Flu hitting seniors hard across the country

Image via CDC.gov

It’s the first week of January and winter seems to have finally arrived with a vengeance. In addition to the cold and snow, many older adults are also fighting this year’s flu.

The CDC reports the virus is widespread in 43 states — from New England to the Pacific Northwest. The flu can cause severe illness and life-threatening complications with older adults and those with respiratory problems at especially high risk.

Some 5 percent to 20 percent of the U.S. population gets the flu each year. More than 200,000 are hospitalized from its complications.

By the first day of 2015, CDC’s influenza surveillance systems were showing “elevated” activity, including increasing hospitalizations rates in people 65 years and older. CBS Atlanta reported that “flu-related hospitalizations for the elderly have doubled from this time last year” across the country. Media outlets report increased flu-related deaths among local elderly in recent days.

Typically 90 percent of seasonal flu-related deaths and between 50 percent and 60 percent of seasonal flu-related hospitalizations in the United States occur in people 65 years and older. Weakened immune systems, multiple chronic conditions, such as heart disease, diabetes or chronic pulmonary disease, make older adults more vulnerable to flu-related complications. Elderly also frequently live in communal style housing – such as nursing homes, assisted living or VA facilities. A mini-epidemic can spread quickly, as KJCT recently reported.

A new, higher-dose vaccine called Fluzone is available for people age 65 and older. According to the CDC, it gives older people “a better immune response, and therefore, better protection against flu.” Results from a multicenter randomized double blind trial among adults age 65 and older found the new vaccine to be “significantly” (24.2 percent) more effective and produced greater antibody response than the standard vaccine. Note that Sanofi Pasteur funded this study.

Reporters can monitor the Flu Portal Dashboard for national and regional outpatient illness and viral surveillance. This map provides a weekly summary of the disease’s progress.

  • State, county or city health department websites like this one can point journalists to communities with major outbreaks.
    • Health departments also post regulations for health workers in contact with at-risk patients and populations.
  • Check with local hospital emergency departments about both ED visits and admissions. Are they higher than last year?
  • Also check with walk-in clinics in your community. Are older people (or other high-risk individuals) kept apart in waiting areas?
  • Talk to staff at a local nursing home or assisted-living facility.
    • Are they prepared for a potential outbreak?
    • Are there special rooms or floors available for those who come down with the flu?
    • What training has the staff had?
    • Are protocols being followed?
    • How does this flu season compare with previous ones?
    • Speak directly with residents or family members. What have they observed or experienced? Does it correlate with what you’ve been told by administrators?
  • Talk to pharmacists at large retail outlets — most offer flu shots on a walk-in basis.
    • How has “business” been? Are seniors filling prescriptions for flu-related medications? Compare that with prior prescribing patterns by cross checking the Dartmouth Atlas Database.
  • As a reminder, Medicare Part B pays for flu vaccines with no copay; ask around and see if anyone has been charged for their flu shot.


1 thought on “Flu hitting seniors hard across the country

  1. Avatar photoNorman Bauman

    Yes, I am an older adult (71) across the country (Manhattan) fighting this year’s flu.

    I got vaccinated, but it didn’t work. A team of nurses from Mount Sinai Beth Israel came to my building, which has a large population of seniors, to give everyone at risk free flu shots.

    They gave us Flucelvax (Novartis), which according to The Medical Letter (Influenza Vaccine for 2014-2015, 56(1453):97, 13 Oct 2014 http://secure.medicalletter.org/TML-article-1453a is $19.13 a dose. I would rather have had the Fluzone High-Dose, which has 60 mcg of hemagglutin antigen from each strain, compared to 15 mcg in the conventional vaccines, and which is recommended for older adults. In a study of 31,989 adults 65 years old or older, the high dose had 1.4% cases of influenza compared to 1.9% with standard dose (DiazGranados et al., Efficacy of high-dose versus standard dose influenza vaccine in older adults. NEJM 2014; 371:635 http://www.nejm.org/doi/full/10.1056/NEJMoa1315727) But according to The Medical Letter, the High-Dose is $29.40. Yes, I would have paid $30 to avoid this flu.

    The first sign of a cold was 5 days ago, although I didn’t realize it. I just felt tired and lousy, couldn’t get any work done, and wasted the day on the Internet. On day 2, I felt like I had a cold, but I didn’t have fever. On day 3, I finally had a 101-degree fever, and decided I had the flu. I had coughing, sneezing, a stuffed nose, tiredness, and all the symptoms of the endogenous interferon response.

    I decided to fight it by doing nothing. Nothing can significantly affect the course of the flu, and many interventions can make things worse. I didn’t go to my doctor, because that would expose the people on the bus, and in my doctor’s office. I take a few comfort measures, like drinking fluids and using hard candies (which are cheaper than cough drops). The antiviral drugs have a statistically significant but clinically small effect. Technically, according to The Medical Letter (Antiviral Drugs for Seasonal Influenza 2014-2015, 56(1457):121, 8 Dec 2014), antiviral drugs (oseltamivir $120, zanamivir $59) are recommended for patients with suspected influenza who are 65 years old or older and therefore “high risk” , which would include me, but by the time I realized I had the flu, I missed the 48-hour window of greatest benefit.

    Above all, I believe people with symptoms of a cold should avoid a doc-in-a-box clinic. I have never heard of anyone who went to a doc-in-a-box who didn’t get a prescription for an (almost always unnecessary and often dangerous) antibiotic. (Choosing Wisely. Antibiotics: When You Need Them and When You Don’t http://consumerhealthchoices.org/catalog/antibiotics-need-dont/) (How I Was Prescribed an Unnecessary Antibiotic While Traveling to a Conference on Antibiotic Resistance, Kevin T. Kavanagh, JAMA Intern Med. August 04, 2014. http://archinte.jamanetwork.com/article.aspx?articleID=1892183 doi:10.1001/jamainternmed.2014.3412)

    I believe in fighting the hopeless battle against inappropriate antibiotics. JAMA Internal Medicine keeps reminding doctors that even appropriate antibiotics wipe out the normal intestinal flora, which allow the digestive tract to become populated in particular by clostridium difficile, which has high mortality. C. difficile is often antibiotic-resistant, thanks to doctors who prescribe fluroquinolones like candy.

    Perhaps a good article for the flu season would be to go to a local hospital and see if you can find a patient who got the flu, took an inappropriate antibiotic, and wound up with a life-threatening C. difficile infection. The evidence is mixed on whether stories like that actually change behavior. I used to think it was hopeless, but Rosenbaum in the latest (8 January) NEJM quoted a study which concluded that they can work (Effect of the first federally funded US antismoking national media campaign. Lancet 213;382:2003-11). Rita Redberg seems to think so.

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