Unusual virus pattern shapes early flu season in WNC

This year’s season for the flu and influenzalike illnesses is packing a wallop, according to Dr. William Hathaway, Mission Health’s chief medical officer. “Across the board, we’ve been hit heavily. We typically see an escalation of influenzalike illnesses, many of which are flu, hit a crescendo and a peak, and then drop off over a six- to eight-week time period. 

“It’s a little bit earlier than what it was last year, and there tends to be more of the influenza B/Victoria strain than in previous years,” Hathaway says. 

Dr. Jennifer Mullendore, medical director for the Buncombe County Department of Health and Human Services, says the U.S. Centers for Disease Control and Prevention has confirmed that it’s unusual to see influenza B viruses circulating this early in the flu season, as the A strain of the virus typically causes the first wave of infections. In fact, this is the first time since 1992-93 that B strains have been the predominant form of the virus at the beginning of the flu season. 

“Influenza B infection is more common in children and can cause severe illness in children,” Mullendore notes. She points to the CDC’s updates for the week ending Jan. 11, which indicate a slight decrease in flu activity but warn, “It is too early to know whether the season has peaked or if flu activity will increase again.”

While Hathaway advises those who are “really critically or desperately ill” to go immediately to the emergency department, many others should first check in with their primary care providers by phone or visit an urgent care clinic. “We don’t want to discourage people from coming to the hospital, but we want to make sure they really need it,” he explains. 

Help in a hurry

A busy flu season in December and January has increased Range Urgent Care’s patient volumes about 20% over other times of the year, according to Alyssa Vahala, physician assistant at the Merrimon Avenue clinic. “We are seeing around 40-45 patients a day, and a big bulk of those individuals have a viral syndrome, whether it’s flu or upper respiratory infections,” Vahala says. The practice also has seen more influenza B patients than typical for early in the flu season.

Range Urgent Care prescribes antiviral medications to patients who are diagnosed with a flulike illness and who come in within 48 hours of the onset of symptoms. The clinic sells a generic version of Tamiflu for $40. A course of the medication includes one pill in the morning and evening for five days, according to Dr. Stephanie Trowbridge, Range medical director. 

Xofluza, a newer medication, is less likely to cause gastrointestinal side effects than Tamiflu, Trowbridge continues, and requires only a single two-tablet dose. Those advantages come with a higher price tag — over $150 using coupons from the GoodRx.com website, which Trowbridge recommends (though it isn’t affiliated with her practice in any way).

Both Tamiflu and Xofluza shorten the duration of symptoms by about 24 hours and lessen their intensity.

Even if someone doesn’t catch the symptoms early enough to take antiviral medication, Trowbridge says, “It doesn’t mean you have to feel miserable for the entire duration of the flu. Things like fluids, and we can give IV anti-inflammatories here — things that can improve the symptoms, even if you’re not a candidate for Tamiflu.”

Ounce of prevention

All the medical authorities consulted for this story echo the CDC’s recommendation that everyone over 6 months of age — except for those with certain medical conditions — should receive the influenza vaccination yearly. The effectiveness of the vaccine in any given year ranges from 60% to over 70%, Hathaway says, so getting it doesn’t guarantee people will avoid the illness. Still, Hathaway and public health officials advise, having received a flu shot is believed to reduce the severity and duration of symptoms if you do get sick.

While the exact form of the B virus that’s circulating is different from the corresponding component of this season’s vaccine, Mullendore notes, “Studies suggest the current vaccine may offer protection against the circulating B/Victoria viruses.”

“Even though the ideal is to get vaccinated by the end of October, it’s still not too late. We say it takes two weeks to be protected, but flu season could extend for months,” Mullendore says. The Buncombe County Health and Human Services Immunization Clinic at 40 Coxe Ave. offers walk-in immunizations Monday-Friday, 8 a.m.-5 p.m., and many pharmacies and primary care providers also offer the flu vaccination. 

Among this year’s flu sufferers who did receive the vaccination, Vahala has noticed lower fevers and less severe symptoms than she would otherwise expect to see with the flu. 

Serious illness

Based on the population of the 18-county region Mission Health serves, the area can expect about 150 total hospitalizations associated with influenzalike illness, Hathaway says. But those cases aren’t likely to be spread evenly across all groups. “It impacts different people — the old, the very young, pregnant women, those with other illnesses like chronic lung disease, diabetes, other long-standing illnesses. They’re at higher risk, not only for getting the illness but having more severe complications with it,” Hathaway says.

Eleven people died of illnesses associated with influenza in North Carolina during the week of Jan. 5-11, the most recent week for which data is available. That brings the statewide flu-related fatality total to 33 since the influenza season began Sept. 29. Of those who died, 21 were over age 65.

In Buncombe County, three flu deaths have been reported through Jan. 15, according to Mullendore. Among them, Haywood County teen Lacie Rian Fisher, 15, died at Mission Hospital on Dec. 30 of sepsis related to influenza.

State health officials note that the number of flu-related fatalities could change as updated information becomes available.

Western North Carolina’s sickest flu patients often come to Mission Hospital, which has advanced medical technology like extracorporeal membrane oxygenation — a type of heart-lung bypass machine that helps patients with compromised lung function take in oxygen — as well as the most highly trained critical care providers. Of ECMO, Hathaway says, “Very few hospitals in the country employ this, but we’ve used it on a couple of patients, some successfully, some not, in an effort to get them through the catastrophic complications that come with lung disease related to influenza.”

Hathaway points out that Mission requires all its employees to receive the vaccination, with very few exceptions for medical conditions or religious beliefs. 

“I cannot overemphasize the critical importance of getting a vaccination,” Hathaway says. “The science supports overwhelmingly that the benefits of vaccination far outweigh any potential risk for an adverse reaction. Your likelihood of having a serious complication if you get sick far outweighs the risk of getting the vaccination.”