Flu a symptoms 2019

The First Signs of Cold And Flu

How we catch cold and flu

Cold and flu viruses can be breathed in, or passed on by your hands to your nose or eyes. When people who are infected cough or sneeze into their hands, they can transfer the virus onto them. If sufferers go on to have hand‐to‐hand contact with healthy people, they can pass their cold or flu on. In the same way, healthy people can pick up viruses when they touch objects that sufferers have held or handled.

The first few days of a cold

As our immune system responds to the virus, we experience the familiar cold symptoms. The first sign of a cold is usually a sore or irritated throat and is typically followed by early symptoms such as a headache, chilliness or lethargy. These develop quickly and can last one to two days.

During the first few days, your nose may also start to run. As your cold takes hold, this watery trickle may become thicker and change colour to yellow, or even green.

A cough can also be a common symptom of a cold. In the early days this may be linked to a sore or irritated throat and an irritating ‘tickle’ in the throat.

Common signs of a cold may include:

A headache –
As your immune system responds to the infection it is common to develop a headache.

Chilliness –
In the first few days of a cold, you may feel shivery or chilly. However, it is rare for adults with a cold to get a fever too.

Sneezing –
This reflex is your body’s way of keeping your nose free from the things that irritate it, like dust, bacteria or viruses.

Tiredness and fatigue –
With a cold you may feel tired and drained. You may also find it difficult to concentrate.

During this initial period, you’re at your most contagious. So wherever possible, it’s a good idea to regularly wash your hands with soap and warm water, and wipe down door handles and worktops with a disinfectant.

It’s worth remembering that the early symptoms of a cold are usually at their worst during the first two to three days of the infection and if you’re otherwise fit and healthy, there is no need to visit a GP. However, if you’re in any doubt, or are concerned about any of your family’s symptoms, please speak to your doctor.

Weekly U.S. Influenza Surveillance Report

U.S. Virologic Surveillance

Clinical Laboratories

The results of tests performed by clinical laboratories nationwide are summarized below. Data from clinical laboratories (the percentage of specimens tested that are positive for influenza) are used to monitor whether influenza activity is increasing or decreasing.

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Public Health Laboratories

The results of tests performed by public health laboratories nationwide are summarized below. Data from public health laboratories are used to monitor the proportion of circulating viruses that belong to each influenza subtype/lineage.

Nationally influenza B/Victoria viruses have been reported more frequently than other influenza viruses this season. However, during recent weeks, influenza A(H1N1)pdm09 viruses have been reported more frequently than B/Victoria viruses. The predominant virus varies by region. Regional and state level data about circulating influenza viruses can be found on FluView Interactive.

The predominant virus also varies by age group. Nationally, influenza B viruses are the most commonly reported influenza viruses among children and young adults age 0-4 years (58% of reported viruses) and 5-24 years (72% of reported viruses), while A(H1N1)pdm09 viruses are the most commonly reported influenza viruses among persons 25-64 years (50% of reported viruses) and 65 years of age and older (57% of reported viruses). For this season, 53% of influenza positive specimens reported by public health laboratories were among persons less than 25 years of age and only 12% were from persons age 65 and older.

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Additional virologic surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or Age Data

Influenza Virus Characterization

CDC performs genetic and antigenic characterization of U.S. viruses submitted from state and local health laboratories using Right Size Roadmap submission guidance. These data are used to compare how similar the currently circulating influenza viruses are to the reference viruses used for developing new influenza vaccines and to monitor evolutionary changes that continually occur in circulating influenza. Antigenic characterization data are based on an animal model (influenza-naive ferrets), and do not reflect pre-existing protection provided by past influenza infections and vaccinations. Additional antigenic characterization studies involving people vaccinated with current influenza vaccines are conducted later in the season; these data account for pre-existing protection in different populations against circulating influenza viruses. Genetic and antigenic characterization data are not used to make calculations about vaccine effectiveness (VE). CDC conducts VE studies each year to measure the benefits of flu vaccines in people.

CDC genetically characterized 1,128 influenza viruses collected in the U.S. from September 29, 2019, to January 25, 2020.

CDC antigenically characterizes a subset of influenza viruses by hemagglutination inhibition (HI) or neutralization based Focus Reduction assays (FRA). Antigenic drift is evaluated by comparing antigenic properties of cell-propagated reference viruses representing currently recommended vaccine components with those of cell-propagated circulating viruses. CDC antigenically characterized 225 influenza viruses collected in the United States from September 29, 2019, to January 25, 2020. These data are not used to make calculations about vaccine effectiveness (VE). CDC conducts VE studies each year to measure the benefits of flu vaccines in people.

Influenza A Viruses

  • A (H1N1)pdm09: 74 A(H1N1)pdm09 viruses were antigenically characterized by HI with ferret antisera, and all were antigenically similar (reacting at titers that were within 4-fold of the homologous virus titer) to cell-propagated A/Brisbane/02/2018-like reference viruses representing the A(H1N1)pdm09 component for the 2019-20 Northern Hemisphere influenza vaccines.
  • A (H3N2): 53 A(H3N2) viruses were antigenically characterized by FRA with ferret antisera, and 22 (41.5%) were antigenically similar to cell-propagated A/Kansas/14/2017-like reference viruses representing the A(H3N2) component for the 2019-20 Northern Hemisphere influenza vaccines.

Influenza B Viruses

  • B/Victoria: 88 B/Victoria lineage viruses, including viruses from both co-circulating sub-clades, were antigenically characterized by HI with ferret antisera, and 53 (60.2%) were antigenically similar to cell-propagated B/Colorado/06/2017-like reference viruses representing the B/Victoria component for the 2019-20 Northern Hemisphere influenza vaccines.
  • B/Yamagata: 10 B/Yamagata lineage viruses were antigenically characterized by HI with ferret antisera, and all 10 (100%) were antigenically similar to cell-propagated B/Phuket/3073/2013-like reference viruses representing the B/Yamagata component for the 2019-20 Northern Hemisphere influenza vaccines.

CDC assesses susceptibility of influenza viruses to the antiviral medications including the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir using next generation sequence analysis supplemented by laboratory assays. Viruses collected in the United States since September 29, 2019, were tested for antiviral susceptibility as follows:

Outpatient Illness Surveillance


Nationwide during week 4, 5.7% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is above the national baseline of 2.4%.

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On a regional level, the percentage of outpatient visits for ILI ranged from 4.1% to 7.7% during week 4. All regions reported a percentage of outpatient visits for ILI which is above their region-specific baselines.

ILI Activity Map

Data collected in ILINet are used to produce a measure of ILI activity* by state.

During week 4, the following ILI activity levels were experienced:

  • High – the District of Columbia, New York City, Puerto Rico, and 41 states (Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming)
  • Moderate – seven states (Alaska, Iowa, Michigan, Montana, Nevada, New Hampshire, and Ohio)
  • Data were insufficient to calculate an ILI activity level from the U.S. Virgin Islands and two states (Delaware and Idaho).

*Data collected in ILINet may disproportionally represent certain populations within a state, and therefore, may not accurately depict the full picture of influenza activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

Additional information about medically attended visits for ILI for current and past seasons:
Surveillance Methods | FluView Interactive: National, Regional, and State Data or ILI Activity Map

Geographic Spread of Influenza as Assessed by State and Territorial Epidemiologists

The influenza activity reported by state and territorial epidemiologists indicates geographic spread of influenza viruses but does not measure the severity of influenza activity.

During week 4 the following influenza activity was reported:

Additional geographic spread surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive

Influenza-Associated Hospitalizations

The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in the Emerging Infections Program (EIP) states and Influenza Hospitalization Surveillance Project (IHSP) states.

The overall cumulative hospitalization rate was 29.7 per 100,000 population which is similar to what has been seen during recent previous influenza seasons at this time of year. Rates in children and young adults are higher than at this time in recent seasons.

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The highest rate of hospitalization is among adults aged ≥65, followed by children aged 0-4 years and adults aged 50-64 years.

Among 1,108 hospitalized adults with information on underlying medical conditions, 91.5% had at least one reported underlying medical condition, the most commonly reported were cardiovascular disease, metabolic disorder, obesity, and chronic lung disease. Among 271 hospitalized children with information on underlying medical conditions, 46.5% had at least one underlying medical condition; the most commonly reported was asthma. Among 216 hospitalized women of childbearing age (15-44 years) with information on pregnancy status, 26.4% were pregnant.

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Additional hospitalization surveillance information for current and past seasons and additional age groups:
Surveillance Methods | FluView Interactive

Pneumonia and Influenza (P&I) Mortality Surveillance

Based on National Center for Health Statistics (NCHS) mortality surveillance data available on January 30, 2020, 6.7% of the deaths occurring during the week ending January 18, 2020 (week 3) were due to P&I. This percentage is below the epidemic threshold of 7.2% for week 3.

View Chart Data | View Full Screen

Additional pneumonia and influenza mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive

Influenza-Associated Pediatric Mortality

Fourteen influenza-associated pediatric deaths occurring during the 2019-2020 season between weeks 45 and 4 (the weeks ending November 9, 2019 and January 25, 2020) were reported to CDC during week 4. Eight were associated with influenza B viruses; one had a lineage determined and was a B/Victoria virus. Six were associated with influenza A viruses, and three were subtyped; all were A(H1N1)pdm09 viruses.

Of the 68 influenza-associated pediatric deaths occurring during the 2019-2020 season and reported to CDC:

  • 45 deaths were associated with influenza B viruses, and eight had a lineage determined; all were B/Victoria viruses.
  • 23 deaths were associated with influenza A viruses, and 13 were subtyped; all were A(H1N1)pdm09 viruses.

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Additional pediatric mortality surveillance information for current and past seasons:
Surveillance Methods | FluView Interactive

Additional National and International Influenza Surveillance Information

FluView Interactive: FluView includes enhanced web-based interactive applications that can provide dynamic visuals of the influenza data collected and analyzed by CDC. These FluView Interactive applications allow people to create customized, visual interpretations of influenza data, as well as make comparisons across flu seasons, regions, age groups and a variety of other demographics. To access these tools, visit http://www.cdc.gov/flu/weekly/fluviewinteractive.htm

National Institute for Occupational Safety and Health: Monthly surveillance data on the prevalence of health-related workplace absenteeism among full-time workers in the United States are available from NIOSH at https://www.cdc.gov/niosh/topics/absences/default.html

U.S. State and local influenza surveillance:Select a jurisdiction below to access the latest local influenza information









District of Columbia





















New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota





Rhode Island

South Carolina

South Dakota







West Virginia



New York City

Puerto Rico

Virgin Islands

World Health Organization: Additional influenza surveillance information from participating WHO member nations is available through FluNet and the Global Epidemiology Reports.

WHO Collaborating Centers for Influenza located in Australia, China, Japan, the United Kingdom, and the United States (CDC in Atlanta, Georgia).

Europe: For the most recent influenza surveillance information from Europe, please see WHO/Europe and the European Centre for Disease Prevention and Control at http://www.flunewseurope.org/.

Public Health England: The most up-to-date influenza information from the United Kingdom is available at https://www.gov.uk/government/statistics/weekly-national-flu-reports

Any links provided to non-Federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization web pages found at these links.

An overview of the CDC influenza surveillance system, including methodology and detailed descriptions of each data component, is available at: http://www.cdc.gov/flu/weekly/overview.htm.


It’s not always easy to distinguish between a common cold and the more serious influenza virus, but according to the Centers for Disease Control and Prevention, people who are feeling under the weather can watch out for some telltale signs.

First and foremost are the onset of the symptoms themselves. The CDC says flu symptoms tend to come on abruptly, while people with a common cold may feel symptoms gradually. Flu symptoms also tend to be more severe overall. Meanwhile, fevers and headaches are rare with a cold but more common with the flu.

The CDC created a handy infographic that lists nine symptoms and how they stack up:

All of this information is especially critical right now as the 2019/2020 flu season appears to be arriving early in many parts of the country. The CDC said Friday that activity in the United States has now been elevated for four weeks. Much of that is being driven by one particular strain of the influential virus called B/Victoria, which the CDC says is “unusual for this time of year.” H1N1 and H3N2 are the next most common strains.

As for which parts of the country are getting hit the hardest, that’s been a consistent picture over the past few weeks. The Deep South states and Puerto Rico are experiencing high levels of people exhibiting influenza-like-illness (what the CDC calls “ILI), as are Washington State, Nebraska, and Nevada. You can check out the CDC’s weekly map here.

Finally, the CDC is reminding people that the flu season is “just getting started,” and there’s still time to get a flu shot. You can learn more about how to prevent the flu on the agency’s prevention page.

“We are seeing severe adult infections,” Kajon told NBC News.

“That’s a big deal, especially for a disease that by all means is vaccine preventable. But this vaccine is not licensed to be used in civilians.”

Adenovirus infections often look like the common cold, or like influenza. They cause fever, headache, body aches and sometimes but not always cough, stomach distress and breathing problems. Some strains cause eye infections. There are 52 different strains.

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Federal health officials say this flu season is the worst in nearly a decade

Jan. 26, 201801:55

Kajon and colleagues collected details of adenovirus infections from 2011 to 2015 at colleges, in nursing homes and elsewhere.

“On the basis of the severity of the clinical presentation of some cases in this study, the (adenovirus) vaccine currently licensed for military use should be considered a potentially valuable resource to prevent disease in susceptible populations living in closed communities, such as college settings, summer camps, and long-term care facilities,” they wrote in a report published in the journal Emerging Infectious Diseases.

An outbreak of adenovirus killed 10 people in 2007. Kajon’s team tested college students at one campus during the severe 2014-15 influenza epidemic and found 13 out of 168 students who came in for flu treatment had adenovirus infections.

Most patients may not suffer much, but the virus can cause very severe complications. Kajon and colleagues described the case of a 43-year-old women from Rochester, New York, who was previously healthy but became infected in 2012 and quickly developed pneumonia and respiratory failure. During her hospital stay she suffered brain swelling and bleeding and stayed on a ventilator for more than a month.

A year later, she was still out of breath if she exerted herself.

There was also the case of a 26-year-old Connecticut man infected in 2011 who had nausea, vomiting and chills. He spent days in the hospital with adenovirus infection.

There have also been outbreaks in long-term care facilities. But most clinics don’t test for adenovirus unless people are hospitalized with severe illness that isn’t helped by immediate treatment, Kajon said.

“These reports are probably the tip of the iceberg. We need more surveillance,” she said.

The Centers for Disease Control and Prevention keeps a log of reported cases of adenovirus.

“Outbreaks are more common in late winter, spring, and early summer but can occur throughout the year,” the CDC said.

There were so many outbreaks among new military recruits that the Department of Defense vaccinates personnel against two of the more serious strains with an oral vaccine. Vaccination was stopped for a few years in 1999 and outbreaks soared again, but there haven’t been many since the vaccine was re-introduced in 2011, the CDC said.

Kajon believes it should be more widely available,

“This is a vaccine-preventable disease,” she said. “A life is a life. Losing a loved one to viral pneumonia when you know it could have been prevented is hard.”

In the U.S., however, that requires catching the interest of a company that might want to develop such a vaccine commercially. “Unfortunately, it all comes down to the perception of having a market,” Kajon said.

Adenovirus is not the killer that influenza is. Influenza kills 12,000 to 50,000 people a year in the United States alone, and puts up to 700,000 in the hospital. A cocktail of other viruses, from coronaviruses to rhinoviruses, also cause seasonal misery.

But Kajon said her studies show adenoviruse can be a significant part of the mix.

As with many viruses, there’s not a good treatment for adenovirus, although the antiviral cidofovir has helped some people with severe infections.

And adenoviruses are very hard to kill. Reports indicate they can survive on plastic and metal surfaces— think countertops and hospital tables— for a month. Some formulations of alcohol and chlorhexidine do not kill them easily, tests have shown, although chlorine does.

Flu season 2019: How bad will it be?

Mainstream media reports are already rife with dire predictions for the upcoming flu season, but experts say it’s really too early to tell how severe it will be.

The severity of the flu season in the Northern Hemisphere typically mirrors that of the Southern Hemisphere. Australia’s flu season just ended and—while not as deadly as in 2017—had more documented cases of flu this season than ever before prompting concerns about the season to come in the north. There were also concerns raised about the efficacy of the vaccine used this year in the Southern Hemisphere.

Influenza expert Scott E. Hensley, PhD, associate professor of microbiology at the University of Pennsylvania co-authored a paper in August suggesting that the egg-adapted H3N2 component of the influenza vaccine used in the Southern Hemisphere was mismatched. The study notes that the vaccine elicited an antibody response in ferrets that was focused on the antigenic site A of hemagglutinin, which would cause a problem with H3N2 viruses that have the antigenic site A substitutions. Still, Hensley says it’s too soon to predict what the flu season will be like in the Northern Hemisphere just yet, or how effective the vaccine will be.

“There is a good chance that the vaccine will be very effective. There is a lot of H3N2 diversity around the world right and it is unclear which of these viruses—if any—will circulate in the Northern Hemisphere this year,” said Scott E. Hensley, PhD, associate professor of microbiology at the University of Pennsylvania. “It may end up being an H1N1 year, and the H1N1 component of the vaccine is very well matched to most circulating H1N1 strains.”

The Centers for Disease Control and Prevention (CDC) updated the flu vaccine in spring 2019, making changes to both the H3N2 and H1N1 influenza A strains, and adding coverage for both lineages of influenza B strains to quadrivalent vaccines in hopes of better matching this season’s vaccine to circulating viruses.

The World Health Organization (WHO) also updated its recommendations for the Northern Hemisphere in September at the close of the Southern Hemipshere’s flu season, with two of the four components—A/south Australia/34/2019 (H3N2)-like virus and the B/Colorado/06/2017-like virus (Victoria lineage)—being recommended as a change from the vaccine that was used for this year’s vaccine in the Southern Hemisphere.

So far, national flu activity in the United States is low, with 2.8 percent of samples testing positive since September. There are pockets of higher activity, with high levels of flu-like illness being reported in Puerto Rico and Louisiana, according to CDC.

Influenza A viruses seem to be predominant so far, making up about 58 percent of the cumulative positive samples for far this season. A third of those were the (H1N1)pdm09 strain and two-thirds were H3N2. Forty-two percent of the positive samples were Influenza B type, with the Victoria lineage making up about 96 percent of those samples and the Yamagata lineage accounting for the remainder. Influenza B viruses tend to circulate predominantly in the southern United States, while the Influenza A viruses are more prominent in the northern states, CDC notes.

In terms of other surveillance outside of confirmed samples, the CDC reports that nationwide in late October, 1.7 percent of patient visits to outpatient healthcare facilities were related to flu-like illness, noting that this is below the national baseline of 2.4 percent.

Severity of this year’s viruses is difficult to predict so early, but 4.9 percent of adult deaths in late October were attributed to pneumonia and influenza, which CDC reports is below the epidemic threshold of 5.7 percent. Two pediatric deaths were also attributed to the flu already this season, with one of those deaths associated with an Influenza A virus of unknown subtype and the other to the Influenza B/Victoria virus.


First, the bad news: There’s a flu epidemic every winter, and there’s no reason to think this season will be any different. Millions of Americans will get stay-in-bed sick and tens of thousands will likely die: In the bad season two years ago, the official death toll hit nearly 80,000. Already this fall, a 4-year-old in California has died.

Now for the good news.

1. This year is likely to be better than last year.

It’s not guaranteed, but the latest tracking from Australia says the flu season there — which can presage ours — has been long and high-volume but it describes the severity this year as “low,” based on ICU admissions and deaths.

And though it’s impossible to predict, under the law of averages we can expect the coming flu season to be shorter than last year’s unusually long one, says Dr. Larry Madoff from the Massachusetts Department of Public Health. “We sort of had two full seasons in a row” extending long into last spring, he says. “That’s why it was so prolonged, because we had first one strain and then another.”

2. No need to feel guilty for not having already gotten vaccinated.

If you’ve felt pangs because you ignored pharmacy vaccine ads or bypassed a clinic this summer, you can rest easy. Dr. David Shay, a medical officer at the CDC, says October is the ideal time to get vaccinated.

“The evidence is still evolving,” he says, about whether summer is in fact too early to get a flu vaccine, particularly for older adults, because the immunity it confers may wane by the time flu tends to peak in late winter.

“I would just emphasize that now is the time,” Shay says. The CDC recommends that the subset of young children who need two doses get their vaccines as soon as possible to be able to get the second dose by the end of October.

3. There’s a whole bouquet of vaccine options this year, including two no-needle versions.

The CDC lists a half dozen vaccine types, including FluMist, the nasal spray that needle-haters between ages 2 and 49 may choose. (Parents of needle-haters everywhere, rejoice!)

The CDC also mentions Afluria, a vaccine that can be given with a typical syringe or using a futuristic-sounding “jet injector” called “PharmaJet Stratis” that uses a high-pressure stream rather than a needle. (Parents of needle-haters, hold your rejoicing: At this point, the jet injector is not recommended for people under 18.) The CDC expresses no preference among the many different vaccines, and lays out a full array of the options here.

4. New vaccine technologies continue to develop, including egg-free forms.

Flu vaccines have traditionally been grown in chicken eggs, but now there are two main newer ways to make them: they’re known as “cell-based” vaccines and “recombinant DNA” vaccines.

They’re good news for most people with egg allergies (details here) and seem to be good news for others as well. Dr. Shay from the CDC says it appears that in some years, the adaptations needed to grow the vaccines in eggs may make them less effective against the virus. The vaccine makers “don’t have to make those kinds of alterations to grow them in either the recombinant systems or the cell-based systems,” he says.

Also, if there’s a pandemic and it’s urgent to make a lot of a new vaccine quickly, production can be ramped up more rapidly without eggs, Shay says. The majority of vaccines are still made with eggs, he adds, but the other types are on the rise.

5. Older adults have two strong vaccine options — and they’ve been using them.

Older people need stronger vaccines because their immune systems need more of a boost. Their flu vaccine options include two that Shay describes as “great”: A high-dose vaccine and a vaccine that uses an adjuvant, or enhancer.

“Uptake of the high-dose vaccine has been very rapid,” he says, meaning “care providers are getting the message that this is an alternative that likely offers improved responses” and better protection.

6. For kids, virtually all the vaccines this year protect against four strains.

For technical reasons, the older-adult vaccines are “trivalent,” meaning they protect against three strains of the virus. But all the regular-dose flu vaccines for younger people this year are quadrivalent, protecting against four strains.

Shay says that’s particularly good news for children who haven’t had much exposure yet to flu viruses: “They tend to get more severe illnesses with influenza B,” and it’s hard to predict which B strains will predominate. In the quadrivalent vaccines, “We have both of them. So it’s another way to help make sure we’ve got our bases covered.”

7. If you do get sick, there’s a new antiviral medication you can take.

The CDC recommends four prescription antivirals for use this season: brand names Tamiflu, Relenza and Rapivab, and a new one, Xofluza, which has a different mechanism of action.

Xofluza looks promising, Dr. Madoff from the state DPH says, because it appears to be as effective as Tamiflu but also to cut the duration of “viral shedding” — or spreading germs — “which is important in terms of the spread of flu.”

Most of all, “it’s good to have something new” in the arsenal, Madoff says, particularly if viruses develop resistance to the existing drugs. Xofluza was approved last year for patients 12 and older who have had flu symptoms for less than 48 hours. All the antivirals need to be used promptly after symptoms develop.

It looks like Xofluza will be widely available: CVS, for example, says it will stock it, along with “Tamiflu and the generic antiviral that makes up a significantly large majority of the flu antiviral scripts occurring during flu season.”

8. Whether the vaccine matches the dominant strains of flu well or not so well, it’s way better than nothing.

Every year, vaccine authorities do their best to choose which strains of the virus to target with the vaccines, trying to predict which will be most prevalent, but it remains an imperfect science. It’s just too early to tell how well this year’s vaccine will match the virus. Noteworthy this year is that vaccine choosers put off their call on one virus type — the nasty H3N2 — for a month to discern better which strains were circulating.

Dr. Shay says one thing is clear: Several big studies have found that “in a typical flu season, we can expect that receipt of a flu vaccine will prevent from 40% to 60% of illnesses compared to those who are not vaccinated.” So the take-home message is: “50% isn’t great but it’s better than 0%,” the prevention benefit of skipping the vaccine.

9. And we do seem to be getting closer to a one-and-done flu vaccine.

Federal scientists have begun testing a possible “universal vaccine” against flu in a few dozen people, checking how safe and effective it could be.

The beauty of a universal vaccine would be not just that we wouldn’t need to get a new vaccine every year, but that it could protect us against the novel strains of the virus that keep infectious disease types up at night. The experimental vaccine has the catchy name H1ssF_3928, and researchers hope to begin sharing results next year.

10. Soon we won’t have to fear mosquitoes for a while.

OK, I’m stretching to get to 10 pieces of good news about flu. But we’re coming to the end of a frightening Eastern equine encephalitis season: the mosquito-borne illness has killed three people in Massachusetts. Once we get to the first hard frost, health officials say, many mosquitoes will die off, reducing concerns about EEE.

Now, instead of mosquitoes, it’s our fellow humans we have to fear. In Massachusetts, four children died from flu last year, along with probably hundreds of adults. At least we all tend to know the rules for avoiding and limiting flu. So wash your hands, cover your cough, stay home if you’re sick.

And one final bit of good news: The communication by public health officials continues to improve as well. Dr. Madoff says Massachusetts will enhance its weekly flu reports this season by including how severe the flu is, and the CDC has one heck of a frequently asked questions list here.

It’s never an easy business to predict which flu viruses will make people sick the following winter. And there’s reason to believe two of the four choices made last winter for this upcoming season’s vaccine could be off the mark.

Twice a year influenza experts meet at the World Health Organization to pore over surveillance data provided by countries around the world to try to predict which strains are becoming the most dominant. The Northern Hemisphere strain selection meeting is held in late February; the Southern Hemisphere meeting occurs in late September.

The selections that officials made last week for the next Southern Hemisphere vaccine suggest that two of four viruses in the Northern Hemisphere vaccine that doctors and pharmacies are now pressing people to get may not be optimally protective this winter. Those two are influenza A/H3N2 and the influenza B/Victoria virus.


The strain selection committee concluded the H3N2 and B/Victoria viruses needed to be updated because the ones used in the Northern Hemisphere vaccine didn’t match the strains of those viruses that are now dominant. Influenza epidemiologist Dr. Danuta Skowronski described the significance of those two changes in one word: “mismatch.”

“I think the vaccine strain selections by the WHO committee are obviously important for the Southern Hemisphere but they’re also signals to us because they’re basing their decisions on what they see current predominating on the global level,” said Skowronski, who is with the British Columbia Center for Disease Control in Vancouver.

Scott Hensley, an associate professor of microbiology at the University of Pennsylvania, agreed. But Hensley cautioned that at this point it’s too soon to know what versions of the viruses will be circulating. And even if there is a mismatch, its impact may be not be massive, depending on which viruses are causing the most illness this winter.

“There are many ways that this flu season may pan out,” Hensley said. “For example, we’ve had a lot of H3N2 the last few years. So it’s possible that this flu season in the Northern Hemisphere will be dominated by H1N1 viruses. And if that’s the case we think that the H1N1 antigens are very well matched with the types of H1N1 viruses that are circulating right now.”

Flu vaccine is a four-in-one or a three-in-one shot that protects against both influenza A viruses — H3N2 and H1N1 — and either both or one of the influenza B viruses, B/Victoria and B/Yamagata. Most flu vaccine is made with killed viruses, and most vaccine used in the United States is quadrivalent — four-in-one.

There was great uncertainty around which version of H3N2 to choose for the Northern Hemisphere vaccine when the committee met last February — there was a lot of variation between the strain the U.S. was seeing and the H3N2 viruses sickening people in Canada and Europe. There was so much uncertainty, in fact, that the committee delayed making the choice of the H3N2 strain for a month to try to get a clearer picture.

In the end, the committee selected a version of the virus that was causing a wave of late season illness in the United States. (Canada also had a late season surge of H3N2 activity, but caused by a different version of the virus.)

“That H3N2 wave was late and it was evolving at the time that they met in February,” Skowronski said of the strain selection committee. “And there was a diverse mix of H3 viruses. And it wasn’t clear to them, I guess, … would emerge the clear winner.”

It appears the virus that was ultimately selected is not the H3N2 that dominated during the Southern Hemisphere’s winter 2019 season.

Hensley said the variant of H3N2 viruses that just swept through the Southern Hemisphere is more likely to be the main cause of H3N2 infections for the Northern Hemisphere this winter than was the case in the U.S. late last winter and into the early spring.

But that version of H3N2 is difficult to grow in eggs, which is the way the vast majority of flu vaccines is made, he noted, suggesting that fact may have influenced the thinking of the selection committee last March.

In recent years the H3N2 component has generally been the least effective part of the vaccine. If H3N2 viruses predominate this coming flu season, a vaccine mismatch could add to the severity of the season. But if those viruses play a smaller role this winter, the impact of a mismatch will be less significant, making it hard to predict if this choice is going to turn out to be a problem.

Flu circulation “remains difficult to predict and flu viruses are constantly breaking rules that we try to establish for them,” Hensley said, adding that flu vaccines “often protect against severe disease even when … mismatched.”

The selection of a new B/Victoria virus for the Southern Hemisphere 2020 shot also concerns Skowronski. There was almost no influenza B activity in the 2018-2019 flu season and it’s been several years since B/Victoria viruses have caused much illness. As a result, there may not be a lot of immunity to those viruses in the population, she said.

B/Victoria flu viruses are especially hard on children, Skowronski said.

Given the possibility that a couple of the components of the vaccine might not be well-matched to circulating flu viruses, Skowronski said it will be important for doctors to realize vaccinated patients may still contract influenza. For those who are at high risk of developing severe illness, rapid treatment with flu antiviral drugs should be considered.

She also suggested older people or people who have underlying health problems — in other words, those who are likely to develop a severe case of flu if they contract the virus — should take steps to avoid being around sick people.

The sliver of good news: The officials meeting at the WHO last week concluded that the H1N1 and the flu B/Yamagata components of the Southern Hemisphere vaccine didn’t need to change, suggesting they are representative of the strains of those viruses we’re likely to encounter this winter.

Healthdirect 24hr 7 days a week hotline

Influenza, or ‘the flu’, is a highly contagious respiratory illness. It’s a common cause of hospitalisation and leads to thousands more GP visits every year. Many people die annually from complications of the flu in Australia.

While you can catch the flu at any time, it’s more likely to happen in the colder months of the year (April to October). The flu season typically peaks in August, but laboratory-confirmed cases of influenza have been higher than usual so far this year — as have calls about flu-related symptoms to the healthdirect helpline.

Early signs of the flu can include cough, sore throat, sinusitis or fever.

Currently there is a moderate level of flu activity in Australia. The flu vaccine and good hygiene are still the best ways of protection against the flu.

Flu-related calls to healthdirect

Healthdirect Australia collects data based on flu-related calls to the healthdirect helpline (1800 022 222). This information is used to publish the flu ‘trend’ graph, below.

The blue line in the graph shows flu-related calls to the helpline for the current year, in proportion to all calls. The grey shaded area in the graph shows the range of flu-related calls between 2013 and 2018.

If the blue line is above the grey area, then this may indicate an increased risk of colds and flu in the community.

This graph contains data up to 19 December 2019.
It shows the percentage (%) of influenza-like illness calls made to healthdirect.

Flu trend report for health professionals

Health professionals can use this interactive report to get more data on flu-related calls to the healthdirect helpline, from January 2012 to the present.

The influenza syndromic surveillance report is updated twice a week between April and October, and less frequently during the warmer months.

7 ways to fight the flu

Follow these easy tips to help prevent the spread of flu.

Get a flu shot

It is important to get the influenza vaccination each year to continue to be protected, since it wears off after 3 to 4 months and flu strains (types) change over time.

Wash your hands

In addition to vaccination, good hygiene is one of the best ways to help prevent flu and other illnesses from spreading. Wash your hands regularly.

Cover coughs and sneezes

Cover your mouth and nose when coughing or sneezing.

Bin your tissues

Throw used tissues in the bin immediately.

Avoid sharing

Don’t share cups, plates, cutlery and towels with other people, if you can.

Keep surfaces clean

Clean surfaces such as your keyboard, phone and door handles regularly to get rid of germs.

Self-care at home

In most cases, you can treat mild flu or cold symptoms at home.

NOTE: Antibiotics won’t help

Antibiotics do not reduce symptoms of flu or a cold, as these illnesses are caused by viruses. Antibiotics only work for bacterial infections.

Is it the flu or a cold?

Click on this handy infographic to help determine whether you have the flu.

Learn more about the flu and the common cold here.

Children’s Hospital New Orleans has already seen more flu cases this fall than it saw all of last winter, said Dr. Toni Gross, the hospital’s chief of emergency medicine. Last month was the busiest ever at the hospital’s emergency department. Officials had to set up a triage system and add extra shifts, Gross said.

“It is definitely causing symptoms that will put you in bed for a week,” including fever, vomiting and diarrhea. But the hospital has not had any deaths and is not seeing many serious complications, she said.

Health officials tend to consider a flu season to be officially underway when — for at least three weeks in a row — a significant percentage of U.S. doctor’s office visits are due to flu-like illnesses. That’s now happened, CDC officials said this week.

The agency on Friday estimated that there have already been 1.7 million flu illnesses, 16,000 hospitalizations, and 900 flu-related deaths nationally.

The most intense patient traffic had been occurring in a six states stretching from Texas to Georgia. But in new numbers released Friday, CDC officials said the number of states with intense activity rose last week to 12. Flu is widespread in 16 states, though not necessarily at intense levels in each, the CDC said.

Last flu season started off as a mild one but turned out to be the longest in 10 years. It ended with around 49,000 flu-related deaths and 590,000 hospitalizations, according to preliminary estimates.

It was bad, but not as bad as the one before it, when flu caused an estimated 61,000 deaths and 810,000 hospitalizations. Those 2017-2018 estimates are new: The CDC last month revised them down from previous estimates as more data — including actual death certificates — came in.

In both of the previous two flu seasons, the flu vaccine performed poorly against the nasty predominant virus. It’s too early to say how well the vaccine is performing right now, Epperson said.

Epperson said there’s a chance the flu season will peak this month, which would be unusually early. Flu season usually doesn’t hit fever pitch until around February.

The early start suggests a lot Americans may be sick at the same time, said Dave Osthus, a statistician who does flu forecasting at Los Alamos National Laboratory. “This could be a precursor to something pretty bad. But we don’t know,” he said.

Gross is pessimistic. “I, personally, am preparing for the worst,” she said.

Weekly Flu Update – Widespread Flu Grips the U.S.

Widespread flu activity is now being reported in every state except for one.
Fourteen more flu-related pediatric deaths were reported this past week, bringing the total deaths so far this season to 68. More than half of all positive influenza tests completed by public health laboratories were from children and young adults younger than 25.
States and territories reporting flu activity include the following:
Widespread – (Puerto Rico and 49 states): Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming
Regional (1 state): Hawaii
Local: the District of Columbia
Sporadic: The U.S. Virgin Islands
Did Not Report: Guam
With the flu season well underway, you should still take precautions to prevent the spread of illness.
Here are some flu facts:
The Centers for Disease Control and Prevention (CDC) recommends all people older than six months of age get the seasonal flu vaccine, either via an injection or the nasal spray. Consult with your doctor or pharmacist to find out about flu vaccine side-effects, precautions and vaccine options – there are several multi-strain variations available this year.
Even though it is now winter, it is still recommended to get a flu shot. Remember: the flu shot cannot give you the flu, but some side effects are possible, including a runny nose, sore throat, muscle aches, redness around the ejection site and a mild fever.
Due to certain health restrictions, not everyone is eligible to receive the flu shot. For those of you who are not able to get a flu shot, there are other things you can do to minimize your risk for contracting the flu, as well as giving it to others:
• Avoid close contact with those who are sick.
• Avoid exposing others when you are sick. Stay home from work or school if you are exhibiting symptoms.
• Cover your mouth and nose when sneezing or coughing.
• Wash your hands frequently.
• Avoid touching your eyes, nose or mouth.
Lastly, getting a flu shot is not a guarantee that you won`t end up getting the flu, but it can help you from catching it as easily and can even help keep symptoms from being as bad. The CDC has urged doctors to prescribe one or a combination of the three-available prescription antiviral drugs to patients with flu-like symptoms. If given early enough, there is evidence that antivirals can lessen the intensity and duration of influenza symptoms.
Source: U.S. Centers For Disease Control and Prevention

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