PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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LESSONS LEARNED FROM FLU SEASON: PREVIOUS DATA AND SOME SPECULATION

What a weird weekend. In the MidAtlantic we had summer-like weather on Saturday and I had on a hat and gloves on Sunday at my son’s soccer game because I WAS SO COLD. The wacky weather seems metaphorical for what a strange winter/spring season we’ve had, and I’ve got to call out flu season for that today because it annoyed me so astronomically with its pervasiveness, acuity, and longevity.  Thankfully, it really seems to be mostly over in most regions, but BOY WAS IT A DRAG.

Sometimes in my business after a particularly notable or stressful event, like a resuscitation, we do a “team debrief” to talk about what went well and what could go better about the particular situation to help learn and improve. I think this type of reflection happens in other industries as well, and I find this type of learning to be incredibly helpful because it’s so experiential and relevant.

So what does this have to do with the weather and flu season, you ask?

Well, I think we should do a little team debrief on some lessons learned from our experience with influenza this year and compare it with data recently published that was compiled from previous years. I’m inspired to do this by an article and some commentary in the April 2018 edition of the journal Pediatrics. Some of the things I’m going to say are just my opinion, based on my clinical experience this year, and some of what I’ll report is from the published research.

What are the things you remember about this year’s flu season? Here are a few that come to my mind:

  1. The flu shot
  2. Low inventory of tests and oseltamivir (Tamiflu)
  3. Record volume of visits and hospitalizations and influenza related deaths, especially for the very young and the very old.purple icon of syringe with needle

So first, the flu shot.

Lots of press coverage about this, right? When is the best time to get the shot; why wasn’t the nasal flu mist available; why was the “match” between circulating viruses and vaccine so poor; plus the commentary from people who are vaccine-hesitant. I’m going to focus on children for this reflection, so one thing I noticed in my practice was that it seemed like the fact that the nasal flu mist wasn’t available didn’t really affect the numbers of people getting the vaccine. Most people just rallied and got their children the flu vaccine injection if they believed in getting immunized. This is speculation on my part, as we don’t have population data on this yet; but I was pleased to observe this personally. I think that the scientific community has really received a call to action to improve how the vaccine is manufactured from year to year, so that a better “match” can be determined season to season, and even to come up with a universal vaccine that will work year to year. I hope that adequate funding will be sought and obtained to invest in this important research.

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Every year, it seems like we “run out” of liquid oseltamivir (Tamiflu) for children.

What I mean by that is it seems like for periods of time during flu season, it’s difficult to find widespread availability of the medicine. Families recounted lots of difficulty finding the medicine. Not really sure why that happens every year, but it’s probably a combination of not enough production and perhaps some overuse of the medicine in low-risk children who didn’t really need it in the first place. Since this past year saw higher prevalence of influenza, there was more liberal use of both the medicine and testing in general, so we ran out. Lesson learned for me-? Whether or not to test and treat should be guided by the CDC recommendations but each decision needs to be a partnership decision between clinician and patient/family that includes risk factors and risk tolerance. Some people’s health seems to be adversely affected if they don’t know FOR SURE, so in some cases those people may just need to get a flu test.

The sheer volume of those affected by the flu really stood out for me,

as well as the number of pediatric deaths associated with it. The data from the Pediatrics article gives us a hint about the trends in the years 2010-2016 of the cases of children who died from influenza, and it tells us the following:

  1. Over half of the children who died due to complications attributed to influenza had NO preexisting medical condition. This surprised me because we typically think of most deaths due to flu happen to people who have chronic medical problems. This data suggests that’s not exactly the case.
  2. About 2/3 of the children who died from influenza did not receive a flu vaccine.
  3. The age group with the highest incidence of death was those 0-6 months, followed by 6-23 months. Amongst the pediatric population, the youngest are the most at risk.

Given this knowledge and adding it to my own experience and opinion, if I were queen of the universe I would:

  1. Pour more funding into R & D for the flu vaccine
  2. More. Liquid. Oseltamivir.
  3. Really do a big push to get the following groups vaccinated: pregnant women, caregivers for young infants, and kids 6-24 months especially.
  4. Help schools and workplaces even better codify their infection control procedures so that practices like hand hygiene occur during the day more systematically and orderly.
  5. Take a moment now that we are out of flu season to remind ourselves that things will go better if we don’t panic about it.

And of course, I’d like to buy endless pizza and cupcakes for all the hardworking medical staff who have to rally in a BIG WAY every year to take care of everyone during the volume surge.

They are heroes for sure.

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 Due to circumstances beyond our control, our Rockville Centre NY office will close at 6pm on June 6. All other offices are fully operational.