With the return of pumpkin spice lattes and cooler temperatures comes another annual rite of passage: flu season.
It’s hard to predict just how hard the influenza will strike Michiganders this year, said Angela Minicuci, a spokeswoman for the Michigan Department of Health and Human Services, because “every flu season is different so we can’t really predict how severe or mild a season may be.”
Seasonal flu activity most commonly begins to rear its ugly head as early as October and can continue to make us sniffly and feverish as late as May, according to the Centers for Disease Control and Prevention. The number of cases tend to peak nationally from December to February.
And yet, sometimes, flu season gets an earlier start.
Kent County had an outbreak in mid-August among 120 people who attended the National Rural Letter Carriers’ Association Conference in Grand Rapids. Several of the people linked to the conference tested positive for an influenza A (H1N1) strain of the virus.
“The best thing that we can do to prepare for this flu season is begin to vaccinate as many people as possible,” Minicuci said. “Flu vaccine is recommended for all people 6 months of age and older.”
But have you ever wondered what’s in the serum that gets poked into your arm each fall?
Because flu viruses are constantly changing, scientists at more than 100 influenza centers around the world work on surveillance, sending their data and samples to the World Health Organization. Those scientists collaborate with other public health experts to determine which strains are most likely to spread during the upcoming season. Vaccines are then developed to target those strains.
This year’s vaccine cocktail includes:
- A/Michigan/45/2015 (H1N1)pdm09-like virus
- A/Singapore/INFIMH-16-0019/2016 A(H3N2)-like virus (updated)
- B/Colorado/06/2017-like (Victoria lineage) virus (updated)
- And some will also have a with fourth strain: B/Phuket/3073/2013-like (Yamagata lineage) virus.
Did you catch “Michigan” in the first strain listed? It’s an H1N1 virus that Minicuci said was first isolated in a lab in Michigan and submitted to the CDC.
University of Michigan scientists in the Influenza Vaccine Evaluation Group lab play a key role in helping public health experts determine which vaccines are most effective and isolate strains of the virus that might be useful in combating the spread of the virus.
“The strain was identified and tested at the University of Michigan in Ann Arbor with Dr. Arnold Monto’s research team,” Minicuci said. “This is how each strain is named, as to where they are identified.”
The Free Press caught up with Emily Martin, an assistant professor of epidemiology at the University of Michigan School of Public Health. She works in the lab that first identified the strain. We asked her some questions about what people should know as we head into flu season this year:
QUESTION: Is it a badge of honor to have a Michigan strain included in this year’s vaccine or is it more like a dubious distinction?
ANSWER: In the flu world, it’s an honor to have collected a strain that becomes part of the vaccine. In fact, the original live vaccine that became FluMist in 2003 — that was developed here at the University of Michigan and the strain of virus that became that vaccine was titled A/Ann Arbor. So for a long time it was called the A/Ann Arbor vaccine and people were very proud of that. It’s been updated since then.
Q: How did the sample that became known as A/Michigan/45/2015 (H1N1)pdm09 get into this year’s flu vaccine?
A: We are one of … six programs around the country that do active surveillance throughout the year to find out how good the flu vaccine is.
So those numbers that come out in the middle of the flu season that estimate how well it’s working, we contribute to that number out of the University of Michigan. It’s a huge program, and it’s really exciting to work on.
We partner with a number of local hospitals. When patients come in and they’ve got respiratory symptoms, we find out whether or not they have the flu, and we find out whether or not they got vaccinated and what flu vaccine specifically they received. Then, we work with the CDC to pool our data with people all around the country to see how well the flu vaccine is working.
It’s about 3,500 total people that we work with every year.
Q: How effective is the flu vaccine overall?
A: We track it from year to year. In years when we have mostly H1N1 viruses, effectiveness is higher. It’ll be in the 60- or the 70-percent range. In years when we’ve got H3N2 — unfortunately, the last three years — we can see estimates in the 20 percent to 30 percent effectiveness range. We believe the vaccine is still avoiding illness even at that level. It’s still averting influenza illnesses, just not as many as we would like.
The final estimate for vaccine effectiveness in the 2017-18 flu season was 25 percent against the H3n2 strain; 65 percent against H1N1, and 49 percent against influenza B.
Q: If effectiveness rates of the vaccine vary so much, why should I bother getting the shot?
A: With all the research we’ve done about trying to make a better vaccine, it’s still better to get it than not get it. The people who get vaccinated as a whole — even though it’s not as good as we want it to be — they are still getting flu less often than the people who don’t get the vaccine.
There is some more recent data … that says that when people have the vaccine and get infected anyways, they have less severe illness. That’s still an active area of research, but the data seems to suggest that could be true.
Q: Because it takes about two weeks for the flu shot to build antibodies and protect a person, what is the ideal time to get a flu shot?
A: Right now there is a vigorous debate in the literature among scientists about when to get it. But our best data still tells us that if you get it now — in the fall before the end of October — you should be protected well throughout the season. You should be fine.
It’s better to get it when you have the opportunity then to put it off and push the vaccine later and then forget. You want to try to get it by the end of October, especially in places like college campuses, where things travel fast. … Shortly after the start of the school year, we will see sometimes see some flu activity.
Q: Does it matter where you get your flu shot — is it better to go to a doctor’s office, for example, or is it OK to get the vaccine at a drug store?
A: Get it where ever you can get it. There are a number of vaccines available on the market, but for the most part, everybody is offering a similar vaccine.
Some of the differences that we’re seeing in the manufacturing now, is we see most vaccines with four strains. We are seeing now that some vaccines have a higher quantity of antigen in it, and these are called high-dose vaccines. Older adults may be interested in asking their doctors for a high-dose vaccine. Those might be a little harder to find at a pharmacy or someplace that isn’t a primary doctor’s office.
There are some new vaccines on the market that are produced in cells rather than in eggs. There is still a lot of research going into finding out if one is better than another.
For people with egg allergies, I would go through your primary care doctor to get a vaccine. The guidance on egg allergies has been updated and it’s much clearer now and there are options for people with egg allergies. There are vaccines that aren’t produced in eggs that are available. That’s one of the options.
Q: I’ve heard that vaccines aren’t safe. Is that true?
A: I think people who are hesitant to receive vaccines, first of all, should know that I vaccinate my family.
It’s not just a matter of protecting yourself against the flu, but it’s also protecting people you could give the flu to. And so, it’s not just an individual-level of consideration. If you’ve got vulnerable people in your life, it’s important to protect them, as well. There are specific scientific conversations we can have as well, but I think that’s a message that often gets lost in the vaccine debate.
In vaccines that are given to children, (the mercury-derived preservative) thimerosal is no longer used.
There are some flu vaccines that do use preservatives still. It’s important to remember that … although it’s in the family of mercury-like things, thimerosal is a different compound than the mercury we hear about in the environment, like the mercury you worry about when you eat certain types of fish, for instance, or that pregnant women need to watch for in a diet. This is a is a different component. It’s structurally different than that other kind of mercury.
Q: Who are the vulnerable people we should be most concerned about in the community?
A: The very young and older people are going to be most vulnerable. Influenza in an older adult, particularly an older adult with any sort of respiratory condition, can have a lasting effect on their quality of life going forward.
Anybody with chronic diseases, particularly lung diseases, people with cardiac diseases and pregnant women are at risk of having severe complications if they have influenza. During the pandemic, we saw that a lot with pregnant women.
Q: What is the risk that we could see another pandemic flu on the scale of the 1918 Spanish flu that killed more than 20 million people around the world?
A: I think that what people are watching in terms of pandemic flu are looking at flus that circulate in birds and in other animals and the possibility of those breaking out into the general population. That is something that would be a public health emergency because we would need new and different vaccines. And it’s a virus that our immune system hasn’t seen anything close to it and that would be a critical situation.
You know, 1918 was an interesting situation because we didn’t have vaccines like we have now. So they were controlling it all through just social means, by telling people to wear masks and not congregate and things like that. We have a lot more tools at our disposal now that we didn’t have back then, which is wonderful.
The pandemics that we’ve had since then have not been as devastating because we have had those tools. We’ve been able to make vaccines quickly.
Q: Can the flu vaccine itself make a person sick?
If the vaccine makes you feel a little bit sick, like a little achy and tired for a day or two, that’s your immune system working. And so that’s not something to be very concerned about.
Most people get vaccinated right now, in the fall, when the season starts to change and everybody goes back to school and there are a lot of viruses circulating, like rhinovirus. The risk is pretty high that you’re going to get infected with something during this time of year. A lot of time it’s just a coincidence that you got vaccinated when a lot of rhinoviruses and other viruses are making people sick at the same time.
Depending on how you count it, there are about 13 other respiratory viruses that cause symptoms that can feel like the flu, and we would vaccinate against hem if we could. But we don’t have vaccines against them.