the ongoing and significant harm caused to <a href="https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/2021-02/lockdown_life_eng.pdf">children and young people by prolonged periods of social isolation</a>. We are also seeing the impact of excessive screen time and social media on many of our young patients. </p>
<p>Accepting or imposing repeated limitations on social contact has consequences in the <a href="https://doi.org/10.1007/s00787-021-01744-3">form of depression and anxiety</a>. While some vulnerable people may try to avoid crowd settings during the viral season, many of our patients — especially younger ones — need to continue to find safe ways to expand and deepen their social contact with others, rather than limit it further.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/496813/original/file-20221122-12-w3j0ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a young person sitting in a red chair with their back to the viewer" src="https://images.theconversation.com/files/496813/original/file-20221122-12-w3j0ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496813/original/file-20221122-12-w3j0ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=257&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496813/original/file-20221122-12-w3j0ie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=257&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496813/original/file-20221122-12-w3j0ie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=257&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496813/original/file-20221122-12-w3j0ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=323&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496813/original/file-20221122-12-w3j0ie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=323&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496813/original/file-20221122-12-w3j0ie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=323&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Parents and health-care providers need to pay attention to the mental health of children and young people.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Finally, vaccination is an excellent protective measure against severe illness. And masks can help to limit transmission. <a href="https://www.ontario.ca/page/covid-19-vaccines#section-1">COVID-19 booster shots</a> are widely available and recommended for those over five years old. Those over 12 years old can receive the bivalent booster, which offers more protection against the omicron variant. </p>
<p>The flu vaccine can be given at the same time. It is strongly recommended for children ages six months and older. Masking indoors has now <a href="https://www.cbc.ca/news/canada/toronto/ontario-dr-kieran-moore-announcement-1.6650571">been recommended by the Chief Medical Officer of Health for Ontario</a>, to help reduce transmission for those that are symptomatic and to protect those who are vulnerable to serious illness as a result of contracting RSV, the flu or COVID-19.</p>
<h2>Supporting through the next wave</h2>
<p>As we all push through another wave of illness, along with the pressures imposed on families, education systems and the healthcare sector, we can draw on the insights that family doctors have gained from the COVID-19 pandemic. </p>
<p>We can be mindful of our responsibility to protect our most vulnerable by getting vaccinated, staying at home when we aren’t feeling well, and making responsible use of our medical system. </p>
<p>Family doctors are there to support our patients’ health, attend to chronic disease management and provide advice and direction — especially in the case of viral infections. We are there to help our patients get through this viral wave and onto the other side.</p><img src="https://counter.theconversation.com/content/195088/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors 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>Family physicians are on the frontline of health care, and their observations and support can help us get through the upcoming winter season.Lita Cameron, Family Physician, Assistant Clinical Professor (Adjunct), Department of Family Medicine, McMaster UniversitySkylar Neblett, Family Physician, Assistant Clinical Professor (Adjunct), Department of Family Medicine, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.