Flu: A tenfold increase in and around Rappahannock

It starts suddenly — fatigue, fever, chills, muscle aches, just an all-over sick feeling. Dry coughs, headaches, a runny nose and sore throat might show up right away, too. The afflicted might wonder if it’s just a bad cold or sinus infection, but influenza is probably the culprit. It’s that time of year.

As several area hospitals reported this week a tenfold increase in flu cases this winter over last, Dr. John McCue of Mountainside Medicine in Washington confirmed that flu season is in full swing.

“It’s the main communicable disease we’re seeing right now,” McCue said. “It’s not hard to pick up because it has a unique set of symptoms that differentiate it from colds: severe arthralgias [joint pain], muscle aches and very high fevers.”

McCue said his office doesn’t wait for tests when patients come in with flu-like symptoms. He immediately starts them on antiviral therapy, especially if they’re children or older than 65. Prescription antivirals such as Tamiflu and Relenza can, according to the CDC and other health experts, “shorten the duration of fever and illness symptoms, reduce the risk of complications from influenza, and reduce the risk of death among hospitalized patients.”

Map courtesy of Centers for Disease ControlMap courtesy of Centers for Disease Control

Receiving antiviral medications if sick with the flu is particularly important this year. Barbara Downes, district epidemiologist of the Rappahannock-Rapidan Health District, part of the Virginia Department of Health (VDH), said this year’s most prevalent strain, H3N2, a subtype of influenza type A, historically causes more deaths in the young and elderly than some other strains.

“Unfortunately,” Downes wrote in an email, “over half of the H3N2 viruses that the Centers for Disease Control and Prevention (CDC) have analyzed this season are different from the H3N2 virus that is included in this year’s flu vaccine.” Flu vaccines are prepared months before the onset of flu season, so, occasionally, targeted viruses will drift (mutate) by the time flu season hits.

This means everyone who received the vaccine this season, although protected from other strains, can get the flu if they come in contact with the drifted H3N2 strain.

“We’re seeing quite a few cases of influenza in area patients we vaccinated,” McCue said. “I was one of them.”

But he noticed that his symptoms were less severe and didn’t last as long as normal, most likely because of the immunity conferred by the flu shot. “I still highly recommend the flu shot,” he said. “If you get the drifted H3N2 virus, the illness will be less harmful, much easier on you.”

The VDH also recommends getting the flu vaccine, even if it’s not as effective as in previous years.

“The flu vaccine is the single best way to protect yourself against the flu,” Downes wrote.

Experts note that good hygiene habits are also imperative for protecting oneself and others.

“Influenza spreads by droplets from the nose or throat that are released when an infected person coughs or sneezes,” Downes wrote. “Influenza can also be spread from contact with hands or object/surfaces contaminated with nose and throat secretions from an infected person. It’s important to cover your mouth and nose with a disposable tissue when coughing or sneezing or use your inner arm (elbow crease), and not use your hands. And avoid touching your eyes, nose or mouth.” The virus easily enters the body when infected hands touch the eyes, nose or mouth.

Mary Locklin, manager of the sterile processing department at Fauquier Health Hospital in Warrenton, emphasizes the importance of handwashing in flu prevention.

“I can’t say enough about hand hygiene!” Locklin wrote in an email. “There are so many opportunities to perform hand hygiene. All of us can be more mindful of things we touch that are commonly touched by others (door handles, elevator buttons, grocery carts, gasoline pump handles, etc). All of these present opportunities to perform hand hygiene. Good hand hygiene means hands are washed [with soap and water] for about 20 seconds.” The VDH recommends turning off public faucets with paper towels, to avoid recontamination after washing hands.

Unfortunately, even with proper preventative measures in place, sometimes catching the flu is inevitable.

“If you develop flu symptoms, call your doctor right away for antiviral therapy,” McCue said. “Then stay at home. Flu virus can be passed to others from one day before symptoms appear to five to seven days after the first symptoms appear. It’s the perfect infectious agent.”

Fauquier Health’s Locklin stressed that left untreated, the flu can cause serious complications that could require immediate medical intervention, including hospitalization.

“If a person with the flu has difficulty breathing (shortness of breath, etc.), chest pain or significant abdominal pain, confusion, dizziness or vomiting that won’t stop, they should seek medical attention right away, either with their family doctor or at the emergency room,” she wrote.

Preventing the flu

1. Avoid close contact. Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick, too.

2. Stay home when you are sick. If possible, stay home from work, school and errands when you are sick. You will help prevent others from catching your illness.

3. Cover your mouth and nose. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.

4. Clean your hands. Washing your hands often will help protect you from germs. If soap and water are not available, use an alcohol-based hand rub.

5. Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose or mouth.

6. Practice other good health habits. Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids and eat nutritious food.

Source: Centers for Disease Control and Prevention (www.cdc.gov)

People with flu symptoms have been visiting the emergency room in significantly larger numbers than last year.

In December 2014, Fauquier Health tested 577 emergency-room patients with influenza-like illness (ILI); 193 tested positive for type A and eight tested positive for type B. In comparison, in December 2013, out of 205 patients seen for ILI, only seven tested positive for type A and one for type B.

“That means that in December of 2014, approximately 35 percent tested positive, as compared to only 3.4 percent last year,” wrote hospital spokesperson Robin Earl. “That’s a tenfold increase from last year.”

UVA Culpeper Hospital is also seeing an increase.

“We’ve seen 277 confirmed cases so far,” Michelle Strider, administrative director of quality resources, reported in an email this week. “Last year we were still in the single digits. We saw eight cases the first week of January 2014, compared to 80 cases the first week of January 2015.” She also noted that most of the confirmed cases were type A.

McCue expects the flu to peak sometime this month, as it usually does, then slowly fade out as spring draws near.

“There are several theories to why it’s seasonal,” McCue said. “It might be simply the virus’ life cycle or that people are indoors more, with more contact with one another, or a combination of things. We just don’t know for sure.”

People often catch the flu over the holidays, since they gather together and inadvertently share germs.

“We are prepared,” he said. “And we want to help. We love the people here, and we do our best to help them.”

For more information about influenza, visit the Centers for Disease Control and Prevention website (cdc.gov/flu/) or the Virginia Department of Health website (vdh.virginia.gov/epidemiology/flu).