tag:theconversation.com,2011:/global/topics/respiratory-viruses-28167/articlesRespiratory viruses – The Conversation2024-01-15T20:46:57Ztag: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>
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<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>
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<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>
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<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/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>
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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>
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<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>
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<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">
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<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>
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<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>
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<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">
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<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>
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<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>
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Read more:
<a href="https://theconversation.com/should-i-get-a-flu-vaccine-this-year-heres-what-you-need-to-know-203406">Should I get a flu vaccine this year? Here's what you need to know</a>
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<h2>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>
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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>
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<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>
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<li>pregnant women</li>
<li>people six months and older with selected chronic conditions</li>
<li>Aboriginal and Torres Strait Islander people. </li>
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<p>For the rest of the population, the flu vaccine costs around A$20-30. Some practitioners also charge a consultation fee. </p>
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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>
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<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>
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Read more:
<a href="https://theconversation.com/should-i-get-a-flu-vaccine-this-year-heres-what-you-need-to-know-203406">Should I get a flu vaccine this year? Here's what you need to know</a>
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<h2>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>
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<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>
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</em>
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<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/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>
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<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>
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<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>
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<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/1982332023-02-26T19:06:02Z2023-02-26T19:06:02ZIs there a vaccine for RSV or respiratory syncytial virus? After almost 60 years, several come at once<figure><img src="https://images.theconversation.com/files/510804/original/file-20230217-22-p39gna.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C997%2C556&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/close-asian-little-baby-boy-treated-1589743531">Shutterstock</a></span></figcaption></figure><p>You might not have heard of respiratory syncytial virus, or RSV. But it caused more than <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00478-0/fulltext">100,000 global deaths</a> in 2019, making it a leading cause of death in children under one year old.</p>
<p>In Australia, child deaths are thankfully <a href="https://pubmed.ncbi.nlm.nih.gov/34845151/">rare</a>. But infection sends thousands to hospital each year, particularly <a href="https://www.mja.com.au/journal/2019/210/10/respiratory-syncytial-virus-associated-hospitalisations-australia-2006-2015">babies and young children</a>.</p>
<p>So for kids, this virus is a very big deal. And despite almost 60 years of research, there are no licensed vaccines to prevent it.</p>
<p>That may change soon. We’ve recently had results of late-stage clinical trials of RSV vaccines from <a href="https://www.statnews.com/2023/01/17/moderna-says-rsv-vaccine-worked-setting-stage-for-competition-with-gsk-and-pfizer/">Pfizer, Moderna and GSK</a>. These vaccines are being assessed (or will be shortly) for regulatory approval in the United States.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1627678804960497664"}"></div></p>
<p>However, these trials were conducted in adults and pregnant women, not children. So we still have a way to go before RSV vaccines are tested in children, shown to be safe and effective, are approved for use, then become widely available.</p>
<p>Here’s why it’s taken so long to develop a RSV vaccine and what we can expect next.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rsv-experts-explain-why-rates-of-this-virus-are-surging-this-year-194403">RSV: experts explain why rates of this virus are surging this year</a>
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</em>
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<h2>What is RSV?</h2>
<p>RSV is a contagious virus causing respiratory infections in both adults and children.</p>
<p>The virus is transmitted from person to person by droplets when someone coughs or sneezes, or by touching their nose or eyes after touching contaminated surfaces.</p>
<p>Infections usually surge in winter, causing symptoms such as a runny nose, sneezing, sore throat, fever, headache and cough. Adults and children can be hospitalised with RSV and its complications, which include pneumonia and <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Bronchiolitis/">bronchiolitis</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rsv-faq-what-is-rsv-who-is-at-risk-when-should-i-seek-emergency-care-for-my-child-195292">RSV FAQ: What is RSV? Who is at risk? When should I seek emergency care for my child?</a>
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<h2>We’ve had a few setbacks</h2>
<p>The <a href="https://journals.asm.org/doi/10.1128/CVI.00609-15">first RSV vaccine</a> was given to infants and children in the mid-1960s. </p>
<p>Although this inactivated vaccine (composed of dead RSV particles) seemed to be well tolerated, it later caused a rare side effect called vaccine-enhanced disease. This is where the vaccine caused more serious RSV symptoms when infants and toddlers caught the virus, instead of protecting them.</p>
<p>This was almost 60 years ago, and the science of vaccine development has come a long way. Even though scientists later found new vaccine strategies, this disaster has unfortunately slowed down RSV vaccine research and development.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/randomised-control-trials-what-makes-them-the-gold-standard-in-medical-research-78913">Randomised control trials: what makes them the gold standard in medical research?</a>
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<h2>Newer technologies, fresh hope</h2>
<p>Advances in what we know about the virus, and newer vaccine technologies, mean researchers are now more optimistic about the prospect of a RSV vaccine.</p>
<p>Ten years ago, <a href="https://www.science.org/doi/10.1126/science.1234914">scientists identified</a> the structure of the RSV viral protein it uses to attach and enter human host cells. This allowed scientists to change strategies and develop protein-based RSV vaccines.</p>
<p>Protein-based vaccines consist of injecting a purified protein from the target virus that stimulates the immune cells. This technology is used in many existing vaccines, such as those for hepatitis B and pertussis (whooping cough).</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1605357061583147009"}"></div></p>
<p>But it’s not been plain sailing for protein-based vaccines either.</p>
<p>In 2019, Novavax <a href="https://ir.novavax.com/2019-02-28-Novavax-Announces-Topline-Results-from-Phase-3-PrepareTM-Trial-of-ResVax-TM-for-Prevention-of-RSV-Disease-in-Infants-via-Maternal-Immunization">announced</a> its prototype protein-based RSV vaccine (ResVax) failed to prevent “medically significant” RSV in babies born to mothers who had been given the vaccine as part of a late-stage clinical trial.</p>
<p>Although the vaccine was shown to be safe, and protected babies from severe RSV, including hospitalisations, the vaccine has not yet made it to market, and further clinical trials <a href="https://www.precisionvaccinations.com/vaccines/resvax-rsv-vaccine">are ongoing</a>.</p>
<p>In recent years, we’ve seen another major technology development – mRNA vaccines. These have proved effective and robust during the COVID pandemic. </p>
<p>These mRNA vaccines involve injecting the information required for the human host cells to produce the viral protein, to later stimulate immune cells.</p>
<p>The front-runner RSV candidate vaccines – from GSK, Pfizer and Moderna – are either protein-based or use mRNA technology.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-fascinating-history-of-clinical-trials-139666">The fascinating history of clinical trials</a>
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<hr>
<h2>The GSK vaccines</h2>
<p>GSK is going with protein-based technology for two of its candidate RSV vaccines.</p>
<p>One (known as RSVPreF3 OA), has had good results in late-stage clinical trials in adults 60 years or older, with data published <a href="https://www.nejm.org/doi/10.1056/NEJMoa2209604">in recent weeks</a>. The US Food and Drug Administration (FDA) <a href="https://www.gsk.com/en-gb/media/press-releases/gsk-s-rsv-oa-vaccine-candidate-granted-priority-review-by-us-fda/">is reviewing</a> the vaccine, with results expected in May.</p>
<p>Another of GSK’s candidate RSV vaccines (GSK3888550A, RSVPreF3) is taking a different approach. The idea is to vaccinate pregnant women to confer immunity to the unborn baby.</p>
<p>Results of late-stage trials in healthy pregnant women aged 18-49 years are <a href="https://www.gsk.com/en-gb/media/press-releases/gsk-starts-phase-3-study-of-rsv-maternal-candidate-vaccine/">set to report in 2024</a>. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9200160/">Earlier studies</a> in non-pregnant women showed the vaccine was well tolerated and activated a good immune response.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pregnant Muslim woman clutching belly looking at phone in hand in front of window" src="https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Some candidate RSV vaccines are given to pregnant women to protect their babies.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-pregnant-arab-woman-hijab-using-1407599552">Shutterstock</a></span>
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<h2>The Pfizer vaccine</h2>
<p>Pfizer has also gone with a protein-based RSV vaccine (RSVpreF). But this time it’s a bivalent vaccine. It contains proteins to stimulate immune protection against two types of RSV – RSV A and B. Again, the idea again is to vaccinate pregnant women to immunise their babies in the womb.</p>
<p>In November 2022, Pfizer <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-announces-positive-top-line-data-phase-3-global">announced</a> interim results of its <a href="https://clinicaltrials.gov/ct2/show/NCT04424316?term=RSVpreF+pfizer&phase=2&draw=2&rank=2">late-stage clinical trial</a> showing 81.8% efficacy in protecting against severe disease in babies (one to 90 days old) of vaccinated pregnant women. Over time, that immunity decreased.</p>
<p>Final clinical trial results are expected <a href="https://www.pfizer.com/news/press-release/press-release-detail/us-fda-accepts-biologics-license-application-pfizers">any day now</a>, and the vaccine is being submitted to the FDA for priority review, with a result expected in August.</p>
<h2>The Moderna vaccine</h2>
<p>Moderna is using mRNA technology for its candidate RSV vaccine (called mRNA-1345). It uses similar technology to its COVID mRNA vaccines.</p>
<p>It has been tested in <a href="https://clinicaltrials.gov/ct2/results?term=mRNA-1345&age_v=&gndr=&type=&rslt=&Search=Apply">late-stage clinical trials</a> in people over the age of 60. The <a href="https://investors.modernatx.com/news/news-details/2023/Moderna-Announces-mRNA-1345-an-Investigational-Respiratory-Syncytial-Virus-RSV-Vaccine-Has-Met-Primary-Efficacy-Endpoints-in-Phase-3-Trial-in-Older-Adults/default.aspx">company announced</a> earlier this year that the vaccine was mostly well tolerated and had an efficacy of 83.7%.</p>
<p>The company is set to make a <a href="https://investors.modernatx.com/news/news-details/2023/Moderna-Granted-FDA-Breakthrough-Therapy-Designation-for-mRNA-1345-An-Investigational-Respiratory-Syncytial-Virus-RSV-Vaccine-Candidate/default.aspx">full submission</a> to the FDA in the first half of 2023.</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>Several hurdles ahead</h2>
<p>Another candidate vaccine, <a href="https://www.janssen.com/janssen-announces-respiratory-syncytial-virus-rsv-adult-vaccine-candidate-maintains-high-efficacy">from Janssen</a>, uses a different type of technology (adenovirus vector technology), and is not so far advanced through clinical trials as the others. But it has shown <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9417128/">promising preliminary results</a> <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2207566?query=recirc_curatedRelated_article">to date</a> in adults.</p>
<p>And that’s the sticking point with all the RSV vaccines mentioned. They’ve only been tested in adults. To have the greatest impact, the vaccines must also be evaluated in young children and infants. </p>
<p>The biggest question is what age should a baby be vaccinated against RSV once it loses the immunity from its mother?</p>
<p>While we wait for RSV vaccines, the best way of slowing the spread of this viral illness are measures we’ve become used to during COVID. If you or your children have RSV, make sure you wear a mask, wash your hands and maintain your distance from others.</p>
<hr>
<p><em>We would like to thank Masters (Doctor of Medicine) student Chloe Scott from Griffith University for her critical review and assistance with this article.</em></p><img src="https://counter.theconversation.com/content/198233/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>Here’s why it’s taken so long to develop a vaccine for respiratory syncytial virus and what we can expect next.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/1966352023-01-03T21:22:02Z2023-01-03T21:22:02ZFears about RSV, flu and winter viruses can cause parental stress. Try these 4 expert tips to balance mental wellness and health risks<figure><img src="https://images.theconversation.com/files/501941/original/file-20221219-20-dl1m5x.jpg?ixlib=rb-1.1.0&rect=422%2C17%2C5568%2C3970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Parents need practical strategies to balance the health risks and stressors of kids getting sick as we trudge through the virulent flu, RSV and COVID-19 winter season. </span> <span class="attribution"><span class="source">(Pexels)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/fears-about-rsv--flu-and-winter-viruses-can-cause-parental-stress--try-these-4-expert-tips-to-balance-mental-wellness-and-health-risks" width="100%" height="400"></iframe>
<p><a href="https://calgary.ctvnews.ca/alberta-children-s-hospital-in-calgary-to-open-heated-trailer-next-to-busy-er-1.6171151">Pediatric emergency departments and clinics have been overcrowded</a> with the dramatic <a href="https://doi.org/10.1038/d41586-022-04408-7">increase in child respiratory viruses</a>, leaving many families anxious about caring for sick kids. </p>
<p>Making decisions about what to do — or not do — can be exhausting, especially coming out of nearly three years of pandemic fears, social isolation and burnout. Parents need practical strategies to balance the health risks and stressors of kids getting sick as we trudge through the virulent flu, RSV and COVID-19 winter season.</p>
<p>As researchers of <a href="https://heartsandmindslab.com/research-projects/">family well-being interventions</a>, we provide four evidence-based stress-management strategies grounded in <a href="https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/">dialectical behaviour therapy</a> skills (DBT). </p>
<figure class="align-center ">
<img alt="A man seen from behind with two children wearing bright pink hats and large backpacks." src="https://images.theconversation.com/files/502575/original/file-20221222-16-d432yn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/502575/original/file-20221222-16-d432yn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/502575/original/file-20221222-16-d432yn.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/502575/original/file-20221222-16-d432yn.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/502575/original/file-20221222-16-d432yn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=512&fit=crop&dpr=1 754w, https://images.theconversation.com/files/502575/original/file-20221222-16-d432yn.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=512&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/502575/original/file-20221222-16-d432yn.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=512&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A father walks into a vaccination clinic with his two children in Montréal.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Paul Chiasson</span></span>
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</figure>
<p>In tough situations, DBT encourages a mindset that balances accepting reality as it currently is (even if this is very much a reality we never wanted!) while identifying actionable steps to change our ability to cope, like bringing in social support and understanding our emotional reactions in compassionate ways. </p>
<p>To bring you the most relevant information, we collaborated with pediatric emergency physicians to integrate their frontline expertise. </p>
<p>Try these tips to build confidence that you’re doing exactly what is needed for your kids this year. </p>
<h2>1) What are my most important values?</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Infographic featuring steps to reduce stress." src="https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1500&fit=crop&dpr=1 600w, https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1500&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1500&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1885&fit=crop&dpr=1 754w, https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1885&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/502980/original/file-20230103-6615-f9h6bn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1885&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Dialectical behaviour therapy (DBT) skills can help manage stress.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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</figure>
<p>For many families, kids’ activities are on the schedule again: fun with friends, time with relatives, celebrations. But having a cavalier attitude about including sick children at events — like in pre-pandemic times — might have costs down the road.</p>
<p>Consider your own values and identify the activities that are the most important, and consider what precautions you’re willing to take to keep your family and community healthy. Maybe it makes sense to attend a small house party with daycare friends, but not a larger gathering at the local arcade? </p>
<p>If limiting sick days matters to you, catching up on <a href="https://www.canada.ca/en/public-health/services/diseases/flu-influenza/get-your-flu-shot.html">COVID-19 boosters or flu shots</a> could save you weeks of sick kids at home. Now is also a great time to teach kids of any age about the basics of hand-washing, tissue use and the “<a href="https://www.nytimes.com/2020/03/17/arts/comic-books-coronavirus.html">batman cough</a>.” </p>
<p>Articles on the <a href="https://www.nytimes.com/2022/12/14/opinion/covid-symptoms.html">new etiquette of coughs</a> highlight the <a href="https://doi.org/10.3389/fpubh.2022.874693">value of masks</a> for residual symptoms, and rebuilding trust with our communities. </p>
<p>Finally, keeping kids home when sick <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/guidance-documents/summary-evidence-supporting-covid-19-public-health-measures.html">really matters</a>. It will also help you avoid the side-eye in public. </p>
<h2>2) How will I manage if they get sick?</h2>
<p>If you have young kids at home, odds are they’ve already been sick and they’ll get sick again. <a href="https://bayareadbtcc.com/cope-ahead-part-1/">Coping ahead</a> — anticipating and rehearsing responses to difficult situations — can reduce anxiety now and help you respond effectively in the future. </p>
<p>With the waves of child sickness, it’s common to find yourself with depleted resources, physically and emotionally. In anticipation of the next onset of illness, a little preparation can go a long way to reduce family stress and promote recovery. Consider replenishing essentials, reviewing the plan for seeking health care, planning for childcare difficulties and managing tough emotions. </p>
<h2>3) My child is sick. How worried should I be?</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Infographic with steps to take to manage a child's illness." src="https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1500&fit=crop&dpr=1 600w, https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1500&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1500&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1885&fit=crop&dpr=1 754w, https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1885&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/502576/original/file-20221222-21-akb8fw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1885&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Having a plan in place can help families manage when a child is sick.</span>
<span class="attribution"><a class="source" href="https://cdn.theconversation.com/static_files/files/2489/5_steps_to_reduce_stress_%282%29.pdf?1671477085">Click here to view</a>, <span class="license">Author provided</span></span>
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</figure>
<p>Managing a sick child is tough when there is little to be done but wait and watch. DBT helps you ask “what is the problem to be solved?” This might be as “simple” as tolerating family physical and emotional discomfort with compassion and care. </p>
<p>Staying present and focusing on <a href="https://centerforcbt.org/2021/11/02/improvemoment/#:%7E:text=The%20DBT%20concept%20of%20improving,mind%20in%20an%20effective%20way.">improving the moment</a> can help reduce distress when nothing else can be done. </p>
<p>Alternatively, more change-based action is needed. When faced with an ill child, consider looking from every angle of the situation. Remember there is no absolute truth and we can’t predict the future. Be open to alternative options, check your assumptions and avoid using extreme language (“always” and “never”). </p>
<p>It’s key to critically assess the validity of information sources and prioritize those that are evidence-based, including <a href="https://www.canada.ca/en/public-health/services/publications/healthy-living/caring-for-sick-child-nobodys-perfect.html">governmental or health board websites</a>. Diving down the rabbit hole of googling symptoms will typically increase stress without offering meaningful benefits. </p>
<p>Fortunately, the <a href="https://cps.ca/en/media/canadian-study-confirms-children-and-youth-at-low-risk-of-severe-covid-19-during-first-part-of-pandemic">odds of serious illness or death are small</a> in Canada for most children. Ask a health-care provider if you’re concerned your child may be at <a href="https://www.cdc.gov/rsv/high-risk/infants-young-children.html">greater risk</a> of serious illness (for example, if they were premature, have underlying heart or lung conditions, neuromuscular disorders, immune problems or take medication that suppresses the immune system).</p>
<h2>4) Back to basics</h2>
<p>You may already be well versed in the importance of “basics” when it comes to serving your emotions. There is a reason why “hangry” is such a common concept! Small steps can go a long way to helping the household stay healthy, recover quickly and keep family moods up. </p>
<p>As a family, try to <a href="https://www.behavioralhealthflorida.com/blog/please-skill-how-can-it-help/">prioritize plenty of sleep, nutritious foods and getting outside once a day</a>. And while this is true for the whole family, parents should also keep in mind the airplane rule: we must <a href="https://www.forbes.com/sites/forbescoachescouncil/2020/06/09/leaders-put-your-own-oxygen-mask-on-first/?sh=4109d4c977ad">put our own masks on before we help those around us</a>. </p>
<p>Lastly, <a href="https://doi.org/10.1111/famp.12618">social connection</a> offers a buffer to stress. Find ways to be creative with scheduling quality social connections consistent with your comfort level such as connecting with friends over FaceTime or only meeting outdoors.</p>
<p>During really tough moments, acknowledge the difficulty of the situation and remind yourself that you’re doing your best in a really challenging time.</p>
<p>It’s normal to be on edge and exhausted managing so much, particularly after three years of pandemic disruptions to family life. We hope these tips may provide even a small amount of relief this winter.</p><img src="https://counter.theconversation.com/content/196635/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily E. Cameron receives funding from the Canadian Institutes of Health Research, Social Sciences and Humanities Research Council of Canada, Children's Hospital Research Institute of Manitoba, and Research Manitoba.
</span></em></p><p class="fine-print"><em><span>Leslie E. Roos receives funding from the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, Research Manitoba, the Canadian Foundation for Innovation, and the Children's Hospital Research Institute of Manitoba.</span></em></p><p class="fine-print"><em><span>Tasmia Hai receives funding from Research Manitoba.</span></em></p><p class="fine-print"><em><span>Darcy Beer, Elisabete Doyle, Karen Gripp, and Merilee Brockway do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Evidence-based tools for dialectical behaviour therapy can help us manage family stressors during the virulent respiratory virus season.Emily E. Cameron, Associate Postdoctoral Fellow, Department of Psychology, University of ManitobaDarcy Beer, Assistant Professor Pediatrics/Pediatric Emergency Medicine, Department of Pediatrics and Child Health, University of ManitobaElisabete Doyle, Section head and Medical Director of Pediatric Emergency, Winnipeg Children's Hospital, Assistant Professor of Pediatrics and Child Health, University of ManitobaKaren Gripp, Section Head, Pediatric Emergency Medicine and Associate Professor, Rady Faculty of Health Sciences, University of ManitobaLeslie E. Roos, Assistant Professor, Department of Psychology, University of ManitobaMerilee Brockway, Assistant Professor, Faculty of Nursing, University of CalgaryTasmia Hai, Postdoctoral fellow, Department of Psychology, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1962982022-12-22T06:56:14Z2022-12-22T06:56:14ZCOVID or the common cold? What to do if you have symptoms this Christmas<figure><img src="https://images.theconversation.com/files/501904/original/file-20221219-26-j2kvq5.jpg?ixlib=rb-1.1.0&rect=0%2C14%2C9489%2C6302&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-african-american-man-sitting-on-2180049017">Krakenimages.com/Shutterstock</a></span></figcaption></figure><p>There’s a lot to be jolly about this Christmas. COVID has been significantly, although not completely, “<a href="https://www.theguardian.com/commentisfree/2022/jan/19/science-covid-ineradicable-disease-prevention">defanged</a>”, thanks to vaccines and treatments. Christmas dos, nativity plays and New Years Eve parties are all back on the festive calendar. </p>
<p>However, the return to “normal” brings with it the return of high rates of all the other winter bugs that were kept at bay largely due to reduced socialising during the previous two winters.</p>
<p>Along with COVID, northern hemisphere countries including <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html">the US</a> and <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1124937/Weekly_Flu_and_COVID-19_report_w50.pdf">the UK</a> are currently seeing or have recently seen large increases in <a href="https://cdn.who.int/media/docs/default-source/influenza/influenza-updates/2022/2022_12_12_surveillance_update_434.pdf?sfvrsn=b7677a7d_1&download=true">influenza</a>, RSV (respiratory syncytial virus) and the common cold.</p>
<p>Combined, these infections are leading to high numbers of <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19latestinsights/hospitals">hospital admissions</a> and putting a <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html">strain on health systems</a>.</p>
<h2>A social distancing debt</h2>
<p>Some have spoken of a lockdown-induced “<a href="https://www.newscientist.com/article/2348968-do-we-have-immunity-debt-and-how-could-it-affect-our-infection-risk/">immunity debt</a>”. This suggests a lack of exposure to seasonal viruses during the pandemic has inhibited our <a href="https://www.sciencedirect.com/science/article/pii/S2666991921001123?via%3Dihub">immune systems</a>, leading to high rates of certain infectious diseases, especially among children. This hypothesis <a href="https://www.ft.com/content/0640004d-cc15-481e-90ce-572328305798">is controversial</a> because at this stage there’s not enough evidence to support it. </p>
<p>I would argue that if anything, we’re seeing a “social distancing debt”. After two years of restrictions, UK data shows people have been <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1124937/Weekly_Flu_and_COVID-19_report_w50.pdf">mixing much more</a> in the lead up to this Christmas compared with last year. It stands to reason that as socialising bounces back, so do the bugs.</p>
<p>So what should you do if you find yourself with symptoms on Christmas day?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/our-third-covid-christmas-heres-how-things-might-play-out-195837">Our third COVID Christmas – here's how things might play out</a>
</strong>
</em>
</p>
<hr>
<h2>A cold or COVID?</h2>
<p>In previous years, in many countries, there were laws, policies and guidance to follow around what to do if you were ill (although these were at times <a href="https://blogs.bmj.com/bmj/2021/02/19/the-public-arent-complacent-they-are-confused-how-the-uk-government-has-created-alert-fatigue/">conflicting and confusing</a>). This year, it’s pretty much down to personal responsibility and “common sense”. </p>
<p>I have previously argued that there’s <a href="https://www.bbc.co.uk/programmes/p091q34n">no such thing as common sense</a> regarding COVID – none us have lived through a pandemic before and we’re learning as we go. Certainly lockdowns and other stringent social distancing laws are, and should be, a thing of the past. But people continue to need guidance. </p>
<p>There is still COVID-related guidance out there, for example from the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public">World Health Organization</a>. Yet the challenge is knowing if you have COVID in the first place.</p>
<p>Part of the problem is how many COVID symptoms are common to other respiratory illnesses. The symptoms of <a href="https://joinzoe.com/learn/covid-new-top-10-covid-symptoms">newer COVID variants</a> are no longer as distinctive as they were with <a href="https://theconversation.com/i-have-covid-symptoms-should-i-do-a-test-186368">the original strain</a> (for example, a “continuous cough” or a loss of taste or smell). </p>
<p>The <a href="https://joinzoe.com/learn/covid-new-top-10-covid-symptoms">most common COVID symptoms</a> now include a sore throat, runny or blocked nose, and a cough without phlegm. These are also common <a href="https://www.nhs.uk/conditions/common-cold/">cold</a> and <a href="https://www.cdc.gov/flu/professionals/acip/clinical.htm">flu</a> symptoms.</p>
<figure class="align-center ">
<img alt="A mother feels her child's forehead. The child is in bed and the bedroom is decorated for Christmas." src="https://images.theconversation.com/files/501905/original/file-20221219-20-x063wd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501905/original/file-20221219-20-x063wd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501905/original/file-20221219-20-x063wd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501905/original/file-20221219-20-x063wd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501905/original/file-20221219-20-x063wd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501905/original/file-20221219-20-x063wd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501905/original/file-20221219-20-x063wd.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">Respiratory illnesses are running rampant.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-checking-fever-her-blond-toddler-2061045425">Tomsickova Tatyana/Shutterstock</a></span>
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<p>In short, if in doubt, buy a COVID test. Admittedly, this is easier said than done during <a href="https://theconversation.com/covid-and-the-cost-of-living-crisis-are-set-to-collide-this-winter-the-fallout-will-be-greatest-for-the-most-vulnerable-190873">a cost of living crisis</a> (I would argue governments should try to make rapid tests free, at least during winters). Testing is the only way to know for sure if your cough or sneeze is due to COVID.</p>
<p>That said, although COVID has been particularly devastating over the past few years, respiratory diseases as a whole are worth preventing where possible. Taken together, COVID, flu and pneumonia still account for a significant proportion of all deaths in many countries, <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/howcoronaviruscovid19compareswithfluasacauseofdeath/2022-05-23">including the UK</a>.</p>
<h2>A hierarchy of protections</h2>
<p>To keep ourselves and others safe this Christmas, we might draw on what I call a “hierarchy of protections”. This takes inspiration from a model used to manage workplace safety, the “<a href="https://www.cdc.gov/niosh/topics/hierarchy/default.html">hierarchy of controls</a>”. </p>
<p>The model outlines five levels of protecting against hazards in the workplace. By substituting occupational hazards for respiratory viruses, we can use this model to guide our actions if we have symptoms – COVID or otherwise – at Christmas (or any time).</p>
<p><strong>1. Protection by elimination:</strong> The only sure-fire way of not spreading an airborne illness is by not coming into close contact with anyone while infectious. But some people may not be able to self-isolate. Perhaps they need to care for loved ones this holiday season, or can’t face the prospect of another Christmas alone.</p>
<p><strong>2. Protection by substitution:</strong> If we can’t eliminate our contacts when we’re sick, we can at least strive to reduce them, especially those who are clinically vulnerable. Meeting outdoors wherever possible is also a good idea. Viruses are <a href="https://www.nhs.uk/conditions/coronavirus-covid-19/how-to-avoid-catching-and-spreading-coronavirus-covid-19/">much less likely to spread</a> at outdoor carol services or Christmas markets than indoor ones.</p>
<p><strong>3. Engineering protections:</strong> If we can’t meet outdoors (it is winter after all), then we can at least try to keep indoor spaces well ventilated, for example by opening windows and buying portable <a href="https://www.nature.com/articles/d41586-021-02669-2">HEPA air filters</a>). </p>
<p><strong>4. Administrative protections:</strong> Where we need to meet, meeting briefly and avoiding physical contact like hugs and handshakes when sick can help.</p>
<p><strong>5. Protection by PPE:</strong> In many countries, mask-wearing and even hand-hygiene practices <a href="https://yougov.co.uk/topics/international/articles-reports/2020/03/17/personal-measures-taken-avoid-covid-19">have decreased considerably</a> over the past year. But these are particularly important when sick. We can think of <a href="https://theconversation.com/living-with-covid-how-treating-masks-like-umbrellas-could-help-us-weather-future-pandemic-threats-187377">face masks like umbrellas</a>, using them as and when needed.</p>
<p>Of course, some of these actions can be used in combination, and will depend on the context.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/six-common-covid-myths-busted-by-a-virologist-and-a-public-health-expert-188396">Six common COVID myths busted by a virologist and a public health expert</a>
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</em>
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<p>Doing what we reasonably can to reduce the spread of respiratory viruses may mean some personal sacrifices this Christmas if you’re one of the unlucky ones to be unwell. But it will benefit your loved ones and public health more widely.</p><img src="https://counter.theconversation.com/content/196298/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Nicholas Williams has received funding from Senedd Cymru, Public Health Wales and the Wales Covid Evidence Centre for research on COVID-19. However, this article reflects the views of the author only and no funding bodies were involved in the writing or content of this article.</span></em></p>‘Tis the season… for coughs, colds and COVID, it seems. So what should you do if you find yourself with symptoms on Christmas Day?Simon Nicholas Williams, Lecturer in Psychology, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1948202022-12-01T19:03:08Z2022-12-01T19:03:08ZVentilation reduces the risk of COVID. So why are we still ignoring it?<figure><img src="https://images.theconversation.com/files/498358/original/file-20221130-11-pl2be8.jpg?ixlib=rb-1.1.0&rect=17%2C673%2C5815%2C3209&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">IsraelAndrade/Unsplash</span></span></figcaption></figure><p>At the end of the third year of the pandemic, we are no longer surprised to hear we’re in a new wave of infection. It’s fuelled by new sub-variants of the virus that <a href="https://doi.org/10.1073/pnas.2204336119">may evade immunity</a> from both vaccination and previous infections. </p>
<p>Authorities recommend control measures, but they are “voluntary”. They include wearing a mask, vaccination, testing if you have symptoms and staying home if you test positive, and ventilation. Ventilation is often the last measure listed – as if it’s an afterthought. </p>
<p>While vaccines are highly effective in reducing the risk of death and serious illness, they are generally <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00143-7/fulltext">not effective</a> in preventing transmission. Wearing a mask reduces the risk of both spreading and acquiring an infection but only when <a href="https://jamanetwork.com/journals/jama/fullarticle/2776536">worn properly</a>.</p>
<p>The best way to reduce the risk of transmission is to reduce the concentration of airborne virus that is available to be inhaled and can therefore cause infection. </p>
<p>Adequate ventilation of air in indoor spaces is the key to achieving this goal and should be at the top of the list of control measures. Ventilation <a href="https://arxiv.org/abs/2207.02678">reduces the risks</a> for everyone, regardless of other individual actions.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-must-get-serious-about-airborne-infection-transmission-heres-what-we-need-to-do-164622">Australia must get serious about airborne infection transmission. Here's what we need to do</a>
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<h2>Virus gets into the air we breathe</h2>
<p>Let’s imagine there’s an infected person in the room we’re sitting in. Imagine we can see the cloud of air they exhale, as if it were laced with a coloured marker, for example, pink.</p>
<p>Imagine how it spreads across the room, eventually <a href="https://www.sciencedirect.com/science/article/pii/S0301932220305498">reaching</a> and engulfing us. We inhale the “pink” air. If the person speaks or sings, the “pink” of the cloud is much more intense: the <a href="https://www.nature.com/articles/s41598-019-38808-z">concentration</a> of <a href="https://www.tandfonline.com/doi/full/10.1080/02786826.2021.1883544">emissions</a> is <a href="https://www.sciencedirect.com/science/article/abs/pii/S0021850208002036">much higher</a>. </p>
<p>Now imagine that in that cloud we also see some tiny dark green beads: lots of them. These are viruses and bacteria that are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499537/">emitted</a> by the infected person. They reach us and we inhale them. </p>
<p>Now let’s imagine we inhale enough of the “green beads”, and we are <a href="https://www.sciencedirect.com/science/article/pii/S0160412020320675">infected</a> with COVID. Or influenza. Or a cold virus. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/498608/original/file-20221202-24-b12y6j.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498608/original/file-20221202-24-b12y6j.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498608/original/file-20221202-24-b12y6j.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498608/original/file-20221202-24-b12y6j.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498608/original/file-20221202-24-b12y6j.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498608/original/file-20221202-24-b12y6j.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498608/original/file-20221202-24-b12y6j.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
<span class="attribution"><span class="source">Wes Mountain/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>We can increase ventilation, either by opening the window, or by activating the mechanical ventilation system – basically using any means to get the contaminated air out of the room. </p>
<p>We will soon see that the “pink” of the cloud emitted by our roommate fades or even disappears. Ventilation efficiently removes emissions from the room, and we no longer inhale them.</p>
<h2>How can we ensure good ventilation?</h2>
<p>We need sufficient and effective ventilation in our buildings. Sufficient means enough of it, and effective means it’s everywhere within the space, so air doesn’t flow from person to person, transmitting viruses or bacteria between people. </p>
<p>Each building is different, and flexible ventilation systems – to ensure sufficient and effective ventilation – will <a href="https://doi.org/10.1126/science.abg2025">depend</a> on the building’s purpose. </p>
<p>To be effective, ventilation airflow rates must be controlled by the number of occupants in the space and their activity; the technologies to achieve this <a href="https://doi.org/10.1126/science.abg2025">exist</a> and are already <a href="https://doi.org/10.1016/j.buildenv.2021.108555">in use</a>.</p>
<figure class="align-center ">
<img alt="Children in a classroom with windows closed write in workbooks." src="https://images.theconversation.com/files/498359/original/file-20221130-20-bgkqqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498359/original/file-20221130-20-bgkqqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498359/original/file-20221130-20-bgkqqt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498359/original/file-20221130-20-bgkqqt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498359/original/file-20221130-20-bgkqqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498359/original/file-20221130-20-bgkqqt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498359/original/file-20221130-20-bgkqqt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Depending on the level of ventilation, we might be sharing air all the time.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/boy-in-green-shirt-3992949/">CDC/Pexels</a></span>
</figcaption>
</figure>
<p>Many buildings already have good ventilation, as assessed by monitors of air flows and carbon dioxide (CO₂) in the building’s heating, ventilation, and air condition (HVAC) systems. </p>
<p>But there are even more buildings where ventilation is inadequate and no one measures it. </p>
<p>Ventilation isn’t often measured because, in the absence of legislation mandating ventilation requirements and indoor air quality, no one is responsible for it. </p>
<p>Although the situation <a href="https://www.health.vic.gov.au/covid-19-ventilation-principles-strategies-to-reduce-aerosol-transmission-community-workplace">varies</a> between different government portfolios and different states, in general, very little has been done to assess or improve ventilation.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/someone-in-my-house-has-covid-how-likely-am-i-to-catch-it-189386">Someone in my house has COVID. How likely am I to catch it?</a>
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<h2>What are the costs of poor ventilation?</h2>
<p>Viral respiratory infections have long been a major cause of illness and death in Australia. In just one year (2017), influenza and pneumonia <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2017%7EMain%20Features%7EAustralia's%20leading%20causes%20of%20death,%202017%7E2">accounted for</a> 4,269 deaths. They were the ninth leading cause of death in 2017, moving from eleventh place in <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2016%7EMain%20Features%7EAustralia's%20leading%20causes%20of%20death,%202016%7E3#:%7E:text=Heart%20disease%20is%20now%20the,first%20and%20second%20leading%20causes">2016</a>. </p>
<p>The economic burden from all lower respiratory infections in Australia was greater than <a href="https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2018-19/contents/data-visualisation">A$1.6 billion</a> in 2018-19. </p>
<figure class="align-center ">
<img alt="Wind blows curtain through open window of an old terrace house" src="https://images.theconversation.com/files/498114/original/file-20221129-26-2d4cyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498114/original/file-20221129-26-2d4cyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498114/original/file-20221129-26-2d4cyv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498114/original/file-20221129-26-2d4cyv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498114/original/file-20221129-26-2d4cyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498114/original/file-20221129-26-2d4cyv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498114/original/file-20221129-26-2d4cyv.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">Opening a window increases ventilation – but it’s not always possible at work and in public spaces.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/g5CUmZHUp48">Alistair Macrobert/Unsplash</a></span>
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<p>If only half these infections could be <a href="https://raeng.org.uk/media/dmkplpl0/infection-resilient-environments-time-for-a-major-upgrade.pdf">prevented</a> by better ventilation removing the viruses from the air and thus limiting the spread, tens of thousands of people would remain healthy, and millions of dollars saved in Australia every year.</p>
<p>Rather than asking whether we can afford it, we need to ask whether we can afford the impact and cost of infections if we don’t implement effective ventilation in our buildings. </p>
<h2>But how much would it actually cost to improve ventilation?</h2>
<p>The cost to society of prevention through better designed buildings and gradual improvement of ventilation in existing buildings is <a href="https://www.science.org/doi/10.1126/science.abg2025">much lower</a> than the cost of infections. According to some estimates, this would amount to only 1% of initial construction costs. </p>
<p>But better building designs and improvements won’t be done voluntarily because the money for them doesn’t come out of the same pocket as the money to cover the health-care costs for infected people, or other costs, such as lost productivity or absenteeism due to illness. </p>
<p>As we <a href="https://theconversation.com/australia-must-get-serious-about-airborne-infection-transmission-heres-what-we-need-to-do-164622">argued previously</a> in The Conversation, we need a national regulatory group for clean indoor air. Establishing such a group will require cooperation across various areas of government, with the goal of explicitly including protection against indoor air hazards in relevant Australian legislation.</p>
<p>However, the complexity of this public health problem seems to scare the authorities, which prefer to <a href="https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/health-advice/traffic-light-advice">pretend</a> it’s a minor issue.</p>
<p>Clearly, we have a long way to go to change this mindset. But it all starts with raising the <a href="https://www.mja.com.au/journal/2022/217/11/healthy-indoor-air-our-fundamental-need-time-act-now">awareness</a> of each individual, then legislating indoor air quality standards to remove the “green beads” from the air that end up in our lungs.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/four-tips-to-avoid-your-office-christmas-party-turning-into-a-superspreader-event-194602">Four tips to avoid your office Christmas party turning into a superspreader event</a>
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<img src="https://counter.theconversation.com/content/194820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lidia Morawska receives funding from the NHMRC and ARC. She is Vice-Chancellor Fellow, Global Centre for Clean Air Research (GCARE), University of Surrey, UK.</span></em></p><p class="fine-print"><em><span>Guy B. Marks 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>When it comes to reducing the spread of COVID, ventilation is often an afterthought. But cleaner air needs to be front and centre of our COVID mitigation strategy. Here’s why.Lidia Morawska, Professor, Science and Engineering Faculty; Director, International Laboratory for Air Quality and Health (WHO CC for Air Quality and Health); Director - Australia, Australia – China Centre for Air Quality Science and Management (ACC-AQSM), Queensland University of TechnologyGuy B. Marks, Scientia Professor, Faculty of Medicine and Health, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952922022-11-27T13:09:07Z2022-11-27T13:09:07ZRSV FAQ: What is RSV? Who is at risk? When should I seek emergency care for my child?<figure><img src="https://images.theconversation.com/files/497240/original/file-20221124-14-7r3k7l.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5100%2C2868&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">RSV is the leading cause for hospital stays in infants in developed countries.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><h2>What is RSV?</h2>
<p>Respiratory syncytial virus (RSV) is <a href="https://doi.org/10.1093/cid/ciaa1719">one of many viruses that causes infection of the ear, nose, throat and lungs</a>. It <a href="https://doi.org/10.7150/ijbs.64762">infects people of all ages</a> and can be found worldwide.</p>
<h2>Who is at risk of RSV?</h2>
<p>RSV is an important cause of lung infections in children under two years of age, and is the leading reason for <a href="https://doi.org/10.1155/2017/4521302">hospital stays in children under one year of age (infants) in developed countries</a>. Premature infants, adults above 65 years of age and those with chronic heart and lung conditions are at <a href="https://doi.org/10.1056/nejmoa043951">higher risk for severe disease and hospitalization</a>.</p>
<h2>Why is RSV so prevalent this season?</h2>
<p>Infections due to RSV occur throughout the year, with higher numbers of infections in the late fall to early spring in North America. The start and end of RSV season changes slightly each year, <a href="http://dx.doi.org/10.15585/mmwr.mm6702a4">and infections peak in January and February</a>. Typically, RSV infections occur in two-year cycles — <a href="https://doi.org/10.1001/jamanetworkopen.2021.24650">a year of increased numbers and higher severity of illness alternating with a milder year</a>.</p>
<p>Most children will have had one RSV infection by two years of age, and some may have had more than one infection. Unfortunately, having been infected by RSV does not provide long lasting immunity, although re-infections are usually milder. Although antibodies (proteins made by the immune system in response to infection) are made against RSV, they only last six to 12 months and <a href="https://doi.org/10.1093/infdis/jiac192">require repeated exposure to keep high antibody levels</a>. </p>
<p>This likely explains why RSV infections have an alternating severe-mild cycle: in a bad year, patients develop high levels of antibodies that help protect against infection or a bad infection in the subsequent year.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/rsv-experts-explain-why-rates-of-this-virus-are-surging-this-year-194403">RSV: experts explain why rates of this virus are surging this year</a>
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<h2>How does RSV spread?</h2>
<p>RSV is spread through two ways:</p>
<ul>
<li><p>Contact with an object that has been sneezed on, coughed on, drooled on, touched or been in the mouth of a person who is sick with RSV. That person, who now has germs on their hands, becomes sick when he/she touches their nose or mouth.</p></li>
<li><p>Breathing in the virus when the infected person coughs or sneezes, within one metre of others, without covering their nose or mouth.</p></li>
</ul>
<h2>What are the symptoms of RSV?</h2>
<p>In general, approximately three to seven days after being infected, people will develop symptoms of a common cold including fever, runny or stuffy nose, sore throat, cough and decreased energy. Patients may complain of muscle aches and their appetite may decrease. Some may have difficulty breathing. The symptoms of infection due to RSV are identical to the symptoms of other respiratory viruses.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KlHjKaGiWFY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">CBC covers the surge in children needing treatment for respiratory viruses.</span></figcaption>
</figure>
<p>Some patients develop pneumonia (infection of the lungs). Infants may develop bronchiolitis — inflammation (swelling) of the very small tubes that deliver air (oxygen) to the lungs. Infants with bronchiolitis commonly have wheezing — a whistling sound when they breathe out. This whistling sound sometimes is only heard using a stethoscope, but sometimes can be heard even without one. </p>
<p>Bronchiolitis and pneumonia can lead to lower oxygen levels in the blood in some patients. It is important to remember that other respiratory viruses can also lead to pneumonia and bronchiolitis.</p>
<h2>How is RSV treated?</h2>
<p>Since RSV is a virus, use of antibiotics will not lead to shortening of the illness nor will it lead to shortening the period that sick people are infectious to others. There are no antivirals for treatment of RSV infections. Most patients can be managed at home:</p>
<ul>
<li><p>Antipyretics (medications to lower fever) if fever is present. Lowering the fever does not lead to shortening of the illness, but will also treat any muscle aches and the general feeling of being unwell.</p></li>
<li><p>Saline sprays or drops help with nasal congestion, and can be used often without the risk of overdose.</p></li>
<li><p>Commercially available nasal aspirators can be used to help infants and children breathe easier </p></li>
<li><p>Encourage fluids to reduce the risk of dehydration — offer small amounts, but offer often. Fluids for infants should be breastmilk or formula. Older children can be offered a variety of fluids including oral rehydration fluids like <a href="https://www.webmd.com/drugs/2/drug-11147/pedialyte-oral/details">Pedialyte</a>, chicken broth, popsicles, ice cream and jello. Extended periods of only water should be avoided, as should relying on soda. A few days without solid food is not harmful.</p></li>
</ul>
<h2>When should I seek emergency care for my child for RSV?</h2>
<p>Although most patients can be managed at home, there are several reasons to seek medical care. They include:</p>
<ul>
<li>Breathing too hard to sleep or feed properly even when fever is not present;</li>
<li>For infants, feeding has been significantly reduced below normal; </li>
<li>Being excessively sleepy or difficult to wake;</li>
<li>Not urinating in 12 hours.</li>
</ul>
<p>Patients with RSV infections will need to be hospitalized if they need:</p>
<ul>
<li>extra oxygen;</li>
<li>intravenous fluids if they are dehydrated.</li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a hospital sign directing people to EMERGENCY CHILDREN / URGENCE ENFANTS" src="https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=349&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=349&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=349&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=439&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=439&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=439&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ontario has asked thousands of family health-care workers to work evenings and weekends to help ease the burden on overwhelmed children’s hospitals.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Adrian Wyld</span></span>
</figcaption>
</figure>
<h2>How do I protect myself and my family from RSV?</h2>
<p>Although there are no vaccines against RSV, a scientifically prepared antibody, palivizumab, <a href="https://doi.org/10.14745/ccdr.v48i78a08">is recommended to reduce the risk of complications of RSV infection in premature infants and children with chronic lung or heart disease who meet certain criteria</a>. Palivizumab is given as monthly injections during RSV season.</p>
<p>The same general measures that protect against COVID-19 and other respiratory viruses lead to reduced risk of getting infected with RSV:</p>
<ul>
<li>Wash your hands well and often;</li>
<li>Stay two meters from others when in public places — patients with RSV may be infected and capable of infecting others before they have symptoms;</li>
<li>Wear a mask when in enclosed public places.</li>
</ul>
<p>Be a good neighbour and reduce the risk that others will get sick:</p>
<ul>
<li>Stay home from school or work if you are sick;</li>
<li>Cough etiquette — cough into your elbow or a tissue. This reduces the chance that viruses are on your hands, which can then be passed onto others or objects that others may handle.</li>
</ul><img src="https://counter.theconversation.com/content/195292/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Athena McConnell is affiliated with Sanofi as a member of an advisory board related to the development of nirsevimab, an alternate monoclonal antibody against RSV. </span></em></p>As visits to emergency departments surge — and in some cases overwhelm hospitals — here are answers to frequently asked questions about Respiratory syncytial virus (RSV).Athena McConnell, Associate Professor, Pediatric Infectious Diseases, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1947262022-11-20T15:22:34Z2022-11-20T15:22:34ZWith COVID, flu and RSV circulating, it’s time to follow the evidence: Return to mask mandates<figure><img src="https://images.theconversation.com/files/495816/original/file-20221117-13-u0jyep.JPG?ixlib=rb-1.1.0&rect=0%2C10%2C3190%2C2069&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ontario Premier Doug Ford and Health Minister Sylvia Jones in conversation at Queen's Park, the day after Ontario’s chief medical officer of health ‘strongly recommended’ mask wearing.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Chris Young</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/with-covid--flu-and-rsv-circulating--it-s-time-to-follow-the-evidence--return-to-mask-mandates" width="100%" height="400"></iframe>
<p>The number of children and babies with respiratory illnesses currently <a href="https://globalnews.ca/news/9273442/mcmaster-childrens-hospital-patient-crisis-grows/">exceeds the capacity of our health system</a> to care for them. More adult Canadians will die directly of COVID-19 this year <a href="https://public.tableau.com/app/profile/bill.comeau/viz/CanadaCovid19_16636261617930/Dashboard1">than died last year or in 2020</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bar graph showing deaths from COVID in Canada" src="https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=260&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=260&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=260&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=326&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=326&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=326&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">COVID deaths in 2022 outnumber those in 2020 or 2021.</span>
<span class="attribution"><span class="source">(Bill Comeau)</span></span>
</figcaption>
</figure>
<p>Eight per cent of vaccinated people with COVID infections that don’t require hospitalization <a href="https://doi.org/10.1038/s41591-022-01840-0">end up with long COVID</a>, with each subsequent infection <a href="https://doi.org/10.1038/s41591-022-02051-3">repeating the risk</a>. COVID increases the risk of <a href="https://doi.org/10.1038/s41591-022-01689-3">cardiovascular</a> <a href="https://doi.org/10.1016/S0140-6736(22)01214-4">and</a> <a href="https://www.ecdc.europa.eu/sites/default/files/documents/Prevalence-post-COVID-19-condition-symptoms.pdf">other health</a> <a href="https://doi.org/10.1038/s41591-022-01840-0">problems</a>, enough to cause a stark rise in <a href="https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm">excess deaths</a> and to <a href="https://www.cdc.gov/nchs/data/vsrr/vsrr023.pdf">shorten life expectancy</a>.</p>
<p>In 2020, when adult intensive care units were at risk of being overwhelmed, we wore masks and accepted restrictions. With pediatric intensive care now at risk, will leaders follow the evidence and tell us to mask up? While federal officials and <a href="https://www.cbc.ca/news/canada/toronto/ontario-dr-kieran-moore-announcement-1.6650571">several provinces are now recommending masks in all indoor public settings</a> — although <a href="https://toronto.ctvnews.ca/ontario-s-top-doctor-goes-against-own-advice-while-maskless-at-toronto-party-1.6159050">Ontario’s Chief Medical Officer of Health Kieran Moore was seen without one at a party</a> — <a href="https://www.ctvnews.ca/canada/what-provinces-and-territories-are-saying-about-mask-mandates-as-covid-19-rsv-flu-cases-rise-1.6157262">there are no returns to mandates for the public yet</a>.</p>
<h2>Wear the best mask available</h2>
<p>We now know that <a href="https://doi.org/10.1073/pnas.2014564118">masks prevent the spread of respiratory diseases</a>; some better than others. </p>
<figure class="align-right ">
<img alt="A young woman wearing a white face masks with overhead ties" src="https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=427&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=427&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=427&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=536&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=536&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=536&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Vitacore CaN99 respirator with overhead elastic; N95s, CaN99 and FFP3 typically provide greater than 90 per cent filtration without formal fit testing.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The most effective masks, and the only ones recognized as respiratory protection by formal standards, are respirator masks: N95s, CaN99s, FFP3s and reusable elastomeric respirators. In workplaces, respirators are fit-tested to the individual, resulting in greater than 99 per cent protection. </p>
<p>Even without fit testing, respirator masks prevent <a href="https://doi.org/10.1093/annhyg/meq085">more than</a> <a href="https://doi.org/10.1371/journal.pone.0245688">90 per cent</a> <a href="https://doi.org/10.1097/MD.0000000000023709">of particles</a> smaller than one micron from reaching the wearer (submicron particles, the smallest among <a href="https://doi.org/10.1016%2FS2213-2600(20)30323-4">those thought</a> <a href="https://doi.org/10.1080/23744235.2022.2140822">to be</a> <a href="https://doi.org/10.1038/s41564-021-01047-y">relevant</a>).</p>
<p>Respirator masks are relatively expensive — typically a few dollars each — but thanks to Canadian manufacturers, they are <a href="https://www.clothmasks.org/">available</a> and there are no longer concerns about supply chains for front-line workers. They can be safely <a href="https://www.clothmasks.org/extended-use">reused, with good retention of their filtration</a>. New designs are comfortable and fit most faces. </p>
<figure class="align-left ">
<img alt="A young woman wearing a black face mask with ear loops" src="https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A KN95/KF94 mask with ear loops typically provides about 70 per cent filtration.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>N95s are secured with overhead attachments, providing a good seal at the edges. KN95s and KF94s have excellent filtration material, but their ear loops do not provide as secure a seal, and <a href="https://doi.org/10.1371/journal.pone.0258191">their filtration</a> is <a href="https://doi.org/10.1371/journal.pone.0245688">around 70 per cent</a>. A certified medical mask with a well-fitted cloth mask over it, preferably with overhead ties, provides <a href="https://doi.org/10.1038/s41591-022-01840-0">comparable</a> <a href="https://doi.org/10.1016/j.ajic.2021.10.041">filtration</a> at lower cost.</p>
<figure class="align-right ">
<img alt="A young woman wearing a cloth face mask over a surgical mask" src="https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A well-fitting cloth mask over a certified medical mask typically produces about 70 per cent filtration.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Certified Level 1 medical masks alone do not fit well, which affects their filtration ability because unfiltered air passes around the edges with every breath. In tests on humans, these have <a href="https://doi.org/10.1371/journal.pone.0264090">typically </a><a href="https://doi.org/10.1371/journal.pone.0245688">filtered </a><a href="https://doi.org/10.1001/jamainternmed.2020.8168">at around 50 per cent</a>, similar to <a href="https://doi.org/10.1016/j.mayocp.2020.07.020">well-designed</a> <a href="https://doi.org/10.1371/journal.pone.0264090">two-layer cotton cloth masks, ideally with overhead ties</a>; both are around 50 per cent.</p>
<p>Poorly fitting <a href="https://doi.org/10.1016/j.ajic.2021.10.041">cloth masks</a> and non-certified procedure masks are likely worse than 50 per cent, but better than nothing. The World Health Organization advises: “<a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks">Make wearing a mask a normal part of being around other people</a>,” to which we would add: wear the best mask available.</p>
<figure class="align-left ">
<img alt="A young woman wearing a blue surgical face mask" src="https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=514&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=514&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=514&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=646&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=646&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=646&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Level 1 certified mask provides filtration around 50 per cent because of visible gaps and poor fit. To test fit, breathe out rapidly and feel for air leaks around the mask with your hands.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The filtration data above are mirrored by epidemiologic data showing that <a href="http://dx.doi.org/10.15585/mmwr.mm7106e1">protection correlates with mask type</a>. In studies of source control (prevention of contamination of the air by respiratory particles), the same hierarchy of efficiency is seen, with N95s at the top. N95s with exhalation valves are an exception and should not be used to prevent spread of respiratory diseases.</p>
<p><a href="https://doi.org/10.1136/bmj-2021-068302">Masks protect </a><a href="https://doi.org/10.1073/pnas.2014564118">against COVID-19</a> and other respiratory infections. They are also an <a href="https://doi.org/10.7326/M20-6625">ideal tool to counter COVID variants</a>, as well as <a href="https://theconversation.com/influenza-and-covid-19-whats-in-store-for-the-fall-winter-respiratory-virus-season-193076">RSV and influenza</a>. Working on basic physical principles — <a href="https://doi.org/10.7326/M20-6625">impaction, sedimentation and diffusion</a> — they protect regardless of the variant or strain. </p>
<p>Staying home when sick is helpful, but many people are infectious <a href="https://doi.org/10.1186/s12879-022-07440-0">before they have symptoms, or never have symptoms</a>. Wearing a mask to prevent infected particles from reaching the environment is basic pollution management: control is best at the source. </p>
<p>Wearing a mask to protect the individual, once controversial, is now settled by <a href="https://www.clothmasks.org/mask-hierarchy">filtration science</a> and <a href="http://dx.doi.org/10.15585/mmwr.mm7106e1">epidemiology</a>. The impact of mask mandates in countries where spontaneous mask wearing was low was repeatedly demonstrated, proving that masks protect us all.</p>
<h2>Why people aren’t wearing masks</h2>
<p>Why aren’t people wearing masks? Some remember the <a href="https://doi.org/10.1111/1467-9566.13525">inconsistency of the advice</a> early in the pandemic. Masks may be conflated with closures and capacity restrictions and the resulting hardships. Whatever the reason — <a href="https://www.theguardian.com/world/2021/oct/26/the-great-cover-up-why-the-uk-stopped-wearing-face-masks">stigma, peer pressure or concern about virtue signalling</a> — countries outside Asia do not have a mask-wearing culture. </p>
<figure class="align-center ">
<img alt="Infographic summarizing the literature on filtration properties of respirators and masks." src="https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=776&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=776&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=776&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=976&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=976&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=976&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Infographic summarizing the literature on filtration properties of respirators and masks.</span>
<span class="attribution"><span class="source">(Shiblul Hasan)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Under these circumstances, it will likely take more than strong recommendations to achieve the <a href="https://doi.org/10.1073/pnas.2014564118">high uptake of mask use that will be most effective</a> in reducing transmission of respiratory viruses. Masks protect individuals, imperfectly. Mask mandates (or high voluntary use of masks) protect populations.</p>
<p>Bringing back mask mandates with unequivocal signalling from governments about the effectiveness of both masks and mask mandates would be the best immediate response to our current crisis. <a href="https://doi.org/10.1038/s41398-022-01814-3">Confidence that mask-wearing is effective correlates geographically with willingness to wear a mask</a>: in time, we hope knowledge will change culture. Strong communication from political and public health leadership would increase community understanding that the minor inconvenience of wearing a mask in public indoor spaces is justified by the death and disability prevented. </p>
<p>In North America, the strategy of using masks according to personal judgment has predictably failed, the strategy of strongly recommending masks is unproven, and it’s too late to experiment. Mask mandates, however, are backed by strong evidence of effectiveness in <a href="https://www.nber.org/papers/w27891">both Canada</a> and the <a href="https://doi.org/10.1377/hlthaff.2020.00818">United States</a>. </p>
<p>Mask mandates are less damaging to a recovering economy than physical distancing and capacity limits, and less damaging to learning than a return to remote schooling.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two line graphs showing relationship between school openings, mask use and community COVID 19 cases and deaths" src="https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=249&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=249&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=249&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=313&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=313&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.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"></a>
<figcaption>
<span class="caption">The relationship between mode of school opening (remote, hybrid and in-person) and mask use at school with community cases and deaths, based on county-level data in the U.S.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1073/pnas.21034201">(Chernozhukov et al, PNAS 2021:118;e2103420118)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Schools and universities represent a particularly important opportunity. COVID spreads between children in schools <a href="https://doi.org/10.1073/pnas.2103420118">to infect the whole population; this is mitigated by mask wearing</a>. After Massachusetts lifted its mask mandate, school boards did so at different times, creating a natural experiment: <a href="https://doi.org/10.1056/NEJMoa2211029">transmission was higher among students and staff where mandates were lifted</a> compared with where they were still in place. </p>
<p>There is <a href="https://web.archive.org/web/20220826213955/https:/healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Do-face-masks-interfere-with-language-development.aspx">no convincing</a> <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html">evidence</a> to date that masks reduce social or language skills. Decreasing spread in schools would increase learning by reducing student and teacher sick days and preserving in-person instruction. Keeping children in schools <a href="https://www.washingtonpost.com/business/2022/11/15/work-absences-childcare/">keeps parents at work</a>.</p>
<p>Mask mandates will not produce a rapid fix of our current problems with respiratory viruses. Indicators will lag by weeks. Until we have a <a href="https://doi.org/10.1038/s41586-022-05398-2">whole-of-society approach</a> that recognizes that <a href="https://doi.org/10.1016/S0140-6736(21)00869-2">COVID is airborne</a>, mask mandates offer us the best immediate opportunity to preserve our health-care system, mitigate death and disability from respiratory viruses, support the economy and safely maintain social contacts in our private lives. </p>
<p><em>Rebecca Rudman, co-founder of the Windsor Essex Sewing Force and member of McMaster’s Cloth Mask Knowledge Exchange, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/194726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Clase is editor-in-chief of clothmasks.org and a member of the Cloth Mask Knowledge Exchange, a research and knowledge translation group that includes industry stakeholders. Industry stakeholders contribute to the Cloth Mask Knowledge Exchange by contributing to grant funding, and through in-kind contributions of time and expertise. Industry stakeholders make masks and distribute polypropylene and other fabrics. They may potentially benefit from this article. She is a member of McMaster's Centre of Excellence in Protective Equipment and Materials. Catherine has received consultation, advisory board membership or research funding from the Ontario Ministry of Health, Sanofi, Pfizer, Leo Pharma, Astellas, Janssen, Amgen, Boehringer-Ingelheim and Baxter. In 2018 she co-chaired a KDIGO potassium controversies conference sponsored at arm's length by Fresenius Medical Care, AstraZeneca, Vifor Fresenius Medical Care, Relypsa, Bayer HealthCare and Boehringer Ingelheim. Catherine Clase receives funding from CIHR, and is a member of the Green Party, the American Society of Nephrology, the Canadian Society of Nephrology, the American Association of Textile Chemists and Colorists and ASTM International.</span></em></p><p class="fine-print"><em><span>Charles-Francois de Lannoy receives funding from the Natural Sciences and Engineering Research Council (NSERC) of Canada, the Global Water Futures (GWF) Research organization, Ontario Centres of Excellence (OCE), Federal Economic Development Agency for Southern Ontario (FedDev), Canadian Foundation for Innovation (CFI), the French Embassy, and McMaster University. He has received funding in partnership with Pall Water, Trojan Technologies, Hatch Ltd., and PW Fabrication. He has engaged in various research projects and testing/validation of facemasks for several private companies in Ontario. He is affiliated with the Cloth Mask Knowledge Exchange as an expert advisor.</span></em></p><p class="fine-print"><em><span>Ken G. Drouillard receives funding from Natural Sciences and Engineering Research Council (NSERC) of Canada, Environment and Climate Change Canada, Ontario Ministry of Environment, Conservation and Parks and Mitacs. He is affiliated with the WE-Spark Health Institute, Detroit River Canadian Cleanup Committee, International Association of Great Lakes Research, Editor of Bulletin of Environmental Contamination and Toxicology and science advisor for Windsor-Essex Sewing Force. </span></em></p>In 2020, with adult ICUs at risk of being overwhelmed, we wore masks and accepted restrictions. Now pediatric intensive care is at risk. Will leaders follow the evidence and tell us to mask up?Catherine Clase, Professor of Medicine, Epidemiologist, Physician, McMaster UniversityCharles-Francois de Lannoy, Associate Professor, Chemical Engineering, McMaster UniversityKen G. Drouillard, Professor, Great Lakes Institute for Environmental Research, School of the Environment, University of WindsorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1942422022-11-18T13:33:47Z2022-11-18T13:33:47ZCOVID-19, RSV and the flu are straining health care systems – two epidemiologists explain what the ‘triple threat’ means for children<figure><img src="https://images.theconversation.com/files/495979/original/file-20221117-11-mwkz5y.jpg?ixlib=rb-1.1.0&rect=97%2C64%2C5302%2C3497&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pediatric emergency rooms in some states are at or over capacity due to the surging number of respiratory infections. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/toddler-boy-using-nebulizer-to-cure-asthma-or-royalty-free-image/1146454661?phrase=kids%20hospital%20RSV&adppopup=true">GOLFX/iStock via Getty Images Plus</a></span></figcaption></figure><p>Every fall and winter, viral respiratory illnesses like the common cold and seasonal flu keep kids out of school and social activities. But this year, more children than usual are <a href="https://www.washingtonpost.com/health/2022/11/04/flu-rsv-covid-cases-surge/">ending up at emergency departments and hospitals</a>. </p>
<p>In California, the Orange County health department declared a state of emergency in early November 2022 due to record numbers of <a href="https://www.msn.com/en-us/health/medical/oc-declares-health-emergency-due-to-viral-infections-causing-rise-in-pediatric-hospitalizations/ar-AA13Cs2k">pediatric hospitalizations for respiratory infections</a>. In Maryland, <a href="https://www.wbaltv.com/article/rsv-maryland-hospitals-at-capacity-transfer-patients-out-of-state/41858233">emergency rooms have run out of beds</a> because of the <a href="https://theconversation.com/rsv-a-pediatric-disease-expert-answers-5-questions-about-the-surging-outbreak-of-respiratory-syncytial-virus-193275">unusually high number</a> of severe <a href="https://www.cdc.gov/rsv/index.html">respiratory syncytial virus</a>, or RSV, infections. So emergency departments there are having to refer patients across state lines for care. </p>
<p>In the U.S., the winter respiratory virus season started earlier than usual this year. Since peak infections usually occur in late December or January, this uncharacteristic early wave suggests that the situation could get much worse for people of all ages, particularly children.</p>
<p>We are epidemiologists with <a href="https://public-health.tamu.edu/directory/fischer.html">expertise in epidemic analysis</a> for <a href="https://www.usfca.edu/faculty/annette-regan">emerging disease threats</a>, including respiratory infections. We watch patterns in these infections closely, and we pay particular attention when the patterns are unusual. We’ve grown increasingly concerned about the amount of pediatric hospitalizations over the last few months and the pattern that is emerging.</p>
<h2>The ‘triple threat’</h2>
<p>In early November, the Centers for Disease Control and Prevention <a href="https://emergency.cdc.gov/han/2022/han00479.asp">issued a health advisory</a> about increased activity in respiratory infections – especially among children. The CDC and other health experts are warning of the so-called “triple threat” of respiratory illness from <a href="https://www.cdc.gov/rsv/index.html">RSV</a>, <a href="https://www.cdc.gov/flu/about/keyfacts.htm">influenza</a> – or the seasonal flu – and <a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/about-covid-19/basics-covid-19.html">COVID-19</a>.</p>
<p>The underlying reasons for the convergence of these viruses and the increase in infections so early in the season are not yet clear. But health experts have some clues about contributing factors and what it could mean for the coming months.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/gzkZeb-wW8k?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">As of mid-November 2022, a children’s hospital in Buffalo, N.Y., had already admitted more than double the number of respiratory syncytial virus patients than in the entire 2019-2020 respiratory season.</span></figcaption>
</figure>
<p>When it comes to COVID-19, 2022 is expected to usher in another <a href="https://doi.org/10.1038/d41586-022-03157-x">winter wave of infections</a>, similar to patterns seen in 2020 <a href="https://www.politico.com/news/2021/11/22/covid-surge-winter-523109">and 2021</a>. Previous winter surges stemmed from a combination of factors, including the emergence and spread of new viral variants, more people gathering indoors rather than distanced outside, and people coming together for the holidays.</p>
<p>But unlike previous pandemic winters, most COVID-19 precautions – such as using masks in public areas or avoiding group activities – are more relaxed than ever. Together with the <a href="https://www.nbcnews.com/health/health-news/new-coronavirus-subvariants-surpass-ba5-dominance-rcna57294">looming threat of new variants</a>, it is difficult to predict how big the next COVID-19 wave could be.</p>
<p>And while the seasonal flu has proved somewhat unpredictable during the COVID-19 pandemic, it nearly always hits during late October. Flu season also arrived about a month early and in greater numbers than in recent history. By <a href="https://gis.cdc.gov/grasp/fluview/FluHospRates.html">our read of the data</a>, pediatric flu hospitalizations are nearing 10 times what has been seen for this time of year for more than a decade. </p>
<p>RSV infections tend to follow a similar seasonal pattern as the flu, peaking in winter months. But this year, there was an unexpected <a href="https://www.cdc.gov/surveillance/nrevss/rsv/natl-trend.html">summer wave</a>, well before the start of the typical fall respiratory virus season.</p>
<p>In typical years, RSV garners little media attention. It’s incredibly common and usually causes only mild illness. In fact, most children <a href="https://www.cdc.gov/rsv/high-risk/infants-young-children.html">encounter the virus before age 2</a>. </p>
<p>But RSV can be a formidable respiratory infection with serious <a href="https://www.cdc.gov/rsv/high-risk/index.html">consequences for children</a> under 5, especially infants. It is the <a href="https://doi.org/10.1016/S0140-6736(22)00478-0">most common cause of lower respiratory infections</a> in young children, and more severe illnesses can lead to pneumonia and other complications, often requiring hospitalization. </p>
<h2>Why children are particularly at risk</h2>
<p><a href="https://www.cdc.gov/flu/about/keyfacts.htm">Children</a>, especially young children, tend to get <a href="https://doi.org/10.1093/cid/cix1060">sicker from flu</a> and <a href="https://www.cdc.gov/rsv/high-risk/index.html">RSV</a> than other age groups. But infants younger than 6 months old <a href="https://doi.org/10.1542/peds.2012-1255">stand to suffer the most</a>, with nearly double the <a href="https://doi.org/10.1016/S0140-6736(22)00478-0">risk of RSV-related death</a> compared to other children younger than 5. COVID-19 hospitalization rates are also <a href="https://covid.cdc.gov/covid-data-tracker/#covidnet-hospitalization-network">four to five times higher for infants</a> than older children.</p>
<p>One reason the youngest children are at greater risk is that their immune systems are not yet fully developed and don’t produce the robust immune response seen in most adults. What’s more, infants younger than 6 months – who are most at risk of severe disease – are still too young to be vaccinated against influenza or COVID-19. </p>
<p>These viruses present challenges on their own, but their co-circulation and coinciding surges in infections create a perfect storm for multiple viruses to infect the same person at once. Viruses might even <a href="https://doi.org/10.1038/s41564-022-01242-5">act together</a> to evade immunity and cause damage to the respiratory tract. </p>
<p>Such co-infections are <a href="https://doi.org/10.1016/j.ajem.2016.12.001">typically uncommon</a>. However, the likelihood of co-infection is <a href="https://doi.org/10.1016/j.jcvp.2021.100036">substantially higher for children</a> than adults. Co-infections can be difficult to diagnose and treat, and can ultimately lead to <a href="https://doi.org/10.1016/S0140-6736(22)00383-X">greater disease severity</a>, complications, hospitalization and death. </p>
<h2>Factors behind the triple threat</h2>
<p>There are a few reasons why the U.S. may be seeing a surge in pediatric respiratory infections. First, COVID-19 protection strategies actually help prevent the <a href="https://doi.org/10.1038/s41579-022-00807-9">transmission of other respiratory pathogens</a>. School and daycare closures likely also minimized exposures children normally have to various respiratory viruses. </p>
<p>These and other efforts to prevent the spread of COVID-19 seem to have suppressed the broad circulation of other viruses, including influenza and RSV. As a result, the U.S. saw an overall <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7140a1.htm">drop in non-COVID respiratory infections</a> – and an <a href="https://www.cdc.gov/flu/about/season/flu-season.htm">almost nonexistent flu season</a> in the winter of 2020. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A young boy sits on an exam table with his mother soothing him while a doctor puts a Band Aid on his arm after giving him a shot." src="https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495976/original/file-20221117-9929-wnorup.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The early surge of respiratory infections underscores the need to get children up to date on flu and COVID-19 vaccinations.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/little-boy-getting-vaccinated-at-the-pediatricians-royalty-free-image/1266488183?phrase=flu%20shots%20kids&adppopup=true">Geber86/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>The decreased viral activity means that children missed out on some exposures to viruses and other pathogens that typically help build immunity, particularly during the first few years of life. The resulting so-called <a href="https://doi.org/10.1016/S1473-3099(22)00544-8">“immunity debt”</a> may contribute to an excess of pediatric respiratory infections as we continue into this season.</p>
<p>To further complicate the picture, the changing nature of viruses, including the<a href="https://www.cbsnews.com/news/cdc-now-tracking-bn-1-the-latest-new-covid-variant-on-the-rise/">emergence of new COVID-19 variants</a> and the natural evolution of seasonal influenza viruses, means that we could be seeing a unique combination of particularly transmissible strains or strains that cause more severe illness.</p>
<h2>Proactive steps people can take</h2>
<p>The early surge in respiratory infections with high rates of hospitalization highlights the importance of prevention. The best tool we have for prevention is vaccination. Vaccines that <a href="https://theconversation.com/when-should-you-get-the-new-covid-19-booster-and-the-flu-shot-now-is-the-right-time-for-both-190826">protect against COVID-19 and influenza</a> are available and <a href="https://www.cdc.gov/flu/prevent/vaccinations.htm">recommended for everyone over 6 months of age</a>.
They have been shown to be safe and effective, and they can and do save lives. </p>
<p>In particular, most recent data on the newly <a href="https://theconversation.com/will-omicron-specific-booster-shots-be-more-effective-at-combating-covid-19-5-questions-answered-189610">updated bivalent COVID-19 booster vaccine</a> suggests that it produces a <a href="https://doi.org/10.1056/NEJMoa2208343">more rigorous antibody response</a> against the current circulating omicron variants than the <a href="https://www.nytimes.com/2022/11/14/us/politics/moderna-booster.html">original COVID-19 vaccines</a>.</p>
<p>The best way to protect infants younger than 6 months old against flu and COVID-19 is by <a href="https://www.cdc.gov/vaccines/pregnancy/index.html">vaccination during pregnancy</a>. When a pregnant mother is vaccinated, <a href="https://doi.org/10.1093/cid/ciac793">maternal antibodies</a> cross the placenta to the baby, reducing the <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7107e3.htm?s_cid=mm7107e3_w">risk of COVID-19 hospitalization</a> in young infants by 61%. Vaccination of other caregivers, family and friends can also help protect infants. </p>
<p>Other preventive measures, like hand-washing, covering sneezes and coughs, staying at home and isolating when sick, can help to protect the community from these viruses and others. Paying attention to local public health advisers can also help people to have the most up-to-date information and make informed decisions to keep themselves and others – of all ages – safe.</p><img src="https://counter.theconversation.com/content/194242/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca S.B. Fischer receives funding from the Fogarty International Center at the U.S. National Institutes for Health and has previously received research funding from the National Institute for Allergy & Infectious Diseases. </span></em></p><p class="fine-print"><em><span>Annette Regan currently receives funding from the National Institutes for Health and the US Centers for Disease Control and Prevention. She has previously received research funding from the National Health and Medical Research Council (Australia), HRSA's Federal Office of Rural Health Policy, the Wesfarmers Center for Vaccines and Infectious Diseases, and the EuroQol Research Foundation.</span></em></p>Respiratory viruses are hitting young children and infants particularly hard this fall and winter season, and experts don’t yet know exactly why.Rebecca S.B. Fischer, Assistant Professor of Epidemiology, Texas A&M UniversityAnnette Regan, Assistant Professor of Epidemiology, University of San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1930762022-11-10T18:49:58Z2022-11-10T18:49:58ZInfluenza and COVID-19: What’s in store for the fall/winter respiratory virus season?<figure><img src="https://images.theconversation.com/files/493682/original/file-20221106-1597-j4udyc.jpg?ixlib=rb-1.1.0&rect=309%2C0%2C4264%2C3238&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Model of an influenza virus. Flu season is expected to make a big comeback this year.</span> <span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/influenza-and-covid-19--what-s-in-store-for-the-fall-winter-respiratory-virus-season" width="100%" height="400"></iframe>
<p>Public health experts in the Northern Hemisphere are <a href="https://www.cbc.ca/news/canada/hamilton/2022-flu-season-intense-1.6616707">predicting a fall/winter respiratory virus season</a> for the ages — one that highlights the importance of global surveillance efforts and vaccines as tools in the fight against influenza (flu) and COVID-19. </p>
<h2>Making sense of COVID-19’s impact on seasonal flu</h2>
<p>Prior to the COVID-19 pandemic, the annual respiratory virus season in northern and southern climates was an epidemic of sorts, one that was characterized by a rapid uptick in the rate of influenza (flu) and of influenza-like illness beginning in mid-fall, peaking in mid-winter and winding down in mid-spring. </p>
<p>The previously predictable pattern of influenza activity in the global North and South has become somewhat unpredictable in post-pandemic seasons. In the United States, approximately 36 million infections, 390,000 hospitalizations and 25,000 deaths due to flu were <a href="https://www.cdc.gov/flu/about/burden/past-seasons.html">reported during the 2019-20 season</a>. </p>
<p>In contrast, minimal influenza activity was noted in 2020-21 while the 2021-22 season saw a four-fold decline in activity compared to pre-pandemic seasons.</p>
<p>Implementation of strict public health measures during the COVID-19 pandemic was instrumental in reducing the incidence of flu and flu-like illnesses during the past two respiratory virus seasons in both hemispheres. However, the <a href="https://doi.org/10.1016/S2214-109X(22)00358-8">relaxation of these measures</a> is expected to promote a tidal wave of respiratory virus infections in the weeks to come. </p>
<p>These infections include <a href="https://doi.org/10.1016%2Fj.ijid.2022.08.002">influenza</a>, <a href="https://covid19.healthdata.org/global?view=cumulative-deaths&tab=trend">SARS-CoV-2</a> and <a href="https://www.cdc.gov/surveillance/nrevss/rsv/natl-trend.html">Respiratory Syncytial Virus (RSV)</a>, which often <a href="https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/palivizumab-respiratory-syncitial-virus-infection-infants.html">affects children</a>.</p>
<h2>Influenza in the Southern Hemisphere</h2>
<figure class="align-center ">
<img alt="Four red circular spots on a blue background." src="https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=495&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=495&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=495&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=622&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=622&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494631/original/file-20221110-19-jsi5eg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=622&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microscopic view of influenza B virus particles.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Despite the impact of COVID-19 on global health and the almost negligible level of seasonal influenza activity over the past two years, the Southern Hemisphere experienced a major shift in influenza activity during the 2022 respiratory virus season. </p>
<p>In <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7143a1.htm?s_cid=mm7143a1_w">Chile</a>, the season began with a burst of influenza B activity in January, followed by a relative lull in March and April, and then a surge in influenza A that peaked in June. In contrast, <a href="https://www.health.gov.au/sites/default/files/documents/2022/10/aisr-fortnightly-report-no-7-20-june-to-3-july-2022.pdf">Australia’s flu season</a> started in March, had a record peak in June, and was dominated throughout by influenza A.</p>
<h2>What’s in store for fall and winter?</h2>
<p>Unlike seasonal influenza, COVID-19 primarily behaves as a pandemic virus, with simultaneous, high-level viral transmission in all parts of the globe. COVID-19 activity may be “seasonal” in some respects, with higher rates of transmission during the fall and winter months when people are indoors more often than not and, consequentially, less socially-distanced. </p>
<p>The 2022 Southern Hemisphere experience serves as a harbinger for what to expect during the 2022-23 respiratory virus season in northern climates. </p>
<p>In the North, the respiratory virus season is already off to an early and blazing start, particularly in the <a href="https://www.cdc.gov/flu/weekly/index.htm">U.S.</a> and <a href="https://www.canada.ca/en/public-health/services/diseases/flu-influenza/influenza-surveillance/weekly-influenza-reports.html">Canada</a>, and appears destined to wreak havoc on <a href="https://www.thestar.com/news/canada/2022/11/04/doctors-nurses-advocates-call-on-governments-to-address-health-care-crisis.html">health-care systems that are already struggling</a> from the impact of COVID-19. </p>
<h2>The importance of influenza vaccination</h2>
<figure class="align-right ">
<img alt="Green circular spots with black markings on a blue background." src="https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494632/original/file-20221110-12-2iphk0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microscopic view of H1N1 influenza virus particles.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Vaccination is one of the most effective public health interventions in our battle against influenza and COVID-19. Recommendations on the composition of flu vaccines are made biannually by the World Health Organization (WHO) several months in advance of the forthcoming respiratory virus season in each respective hemisphere. </p>
<p>However, licensing of influenza vaccines generally falls under national jurisdictions. Similar vaccine formulations are approved for use in the <a href="https://www.cdc.gov/flu/professionals/acip/2022-2023/acip-table.htm">U.S.</a>, <a href="https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2022-2023.html">Canada</a>, <a href="https://www.gov.uk/government/publications/flu-vaccines-for-the-current-season/flu-vaccines-for-the-2022-to-2023-season">United Kingdom</a> and other northern countries, and are now widely available. </p>
<p><a href="https://www.who.int/news/item/25-02-2022-recommendations-announced-for-influenza-vaccine-composition-for-the-2022-2023-northern-hemisphere-influenza-season">Flu vaccine composition</a> for the 2022-23 respiratory virus season in northern latitudes is based on surveillance of circulating influenza virus strains during the most recent respiratory virus season in the Southern Hemisphere. The WHO has recommended both quadrivalent vaccines (containing four strains) and trivalent vaccines (containing three strains), with no preference given to either formulation. </p>
<p>The quadrivalent vaccine contains two <a href="https://www.mcgill.ca/oss/article/health/what-does-it-mean-when-vaccine-contains-inactivated-virus">inactivated strains</a> of influenza A (H1N1 and H3N2) and two inactivated strains of influenza B. The trivalent vaccine is similar with the exception of having a single inactivated strain of influenza B.</p>
<h2>How effective are flu shots?</h2>
<figure class="align-center ">
<img alt="Gloved hands giving an injection in someone's shoulder" src="https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494637/original/file-20221110-20-4mq02t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">You can get the flu jab concurrently with COVID-19 vaccine.</span>
<span class="attribution"><span class="source">(AP Photo/Rogelio V. Solis)</span></span>
</figcaption>
</figure>
<p>Vaccine-mediated protection against influenza infection, severe illness and death has immense public health ramifications, yet is often misunderstood. <a href="http://doi.org/10.1183/16000617.0258-2020">Vaccine effectiveness</a> varies from one respiratory virus season to another and <a href="https://www.cdc.gov/flu/vaccines-work/effectivenessqa.htm#:%7E:text=In%20addition%20to%20virus%20factors,the%20benefits%20received%20from%20vaccination.">hinges on several factors</a>, including the degree of vaccine mismatch with circulating strains, the use of high-dose versus standard-dose vaccines, prior influenza illness or vaccination, age, general health status, and public health measures such as social distancing, medical mask use, and travel restrictions.</p>
<p>Flu vaccines tend to confer a <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm">greater degree of protection against influenza B and influenza A H1N1 subtypes</a>, with a lower degree of effectiveness against the influenza A H3N2 subtype. </p>
<p><a href="https://doi.org/10.1093/cid/ciab462">Research</a> has shown that the effectiveness of standard-dose flu vaccines in preventing severe influenza illness during the 2019-20 U.S. respiratory virus season was highest in young adults (60 per cent), relatively low in middle-aged adults (20 per cent) and modest or negligible in the elderly. </p>
<p>High-dose vaccines improve effectiveness to 30 per cent in the elderly. Therefore, people 65 years of age or older should receive a high-dose quadrivalent vaccine. Flu shots should be complemented by other infection control precautions including social distancing, indoor masking and frequent handwashing.</p>
<h2>Do I really need a flu shot?</h2>
<p>You can get a <a href="https://www.cdc.gov/flu/prevent/coadministration.htm">flu shot concurrently with a COVID-19 shot</a>. </p>
<p>Influenza vaccines are considered safe and effective in virtually all individuals, despite the <a href="https://www.scientificamerican.com/article/flu-shots-may-not-protect-the-elderly-or-the-very-young/">lack of robust evidence of protection in very young children and the elderly</a>. Their use is akin to protection from wearing seatbelts; you may not necessarily be involved in an accident but if you are, the chances of survival and protection from serious injury are higher with their use than without. </p>
<p>During the <a href="https://www.cdc.gov/flu/prevent/flushot.htm">2019-20 respiratory virus season in the U.S</a>, influenza vaccination prevented over 100,000 hospitalizations and over 6,000 deaths. Given the expected burden of influenza illness and the ongoing COVID-19 pandemic, the benefits of vaccination will likely be greater during the current respiratory viral season compared to those in the past few years.</p>
<h2>What is the role of COVID-19 boosters?</h2>
<figure class="align-right ">
<img alt="Orange masses studded with small green dots." src="https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=515&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=515&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=515&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=647&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=647&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494633/original/file-20221110-3879-pcpp93.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=647&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microscopic view of the Omicron strain of SARS-CoV-2 virus particles (coloured green) on a human cell.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>For COVID-19, the <a href="https://doi.org/10.1136/bmj-2022-072141">effectiveness of a two-dose primary vaccine series plus a single booster</a> in preventing hospitalization is close to 90 per cent but gradually drops to around 65 per cent over the course of four to five months after the last vaccine dose. Bivalent vaccine boosters may serve as a means of <a href="https://doi.org/10.1016/S1473-3099(22)00692-2">preserving vaccine-induced immunity</a> against newer variants of SARS-CoV-2. </p>
<p>COVID-19 vaccines remain part of an effective strategy to counter the next wave of infection. The latest <a href="https://secure.medicalletter.org/TML-article-1660c">bivalent vaccines</a> manufactured by Pfizer and Moderna are recommended as boosters for individuals with at least two primary COVID-19 vaccinations. </p>
<p>The bivalent vaccines are believed to be more effective against the dominant BA.4 and BA.5 Omicron subvariants of SARS-CoV-2 than the original mRNA vaccines, but <a href="https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/summary-national-advisory-committee-immunization-november-3-2022-recommendations-use-moderna-spikevax-bivalent-mrna-50-mcg-covid-19-booster-vaccine-adults.html">equal in effectiveness to first-generation bivalent vaccines</a> that target the original strain and the BA.1 Omicron subvariant. The <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-and-pfizer-biontech-bivalent-covid-19-vaccines">U.S.</a>, <a href="https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/summary-national-advisory-committee-immunization-november-3-2022-recommendations-use-moderna-spikevax-bivalent-mrna-50-mcg-covid-19-booster-vaccine-adults.html">Canada</a> and <a href="https://www.ema.europa.eu/en/news/comirnaty-spikevax-ema-recommendations-extra-doses-boosters">Europe</a> have slightly different age-based and time-based eligibility criteria for these boosters. </p>
<p>Influenza and COVID-19 are expected to make headway during the current respiratory virus season in northern climates. Vaccination in conjunction with personal protective measures are the best means of staying healthy.</p><img src="https://counter.theconversation.com/content/193076/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sameer Elsayed does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Flu and COVID-19 are expected to make headway during the current respiratory virus season. The best way to stay healthy is vaccination in conjunction with personal protective measures.Sameer Elsayed, Professor of Medicine, Pathology & Laboratory Medicine, and Epidemiology & Biostatistics, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1869702022-08-04T12:23:36Z2022-08-04T12:23:36ZLong COVID-19 and other chronic respiratory conditions after viral infections may stem from an overactive immune response in the lungs<figure><img src="https://images.theconversation.com/files/477255/original/file-20220802-23-r6z7fj.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2297%2C1292&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The immune system usually stays dormant in the lungs in times of health.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/lung-virus-infection-royalty-free-image/1205199983">wildpixel/iStock via Getty Images</a></span></figcaption></figure><p>Viruses that cause respiratory diseases like the flu and COVID-19 can lead to mild to severe symptoms within the first few weeks of infection. These symptoms typically resolve within a few more weeks, sometimes with the help of treatment if severe. However, some people go on to experience persistent symptoms that last several months to years. Why and how respiratory diseases can develop into chronic conditions like <a href="https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html">long COVID-19</a> are still unclear.</p>
<p>I am a <a href="https://scholar.google.com/citations?hl=en&user=BNGZA1MAAAAJ">doctoral student</a> working in the <a href="https://www.immunology.virginia.edu/Sun/">Sun Lab</a> at the University of Virginia. We study how the immune system sometimes goes awry after fighting off viral infections. We also develop ways to target the immune system to prevent further complications without weakening its ability to protect against future infections. Our <a href="https://doi.org/10.1126/sciimmunol.abm7996">recently published review</a> of the research in this area found that it is becoming clearer that it might not be an active viral infection causing long COVID-19 and similar conditions, but an overactive immune system.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/OLHtVfp6PJM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Long COVID-19 patients can experience persistent respiratory, cognitive and neurological symptoms.</span></figcaption>
</figure>
<h2>The lungs in health and disease</h2>
<p>Keeping your immune system dormant when there isn’t an active infection is essential for your lungs to be able to function optimally. </p>
<p>Your respiratory tract is in constant contact with your external environment, sampling around <a href="https://www.acepnow.com/article/avoid-airway-catastrophes-extremes-minute-ventilation/">5 to 8 liters (1.3 to 2 gallons) of air</a> – and the toxins and microorganisms in it – every minute. Despite continuous exposure to potential pathogens and harmful substances, your body has evolved to <a href="https://doi.org/10.1164/ajrccm.162.supplement_3.15tac6">keep the immune system dormant in the lungs</a>. In fact, allergies and conditions such as asthma are byproducts of an <a href="https://doi.org/10.1513/AnnalsATS.201401-028AW">overactive immune system</a>. These excessive immune responses can cause your airways to constrict and make it difficult to breathe. Some severe cases may require treatment to suppress the immune system. </p>
<p>During an active infection, however, the immune system is absolutely essential. When viruses infect your respiratory tract, immune cells are recruited to your lungs to fight off the infection. Although these cells are crucial to eliminate the virus from your body, their activity often results in collateral damage to your lung tissue. After the virus is removed, your body <a href="https://doi.org/10.1007%2Fs00281-016-0560-6">dampens your immune system</a> to give your lungs a chance to recover.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/rgphaHmAC_A?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">An overactive immune system, as in the case of asthma, can damage the lungs.</span></figcaption>
</figure>
<p>Over the past decade, researchers have identified a variety of <a href="https://doi.org/10.1016/j.stem.2020.03.009">specialized stem cells in the lungs</a> that can help regenerate damaged tissue. These stem cells can turn into almost all the different types of cells in the lungs depending on the signals they receive from their surrounding environment. <a href="https://doi.org/10.1126/scitranslmed.abo5254">Recent</a> <a href="https://doi.org/10.1016/j.stem.2020.06.020">studies</a> <a href="https://doi.org/10.1016/j.stemcr.2019.02.013">have highlighted</a> the prominent role the immune system plays in providing signals that facilitate lung recovery. But these signals can produce more than one effect. They can not only activate stem cells, but also perpetuate damaging inflammatory processes in the lung. Therefore, your body tightly regulates when, where and how strongly these signals are made in order to prevent further damage.</p>
<p>While the reasons are still unclear, some people are unable to turn off their immune system after infection and <a href="https://doi.org/10.1126/sciimmunol.abk1741">continue to produce tissue-damaging molecules</a> <a href="https://doi.org/10.1038/s41590-021-01113-x">long after</a> the virus has been flushed out. This not only further damages the lungs, but also interferes with regeneration via the lung’s resident stem cells. This phenomenon can result in chronic disease, as seen in several respiratory viral infections including <a href="https://doi.org/10.1016/j.immuni.2022.01.017">COVID-19</a>, <a href="https://doi.org/10.2340/16501977-2694">Middle East Respiratory Syndrome (MERS)</a>, <a href="https://doi.org/10.1056/NEJMoa1211917">respiratory syncytial virus (RSV)</a> and the <a href="https://doi.org/10.1016/j.jaci.2005.06.024">common cold</a>.</p>
<h2>The immune system’s role in chronic disease</h2>
<p>In our review, my colleagues and I found that many <a href="https://doi.org/10.1126/sciimmunol.abm7996">different types of immune cells</a> are involved in the development of chronic disease after respiratory viral infections, including long COVID-19.</p>
<p>Scientists so far have identified one particular type of immune cells, <a href="https://doi.org/10.1126/sciimmunol.abk1741">killer T cells</a>, as potential contributors to chronic disease. Also known as cytotoxic or CD8+ T cells, they specialize in killing infected cells either by interacting directly with them or by producing damaging molecules called cytokines. </p>
<p>Killer T cells are essential to curbing the virus from spreading in the body during an active infection. But their persistence in the lungs after the infection has resolved is linked to extended <a href="https://doi.org/10.1126/sciimmunol.abc4557">reduced respiratory function</a>. Moreover, animal studies have shown that <a href="https://doi.org/10.1126/sciimmunol.abk1741">removing killer T cells from the lungs</a> after infection may improve lung function and tissue repair.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/PSRJfaAYkW4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A legion of immune cells work together to remove invading pathogens.</span></figcaption>
</figure>
<p>Another type of immune cells called monocytes are also involved in fighting respiratory infections, serving among the first responders by producing virus- and tissue-damaging cytokines. Research has found that these cells also <a href="https://doi.org/10.1016/j.immuni.2022.01.017">continue to accumulate</a> in the lungs of long COVID-19 patients and promote a pro-inflammatory environment that can cause further damage.</p>
<p>Understanding the immunological mechanisms underlying long COVID-19 is the first step to addressing a <a href="https://www.kff.org/policy-watch/what-are-the-implications-of-long-covid-for-employment-and-health-coverage/">quickly worsening public health problem</a>. Identifying the subtle differences in how the same immune cells that protect you during an active infection can later become harmful could lead to earlier diagnosis of long COVID-19. Moreover, based on our findings, my team and I believe treatments that target the immune system could be an effective approach to manage long COVID-19 symptoms. We believe that this strategy may turn out to be useful not only for COVID-19, but also for other respiratory viral infections that lead to chronic disease as well.</p><img src="https://counter.theconversation.com/content/186970/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harish Narasimhan 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>While a strong immune response is essential to fight against viral infection, an immune system that continues to stay active long after the virus has been cleared can lead to lung damage.Harish Narasimhan, PhD Candidate in Immunology, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1686362021-11-10T13:40:52Z2021-11-10T13:40:52ZThe chickenpox virus has a fascinating evolutionary history that continues to affect peoples’ health today<figure><img src="https://images.theconversation.com/files/429786/original/file-20211102-19-1gjsqqg.jpg?ixlib=rb-1.1.0&rect=57%2C0%2C5406%2C3489&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most children today receive the chickenpox vaccine as a routine part of childhood immunizations. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/chickenpox-royalty-free-image/1144939011?adppopup=true">Solidcolours/E+ via Getty Images</a></span></figcaption></figure><p>In July 2021, a Centers for Disease Control and Prevention presentation <a href="https://www.washingtonpost.com/context/cdc-breakthrough-infections/94390e3a-5e45-44a5-ac40-2744e4e25f2e/">obtained by the press</a> noted that the delta variant of COVID-19 “is as transmissible as chickenpox.” </p>
<p>As some researchers have pointed out, <a href="https://www.npr.org/sections/goatsandsoda/2021/08/11/1026190062/covid-delta-variant-transmission-cdc-chickenpox">the CDC’s comparison was an overstatement</a>. Based on various studies and projections, on average a person infected with the delta strain of COVID-19 can infect six or seven people, whereas someone infected with chickenpox can infect nine or 10. Nonetheless, both diseases are highly contagious, although the viruses that cause them are very different.</p>
<p>While many diseases, such as <a href="https://www.cdc.gov/vhf/ebola/about.html">Ebola</a> and <a href="https://theconversation.com/influenzas-wild-origins-in-the-animals-around-us-91058">influenza</a>, originate from viruses that made relatively recent “jumps” from animals to humans, other disease-causing pathogens have been with humans throughout evolution. The virus that causes chickenpox is one of these, coexisting with the human evolutionary line for <a href="https://doi.org/10.1128/JVI.00357-12">millions of years</a>. </p>
<p>I am a microbiologist interested in <a href="https://biology.indiana.edu/about/faculty/foster-patricia.html">pathogens and the diseases they cause</a>. Chickenpox is a childhood disease, and until a couple of decades ago, nearly <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/chickenpox">all children in the United States got it</a>. A vaccine campaign that began in the 1990s has made the disease rare in children in the U.S., but the virus lingers in the body and can reappear in unvaccinated adults years later as shingles. The virus’s ability to do this disappearing-and-reappearing trick may be the key to its <a href="https://doi.org/10.1128/JVI.00357-12">long evolutionary history</a>.</p>
<h2>Chickenpox and shingles stem from the same virus</h2>
<p>I became painfully aware of the virus that causes chickenpox a few years ago when my husband developed shingles soon after starting a stressful job. <a href="https://doi.org/10.1111/bjd.19832">Chronic stress is one trigger</a> for reactivation of the dormant virus, as it is for the closely related <a href="https://doi.org/10.3389/fmicb.2019.00016">herpes viruses</a>.</p>
<p>The virus that causes both chickenpox and shingles, varicella-zoster, is only known to <a href="https://doi.org/10.1038/nrdp.2015.16">infect humans</a>. “Varicella” means “<a href="https://www.merriam-webster.com/dictionary/varicella">little variola</a>,” or little smallpox, because both diseases cause skin blisters.</p>
<figure class="align-center ">
<img alt="Varicella zoster (chickenpox) virus, illustration." src="https://images.theconversation.com/files/427906/original/file-20211021-22-18g4m4p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427906/original/file-20211021-22-18g4m4p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427906/original/file-20211021-22-18g4m4p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427906/original/file-20211021-22-18g4m4p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427906/original/file-20211021-22-18g4m4p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=540&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427906/original/file-20211021-22-18g4m4p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=540&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427906/original/file-20211021-22-18g4m4p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=540&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Varicella-zoster, the virus depicted in this illustration, causes both chickenpox in children and shingles in adults.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/varicella-zoster-viruses-illustration-royalty-free-illustration/1209159885?adppopup=true">Roger Harris/Science Photo Library/Science Photo Library via Getty Images</a></span>
</figcaption>
</figure>
<p>Shingles is known in medical terms as herpes zoster. Both “zoster” and “shingles” derive from words for belt or girdle in <a href="https://www.merriam-webster.com/dictionary/zoster">Greek</a> and <a href="https://www.merriam-webster.com/dictionary/shingles">Latin</a>, respectively, referring to the typical arrangement of blisters on the torso during shingles outbreaks. </p>
<h2>Chickenpox is primarily a childhood disease</h2>
<p>Chickenpox is spread by inhalation, and children are infectious a few days before <a href="https://www.cdc.gov/chickenpox/about/transmission.html">symptoms appear</a>. The blisters also contain live viruses that can become <a href="https://doi.org/10.1038/nrdp.2015.16">airborne and inhaled</a> or can be transmitted through direct contact. After inhalation, chickenpox viruses invade the cells of the respiratory tract, replicate in the lymph nodes and are spread by white blood cells throughout the body. Eventually, they <a href="https://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html">lodge in the skin</a>, causing the itchy blisters that are characteristic of the disease.</p>
<p>In healthy children, chickenpox lasts about a week and goes away without medical intervention. But it can be more severe in adolescents, adults and people with compromised immune systems. Infection with chickenpox typically provides <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/chickenpox">lifelong immunity to reinfection</a>.</p>
<h2>Shingles mostly affects older adults</h2>
<p>Even after the chickenpox blisters are gone, the varicella-zoster virus is not. The viruses travel to nerve root clusters <a href="https://www.cdc.gov/vaccines/pubs/pinkbook/herpes-zoster.html">located along the spinal cord</a>. There, the viruses establish a persistent, dormant state in the <a href="https://doi.org/10.1038/nrdp.2015.16">nuclei of the nerve cells</a>.</p>
<p>Over the course of a person’s life, the viruses may reactivate, but usually the immune system eliminates the active viruses before they can appear as shingles. However, as the immune system weakens with age, or as a result of illness or stress, reactivated viruses can travel back along the nerves and erupt again as painful blisters. Typically, only one nerve-root cluster is involved, and the blisters appear in the area of the skin supplied by those nerves. This leads to the classic <a href="https://www.cdc.gov/vaccines/pubs/pinkbook/herpes-zoster.html">belt-like appearance</a>, although the blisters can localize to other areas of the skin.</p>
<p>Although even children can develop shingles, the risk of that happening and the severity of the disease increases sharply after the age of 50. The CDC estimates that 1 in 3 people in the U.S. <a href="https://www.cdc.gov/shingles/surveillance.html">will have shingles</a> at some point in their lives. In healthy adults, a shingles outbreak typically lasts from seven to 10 days; however, about 15% of shingles sufferers develop persistent, often debilitating, neurological pain, called <a href="https://doi.org/10.1038/nrdp.2015.16">postherpetic neuralgia</a>, that can last for months or even years. </p>
<h2>Varicella-zoster has a long, slow evolutionary history</h2>
<p>Unlike the COVID-19 and influenza viruses, which have genomes of <a href="https://asm.org/Articles/2020/July/COVID-19-and-the-Flu">single-stranded RNA</a>, varicella-zoster’s genome is double-stranded DNA. This makes its genome more stable and able to be copied more accurately than <a href="https://doi.org/10.1128/JVI.00694-10">single-stranded RNA genomes</a>. </p>
<p>Although experts disagree on the exact rate at which varicella-zoster accumulates genetic changes, called mutations, a reasonable estimate of its evolution rate is one new mutation every <a href="https://doi.org/10.1099/0022-1317-75-3-513">200</a> to <a href="https://doi.org/10.1371/journal.pone.0022527">400</a> years. This rate is in contrast to influenza, for example, whose RNA genome is copied so sloppily that it accumulates about 40 new mutations every year, according to my calculations based on <a href="https://doi.org/10.1128/JVI.02163-13">data published here</a>. </p>
<p>Varicella-zoster is a member of a large group of viruses, the Herpesviridae, that <a href="https://doi.org/10.1007/s00705-008-0278-4">infect mammals, birds and reptiles</a>. Although there have been some “<a href="https://doi.org/10.1093/ve/veab025">jumps” between hosts in the distant past</a>, these viruses tend to infect only specific hosts. Thus, scientists can deduce the evolutionary history of the viruses by looking at the known <a href="https://doi.org/10.1006/jmbi.1995.0152">evolutionary relationships of their hosts</a>. </p>
<p>Such analyses indicate that the viruses that eventually led to varicella-zoster and its relatives existed 200 million years ago in the <a href="https://doi.org/10.1093/ve/veab025">Triassic/Jurassic period</a> – the age of dinosaurs! The closest existing relative to varicella-zoster infects an <a href="https://doi.org/10.1006/viro.2001.0912">old-world monkey</a>. The evolutionary lines that led to humans and old-world monkeys split <a href="https://doi.org/10.1093/molbev/msg050">23 million years ago</a>; thus, our cohabitation with varicella-zoster goes back at least that far.</p>
<p>Recent DNA analysis of varicella-zoster strains currently infecting humans complicates this history somewhat. The data indicates that the virus is accumulating <a href="https://doi.org/10.1093/infdis/jiz227">mutations faster</a> than would be consistent with its evolutionary history, and that the ancestor of the current strains appeared only <a href="https://doi.org/10.1093/molbev/msu406">about 8,000 years ago</a>. Such discrepancies between short-term and long-term evolutionary rates have appeared in <a href="https://doi.org/10.1016/j.cub.2021.08.020">numerous similar studies</a>, and scientists are <a href="https://doi.org/10.1146/annurev-ecolsys-011921-023644">currently analyzing why this is so</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of Shingles vaccine with syringe in background." src="https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.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 CDC recommends that all adults age 50 and older get vaccinated for shingles.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/shingles-vaccine-syringe-stock-photo-royalty-free-image/1264660305?adppopup=true">Fotolgahan/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p>The ability to enter a latent state may have given varicella-zoster a survival advantage. Ancient hunter-gatherers would have lived in small groups where an outbreak of chickenpox could have infected the whole population. <a href="https://doi.org/10.1128/JVI.00357-12">A credible theory</a> proposed by Charles Grose, a pediatric infectious disease specialist at the University of Iowa, holds that, since chickenpox conveys lifelong immunity, the survivors could not be reinfected. And without new hosts, the virus would die out. However, by persisting for years in survivors in its latent state, varicella-zoster could reappear after a new generation of children was born. Since the shingles blisters are infectious, these children would get chickenpox and a new cycle would begin.</p>
<h2>Vaccines for chickenpox and shingles are effective</h2>
<p>Prior to 1995, when the chickenpox vaccine was introduced, nearly all U.S. children got infected with <a href="https://doi.org/10.1038/nrdp.2015.16">chickenpox by age 10</a>. Although usually mild, rare complications resulted in more than <a href="https://www.cdc.gov/chickenpox/vaccine-infographic.html">10,000 hospitalizations and 100 deaths per year</a>. </p>
<p>The two-dose vaccine has resulted in greater than 90% protection against infection. Currently the vaccination rate among schoolchildren <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7003a2.htm">approaches 95%</a>. By preventing the virus from spreading, this level of vaccination <a href="https://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html">protects unvaccinated children</a> through <a href="https://theconversation.com/what-is-herd-immunity-a-public-health-expert-and-a-medical-laboratory-scientist-explain-170520">herd immunity</a>. </p>
<p>The chickenpox vaccine is a live, attenuated varicella-zoster strain that, like the original strain, stays in the body in a dormant state. But the vaccine strain is <a href="https://doi.org/10.1542/peds.2018-2917">weakened for activation</a>, and as of 2016 <a href="https://doi.org/10.1093/cid/ciy954">data show</a> that children vaccinated for chickenpox develop shingles less frequently than children did when chickenpox was common. Public health experts do not yet know whether the rate of vaccine-derived shingles will rise as the vaccinated population ages and becomes more susceptible to the disease.</p>
<p>Shingrix, an effective, protein-based vaccine against shingles, has been available since 2017. The CDC recommends <a href="https://www.cdc.gov/shingles/multimedia/shringrix-50-older.html">everyone over age 50 to get vaccinated</a> for shingles, whether or not they have had chickenpox, shingles or have been vaccinated with Zostavax – a former shingles vaccine that was less effective. Shingrix reduces the incidence of shingles an average of 97% and, if a case occurs, reduces the <a href="https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html#how-well-does-shingrix-work">incidence of postherpetic neuralgia by 91%</a>.</p>
<p>Vaccination requires two doses and is known, so far, to be protective for <a href="https://doi.org/10.1093/infdis/jiab387">at least 10 years</a>. As of 2018, <a href="https://www.cdc.gov/nchs/products/databriefs/db370.htm?deliveryName=USCDC_171-DM32740">34.5% of U.S. adults 60 and over</a> were vaccinated against shingles, most with Zostavax.</p>
<p>With effective vaccines against both chickenpox and shingles now available, I believe that the countries with high vaccination rates could eventually be free of both of the diseases caused by varicella-zoster – ultimately making the chickenpox-shingles duo go the way of the dinosaurs.</p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/168636/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patricia L. Foster is affiliated with the Union of Concerned Scientists and Concerned Scientists at Indiana University.</span></em></p>Chickenpox has largely disappeared from the public’s memory thanks to a highly effective vaccine. But the virus’s clever life cycle allows it to reappear in later adulthood in the form of shingles.Patricia L. Foster, Professor Emerita of Biology, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1702632021-11-07T19:11:39Z2021-11-07T19:11:39ZWe can expect more colds and flu as COVID restrictions lift. 5 germs to look out for<figure><img src="https://images.theconversation.com/files/430419/original/file-20211105-21-ygv39e.jpg?ixlib=rb-1.1.0&rect=19%2C0%2C6504%2C4851&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-vector/sick-man-unhappy-character-vector-cartoon-491241730">Shutterstock</a></span></figcaption></figure><p>Australia is opening up, people are mixing and mingling, and schools are back. But there’s a downside. Sharing our lives with each other again also means sharing our germs.</p>
<p>When we look at trends of illnesses in cities coming out of lockdown <a href="https://www.theguardian.com/science/2021/jul/09/non-covid-respiratory-illnesses-rise-uk-medical-experts-say-people-mixing-easing-lockdown">internationally</a>, one thing is clear. We can expect to see more colds and flu. But what’s actually causing these?</p>
<p>Here are five germs I expect we’ll see more of in the coming months.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-does-my-snot-turn-green-when-i-have-a-cold-98379">Curious Kids: Why does my snot turn green when I have a cold?</a>
</strong>
</em>
</p>
<hr>
<h2>1. Influenza</h2>
<p>Usually seasonal influenza kills <a href="https://www.who.int/news/item/13-12-2017-up-to-650-000-people-die-of-respiratory-diseases-linked-to-seasonal-flu-each-year">290,000 to 650,000 people</a>
a year worldwide. But since COVID hit, it has practically <a href="https://www.who.int/publications/i/item/who-wer-9625-241-264">vanished</a>.</p>
<p>The most likely reason for such a dramatic drop is the reduction in international travel. Public health interventions designed to curb COVID (such as mask wearing, hand washing, physical distancing) have also likely contributed.</p>
<p>With global travel opening up again, influenza will likely travel too. So we anticipate seeing a <a href="https://www.nature.com/articles/d41586-021-02558-8">lot more of it around</a>.</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>2. <em>Streptococcus pneumoniae</em></h2>
<p>Pandemic response measures have also curbed some bacteria, such as <em>Streptococcus pneumoniae</em>.</p>
<p>A <a href="https://www.thelancet.com/journals/landig/article/PIIS2589-7500(21)00077-7/fulltext">study</a> was conducted on data from 26 countries across six continents in the first half of 2020. It found <em>S. pneumoniae</em> infections decreased by 82% after eight weeks of restricted population movement, such as lockdown.</p>
<p>This bacteria causes pneumonia (which is how it got its name). It can also cause a range of other illnesses from ear infections and sinusitis to life-threatening infections of the bloodstream (sepsis), and central nervous system (meningitis).</p>
<p>Young children, older people and people with impaired immune systems are <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/pneumococcal-disease">most at risk</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430416/original/file-20211105-21-1xc3e8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Young child in pain, clutching ear" src="https://images.theconversation.com/files/430416/original/file-20211105-21-1xc3e8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430416/original/file-20211105-21-1xc3e8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430416/original/file-20211105-21-1xc3e8d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430416/original/file-20211105-21-1xc3e8d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430416/original/file-20211105-21-1xc3e8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430416/original/file-20211105-21-1xc3e8d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430416/original/file-20211105-21-1xc3e8d.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">This bacteria can cause everything from ear infections to meningitis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-toddler-boy-has-earache-when-1502458520">Shutterstock</a></span>
</figcaption>
</figure>
<p>Thankfully, we have vaccines (known as pneumococcal vaccines) to help prevent the nastier diseases you can get from this bacteria.</p>
<p>These are already part of the <a href="https://www.health.gov.au/health-topics/immunisation/immunisation-throughout-life/national-immunisation-program-schedule">Australian vaccination schedule</a>. So if you have been vaccinated according to routine recommendations, you should already be protected.</p>
<p>If you catch <em>S. pneumoniae</em>, it does respond to antibiotics. However, it’s resistant to at least one antibiotic in <a href="https://www.cdc.gov/drugresistance/pdf/threats-report/strep-pneumoniae-508.pdf">three out of every ten cases</a>.</p>
<p>Prevention (with vaccines and hygiene) is definitely the better option. So as a community, we must carefully <a href="https://bmjopen.bmj.com/content/9/3/e026735">steward our use of antibiotics</a> to make sure they actually work when we really need them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-resistance-is-common-in-antibiotics-but-rare-in-vaccines-152647">Why resistance is common in antibiotics, but rare in vaccines</a>
</strong>
</em>
</p>
<hr>
<h2>3. <em>Neisseria meningitidis</em></h2>
<p>This is another nasty bacteria. You may have already guessed from its name that it can cause meningococcal meningitis, a serious infection of the central nervous system. </p>
<p>The same <a href="https://www.thelancet.com/journals/landig/article/PIIS2589-7500(21)00077-7/fulltext">international study</a> that found a reduction in <em>S. pneumoniae</em> during lockdowns also found rates of <em>Neisseria meningitidis</em> greatly reduced.</p>
<p>This is not surprising as <em>N. meningitidis</em> also lives in the nose and throat and can be transmitted from person to person via droplets as people cough and sneeze.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1106948243886428160"}"></div></p>
<p>Meningitis <a href="https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30387-9/fulltext">outbreaks have occurred worldwide</a> over the years, and a high proportion of people who become sick with it die. Survivors sometimes have severe, lifelong disability. </p>
<p>Like with <em>S. pneumoniae</em>, there is both prevention (via a <a href="https://wwwnc.cdc.gov/travel/diseases/meningococcal-disease">vaccine</a>) and treatment (with antibiotics) for <em>N. meningitidis</em> infections. But there is also growing <a href="https://www.sciencedirect.com/science/article/pii/S0264410X2100270X">antibiotic resistance</a>. </p>
<p>So getting vaccinated, and avoiding antibiotic overuse, are important ways to reduce the risk of being seriously impacted by this bacteria.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-meningococcal-disease-and-what-are-the-options-for-vaccination-88769">What is meningococcal disease and what are the options for vaccination?</a>
</strong>
</em>
</p>
<hr>
<h2>4. Respiratory syncytial virus</h2>
<p>Respiratory syncytial virus (or RSV) is a common virus causing a flu-like lung infection called <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Respiratory_syncytial_virus_RSV/">bronchiolitis</a>. This mostly seriously affects <a href="https://pubmed.ncbi.nlm.nih.gov/31384456/">children under the age of two</a>.</p>
<p>Although RSV infections usually cause mild cold symptoms, they are also responsible for a significant number of deaths <a href="https://pubmed.ncbi.nlm.nih.gov/27480325/">in children under five worldwide</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430417/original/file-20211105-22-olr4kp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Young child in hospital with nebuliser to help breathing" src="https://images.theconversation.com/files/430417/original/file-20211105-22-olr4kp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430417/original/file-20211105-22-olr4kp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430417/original/file-20211105-22-olr4kp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430417/original/file-20211105-22-olr4kp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430417/original/file-20211105-22-olr4kp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430417/original/file-20211105-22-olr4kp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430417/original/file-20211105-22-olr4kp.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">RSV can be particularly serious in toddlers.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-toddler-nebulizer-mask-on-bed-1667814397">Shutterstock</a></span>
</figcaption>
</figure>
<p>During COVID lockdowns around the world, RSV infections were at a <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1906/6140790">historic low</a> for a year. But they started rising again in April 2021 even in the Northern Hemisphere (for example, in the <a href="https://emergency.cdc.gov/han/2021/han00443.asp">United States</a> and the <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00411-2/fulltext">United Kingdom</a>) where countries were entering summer. </p>
<p>Doctors usually expect to see spikes of RSV in winter months, and before COVID many assumed this was because it survived and replicated better in colder weather. </p>
<p>However, we now realise RSV is less dependent on colder temperatures in winter and <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab240/6178344">more dependent on our hygiene behaviours</a>. </p>
<p>So for the sake of our little ones we should not lose all the good habits we developed to combat COVID, such as staying home when sick, washing our hands, covering our coughs/sneezes and wearing masks in higher risk settings.</p>
<h2>5. Rhinovirus</h2>
<p>Rhinovirus continued to spread throughout the pandemic and infections even <a href="https://onlinelibrary.wiley.com/doi/10.1111/irv.12854">shot up</a> in some countries. But I am including it in this list as its prevalence holds some fascinating potential in our fight against COVID. </p>
<p>Rhinovirus, like RSV, is a major cause of the common cold, particularly in infants. Both rhinovirus and RSV show the same symptoms. So without doing a diagnostic test it is <a href="https://pubmed.ncbi.nlm.nih.gov/21909047/">impossible to tell which of these someone has</a>. They require the same acute treatment anyway. </p>
<p>However, recently there has been interest in distinguishing between them for two reasons.</p>
<p>First, if a child has a rhinovirus infection in early childhood they may have a higher risk of recurrent respiratory symptoms and a higher risk of developing recurrent <a href="https://www.tandfonline.com/doi/abs/10.1586/14787210.2014.906901?journalCode=ierz20">wheezing and childhood asthma</a>. </p>
<p>Second, there is the exciting potential for rhinovirus infections to actually <a href="https://academic.oup.com/jid/article/224/1/31/6179975">train our immune system</a> to block other viruses, such as the coronavirus and influenza. This is still in the early stages of research but is something to watch.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-whats-the-right-way-to-blow-your-nose-74977">Health Check: what's the right way to blow your nose?</a>
</strong>
</em>
</p>
<hr>
<h2>What about COVID testing?</h2>
<p>We can reduce the impact of these five germs by keeping up simple hygiene habits, getting immunised where possible, and making sure we only use antibiotics when absolutely necessary.</p>
<p>However, if you do have respiratory symptoms as restrictions ease, and as <a href="https://www.health.gov.au/resources/publications/identifying-the-symptoms-english">symptoms do overlap with COVID</a>, you should get a COVID test.</p><img src="https://counter.theconversation.com/content/170263/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natasha Yates is affiliated with the RACGP</span></em></p>As international borders open, restrictions ease and we mingle with others, we can expect more germs to circulate.Natasha Yates, Assistant Professor, General Practice, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1570512021-03-23T18:51:54Z2021-03-23T18:51:54ZYes, COVID vaccines are front and centre. But don’t forget about your flu shot<figure><img src="https://images.theconversation.com/files/391049/original/file-20210323-23-gtaapm.jpg?ixlib=rb-1.1.0&rect=9%2C0%2C6420%2C4280&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>As the nights begin to close in and the temperatures cool, it’s clear winter is approaching again. </p>
<p>With the winter season comes the risk of the usual winter lurgies, most of which result from respiratory infections. Some of the usual suspects include rhinoviruses (the common cold), RSV (respiratory syncytial virus), and influenza. </p>
<p>This year, of course, we’re also contending with the possibility that SARS-CoV-2 (the virus that causes COVID-19) could escape from its quarantine status and circulate alongside these other viruses.</p>
<p>We don’t know yet how the winter season will play out in terms of respiratory viruses. But one important way we can prepare for it is by getting a flu vaccine.</p>
<h2>What will winter bring?</h2>
<p>In 2020 there was a paucity of <a href="https://pubmed.ncbi.nlm.nih.gov/33243355/">seasonal winter viruses</a>. Only rhinoviruses circulated widely, while the others were either vastly reduced (for example, we saw a very minimal flu season) or very delayed (RSV circulated <a href="https://theconversation.com/rsv-is-a-common-winter-illness-in-children-why-did-it-see-a-summer-surge-in-australia-this-year-156492">later than usual in some states</a> until spring or even summer).</p>
<p>So what’s going to happen in 2021? Will it be similar to 2020, or will it be like 2019, which saw <a href="https://theconversation.com/its-a-bad-year-for-flu-but-its-too-early-to-call-it-the-worst-ever-5-charts-on-the-2019-season-so-far-120093">very high levels</a> of influenza? Or perhaps something completely different? </p>
<p>We simply don’t know for sure. With COVID-related restrictions having eased in all Australian states and territories — albeit to varying degrees — people are free to move around, come together in crowds, and attend schools, universities and offices. </p>
<p>These activities promote the transmission of respiratory viruses, which explains why we saw such different trends in the usual winter lurgies last year, when we were mixing much less.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rsv-is-a-common-winter-illness-in-children-why-did-it-see-a-summer-surge-in-australia-this-year-156492">RSV is a common winter illness in children. Why did it see a summer surge in Australia this year?</a>
</strong>
</em>
</p>
<hr>
<p>But the virus circulation needs to start from somewhere. While some viruses are happy to circulate domestically, like <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/covid-19-surveillance-report-20201226.pdf">rhinoviruses and adenoviruses</a>, others, like <a href="https://pubmed.ncbi.nlm.nih.gov/29324895/">influenza</a>, are largely transported into the country each year. So it’s possible that if Australia’s international borders remain closed through winter, we may again have a less serious flu season in 2021.</p>
<p>On the other hand, if borders are opened and the flu does take hold, people might have reduced immunity to the viruses given the missed season last year, and be more susceptible.</p>
<figure class="align-center ">
<img alt="A hand holds a thermometer. There is a cup of tea and tablets on a table in the background." src="https://images.theconversation.com/files/391052/original/file-20210323-23-iaxzj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/391052/original/file-20210323-23-iaxzj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391052/original/file-20210323-23-iaxzj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391052/original/file-20210323-23-iaxzj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391052/original/file-20210323-23-iaxzj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391052/original/file-20210323-23-iaxzj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391052/original/file-20210323-23-iaxzj8.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">Last winter we saw significantly fewer cases of the flu than usual.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>A vaccine is your best bet</h2>
<p>In the face of this uncertainty, the usual adage prevails: “prevention is better than cure”. The best measure we can take is to get our influenza vaccine. </p>
<p>The flu vaccines available in Australia <a href="https://www.health.nsw.gov.au/immunisation/Factsheets/influenza-information-sheet.pdf">in 2021</a> under the National Immunisation Program are:</p>
<ul>
<li><p>for children aged six months to five years — Vaxigrip Tetra® (Sanofi) and Fluarix® Tetra (GSK)</p></li>
<li><p>for children and adults aged five to 64 years — Vaxigrip Tetra®, Fluarix® Tetra and Afluria® Quad (Seqirus)</p></li>
<li><p>for adults aged 65 and over — Vaxigrip Tetra®, Fluarix® Tetra, Afluria® Quad and Fluad® Quad (Seqirus).</p></li>
</ul>
<p>The Fluad® Quad vaccine, which is slightly different and more potent than the others, is the preferred vaccine for the over-65 age group. It contains a component called an adjuvant, which helps <a href="https://theconversation.com/heres-what-you-need-to-know-about-the-new-flu-vaccines-for-over-65s-92020">boost the immune response</a> in elderly people.</p>
<p>This season’s flu vaccines are made up of <a href="https://www.health.nsw.gov.au/immunisation/Pages/flu.aspx">four different viruses</a> — two influenza A types and two influenza B types. The 2021 vaccines have two changes (both in the influenza A types) from the 2020 influenza vaccines.</p>
<p>It’s very hard to predict in advance which strains will circulate, but the World Health Organization <a href="https://theconversation.com/flu-vaccines-are-updated-every-year-we-can-learn-from-this-process-as-we-respond-to-covid-variants-156580">provides guidance on this every year</a>, and recommends which components of the vaccine should be updated accordingly. </p>
<p>All the influenza vaccines used in Australia are inactivated virus vaccines, meaning the virus contained in the vaccine doesn’t replicate, so <a href="https://theconversation.com/you-cant-get-influenza-from-a-flu-shot-heres-how-it-works-118916">you can’t get the flu</a> from the vaccination.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flu-vaccines-are-updated-every-year-we-can-learn-from-this-process-as-we-respond-to-covid-variants-156580">Flu vaccines are updated every year. We can learn from this process as we respond to COVID variants</a>
</strong>
</em>
</p>
<hr>
<p>In addition to the flu vaccines under the National Immunisation Program, a new vaccine called <a href="https://labeling.seqirus.com/CMI/AU/Flucelvax/EN/Flucelvax-Quad-Consumer-Medicine-Information.pdf">Flucelvax® Quad</a> (Seqirus) is available through retail outlets, like pharmacies, for people aged nine years and older.</p>
<p>This vaccine is the first influenza vaccine available in Australia which has been produced entirely in <a href="https://en.wikipedia.org/wiki/Cell_culture">cell culture</a>, rather than chickens eggs. This new vaccine may have some benefits over the traditional egg-based vaccines for certain people, for example those with severe egg allergies.</p>
<h2>How effective are flu vaccines?</h2>
<p>Flu vaccines are only moderately effective at preventing infection with influenza. On average, they offer <a href="https://pubmed.ncbi.nlm.nih.gov/22032844/">around 60%</a> protection across the population, although rates can often be higher in children. </p>
<p>While this is lower than we’d like, it’s the best measure we currently have to protect us from influenza infections. There’s also evidence it reduces the more severe consequences of being infected, such as <a href="https://doi.org/10.1016/j.vaccine.2018.07.028">being hospitalized</a> or <a href="https://pubmed.ncbi.nlm.nih.gov/28557757/">dying</a>. </p>
<p>Scientists are continuing to work on <a href="https://theconversation.com/a-universal-influenza-vaccine-may-be-one-step-closer-bringing-long-lasting-protection-against-flu-152274">new flu vaccines</a> that may offer greater protection.</p>
<h2>The practicalities</h2>
<p>This year’s vaccines are already becoming available through pharmacies and some GP clinics, and will be available under the National Immunisation Program from GPs and other providers, such as workplace immunisation programs, in April.</p>
<p>The flu season generally starts in earnest around June, so it’s reasonable to get your vaccine any time between now and then.</p>
<p>Under the <a href="https://www.health.gov.au/health-topics/immunisation/immunisation-throughout-life/national-immunisation-program-schedule#flu-influenza-vaccines">National Immunisation Program</a>, some groups are eligible to receive the influenza vaccine for free. These include: </p>
<ul>
<li><p>adults 65 and older</p></li>
<li><p>all Aboriginal and Torres Strait Islander Australians six months and older</p></li>
<li><p>children aged six months to five years</p></li>
<li><p>pregnant women </p></li>
<li><p>people with certain medical conditions.</p></li>
</ul>
<p>For people who don’t fall into these groups, the vaccine costs as little as <a href="https://rsvp.chemistwarehouse.com.au/event-details?eventid=186">A$14.99</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>
<p>Influenza vaccines are being rolled out this year alongside the COVID-19 vaccines. With both programs operating at the same time, there may be some confusion and logistical challenges.</p>
<p>The Australian Technical Advisory Group on Immunisation have recommended <a href="https://www.health.gov.au/resources/publications/atagi-advice-on-seasonal-influenza-vaccines-in-2021">a 14-day gap</a> between the COVID and flu vaccinations, regardless of which one you have first. This is something both individuals and providers will need to keep in mind and will mean some extra planning this year.</p><img src="https://counter.theconversation.com/content/157051/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Barr has shares in an influenza vaccine producing company. The Centre receives funding from the Australian Government and from other industry based sources.</span></em></p>We don’t yet know what this winter’s influenza season will bring. But here’s what we can expect from the 2021 crop of flu vaccines.Ian Barr, Deputy Director, WHO Collaborating Centre for Reference and Research on InfluenzaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1416332020-11-25T13:22:07Z2020-11-25T13:22:07ZWith all the focus on coronavirus, let’s not forget the other respiratory viruses<figure><img src="https://images.theconversation.com/files/367207/original/file-20201103-15-1y9clyp.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5472%2C3628&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-woman-buying-supermarket-coughing-into-1685691637">Drazen Zigic/Shutterstock</a></span></figcaption></figure><p>With coronaviruses taking over our news feeds – and lives – you may be fooled into thinking it’s the only virus affecting humans at the moment. But it’s important to remember that there are many viruses, especially respiratory viruses, that regularly infect us. These viruses range from the mildly annoying, such as those that cause the common cold, to the potentially deadly, such as influenza. </p>
<p>Despite the challenges posed by the pandemic, scientists around the world are still working hard on these viruses, to find treatments and vaccines to improve our quality of life. </p>
<h2>1. Rhinoviruses</h2>
<p>Rhinoviruses (from the Greek “rhinos” for “of the nose”) are usually associated with the common cold. They cause a nasal infection, resulting in congestion and a runny nose. But rhinoviruses have a more malevolent side. They have been linked to exacerbating lower respiratory tract diseases, such as asthma and <a href="https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/">COPD</a> (an obstructive lung disease that causes long-term breathing problems and poor airflow). </p>
<p>Rhinoviruses can spread all year round, and there is no vaccine against them as they are an incredibly diverse group of viruses. There is also no licensed antiviral medication against rhinoviruses, although scientists are working on this to help manage conditions such as asthma and COPD.</p>
<p>Interestingly, rhinoviruses have only been found in humans and are closely related to viruses that infect our guts.</p>
<h2>2. Adenoviruses</h2>
<p>Adenoviruses were first isolated from the adenoids – an area of the throat near the tonsils – hence the name. There are over 50 human adenoviruses, most of which cause respiratory disease. But some cause infections of the gastrointestinal tract, the eye (conjunctivitis), and the urinary tract (cystitis). In most healthy people these viruses only cause mild, short-lived disease, but they tend to spread quickly in densely populated areas.</p>
<p>There are no antiviral treatments for adenoviruses, although <a href="https://pubmed.ncbi.nlm.nih.gov/32842697/">some are in clinical trials</a>). But there are vaccines for two of the respiratory adenoviruses that cause regular outbreaks in crowded populations. These vaccines are <a href="https://pubmed.ncbi.nlm.nih.gov/32718082/">regularly used by armed forces</a>.</p>
<p>An <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857090/#:%7E:text=Oncolytic%20adenoviruses%20provide%20a%20new,the%20anti%2Dtumor%20immune%20response.">exciting area of research</a> is using adenoviruses as anti-cancer therapies, as some strains can selectively infect and destroy cancer cells while leaving healthy cells untouched.</p>
<h2>3. Pneumoviruses</h2>
<p>Humans are infected with two kinds of pneumoviruses: respiratory syncytial virus (RSV) and metapneumovirus (MPV). All members of the pneumoviruses (“pneumo” being Greek for lung) are respiratory viruses, but they have a range of hosts they can infect. As well as humans, certain pneumoviruses can infect cows (bovine respiratory syncytial virus), mice (murine pneumonia virus) and birds (avian metaphneumovirus).</p>
<p>Most people will have had many human respiratory syncytial virus (HRSV) infections in their lifetime, <a href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/512921">with over 80% of the population infected by the age of two years</a>. For most healthy people, HRSV causes a nasty cold, but this will resolve itself without the need for any treatment. In those with respiratory conditions such as asthma, however, the consequences can be severe. In 2015 alone, it is estimated that RSV caused <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592248/">3.2 million hospitalisations and over 59,000 deaths in the under-fives</a>.</p>
<p>HRSV has been linked with the development of asthma, though this is a contentious area of science that is <a href="https://pubmed.ncbi.nlm.nih.gov/26766408/">still much debated and researched</a>.</p>
<h2>4. Parainfluenza viruses</h2>
<p>The <a href="https://www.cdc.gov/parainfluenza/index.html">parainfluenza viruses</a> (PIVs) are a sub-group of viruses known as paramyxoviruses and are closely related to other pathogens such as mumps and measles. They also infect our respiratory tract and are major causes of a lower respiratory tract disease called croup. People with croup often have a barking cough, like a seal.</p>
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<figcaption><span class="caption">What croup sounds like.</span></figcaption>
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<p>There are two distinct paramyxovirus groups of parainfluenza viruses, one called the respiroviruses (PIV1 and 3) and the other the rubulaviruses (PIV2 and 4). PIV1 and 3 have counterparts in other animal species, such as mice and cows, while PIV2 and 4 are relatively closely related to the mumps virus. </p>
<p>PIVs tend to spread in autumn and spring. There is no licensed vaccine or antivirals against PIVs, although researchers have made <a href="https://www.pnas.org/content/115/48/12265">significant progress on this</a>.</p>
<h2>5. Influenza viruses</h2>
<p><a href="https://www.cdc.gov/flu/about/viruses/index.htm">Influenza viruses</a> are perhaps the most worrying of respiratory viruses, given their capacity for causing pandemics, such as the 1918 flu pandemic. They are highly diverse viruses with four major types (A, B, C and D). All but influenza D virus infect humans, and A and B can cause significant lower respiratory tract disease and even death. Influenza B and C remain associated with humans while influenza A virus is really a virus of aquatic birds, although influenza A viruses circulate in humans, pigs and even bats. </p>
<p>Occasionally, avian flu A viruses jump species into humans and may even spread well and can cause pandemics. </p>
<p>Influenza viruses continuously circulate in humans because they are able to mutate and evade our immune responses. We have vaccines against influenza viruses, but they have to be updated each year to keep up with the mutations. </p>
<p>Antivirals, such as Tamiflu, when used early enough, can be <a href="https://www.nhs.uk/news/medication/effectiveness-of-tamiflu-and-relenza-questioned/">effective at reducing how long you are sick for</a>. Researchers are continuing to develop broader, long-lasting flu vaccines and more potent antivirals.</p>
<p>All the above respiratory viruses routinely infect humans. Most lack a vaccine and effective treatments – and many disproportionately affect the most vulnerable in society. Now that there is a raised scientific and public awareness on respiratory infections, we must take this opportunity now to make major advances against respiratory infections through research and increased preventative measures such as hand hygiene and social distancing.</p><img src="https://counter.theconversation.com/content/141633/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Connor Bamford receives funding from UKRI, SFI, DfE and Wellcome Trust.</span></em></p><p class="fine-print"><em><span>Grace C Roberts works at Queen's University, Belfast and receives funding from The Wellcome Trust.</span></em></p>Five respiratory viruses everyone should know about.Connor G G Bamford, Research Fellow, Virology, Queen's University BelfastGrace C Roberts, Research Fellow in Virology, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1353862020-04-19T08:10:38Z2020-04-19T08:10:38ZSouthern Africa’s porous borders pose a problem for containing the coronavirus<figure><img src="https://images.theconversation.com/files/328360/original/file-20200416-192762-zc0cke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An illegal Zimbawean immigrant crosses into South Africa.</span> <span class="attribution"><span class="source">EFE-EPA/Kim Ludbrook</span></span></figcaption></figure><p>Many countries around the world have declared lockdowns in an attempt <a href="https://www.theguardian.com/world/2020/mar/18/what-a-coronavirus-lockdown-might-mean-for-london">to curb</a> the sharp rise in deaths from the COVID-19 pandemic. </p>
<p>In South Africa, which has the highest number of cases in Africa, President Cyril Ramaphosa imposed <a href="http://www.thepresidency.gov.za/speeches/statement-president-cyril-ramaphosa-escalation-measures-combat-covid-19-epidemic%2C-union">a three week lockdown</a> from 27 March. This has since been <a href="https://www.gov.za/speeches/president-cyril-ramaphosa-extension-coronavirus-covid-19-lockdown-end-april-9-apr-2020-0000">extended by two weeks</a>. Other African countries in general, and within the 16-member <a href="https://www.sadc.int/member-states/">Southern African Development Community (SADC)</a> region, have followed suit.</p>
<p>Zimbabwe is also <a href="https://www.businesslive.co.za/bd/world/africa/2020-03-30-zimbabwe-begins-21-day-covid-19-lockdown/">in lockdown</a>. Botswana has imposed a <a href="https://inkjournalism.org/2093/botswana-declares-state-of-emergency-goes-on-lockdown/">state of emergency and lockdown</a>. So has <a href="https://www.worldaware.com/covid-19-alert-mozambique-declares-state-emergency-through-least-april-30">Mozambique</a>, <a href="https://www.msn.com/en-za/news/africa/lesotho-declares-national-emergency-over-covid-19-outbreak/ar-BB11ozHJ">Lesotho</a>, <a href="https://www.dispatchlive.co.za/news/africa/2020-04-07-angola-deploys-emergency-police-armoured-vans-to-enforce-lockdown/">Angola</a>, Democratic Republic of Congo <a href="https://www.france24.com/en/20200325-dr-congo-president-imposes-state-of-emergency-to-contain-coronavirus-outbreak">(DRC)</a>, <a href="https://www.bbc.com/news/topics/cdl8n2edxept/mauritius">Mauritius</a>, <a href="https://www.garda.com/crisis24/news-alerts/324541/comoros-authorities-implement-measures-amid-covid-19-as-of-march-18">Comoros</a>, <a href="https://www.garda.com/crisis24/news-alerts/329996/madagascar-nationwide-state-of-emergency-extended-lockdown-measures-in-fianarantsoa-april-5-update-5">Madagascar</a>, <a href="https://newsaf.cgtn.com/news/2020-04-09/COVID-19-Seychelles-declares-a-21-day-lockdown-PxbcqdAx4k/index.html">Seychelles</a> and <a href="https://www.bbc.com/news/live/world-africa-47639452">Malawi</a>. <a href="https://allafrica.com/view/group/main/main/id/00072524.html">Namibia</a> and <a href="https://www.africanews.com/2020/04/02/coronavirus-eswatini-partial-lockdown-update-covid-19//">eSwatini</a> have declared partial lockdowns.</p>
<p>In Zambia, only <a href="https://www.britannica.com/place/Kafue">Kafue</a>, a town in south-central Zambia and its surrounds, and about 40 km from the capital Lusaka, is in <a href="https://www.lusakatimes.com/2020/04/14/president-lungu-orders-the-complete-lockdown-of-kafue/">a total lockdown</a>, leaving most of the country uncovered. Similarly, Tanzania has implemented very mild measures, <a href="https://atlanticcouncil.org/blogs/africasource/tanzanias-mild-response-to-covid-19-and-its-implications-for-the-2020-elections/">short of a lockdown</a>.</p>
<p>This shows that there’s no uniform lockdown of all the region’s 16 countries in response to the pandemic. </p>
<p>A lockdown means that a nation-state shuts its borders and restricts all forms of movement and business. In the case of South Africa, this has actually meant that people are restricted to their homes, and only workers in the essential services are allowed to travel. </p>
<p>Likewise, all businesses except those involved in essential services, <a href="https://www.gov.za/documents/disaster-management-act-regulations-address-prevent-and-combat-spread-coronavirus-covid-19">ceased operations</a>. </p>
<p>In my view closing borders in Africa in general, and in the Southern African Development Community region specifically, will not stop the spread of the coronavirus. This is because, by and large, borders in the region are porous. </p>
<p>This means countries in the region need to rethink their approach. The solution, in my view, lies in a coordinated approach, as envisaged in the Southern African Development Community <a href="https://www.sadc.int/files/8613/5292/8378/Declaration__Treaty_of_SADC.pdf">treaty</a> and protocols.</p>
<h2>Borders have little power</h2>
<p>Borders on the continent were arbitrarily imposed by former colonial powers, and aren’t respected. This includes cross border regions between South Africa and Zimbabwe and Botswana and Zimbabwe in which people have continued to cross the border at unofficial points <a href="https://www.palgrave.com/gp/book/9783319553986">despite the existence of fences</a>. </p>
<p>In some parts of the region, particularly the contiguous border regions of Zambia, Malawi, and Mozambique, people have long established a strong cross border socio-cultural and economic clout which has diminished the impact of the border.</p>
<p>In the minds and lives of people, the borders do not actually exist. That is why in the contiguous borderlands of Zambia, Malawi, and Mozambique people move in between countries to access various services, such as health services across borders. This is <a href="https://www.palgrave.com/gp/book/9783319553986">considered acceptable and “normal”</a>.</p>
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Read more:
<a href="https://theconversation.com/unravelling-why-some-democracies-but-not-all-are-better-at-fighting-pandemics-136267">Unravelling why some democracies -- but not all -- are better at fighting pandemics</a>
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<p>Some borders are not even fenced. In some places the physical “border” is marked by an isolated concrete pillar or beacon a few centimetres above the ground. </p>
<p>People have always disregarded them, moving easily in between countries, in the conduct of their everyday lives in line with their social, economic, cultural and other needs. For instance, at Mwami (Malawi-Zambia border), people <a href="https://www.tandfonline.com/doi/abs/10.1080/08865655.2017.1390689?journalCode=rjbs20">simply walk or cycle freely between the two countries</a>.</p>
<p>In such a situation, declaring a lockdown of a country and closing its borders is not an effective way of stopping the spread of the coronavirus. </p>
<h2>Coordinated approach</h2>
<p>The Southern African Development Community needs to look to its regional integration project for how best to address the COVID-19 pandemic. Briefly, the <a href="https://www.sadc.int/files/8613/5292/8378/Declaration__Treaty_of_SADC.pdf">1992 declaration and treaty</a> outlines the programmes, projects and activities towards the establishment of a regional community. </p>
<p>Several protocols have been signed to make this a reality. For example, the <a href="https://www.sadc.int/files/7413/5292/8365/Protocol_on_Health1999.pdf">SADC Protocol on Health </a> was approved by the regional body’s heads of state in 1999, and came into force in 2004. </p>
<p>It encourages cooperation among the member countries on health issues, such as curbing communicable and non-communicable diseases. It also calls for cooperation in managing disasters. Hence, member states need to adopt a regional and coordinated response to such pandemics as COVID-19. An example of this would be to establish a regional fund to deal with pandemics. </p>
<p>Similarly, there needs to be a proactive plan of action, such as concrete procedures in terms of the uniform application of COVID-19 lockdown rules across all states in the region.</p>
<h2>Disaster preparedness</h2>
<p>There is an urgent need to move beyond political declarations to the actual setting up of systems and mechanisms to enable the region to jointly tackle communicable diseases and other disasters.</p>
<p>Such a proactive approach would entail uniform action by all states in the region, instead of the current disparate responses, which leaves each country to look after its own. </p>
<p>Failure by member states to establish a fully operational regional architecture will mean that it will be impossible to bring the epidemic under control in the region.</p><img src="https://counter.theconversation.com/content/135386/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Inocent Moyo 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>Borders in southern Africa – as on the entire continent – were arbitrarily imposed by former colonial powers, and aren’t respected.Inocent Moyo, Senior Lecturer and Head of Department of Geography and Environmental Studies, University of ZululandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1355802020-04-13T07:40:06Z2020-04-13T07:40:06ZDebunking 9 popular myths doing the rounds in Africa about the coronavirus<figure><img src="https://images.theconversation.com/files/326510/original/file-20200408-153819-1etgmdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Somali women on a coronavirus awareness campaign</span> <span class="attribution"><span class="source">Abdirazak Hussein/GettyImages</span></span></figcaption></figure><p>In the second week of March the World Health Organisation (WHO) declared COVID-19 <a href="https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020">a pandemic</a>. By mid-March the disease had spread rapidly in many countries around the world.</p>
<p>Governments are taking drastic steps, including the complete lockdown of cities, as well as extensive health interventions to try and stem the disease which is caused by a new coronavirus called SARS-CoV-2.</p>
<p>There is still a great deal that’s not known about SARS-CoV-2. This limited scientific information has contributed to a <a href="https://www.bbc.com/news/world-africa-51710617">slew of myths and misconceptions</a>. Some claims being made are harmless. Others can be potentially dangerous. </p>
<p>We have identified nine misconceptions doing the rounds on social media in Africa and set out to counter them. The purpose of debunking these myths is to provide people with trusted information. And to provide people with valid scientifically backed answers which they can share on social media to counter the misinformation and disinformation out there. </p>
<h2>Myth 1: SARS-CoV-2 does not affect Africans</h2>
<p>Across the continent rumours have been rife that the virus does <a href="https://archive.fo/oioB5">not affect black people</a>. This was fuelled partly by the fact that a Cameroonian student in China, who was among the first people to contract the disease, responded well to treatment.</p>
<p>But there is <a href="https://www.politifact.com/factchecks/2020/mar/10/facebook-posts/melanin-doesnt-protect-against-coronavirus/">no proof</a> that melanin protects black people from the coronavirus. There is also no scientific evidence that African blood composition <a href="https://www.iol.co.za/news/south-africa/gauteng/medical-experts-slam-claims-that-black-people-are-immune-to-coronavirus-45735869">prevents</a> Africans from contracting the coronavirus. </p>
<p>This misinformation persisted even after the deaths of high-profile black Africans, such as legendary Cameroonian musician <a href="https://theconversation.com/tribute-to-manu-dibango-cameroonian-jazz-pioneer-loved-across-africa-and-the-world-134673">Manu Dibango</a>, and Zimbabwean media personality <a href="https://www.news24.com/SouthAfrica/News/journalist-zororo-makamba-becomes-zimbabwes-first-covid-19-death-20200323">Zororo Makamba</a>. </p>
<p>This myth is not limited to Africa. Twitter has recently been <a href="https://www.okayplayer.com/news/are-black-people-immune-to-coronavirus.html">abuzz with claims</a> of African-Americans being immune to coronavirus</p>
<h2>Myth 2: SARS-CoV-2 cannot survive in Africa’s warm climate</h2>
<p>This myth arose after research, which hadn’t been peer reviewed, pointed to temperature having a role in the survival of the virus. One of the most widely quoted sources was John Nicholls, a pathology professor at Hong Kong university who <a href="https://www.accuweather.com/en/health-wellness/new-study-says-high-temperature-and-high-relative-humidity-significantly-reduce-spread-of-covid-19/703418">said that</a> “in cold environments, there is longer virus survival than warm ones”.</p>
<p>This claim, however, was not based on verified research. It was nevertheless seized on as proof that the virus cannot thrive in Africa’s <a href="https://cityscrollz.com/4002">warm climate</a>.</p>
<p>According to the WHO, the virus can be transmitted to all areas, <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters">event hot and humid countries</a>. </p>
<p>The only continent that has no cases of COVID-19 is <a href="https://www.washingtonpost.com/world/2020/03/24/one-continent-remains-untouched-by-coronavirus-antarctica/">Antarctica</a>. This could change. </p>
<h2>Myth 3: Spray alcohol and chlorine all over your body</h2>
<p>Using hand sanitisers that contain 60% or more of alcohol has been found <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html">to kill the coronavirus</a>. But, there has been a myth that <a href="https://economictimes.indiatimes.com/news/politics-and-nation/coronavirus-will-consuming-alcohol-protect-you/the-misconceptions/slideshow/74524979.cms">spraying alcohol</a> and chlorine will kill the virus. </p>
<p>Alcohol and chlorine <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters">will not kill the virus</a> if it has entered the body already. </p>
<p>Spraying alcohol all over your body can be harmful, particularly to your eyes and mouth. Importantly, the alcohol in the sanitiser is not the same as the alcohol that people drink. The latter ranges up to 40% while hand sanitisers need to be 60% and above.</p>
<h2>Myth 4: Drink black tea first thing in the morning</h2>
<p>The media in Kenya have been reporting on false claims that <a href="https://www.bbc.com/news/world-africa-51710617">drinking black tea</a> first thing in the morning is effective against the COVID-19 disease. </p>
<p>This is untrue. There is <a href="https://factcheck.afp.com/no-evidence-drinking-tea-can-cure-or-relieve-symptoms-covid-19-doctors-say">no evidence</a> to suggest that tea can protect a person from the virus. These claims can result in a sense of false security and can be dangerous. </p>
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<img alt="" src="https://images.theconversation.com/files/325282/original/file-20200403-74202-i9usct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325282/original/file-20200403-74202-i9usct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325282/original/file-20200403-74202-i9usct.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325282/original/file-20200403-74202-i9usct.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325282/original/file-20200403-74202-i9usct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325282/original/file-20200403-74202-i9usct.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325282/original/file-20200403-74202-i9usct.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">World-renowned Cameroonian musician Manu Dibango’s death from coronavirus hasn’t stopped people claiming blacks are immune to it.</span>
<span class="attribution"><span class="source">EFE-EPA/Daniel Karmann</span></span>
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<p>Coronavirus can be prevented by maintaining a safe social distance and <a href="https://theconversation.com/yes-washing-our-hands-really-can-help-curb-the-spread-of-coronavirus-132915">washing your hands with soap and water for 20 seconds</a>.</p>
<h2>Myth 5: Pepper soup with lime or lemon flushes out the virus</h2>
<p>The <a href="https://www.tastecooking.com/recipes/nigerian-pepper-soup/">pepper soup</a> myth has been circulating mostly in <a href="https://www.mirror.co.uk/tech/coronavirus-hoax-circulating-claims-virus-21615051">Nigeria</a>. </p>
<p>Pepper has anti-oxidant, detoxification and antimicrobial properties. But, there is no evidence that it prevents or kills SARS-CoV-2. It is also a rich source of vitamin C, which helps <a href="https://www.health.harvard.edu/cold-and-flu/can-vitamin-c-prevent-a-cold">maintain a good immune system</a>. </p>
<p>Likewise, lemon and lime also contain high amounts of vitamin C. But there is no evidence to support the claim that they flush the virus out of an infected person’s system.</p>
<h2>Myth 6: Steam your face with and inhale neem tree leaves</h2>
<p>There have been claims, <a href="https://www.ghanaweb.com/GhanaHomePage/NewsArchive/Neem-traditional-herbal-practices-can-help-fight-coronavirus-Traditional-Medicine-Practitioners-898801">mostly in Ghana</a>, that steam therapy with neem can prevent COVID-19. What we know is that according to ayurvedic medicine experts, <a href="https://www.dtnext.in/Lifestyle/Wellbeing/2020/03/08084719/1218960/What-Ayurveda-has-to-offer-in-fight-against-coronavirus.vpf">neem can assist</a> in strengthening the immune system and prevent viral infections. </p>
<p>Neem is known to exhibit immunomodulatory, anti-inflammatory, antihyperglycaemic, anti-oxidant and <a href="https://www.ncbi.nlm.nih.gov/pubmed/15777222">anticarcinogenic properties</a>. But, the Centres for Disease Control and Prevention has emphasised that there is <a href="https://www.reuters.com/article/uk-factcheck-steam-kills-coronavirus/false-claim-steam-therapy-kills-coronavirus-idUSKBN21H2LK">no clinical evidence</a> to suggest that steaming and inhaling with neem will prevent coronavirus.</p>
<h2>Myth 7: Vitamin C tablets prevent COVID-19</h2>
<p>Vitamin C is a <a href="https://www.sciencedirect.com/science/article/abs/pii/S8755966886800217">known anti-oxidant</a>. It prevents damage to tissue in the body by neutralising free radicals, which are charged particles that cause damage to cells and tissues and result in inflammation. Vitamin C is also known to protect against pathogens. </p>
<p>But there is <a href="https://www.livescience.com/coronavirus-myths.html">no proof</a> that vitamin C can prevent one from contracting COVID-19 though there are trials being undertaken on the use of vitamin C among COVID-19 patient. None has <a href="https://www.ctvnews.ca/health/coronavirus/claims-vitamin-c-can-prevent-or-cure-covid-19-unfounded-experts-warn-1.4875757">provided conclusive proof</a>.</p>
<h2>Myth 8: Having had malaria makes one immune</h2>
<p>There have been several social media posts that suggest that <a href="https://www.weforum.org/agenda/2020/04/covid-19-in-africa-insights-from-our-media-briefing-with-who/">malarial endemic countries have a decreased risk</a> of acquiring new coronavirus cases. </p>
<p>There is <a href="https://www.outlookindia.com/newsscroll/no-evidence-countries-with-malaria-immune-against-covid19/1782217">no evidence to support this</a>.</p>
<p>Malaria – which is caused by a parasite and is transmitted from the bite of an infected <em>Anopheles</em> mosquito to humans – used to be treated with the drugs chloroquine and hydroxychloroquine. These have been used, respectively, as an anti-malarial and as an auto-immune disease drug for inflammation. </p>
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Read more:
<a href="https://theconversation.com/chloroquine-and-hydroxychloroquine-no-proof-these-anti-malarial-drugs-prevent-novel-coronavirus-in-humans-134703">Chloroquine and hydroxychloroquine: no proof these anti-malarial drugs prevent novel coronavirus in humans</a>
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<p>The over-hyping of chloroquine has led to worldwide shortages and resulted in people self-medicating. Experts have warned that <a href="https://www.linkedin.com/posts/uppsala-monitoring-centre_covid19-chloroquine-hydroxychloroquine-activity-6650407616814153728-kObk/">high doses of the drug are toxic</a>.</p>
<h2>Myth 9: The flu injection will protect you</h2>
<p>The fact that health practitioners <a href="https://www.iol.co.za/lifestyle/health/in-the-time-of-coronavirus-this-is-why-you-should-get-vaccinated-against-the-flu-44578172">encourage people to vaccinate themselves against the flu</a>, might have led to the mistaken view that the flu shot protects against the new coronavirus.</p>
<p>No, it does not. The flu vaccine is <a href="https://www.livescience.com/getting-flu-shot-help-coronavirus-outbreak.html">only effective against the influenza virus</a> – and even then against only some flu viruses. </p>
<p>Humans have been known to be affected by six coronaviruses, <a href="https://theconversation.com/a-brief-history-of-the-coronavirus-family-including-one-pandemic-we-might-have-missed-134556">four causing the common cold</a>. The other two were the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2002 and 2012, respectively. </p>
<p>Now there is a <a href="https://theconversation.com/a-brief-history-of-the-coronavirus-family-including-one-pandemic-we-might-have-missed-134556">seventh</a> coronavirus, <a href="https://www.ncbi.nlm.nih.gov/pubmed/31978945">the SARS-CoV-2</a>. </p>
<p>There is no scientific evidence that a flu shot can protect people against coronaviruses.</p><img src="https://counter.theconversation.com/content/135580/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>Some of the false claims about coronavirus may be harmless. But others can be potentially dangerous.Neelaveni Padayachee, Lecturer, Department of Pharmacy and Pharmacology, University of the WitwatersrandLisa Claire du Toit, Associate Professor, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1356902020-04-06T13:17:24Z2020-04-06T13:17:24ZHow Mandela stayed fit: from his ‘matchbox’ Soweto home to a prison cell<figure><img src="https://images.theconversation.com/files/325705/original/file-20200406-74261-ru1dh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Former South African President Nelson Mandela with former American world boxing champion Marvin Hagler. The undated photo was taken after Mandela's release.
</span> <span class="attribution"><span class="source">Louise Gubb/GettyImages</span></span></figcaption></figure><p><em>The spread of the coronavirus has forced millions all over the world to retreat to base and abandon outdoor exercise and gym sessions. If they own a big house and garden, it’s manageable, but many live in shacks, cramped houses or tiny high-rise flats. How can they avoid going to seed during lockdown? Gavin Evans takes a look at how former boxer and South African liberation struggle icon <a href="https://www.sahistory.org.za/people/nelson-rolihlahla-mandela">Nelson Mandela</a> adapted while incarcerated in a tiny cell on Robben Island.</em></p>
<p>February 15, 1990: Nelson Mandela wakes as always at 5am and begins his hour-long exercise routine. The difference this time is that instead of a prison cell, his gym is the front room of his <a href="https://www.sowetanlive.co.za/news/2008-07-17-matchbox-house-revolution-is-needed-for-soweto/">“matchbox” house</a> – so-called for its small size – at 8115 Vilakazi Street, Soweto. And soon he’ll be besieged by journalists, well-wishers, diplomats and family members.</p>
<p>I get to interview him a few hours later to ask about his plans. His answers are clear and concise and I’m too nervous to probe deeper. But towards the end I toss in a question about boxing, and his stern demeanour changes. He beams with delight and begins to chat about his favourite fighters and how he followed the sport in prison.</p>
<p>Mandela started boxing as a student at <a href="https://www.sahistory.org.za/place/university-fort-hare">Fort Hare University</a>, and then trained more seriously when studying, working and struggling in Johannesburg during the 1940s and 50s, although he didn’t fight competitively and was modest about his prowess. “I was never an outstanding boxer,” he said in his autobiography, <a href="https://www.goodreads.com/book/show/318431.Long_Walk_to_Freedom">Long Walk to Freedom</a>. “I was in the heavyweight division, and I had neither enough power to compensate for my lack of speed nor enough speed to make up for my lack of power.”</p>
<p>What he relished about it was the rigour of training, a routine periodically broken by arrest and the demands of the “struggle”, but not often. He wrote:</p>
<blockquote>
<p>I unleashed my anger and frustration on a punchbag rather than taking it out on a comrade or even a policeman.</p>
</blockquote>
<h2>Refuge in exercise</h2>
<p>Mandela believed this routine was the key to both physical health and peace of mind.</p>
<blockquote>
<p>Exercise dissipates tension, and tension is the enemy of serenity. I found that I worked better and thought more clearly when I was in good physical condition, and so training became one of the <a href="http://www.mindfulnext.org/mandela-on-peace-of-mind/">inflexible disciplines of my life</a>.</p>
</blockquote>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/325700/original/file-20200406-74206-1oblloc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/325700/original/file-20200406-74206-1oblloc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=893&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325700/original/file-20200406-74206-1oblloc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=893&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325700/original/file-20200406-74206-1oblloc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=893&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325700/original/file-20200406-74206-1oblloc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1123&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325700/original/file-20200406-74206-1oblloc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1123&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325700/original/file-20200406-74206-1oblloc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1123&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nelson Mandela was a boxing enthusiast. The photo depicts him circa 1950.</span>
<span class="attribution"><span class="source">GettyImages</span></span>
</figcaption>
</figure>
<p>Four mornings a week he’d set off for a run and three evenings a week he’d work out in a Soweto boxing gym – his way of losing himself “in something that was not the struggle”. He said he’d wake up the next morning feeling refreshed – “mentally and physically lighter” and “ready to take up the fight again”.</p>
<p>From 1960 Mandela led the underground campaign of the African National Congress’s military wing, <a href="https://www.sahistory.org.za/article/umkhonto-wesizwe-mk">umKhonto weSizwe</a>, moving around the country disguised as a chauffeur, with trips abroad to rally support, so his boxing training became sporadic. The “Black Pimpernel”, as he was dubbed, was arrested in 1962 – the result of a tip-off to the apartheid police from the CIA, <a href="https://www.theguardian.com/us-news/2016/may/15/cia-operative-nelson-mandela-1962-arrest">it has since emerged</a> – and spent the next 27-and-a-half years in jail, 18 of them on Robben Island.</p>
<h2>Life behind bars</h2>
<p>When Mandela arrived, a prison warder sneered: “This is the Island. This is where you will die.” </p>
<p>Part of the challenge was getting used to monotony. As he put it: </p>
<blockquote>
<p>Prison life is about routine: each day like the one before; each week like the one before it, so that the months and years blend into each other.</p>
</blockquote>
<p>The daily routine of <a href="https://www.bbc.com/news/world-africa-23618727">Prisoner 46664</a> consisted of gruelling manual labour – working in a quarry to dig out limestone and using heavy hammers to smash rocks into gravel. This was draining but he decided not to use it as an excuse to abandon his exercise regime. From then on it started at 5am and was carried out in a damp 2.1m squared cell rather than a sweat-soaked Soweto boxing gym. “I attempted to follow my old boxing routine of doing roadwork and muscle-building,” he said. </p>
<p>He’d begin with running on the spot for 45 minutes, followed by 100 fingertip push-ups, 200 sit-ups, 50 deep knee-bends and calisthenic exercises learnt from his gym training (in those days, and even today, this would include star jumps and ‘burpees’ – where you start upright, move down into a squat position, kick your feet back, return to squat and stand up).</p>
<p>Mandela would do this Mondays to Thursdays, and then rest for three days. This continued even during his several spells in solitary confinement.</p>
<h2>Beating TB</h2>
<p>In 1988, aged 70, he contracted tuberculosis, exacerbated by the damp cell, and was admitted to hospital, coughing blood. He was moved to a prison warder’s house in <a href="https://www.sahistory.org.za/dated-event/mandela-moved-victor-verster-prison">Victor Verster Prison</a> near Paarl and soon resumed a truncated version of his exercise programme, which now included laps of the prison swimming pool.</p>
<p>He was released from prison, along with other political prisoners, on 11 <a href="https://www.youtube.com/watch?v=v1azBzDpmEU">February 1990</a>, nine days after the African National Congress and other liberation movements <a href="https://theconversation.com/fw-de-klerk-made-a-speech-30-years-ago-that-ended-apartheid-why-he-did-it-130803">were unbanned</a> by the apartheid government. He went on to become the first president of a democratic South Africa, <a href="https://www.sahistory.org.za/article/nelson-mandela-presidency-1994-1999">from 1994 to 1999</a>. </p>
<p>Inevitably as he reached his 80s, his exercise routine was moderated but never abandoned. He <a href="https://mg.co.za/article/2013-12-05-nelson-mandela-dies/">died on 5 December 2013</a>, aged 95, of a respiratory infection.</p>
<p>Mandela believed a lifetime’s habit of exercise helped him to survive prison, ready for the challenges that lay ahead. “In prison, having an outlet for my frustrations was absolutely essential,” he said – words that might be taken to heart by those facing months of coronavirus-prompted lockdowns in cramped conditions.</p><img src="https://counter.theconversation.com/content/135690/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gavin Evans 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>Prison life is about routine: each day like the one before; each week like the one before it, so that the months and years blend into each other.Gavin Evans, Lecturer, Culture and Media department, Birkbeck, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1307862020-01-30T13:14:36Z2020-01-30T13:14:36ZHow do I know if I might have coronavirus? 5 questions answered<figure><img src="https://images.theconversation.com/files/312554/original/file-20200129-92954-jmbn1k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Students line up to sanitize their hands to avoid the contact of coronavirus in Phnom Penh, Cambodia, Jan. 28, 2020.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/APTOPIX-Asia-Protective-Masks/60d099fce47a44b5b87bdfc130224039/20/0">AP Photo/Heng Sinith</a></span></figcaption></figure><p><em>Editor’s note: The new coronavirus, 2019 n-CoV, continues to spread in China, and cases are being diagnosed in many other countries, including the U.S. In <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-home-care.html">some of those countries</a>, including Germany and Vietnam, <a href="https://www.nytimes.com/2020/01/29/world/asia/coronavirus-china.html">people who have not visited China have been diagnosed</a>. With initial symptoms that resemble other diseases, many people are wondering how to know whether to seek medical help.</em></p>
<h2>With the new coronavirus now in the US, am I at risk?</h2>
<p>The biggest risk factors for being infected with the new coronavirus are travel to China, particularly Wuhan and other areas of Hubei Province, and close contact with a person who has a suspected or confirmed n-CoV case. Without those risk factors, the chance for the general American public of catching this virus is low. </p>
<p>However, the outbreak is rapidly changing, and it is unclear how the situation in the U.S. will evolve in upcoming weeks.</p>
<h2>What are the symptoms of 2019 n-CoV?</h2>
<p>Most cases of 2019 n-CoV have had fever and signs of pneumonia, like cough or shortness of breath. In some cases people are not able to breathe on their own and require the use of a ventilator. A small percentage of people die.</p>
<h2>What should I do if I have any of these symptoms?</h2>
<p>If you experience any of these symptoms within 14 days of travel to China, or within 14 days of coming in <a href="https://www.cdc.gov/coronavirus/2019-ncov/faq.html#footnote2">close contact</a> with an individual infected with the coronavirus, you should immediately call your health care provider. It is best to call ahead before going to a clinic or emergency room. </p>
<p>Your health care provider will evaluate you with the help of your state’s public health department and the federal <a href="https://www.cdc.gov/coronavirus/about/symptoms.html">Centers for Disease Control and Prevention</a>. If your travel history and reported symptoms fit with n-CoV infection, you may be tested for the virus. Right now that test can be performed only at the CDC, so your health care provider would send samples to the CDC for testing.</p>
<h2>What else could it be?</h2>
<p>At this time of year many respiratory viruses are circulating in the community, including influenza, <a href="https://www.cdc.gov/rsv/index.html">RSV</a>, rhinovirus and human coronaviruses, which are different from the 2019 n-CoV virus. It is much more likely that you have one of these viruses than the 2019 n-CoV virus, even if you have traveled to China. </p>
<h2>So there are other coronaviruses?</h2>
<p>Yes. There are four human coronaviruses that circulate each year in the U.S. They cause <a href="https://doi.org/10.1001/jama.2020.0757">10% to 30% of upper respiratory tract illnesses</a> in the U.S., with mild symptoms akin to the common cold. Health care labs can test for these coronaviruses – but not for 2019 n-CoV.</p><img src="https://counter.theconversation.com/content/130786/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catharine Paules 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>With coronavirus continuing to spread, you may wonder: How do I know if I might have it? An infectious disease expert explains.Catharine Paules, Associate Professor of Medicine, Infectious Diseases, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/749772017-06-14T02:32:21Z2017-06-14T02:32:21ZHealth Check: what’s the right way to blow your nose?<figure><img src="https://images.theconversation.com/files/171227/original/file-20170527-6408-1i3qcfb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">One nostril or two? Hard blow or gentle? Some ways are more effective and less risky than others.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/564920515?src=5zjuu6SdjG6AFqWno9dbCw-1-3&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>If you have a blocked or runny nose, chances are you’ll reach for a tissue or hanky to clear the mucus by having a good blow.</p>
<p>But is there a right way to blow your nose? Could some ways make your cold worse? And could you actually do some damage?</p>
<p>The three most common reasons for extra mucus or snot are the <a href="https://theconversation.com/health-check-what-is-the-common-cold-and-how-do-we-get-it-60857">common cold</a>, <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/sinusitis">sinusitis</a> (infection or inflammation of the sinuses, the air-filled spaces inside the face bones) and <a href="https://theconversation.com/hay-fever-survival-guide-why-you-have-it-and-how-to-treat-it-34000">hay fever</a>. Each of these conditions cause the lining in the nose to swell up, and to produce extra mucus to flush away infection, irritants or allergens.</p>
<p>Both the swelling and extra mucus lead to nasal congestion. This is when the narrowed passages increase the effort of breathing through the nose. Clearing the mucus by blowing the nose should reduce this congestion somewhat.</p>
<p>At the beginning of colds and for most of the time with hay fever, there’s lots of runny mucus. Blowing the nose regularly prevents mucus building up and running down from the nostrils towards the upper lip, the all-too-familiar runny nose.</p>
<p>Later in colds and with sinusitis, nasal mucus can become thick, sticky and harder to clear.</p>
<hr>
<p><em>Further reading: <a href="https://theconversation.com/health-check-what-you-need-to-know-about-mucus-and-phlegm-33192">Health Check: what you need to know about mucus and phlegm</a></em></p>
<hr>
<p>Think of “snotty nosed kids”, in particular infants or toddlers who haven’t yet learnt to coordinate the mechanics of blowing their noses. They tend to repeatedly sniff thick mucus back into their nose or allow it to dribble down their upper lip. </p>
<p>Keeping this mucus (rather than blowing it out) is <a href="http://thailand.digitaljournals.org/index.php/APJAI/article/viewFile/12242/11641">thought to contribute</a> to a cycle of irritation that causes the snotty nose to persist for weeks or longer. </p>
<p>This may be due to the retained mucus acting as a good “home” for bacteria to grow in, as well as fatigue of the “hairs” (cilia) that cleanse the nose by moving along mucus and carrying with it irritants, inhaled debris and bacteria.</p>
<p>Thick retained mucus is also more likely to be transported to the throat rather than gravity working it from the nostrils, leading to throat irritation and possibly a cough. This is the <a href="http://thailand.digitaljournals.org/index.php/APJAI/article/viewFile/12242/11641">mechanism</a> behind the most common cause of prolonged cough after a viral infection or hay fever, known as the post-nasal drip cough.</p>
<p>So it makes sense to encourage people to blow their nose to remove unwanted mucus. </p>
<h2>Rare risks if you blow too hard and too often</h2>
<p>Although extremely rare, there are a few examples in the medical literature of people blowing so hard they generated pressures high enough to cause serious damage. In most of these cases people had underlying chronic sinusitis or an existing weakness in the structure they damaged after blowing too hard.</p>
<p>These injuries included fractures of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769614">base of the eye socket</a>; air forced into the tissue between the <a href="http://www.sciencedirect.com/science/article/pii/S0022347615000803">two lobes of the lung</a>; severe headache from air forced <a href="http://www.magonlinelibrary.com/doi/abs/10.12968/hmed.2010.71.11.79655?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&">inside the skull</a>; and <a href="https://www.ncbi.nlm.nih.gov/pubmed/15875619">rupture of the oesophagus</a>, the tube that sends food to the stomach.</p>
<p>One <a href="https://www.researchgate.net/profile/Hana_Chovanova/publication/9038795_Pressures_generated_during_nose_blowing_in_patients_with_nasal_complaints_and_normal_test_subjects/links/0c96051a49dfb0c521000000.pdf">study</a> looked at the pressures generated when people with and without a range of nasal complaints blew their noses.</p>
<p>People with chronic sinusitis generated pressures significantly higher than people without a nasal complaint, up to 9,130 Pascals of pressure. They also found blowing by blocking both nostrils generated much higher pressures than blowing with one nostril open.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/171228/original/file-20170527-6373-wnmvq1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/171228/original/file-20170527-6373-wnmvq1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171228/original/file-20170527-6373-wnmvq1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171228/original/file-20170527-6373-wnmvq1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171228/original/file-20170527-6373-wnmvq1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171228/original/file-20170527-6373-wnmvq1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171228/original/file-20170527-6373-wnmvq1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171228/original/file-20170527-6373-wnmvq1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">One study showed how blowing your nose hard could send mucus from the nose into the sinuses, potentially infecting them too.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?src=RXdkQFSdx3_8WR8PTNPzDg-1-28">www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Another <a href="https://academic.oup.com/cid/article-lookup/doi/10.1086/313661">study</a> comparing pressures from nose blowing, sneezing and coughing found pressures generated during blowing were about ten times higher than during the other two activities.</p>
<p>More worrying was their second finding – viscous fluid from the nose had found its way into the sinus cavities after vigorous nose blowing. The researchers said this could be a mechanism for sinus infection complicating some colds, with the introduction of nasal bacteria to the sinuses. But they did not produce evidence for this.</p>
<p>On balance it seems repeated and vigorous blowing of the nose may carry more risk than benefit, even though it seems to be a natural response to nasal congestion. </p>
<h2>Can I take anything to stop the snot?</h2>
<p>So looking to remove the need to blow so forcefully is probably a better option.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5169079/">Decongestants and antihistamines</a>, which you can buy without prescription from pharmacies, reduce both nasal congestion and the volume of mucus.</p>
<p>Decongestants contain ingredients like oxymetazoline and phenylephrine and come in tablets or sprays, and are often included in cold and flu tablets. They work by constricting (narrowing) dilated blood vessels in the inflamed lining of the nose, and decreasing the volume of mucus produced.</p>
<p>While decongestant sprays are <a href="https://www.ncbi.nlm.nih.gov/pubmed/27748955">effective</a>, they are probably underused due to concerns about nasal congestion when you stop taking them after long-term use (rhinitis medicamentosa). But further studies <a href="http://www.sciencedirect.com/science/article/pii/S1879729612001378">have questioned</a> this increased risk.</p>
<p>Antihistamines treat nasal congestion associated with <a href="https://www.ncbi.nlm.nih.gov/pubmed/24992553">hay fever</a>, but may be less effective for treating cold symptoms.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/171229/original/file-20170527-6421-1p6jm8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/171229/original/file-20170527-6421-1p6jm8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171229/original/file-20170527-6421-1p6jm8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171229/original/file-20170527-6421-1p6jm8q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171229/original/file-20170527-6421-1p6jm8q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171229/original/file-20170527-6421-1p6jm8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171229/original/file-20170527-6421-1p6jm8q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171229/original/file-20170527-6421-1p6jm8q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Saline nasal sprays and washes can help.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/300564986?src=4oiPHBl0KHFB7hPxMk4QkA-1-3&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Saline nose sprays have <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006821.pub3/abstract;jsessionid=1F06BD4AF4D872E987E4F65E555C0A0A.f04t01">some evidence</a> they work for acute and chronic rhinosinusitis (inflammation of the nasal lining and sinuses), and can reduce the need for medications. They are believed to clear mucus through increasing the effectiveness of the cilia as well as diluting thick and sticky mucus.</p>
<p>A related technique, known as nasal aspiration, is when you squirt liquid saline up the nose with a special medical device to flush out mucus and debris from the nose and sinuses. One <a href="https://www.ncbi.nlm.nih.gov/pubmed/25336097">study</a> found it lowered the risk of developing acute otitis media (inflammation of the middle ear) and rhinosinusitis.</p>
<h2>What’s the verdict?</h2>
<p>If you have mucus in the nose, it is probably best to get it out, so blow gently or by clearing one nostril at a time. Use of appropriate treatments can lessen the need to blow, and the force required to clear your nose.</p>
<p>If you are repeatedly blowing your nose you probably have a nasal condition, like hay fever or sinusitis, which should be treated more comprehensively.</p>
<p>And if you see a snotty-nosed kid, please wipe away the mucus discharge for the benefit of all.</p><img src="https://counter.theconversation.com/content/74977/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David King 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>If you have a blocked or runny nose, chances are you’ll reach for a tissue or hanky for a good blow. But is your technique up to scratch?David King, Senior Lecturer, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/695522017-01-03T20:13:55Z2017-01-03T20:13:55ZPrepare for a healthy holiday with this A-to-E guide<figure><img src="https://images.theconversation.com/files/150465/original/image-20161216-26077-3e3ni2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most ill health can be avoided on family holidays through research and planning in advance, plus smart packing. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/534992203?src=as1IsLvnWSXxcMtpIEARZA-1-70&id=534992203&size=huge_jpg">from www.shutterstock.com </a></span></figcaption></figure><p>So your well-earned holiday is finally here. But before you pack your swim gear, magazines and camera, take a moment to think about your health.</p>
<p>Experiencing an illness in a foreign destination can be very challenging. Obviously it will reduce the quality of your trip, but it can also leave travellers with unexpected costs and exposed to a foreign medical system. On occasion, serious complications can follow. </p>
<p>More than <a href="http://www.abs.gov.au/ausstats/abs@.nsf/products/961B6B53B87C130ACA2574030010BD05">nine million Australians</a> travel internationally per year, with most trips undertaken by people between the ages of 25 and 55. The top ten <a href="http://www.abs.gov.au/ausstats/abs@.nsf/products/961B6B53B87C130ACA2574030010BD05">most popular destinations</a> for Australians are New Zealand, Indonesia, the USA, UK, Thailand, China, Singapore, Japan, Fiji and India. </p>
<p>A range of new health problems can be encountered during travel, and existing health problems can be exacerbated. Staying healthy is all about being informed, prepared and sensible.</p>
<p>The <a href="http://wwwnc.cdc.gov/eid/article/15/11/09-1147_article">leading causes</a> of infection-related illness during travel are <a href="http://www.bmj.com/content/353/bmj.i1937">travellers’ diarrhoea</a>, <a href="http://www.mja.com.au/journal/2002/177/4/9-infections-returned-traveller">respiratory infections and infections transmitted by mosquitoes</a>. </p>
<p>Minimise your chances of experiencing these by following a simple ABCDE.</p>
<h2>A: Allow time to prepare</h2>
<p>Around popular holiday periods, it pays to allow plenty of time to book an appointment at a travel clinic, or a local medical clinic that offers travel vaccinations.</p>
<p>Some vaccinations have two or three doses and may need four weeks for the course to be completed. Examples include vaccines for <a href="https://theconversation.com/zika-dengue-yellow-fever-what-are-flaviviruses-53969">Japanese encephalitis</a> and <a href="https://theconversation.com/explainer-the-rabies-virus-28654">rabies</a>. </p>
<p>If travelling as a family, several visits may be required for preparing children for travel certain destinations.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/150463/original/image-20161216-26077-1osi44d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/150463/original/image-20161216-26077-1osi44d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=602&fit=crop&dpr=1 600w, https://images.theconversation.com/files/150463/original/image-20161216-26077-1osi44d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=602&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/150463/original/image-20161216-26077-1osi44d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=602&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/150463/original/image-20161216-26077-1osi44d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=756&fit=crop&dpr=1 754w, https://images.theconversation.com/files/150463/original/image-20161216-26077-1osi44d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=756&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/150463/original/image-20161216-26077-1osi44d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=756&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Indonesia is a popular holiday destination for Australians.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/rueful/6671265895/in/photolist-bavYVM-pXSVcu-n4jBKP-fG1med-phyKiE-biZ1Jk-n4f2Re-bTneje-ogbThR-dtPhwA-9QwroC-dtP2EQ-nhq8eA-4psFFh-n49Dk4-n4aN1M-n4ba2L-dJFmfU-gwTiLK-fG17kQ-o1aTQQ-dJApLB-a8ibfk-cNa3VY-jCJaBY-ChT86B-n3HXiX-qZWMG5-dtHH9Z-96b49x-4poD6X-oyYqCD-b5Foja-fwLdnk-gwSFWs-bN7Cm2-bhP4LM-a15UFd-ohKTqW-ab9Qwp-dJFZTb-bhPF6F-fG1mP9-baBzzx-5HJkHP-bizSLz-5HNdLm-a133GK-dJFbPo-7pMoai">rueful/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Keep in mind that your travel medicine practitioner may need detailed information about your exact itinerary, your past childhood vaccinations, your medical history and medications. If you have all this information readily available, you can get the most out of your travel consultation.</p>
<p>If you have an existing medical condition, get checked out to make sure it’s being managed as expected. For example, blood pressure medications may need to be adjusted if your blood pressure is either too high or too low. </p>
<p>Yellow fever immunisations and other live vaccines – those that contain active components – should be avoided if you are on medications that reduce your immunity, such as steroids like <a href="http://www.nps.org.au/medicines/hormonal-and-metabolic-system/corticosteroids-oral-and-injectable/prednisolone-corticosteroids-oral-and-injectable">prednisolone</a>. You may need alterations to immunosuppressive medications some weeks before you travel, or an official letter exempting you from a vaccine that is necessary for entry into certain countries (as is the case with yellow fever vaccine). </p>
<h2>B: Behaviour - think about it</h2>
<p>Holiday makers often seek to get out of their comfort zones. But it’s worth avoiding the temptation to completely let your hair down: behaviours you would never entertain in the home setting should be avoided in a foreign setting as well. You may also need to alter some of your daily living behaviours. </p>
<p>Traveller’s diarrhoea can largely be avoided by using bottled water in any setting that you consume water, including staying hydrated, brushing your teeth, washing fruit and salads, and making ice blocks and other drinks. </p>
<p>Eat food from venues that appear to adhere to good food hygiene standards – although this can be difficult to judge. Avoid hawker food or street food where items may have been left for long periods at temperatures where bacteria can multiply. When uncertain of hygiene standards, selecting packaged food is the safest choice.</p>
<p>Respiratory infections are common in travellers. If you find yourself in a crowded setting where someone appears unwell and is coughing, create a distance to reduce the risk of being infected. Alcohol-based hand gels are useful to maintain hand hygiene and may protect you from infection due to common colds and other viruses that linger on surfaces.</p>
<p>Smart packing is also important. You should travel with sunscreen and clothes that protect you from sun exposure, and repellent that has an active component to repel insects if travelling to an area where mosquitoes can transmit infections such as <a href="https://theconversation.com/zika-dengue-yellow-fever-what-are-flaviviruses-53969">dengue</a>, <a href="https://theconversation.com/does-zika-virus-pose-a-threat-to-australia-53557">Zika</a> and <a href="https://theconversation.com/how-the-world-can-cut-malaria-cases-by-90-in-the-next-15-years-47146">malaria</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/150651/original/image-20161219-26093-ecnvw0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/150651/original/image-20161219-26093-ecnvw0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/150651/original/image-20161219-26093-ecnvw0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/150651/original/image-20161219-26093-ecnvw0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/150651/original/image-20161219-26093-ecnvw0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/150651/original/image-20161219-26093-ecnvw0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/150651/original/image-20161219-26093-ecnvw0.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">Dengue is a virus transmitted by mosquitoes.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/techbirmingham/298209271/in/photolist-CPCsdq-nMZZee-nMZepS-smpea-o5n6F1-49MHMV-8hGfqB-cveRHb-o3r7wL-nMZasV-6huJv-c7LP9-53Vqkb-e8Cnfk-4eVCHg-qw7BqG-4p7niT-jqTnfj-6CK1SQ-qjGiLn-5c6Cm-4p29oX-qjP63U-pnT92J-qjSpvT-6hvFb-4CkWVr-6hvjM-6hvqR-o5tydZ-8PrkPU-6hvxv-6hvuA-byQJS-CDN877-q3iXy5-bEP4XD-9wTQQu-4pbrDo-9hARcT-5c6Cv-7PmtaW-xnoj4-stKUrP-5r8BHK-9hE8hu-cCWwQJ-5r32eK-52qrga-yEDee">echbirmingham/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Avoid acquiring a sexually transmitted infection by using barrier protection (condoms) for sexual intercourse. </p>
<h2>C: Check safety, and have a check up</h2>
<p>Review travel warnings at a reputable website, such as <a href="http://smartraveller.gov.au/Pages/default.aspx">SmartTraveller</a>. </p>
<p>A general check up is advised to ensure your health is stable. Health conditions such as inflammatory bowel disease, diabetes or a lowered immune system may put you at greater risk of travellers’ diarrhoea. Cancer or recent operations can increase risk of developing a <a href="http://jamanetwork.com/journals/jama/fullarticle/2297171">blood clot</a>. </p>
<p>Check ups are also a good opportunity to ensure that your vaccinations are up-to-date (see below). </p>
<h2>D: Drugs (medications) and vaccines are vital</h2>
<p>Medications that can reduce the time or severity of travellers’ diarrhoea are recommended for almost any destination, but particularly when travelling to developing countries where food hygiene standards can be variable. Examples include antibiotics such as azithromycin that treat bacterial causes of diarrhoea, and drugs such as tinidazole to treat parasitic causes of diarrhoea. </p>
<p>Medications such as doxycycline or malarone that protect against being infected with malaria are recommended in <a href="https://www.cdc.gov/malaria/about/distribution.html">some regions</a> within Africa, Asia, South America and the Pacific. </p>
<p><a href="https://theconversation.com/zika-a-rare-benign-virus-suddenly-turns-nasty-and-heads-for-the-us-52792">Zika virus</a> infection generally causes a mild illness or no symptoms at all. Pregnant female travellers are advised to avoid travel to a Zika endemic area. Couples planning a pregnancy in the near future should seek advice from a health professional if travelling to a Zika endemic country. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/150655/original/image-20161219-28140-ymaga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/150655/original/image-20161219-28140-ymaga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/150655/original/image-20161219-28140-ymaga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/150655/original/image-20161219-28140-ymaga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/150655/original/image-20161219-28140-ymaga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/150655/original/image-20161219-28140-ymaga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/150655/original/image-20161219-28140-ymaga.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">Sunburn can easily be prevented with appropriate clothing, hats and sunscreen.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/nicksie2008/16575104096/in/photolist-rfFJYQ-J2aXh9-esqGcC-tFnag7-9xxtJx-8mRBC1-9bwwao-abNiQK-pbxD2P-CJ4J-81vT16-bCwXbe-4JuBn9-6eRV5i-fLEpN1-6G8bVz-4xLzAM-8fYBiq-5sy4z8-6bKKxR-6hZtvk-9YWwre-9Z3wf3-5qyoAK-2yMKQg-6ZBZ3h-8nNdxo-aAZbU-FGAuZu-nP4KBP-qz5xT-VcKn7-6mSyzN-pyzbk-dGzUsd-bonmUT-nwP7JV-jMbmCJ-jtHZJW-dUhRHG-8qHpnL-76HccA-hQgixL-o46yqu-a76fLS-6XuRKd-8cBCH2-6HqJ7r-36hFn2-9QzTec">nicksie2008/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>If you’re travelling to destinations that are above 2500 metres (such Cusco in Peru), talk to your doctor about medications that help prevent or manage altitude sickness. </p>
<p>The normal schedule of vaccinations provided to Australians may not cover you for illnesses found in your holiday destination. Extra vaccinations are necessary for certain destinations. </p>
<p>For example, <a href="https://theconversation.com/zika-dengue-yellow-fever-what-are-flaviviruses-53969">yellow fever</a> is transmitted by mosquitoes and can cause anything from mild fevers to a severe illness involving multiple organs. Vaccination against yellow fever is required for entry into countries with known yellow fever transmission, and for returning back to Australia if visiting an area of known transmission.</p>
<p>Australians may consider vaccinations against the following diseases before travel to popular holiday destinations:</p>
<ul>
<li>Hepatitis A</li>
<li>Hepatitis B</li>
<li>Influenza</li>
<li>Japanese encephalitis</li>
<li>Meningococcal disease</li>
<li>Rabies</li>
<li>Tuberculosis</li>
<li>Typhoid</li>
<li>Varicella (Chickenpox) </li>
<li>Yellow fever</li>
<li>Cholera</li>
<li>Measles</li>
<li>Polio</li>
<li>Tetanus</li>
</ul>
<p>A full <a href="https://wwwnc.cdc.gov/travel/destinations/list/">list of countries and recommended vaccinations</a> has been compiled by the USA’s Centers for Disease Control and Prevention. </p>
<p>Even if you’re previously been vaccinated for some of these conditions, as time passes you may require boosters to strengthen your immunity. </p>
<h2>E: Enjoy your trip!</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/150876/original/image-20161220-26724-1wqfrqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/150876/original/image-20161220-26724-1wqfrqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/150876/original/image-20161220-26724-1wqfrqj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/150876/original/image-20161220-26724-1wqfrqj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/150876/original/image-20161220-26724-1wqfrqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/150876/original/image-20161220-26724-1wqfrqj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/150876/original/image-20161220-26724-1wqfrqj.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">Relax, you’ve earned a break.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/530479720?src=2QoyDn5t1yavJYuyCgxyeg-1-80&id=530479720&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure><img src="https://counter.theconversation.com/content/69552/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Irani Thevarajan 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>Simple steps can lower your risk of bringing home traveller’s diarrhoea, respiratory infections and mosquito-borne diseases from your holiday.Irani Thevarajan, Honorary Fellow Nossal Institute for Global Health and Infectious Diseases Physician, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/605732016-06-08T14:50:17Z2016-06-08T14:50:17ZWhy it’s still worth getting the flu vaccine each year<figure><img src="https://images.theconversation.com/files/125498/original/image-20160607-15061-qgmfo6.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><em>Influenza, more commonly known as flu, kills <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378466/">between 6,000 and 11,000</a> South Africans every year. About half of those deaths are in the elderly and about 30% in HIV-infected people. During the flu season in South Africa about 14% of patients hospitalised for pneumonia and 25% of patients with flu-like illnesses test positive for flu.
The flu vaccine – which prevents one from getting flu – should ideally be taken between March and June, before the flu season starts. But getting it later will protect you during the rest of the season. Dr Sibongile Walaza, medical epidemiologist at South Africa’s National Institute for Communicable Diseases, explains why the flu vaccine is worth taking.</em></p>
<p><strong>What is the flu and how is it different from a cold?</strong></p>
<p>Influenza or flu is a virus spread from person to person. It can cause many different symptoms, but it commonly causes fever, cough, sore throat and body aches. It can also cause headache, fatigue, muscle pain, shivers, vomiting and diarrhoea.</p>
<p>Influenza is caused by one of several respiratory viruses. There are other respiratory viruses that circulate during the flu season that may cause similar symptoms but are not the flu.</p>
<p>Many of these other viruses cause a common cold, which can be differentiated from the flu by the fact that the person has upper respiratory symptoms (a runny nose/congestion) that are not usually accompanied by the generalised body aches and overall sick feeling that comes with the flu.</p>
<p>In South Africa, flu circulates during the winter months. The average season starts in the first week of June, but it can start as early as April or as late as July. The season typically lasts about 12 weeks, but it can be as short as seven weeks or as long as 25 weeks.</p>
<p>People with the flu maybe able to pass it on to someone else before they know that they are sick or while they are sick. A person with the flu is contagious one day before symptoms appear and for three to seven days after the onset of symptoms. Some people, especially young children and people with weakened immune systems, maybe able to infect others for even longer. Flu symptoms can take from one to four days to present after a person is exposed to a flu virus.</p>
<p><strong>Is the flu in South Africa different from that in other parts of the world? Why?</strong></p>
<p>We cannot predict whether the same influenza strains as those in other countries will be circulating in the coming influenza season in South Africa.</p>
<p>The influenza virus is constantly changing; it is possible that different strains of flu virus circulate each year. The strains in the southern hemisphere may vary from those that circulated in the northern hemisphere and sometimes there is an overlap.</p>
<p>Towards the end of the influenza season, it is possible to compare whether the influenza strains that circulated in South Africa that season are similar to what was circulating in other countries or to strains that circulated during the previous northern hemisphere influenza season.</p>
<p><strong>What is new with this year’s flu and the flu vaccine?</strong></p>
<p>Each year the World Health Organisation gathers data on flu strains from different countries.</p>
<p>The organisation analyses data at the end of the southern hemisphere winter, in September, and at the end of northern hemisphere winter, in February. Based on this analysis a recommendation is made of which influenza strains to include in the formulation of the southern and northern hemisphere vaccines. As a result, information from the strains that circulated the previous influenza season informs the vaccine selection for the following year.</p>
<p>For the southern hemisphere, the flu vaccine for 2016 has changed. It was updated with two new viruses to try to match with what is expected to be circulating this season. South Africa uses a vaccine that contains three types of viruses. Some countries use a combination with four types.</p>
<p><strong>Who should get the vaccine and who shouldn’t?</strong></p>
<p>Pregnant women, people with chronic illnesses like diabetes, lung disease and heart disease, HIV-infected people and those who suffer from tuberculosis are at increased risk of hospitalisation and death from flu infections and should get the flu vaccine.</p>
<p>People older than 65, children between six months and four years, and children over six months who are on long-term aspirin therapy should also get the vaccine.</p>
<p>In addition, health-care workers, residents of old-age homes, chronic care and rehabilitation institutions, adults and children in close contact with individuals at risk of severe flu, and anyone wishing to reduce the risk of getting flu or spreading it to others should consider getting the vaccine.</p>
<p>Anyone who has had a severe reaction to the flu vaccine should not get it. Severe reactions include difficulty breathing, a drop in blood pressure, a loss of sensation in the feet or any condition that required hospitalisation.</p>
<p><strong>How effective is the vaccine and is it only valid for a year?</strong></p>
<p>The vaccine is 60% effective in healthy adults. Elderly people, children under the age of two and people with weakened immune systems may not respond as well to the vaccine – but they may still get some protection from it.</p>
<p>A flu vaccine contains different types of inactivated – or dead – flu viruses. The viruses have been changed (killed) and cannot make you sick. But the flu vaccine does not prevent other viruses from causing colds during the winter season, it only prevents influenza viruses.</p>
<p>It takes 14 days after vaccination for your immune system to build antibodies to provide protection.</p>
<p>The strains of flu virus may change from year to year and a flu vaccine is therefore needed every year. The vaccine may also change to protect against the most recent flu virus strains. Even if the flu strains do not change, yearly vaccination is still recommended as protection from flu through vaccination is not long lasting.</p><img src="https://counter.theconversation.com/content/60573/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sibongile Walaza does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The flu vaccine – which prevents one from getting influenza – changes every year, because it is based on the strains of the virus that presented in the previous year.Sibongile 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.