Normally it’s those 65 and older who get hit hardest by the flu, but this flu season has been particularly deadly for young and middle-aged adults, causing many more deaths and dramatically higher hospitalization rates than the previous three seasons.
The reason is a return of the dangerous H1N1 virus, or swine flu, that caused the 2009-10 pandemic. This particular strain of flu makes people “very sick, very fast, and it kills,” said Centers for Disease Control (CDC) director Tom Frieden, M.D., in a press briefing Thursday.
Add to that the notoriously low vaccination rate among adults in their 20s to 50s (34 percent, compared with more than 60 percent among those 65-plus) and the effect on this age group has been severe. It’s “hitting younger and middle-aged patients hard, and the season is likely to continue for several more weeks,” Frieden said.
According to the latest data from the CDC
- Adults under 64 accounted for 61 percent of flu hospitalizations, higher even than the 56 percent rate during the pandemic 2009-10 season. Pregnant women have accounted for 22 percent of hospitalizations.
- About 60 percent of flu deaths this season were among those ages 25 to 64, compared with 18 percent, 30 percent and 47 percent for the three previous seasons.
- Doctors have been too hesitant to treat patients with possible flu symptoms with antiviral medicines. “Don’t wait for the flu-test results. If you think it might be the flu, treat promptly,” Frieden advised health care providers.
California has been especially hard-hit this flu season, with 243 confirmed deaths; two-thirds of the state’s most severe cases were between ages 41 and 64.
News accounts of the death from flu of an otherwise healthy 46-year-old Sacramento advertising executive, Nancy Pinnella, even persuaded Gov. Jerry Brown’s wife, Anne Gust Brown, to tweet, “After reading the heartbreaking story of Nancy Pinnella, went to CVS and got my first flu shot ever.”
Like many of this season’s flu victims, Pinnella seemed to sicken and die very quickly — unfortunately, a typical scenario with the H1N1 virus.
“The virus affects the lower respiratory tract” and within days can develop into severe pneumonia, Cameron Wolfe, M.D., an infectious disease specialist and assistant professor of medicine at the Duke University School of Medicine in Durham, N.C., said in an interview.
“Often a younger adult will feel like they’re coming down with a cold or maybe the flu, but they’ll decide to wait it out for a few days,” he said. By that time, a respiratory infection and pneumonia can set in, and then they’re in trouble, he added.
In fact, the average age of flu patients hospitalized at Duke between November 1 and January 8 was 28.5 years old, according to a study Wolfe and his colleagues published online last week in the American Journal of Respiratory and Critical Care Medicine.
They also found that the majority of these patients were unvaccinated: Of 55 admitted flu patients, only 13 had been vaccinated; of the 22 admitted to the intensive care unit, only 2 had gotten flu shots.
“Some of our first patients were previously healthy 30- and 40-year-olds. We’ve had pregnant women on ventilators. It’s very rare for these kind of patients to get that sick,” Wolfe said.
The best protection is still getting a flu shot, said both Wolfe and CDC officials, and there’s still time to get one. High flu activity continues to be reported in many states and is likely to continue through March, Wolfe said. The CDC said the flu virus could linger until May.
“It’s not a perfect vaccine, but you’re about two-thirds less likely to get the flu if you get a shot, and unvaccinated people get a more severe case,” Wolfe said. CDC data indicate the flu vaccine this season is about 62 percent effective across all age groups.
“It’s frustrating that we have something that would prevent many more illnesses, hospitalizations and deaths and it’s not being used as much as we’d like,” added the CDC’s Frieden. “We’d like to avoid having you read a scare story [about a flu death] to make you do the right thing.”
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