This year’s flu season is busy, with at least 10 percent of all North Carolina emergency department visits for flu-like symptoms.

By Rose Hoban

Walk into a clinic or an emergency department anywhere in North Carolina these days and you’re likely to encounter a waiting room full of coughing, feverish people.

That’s the way it is at Piedmont Health Clinic in Carrboro, according to nurse Yvette Patterson, who said they’ve got hand sanitizer in the waiting room. Staff members at Piedmont are also offering face masks to people who are actively coughing and sneezing.

“We’re seeing it in every population: Latinos, whites, blacks … all patients,” Patterson said.

According to state health officials, flu is now epidemic in North Carolina. At least 17 people have died, and flu activity reported to the state’s public health surveillance system, NC DETECT, has been peaking over the past few weeks.

Data source: NC DHHS

Zack Moore, a doctor with the state Division of Infectious Disease, told reporters at a press conference Tuesday that North Carolina’s flu activity isn’t that much different from other states in the Southeast, which are all reporting high levels of flu activity.

Moore told reporters that his department expects more flu deaths as the season progresses.

“Keep in mind with flu deaths that they always do lag behind peak activity,” he said. “So unfortunately, we know that the deaths will continue to spike as the activity numbers have spiked in the past few weeks.”

As of the week ending Dec. 27, more than 10 percent of people arriving in emergency departments and doctors’ offices were reporting flu-like symptoms. But according to state epidemiologist Megan Davies, that’s just the tip of the iceberg.

Map showing the extent of flu activity in states. This map uses the proportion of outpatient visits to health care providers for influenza-like illness to measure the ILI activity level within a state. It does not, however, measure the extent of geographic spread of flu within a state. Therefore, outbreaks occurring in a single city could cause the state to display high activity levels. Graphic source: CDC
Map showing the extent of flu activity nationwide. This map uses the proportion of outpatient visits to health care providers for influenza-like illness to measure the ILI activity level within a state. It does not, however, measure the extent of geographic spread of flu within a state. Therefore, outbreaks occurring in a single city could cause the state to display high activity levels. Graphic source: CDC

“Flu affects between 5 and 20 percent of the population, leading to more than 200,000 hospitalizations in a year and an average of 24,000 deaths,” Davies said. Many deaths don’t get counted as flu related because those patients never had the virus confirmed by a lab.

At UNC Hospitals, David Weber said there’ve been two deaths and 323 cases of flu confirmed by lab tests.

“Almost all were the influenza A, H3N2 strain,” said Weber, who heads up infection control and infectious disease surveillance at the hospital.

UNC, like many of the hospitals in the state, have restricted visitation by children under 12 years old to reduce the spread of the flu to vulnerable patients.

“Children often spread viruses because they don’t contain themselves quite as well as adults,” Davies told reporters.

“It’s something for people to consider when they visit a loved one in a [nursing home],” she said. “As much as bringing your child brings joy to the person, that’s the kind of situation where if your child does just have the sniffles, it’d be better for everyone if you waited until they’re well before you go for a visit.”

Drifting viruses

One phenomenon noted by state and federal officials is that this year’s flu vaccine isn’t very well matched to the strain of flu that’s circulating.

Some background: National health labs all over the world send samples of flu viruses collected each year to labs at the Centers for Disease Control and Prevention and national labs in the United Kingdom, China, Australia and Japan. At all these labs, researchers pore over which strains of the flu are most common and consult with one another to predict which strains will be making people sick in the coming year.

In February, the WHO recommends to countries which strains they should include in their flu vaccination. Since the northern and southern hemispheres have flu seasons matched to their cold weather, the WHO makes recommendations to northern countries based on the flu viruses circulating in the southern hemisphere and vice versa.

Because it takes a long time for vaccines to be manufactured and distributed, there’s often time for the strains of flu that are making people sick to “drift” from the strains identified months before. That’s what happened this year, when one of the more virulent strains drifted: the H3N2 strain, which is a type of influenza A.

According to the CDC, the H3N2 virus protected against in this year’s vaccine is the so-called “Texas/ 50/2012” strain. But the H3N2 making more people sick is the “Switzerland/9715293/ 2013” strain.

“We do know that there’s not a good match with the circulating strain,” Moore said.

Nonetheless, he said the vaccine protects against three other flu virus strains. And the H3N2 strain that is in the vaccine might confer some protection against the H3N2 that’s going around.

Advice remains the same

UNC’s Weber said his hospital has been seeing many children between the ages of 5 and 17 with the flu, as well as some young adults and people over 65 years old.

“Almost all were infected with the influenza A, H3N2 strain,” he said.

That’s the same pattern seen all over the state, according to Davies and Moore.

“This H3N2 is the main virus and it really hits the elderly the hardest,” Moore said. Other groups that have more risk for flu include pregnant women and people who have problems with their immune system.

All the health care providers interviewed for this story gave similar advice about preventing the flu:

  • getting a flu shot
  • good hand-washing
  • staying home when sick
  • staying at least six inches away from someone who is sick

Children tend to get high fevers from the flu, whereas older people might have more diarrhea, Patterson said. She said several of their elderly patients had ended up in the emergency department because they had diarrhea combined with fever, which left them dehydrated.

“They don’t realize how quickly you can become dehydrated with fever if you don’t keep up with fluids,” she said.

Weber said antiviral drugs such as Tamiflu (oseltamivir) or Relenza (zanamivir) can be useful to treat flu, but only if they’re started within the first 48 hours after someone starts to feel sick.

“It’s especially useful for folks who have immune system compromise: HIV, cancer, transplant patients,” Weber said.

He also said there’s some evidence that over-the-counter zinc preparations and vitamin C can do some good. Other suggestions for flu treatment include taking ibuprofen or Tylenol (acetaminophen), rest and fluids.

People with the flu should stay away from people who are healthy. But if they’re around family and friends, covering coughs and sneezes is essential, as is frequent handwashing for everyone.

But the best treatment remains prevention. There’s still time to get a flu shot and, according to Moore, many other strains of flu tend to circulate later in the flu season.

“So for that reason, we think it’s still very important to get the flu vaccine,” he said.

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