ENC Health Currents: Local Hospitals Experience Uptick In Patients Reporting Flu

Feb 7, 2018

Credit Centers For Disease Control And Prevention

Across the country and right here in eastern North Carolina, the flu season is hitting hard.   95 deaths in our state have been attributed to the flu so far, and the season is still gaining intensity.  Jared Brumbaugh reports on how local hospitals are impacted by a virulent strain of influenza called H3N2, and why it’s being blamed for a more deadly season.

The number of people reporting influenza like illness to emergency rooms, doctor’s offices and health departments in North Carolina has continued to increase for four consecutive weeks. Even though the flu season has yet to peak, it may be on track to be the worst in nearly a decade.  This flu season has been especially severe due to a highly contagious and deadly strain of influenza known as H3N2. Manager for Infection Prevention at CarolinaEast Medical Center in New Bern Cathy Fischer says people can be contagious 24 hours before symptoms appear.

“It’s really a more virulent, more severe strain that results in more severe sickness, more admissions, particularly high risk to the very young and the very old.”

But this isn’t a typical flu season.  Last month, a 43 year old mother, volunteer firefighter and East Carolina University employee from Martin County died due to complications from the flu.  A week earlier, a 6 year old girl from Cary died three days after being diagnosed.

“I think all flu progress pretty quickly but this one has a very rapid onset so you can go to work feeling fine but by the end of the day or at lunch time you think you’ve been struck by a train.  So this does tend to hit you very, very quickly and very severely.”

More than 300 patients at CarolinaEast have tested positive for influenza, with an uptick in cases at the end of December and in January. Even though the flu season runs through May, Fischer says the number of hospital admissions due to the flu has nearly quadrupled over the entire previous season. 

“We kind of had the perfect storm this year.  So the flu spreads better when the weather is colder and we had some very cold weather hit us right as the flu started to increase. 

The lower humidity during cooler weather actually helps promote the transmission of the virus through the air and from person to person.

“In addition, it’s the H3N2 virus which is very easily spread...and makes a lot of illness.  And then we had an imperfect vaccine. So all of that hit us at just the right time.”

While H3N2 is responsible for most influenza illness this season, another strain popping up in North Carolina is H1N1, also known as swine flu.  These are both strains of Influenza A. Influenza type B flu strains detected this season include B/Yamagata and B/Victoria. 

CarolinaEast and other local medical centers administer a rapid flu test to detect the presence of both influenza A and B in a patient.  In less than 15 minutes, a positive or negative result can tell the physician whether to prescribe antiviral medications.  At CarolinaEast, 83% of the cases this year are influenza A.

“It’s not 100 percent accurate so what the CDC is telling you is that if you use the rapid flu test that just because you’re negative doesn’t necessarily mean you don’t have the flu.  So if you have those flu like symptoms, your physician may still choose to treat you as if you have the flu.”

For further testing, samples may be sent to the State Laboratory of Public Health in Raleigh.  Scientists there are also able to determine specific subtypes of influenza and which strains are most prolific.  Epidemiologist with the North Carolina Division of Public Health Dr. Zack Moore says they also track the number of patients admitted to hospital emergency departments reporting flu like symptoms.

“We also have a network of volunteer providers, that’s doctors’ offices, health departments, student health services, etc. that report information to us every week about how many of their visits are for people with flu-like illness.  And they also take the additional step of collecting swabs from some of those people so that we can know what viruses are actually going around.

According to the North Carolina Influenza Surveillance Summary, at the beginning of January, about 3% of hospital visits were from people reporting influenza-like illness.  By the end of the month, that number rose to 7%. 

At Onslow Memorial Hospital in Jacksonville, Manager of Infection Prevention Gloria Powers says during the last flu season, 64 rapid flu tests were administered during the first two weeks of January.  Two of those came back positive for influenza.

“We’ve already tested 98 this year for the first two weeks.  And of those, 15 have been positive.”

But State Epidemiologist Dr. Moore says the uptick in patients reporting flu like symptoms across the state may be indicative of the peak of flu season occurring earlier than normal this year.

“We did have pretty similar mix of viruses going around last year, in 2016-2017. That was a later peak, we didn’t actually hit the peak until the end of February beginning of March.  So we have a lot more deaths, a lot more people going into the doctor’s office with flu this year than the same time last year but that could relate more to timing than severity.”

On the other hand, flu seasons where H3N2 is the dominant strain are often more deadly.  The strain of influenza can lead to pneumonia or other fatal complications in people with weakened or developing immune systems.

“Other times, what we see is people have what seems like a typical flu illness start to get better and then they end up getting a bacterial infection because their respiratory system is kind of beat up from the flu.  And so they start to recover and then get sicker and the death doesn’t happen until weeks after their first flu illness.”

Frequent handwashing, staying away from sick people and disinfecting surfaces may be your best defense in avoiding the flu.  But a surgical mask may become a more accepted method since a study at the University of Maryland last month found that the flu may be spread just by breathing.  It’s also not too late to get the vaccine.  Even though it’s only 10%-30% effective, Medical Director of Infectious Control for Vidant Medical Center in Greenville Dr. Keith Ramsey says it can lessen the severity of symptoms.

“It takes about 7-10 days for your body to make protective antibodies against the virus and so we’ll continue to vaccinate here through early, the first part of April, that’s when we generally stop.”

If you start have a fever, cough, sore throat, headache and body aches, a prophylactic dose of Tamiflu or other antiviral medication is recommended.  Manager for Infection Prevention at CarolinaEast Cathy Fischer.

“We also recommend that you just stay home, except to go to the doctor, just stay home.  It’s very, very contagious and so don’t go out there and spread the love around to everybody else.”

Across the country, the widespread flu activity has caused Tamiflu and vaccine shortages.  But here in eastern North Carolina, Fischer says there’s still plenty of the vaccine and antiviral to go around.  To see the weekly North Carolina Influenza Surveillance Summary, go to www.flu.nc.gov