The General Situation

Influenza talking points January 2013

The general situation:

Minnesota has experienced an early start to the influenza season and is now seeing vigorous, widespread activity.
Health care partners in some areas of the state, such as South Central, report being overwhelmed with influenza-like illness in the last 1-2 weeks and are working together with their local public health partners to address issues and concerns.
Most areas have seen marked increases but are managing to keep up with the demand for resources.

The first case of influenza confirmed by the Minnesota Department of Health Public Health Laboratory was very early this year— in October. In many years we don’t see the first confirmed case until Thanksgiving or early December. Typically we see widespread community transmission 8-10 weeks after the first case. That is happening now with this year’s flu season.

The past several influenza seasons [since 2008 and excluding the pandemic] have been mild so we are not accustomed to seeing higher levels of seasonal influenza activity. The amount and severity of influenza varies from season to season; we are having a severe seasonal influenza year, which happens every so often.

We are on track to have a greater than usual level of influenza activity this season. With the mild seasons we’ve had, it is easy to forget that influenza is ‘nothing to sneeze at’—it can have significant consequences in the form of increased numbers of serious or even life-threatening illnesses due to complications from influenza.
In the first several months of this season, we have had reported to MDH more than 900 hospitalizations. We are likely to have more than 950 when we update our data on the website Thursday. This compares with 285 in all of 2008-09; 965 in ’10-’11 and 552 in ’11-12. In the pandemic year of 2009-10, there were 1,754 hospitalizations.

To date, MDH has confirmed four deaths due to influenza in the state, however we are continuing to investigate a number of deaths reported to us this week as possible influenza-related.

Influenza disease can be a gateway for secondary infections; you can have primary influenza pneumonia but more common is a secondary bacterial infection causing pneumonia or other complications. That is occurring in a number of our hospitalized cases, and while such illnesses are always concerning, we are not surprised by them.

One of the reasons why we are seeing more influenza this year may be because one of the predominant circulating strains is the H3N2 strain of the virus.In years in which H3N2 is the predominant strain, we typically see more severe cases of illness, particularly in the very young and the elderly, and more cases overall.

Fortunately, the three strains included in the trivalent vaccine appear to be a good match for the predominant circulating strains, although there have been cases of influenza B in Minnesota caused by a strain that is not covered in the vaccine.

Recommendations for individuals

We are encouraging people to be vaccinated. It is not too late to get vaccinated and there is vaccine available at many different venues…doctors’ offices, neighborhood clinics, retail clinics, pharmacies, etc. Because people who are at high risk for influenza complications may not have the best immune response to the vaccine, it is important that those around them are vaccinated.

While the vaccine doesn’t offerperfect protection, it is still the best tool we have for preventing influenza and its complications. If you don’t get it, you have zero protection.
Generally speaking, the vaccine is about 60 percent effective in most people (a little better than that in children, less than that in the elderly), so we would not be surprised to see influenza illness in some people who were vaccinated; but those who are vaccinated typically have less severe illness if they do get sick.

Most people can fight the flu at home with rest and fluids. If you are in a group at high risk for influenza complications and you develop influenza, you should contact your health care provider early on so that you can be given antiviral medication if needed (it is most effective when started within two days of contracting influenza). It is also just a good idea to check in with your health care provider or doctor in case your situation worsens, etc.

MDH and the CDC recommend that everyone get vaccinated for influenza, but especially those at high risk for complications from influenza. Those include:
Children younger than 5, but especially children younger than 2 years old
Adults 65 years of age and older
Pregnant women
American Indians and Alaskan Natives seem to be at higher risk of flu complications
People who have medical conditions such as asthma, diabetes, heart disease, kidney and liver disorders and others. For a list, see CDC’s website:
During flu season, besides getting vaccinated, there are other steps people can take to avoid spreading or catching influenza:
Do your best to stay healthy. Get plenty of rest, physical activity and healthy eating.
Stay home from school or work if you have a respiratory infection. Avoid exposing yourself to others who are sick with flu-like illness.
Cover your nose and mouth with a tissue whenever you cough or sneeze, then throw the tissue away. If you don't have a tissue, cough or sneeze into your sleeve.
Clean surfaces you touch frequently, such as doorknobs, water faucets, refrigerator handles and telephones.
Wash your hands often with soap and water or with an alcohol-based hand sanitizer when soap and water are not available.

Symptoms, treatment, etc.

The symptoms of influenza, which tend to come on suddenly, can include a sore throat, coughing, fever, headache, muscle aches and fatigue. People who become severely ill with influenza-like symptoms should see a physician.