This article appeared in Cleveland.com. Read more here.
In comparison to flu seasons past, experts say this one is looking like it’s going to be a doozy ― particularly for children.
The good news is the flu vaccine is spot on, and while it may not keep kids from getting the flu, it could keep them out of the hospital. That is, if parents and kids make sure to get it.
Kids typically get a number of respiratory viruses throughout the fall and winter, including flu, RSV and more recently, COVID-19. Most of the time the peaks of circulating viruses are staggered, but this year the three viruses have clustered together, resulting in more infections, hospitalizations and deaths than in years prior, and straining pediatric hospitals around the country.
In addition to the ongoing waves of COVID-19, this fall clinics and hospitals were caught off-guard by an uncharacteristically early wave of Respiratory Syncytial Virus ― a virus that produces symptoms ranging from a mild cold in older children to severe infections of the lungs requiring hospitalization in babies and toddlers or older adults.
Generally, RSV peaks in January or February, said Dr. Frank Esper, a pediatric infectious disease specialist at the Cleveland Clinic. But this year, not only did RSV cases peak in the fall, but more children became seriously ill than in years past. Now doctors fear a similar trend is emerging this season with influenza.
In October, reports from hospitals around the country came in about pediatric units operating at or near capacity, in some cases forcing families to wait hours for the hospital to find a bed for a critically ill child with RSV. But despite declining numbers of RSV patients, the numbers of hospitalized children remain largely the same. The reason? A current surge of influenza A, that is hospitalizing babies and children at unprecedented rates.
According to data from the Centers for Disease Control and Prevention, hospitalizations are higher than they’ve been in 10 years. In Ohio, roughly 75% of the pediatric beds are full. By comparison, a number of other states are already at or above capacity. Nearly 3,000 people, including 12 children, have died from the flu in the U.S. since October. Meanwhile, here in Ohio, hospitalizations due to flu were up 77% the last week of November.
“RSV was so October,” said Esper, noting that RSV cases are already on their way down. However, “Influenza is on the upswing,” he said, and right on time.
But like its predecessor, it’s hitting children particularly hard. Roughly half of all children who come in with flu-like symptoms and get tested are positive for influenza A, and Esper says that any time those numbers climb above 40% it’s cause for concern.
Experts believe babies and young children are particularly vulnerable to RSV and flu this year because they have had very little exposure to those viruses over the last couple of flu seasons.
The masking and social distancing that was necessary to protect them from COVID-19, also prevented other respiratory viruses from circulating widely, and as a result, and as a result the youngest children have relatively naive immune systems with regard to these viruses.
Esper says the medical community is preparing for the flu to hit children equally hard or worse than RSV did.
“We gauge what we should expect with flu based on what happened in the southern hemisphere,” said Esper. “Australia had a really bad flu season. But not for everybody — for kids. They had a much higher rate of hospitalization and much more severe disease, just like what we saw with RSV.”
However, while there is no available vaccine for RSV, we do have a vaccine for flu, and Esper says that according to preliminary data collected from Australia, this year it’s particularly effective.
“The vaccine is a good match, especially for the most problematic influenza viruses. It’s hitting each and every one of the strains very well,” Esper said.
But a vaccine only works if people actually get vaccinated, and as was learned with COVID-19, the number of people who get the vaccine determines how well it stops transmission.
Unfortunately, Esper said, vaccination rates for flu are historically poor.
Compared to diseases like measles, mumps, or polio, for which greater than 90% of the population is vaccinated, vaccination rates for flu are typically only around 50% in adults and 60% in children, according to data provided by the CDC.
On the heels of COVID-19 and its many boosters, Esper fears many people are feeling somewhat “vaccine fatigued,” or perhaps doubtful that the flu vaccine offers any real benefits. After all, the flu vaccine doesn’t necessarily prevent children or adults from getting sick,
But Esper argues that the flu vaccine itself isn’t there to prevent infection as much as it is to prevent hospitalization, getting put on ventilators or even dying.
When it comes to vaccines for respiratory viruses like COVID-19, RSV and flu, it requires the public adopt a shift in mindset away from the idea of a vaccine as a silver bullet.
“Medically we moved the goal post,” Esper said. “The vaccine works, it just doesn’t completely eradicate the disease.”
The true measure of the vaccine is no longer if it keeps you from getting sick, said Esper, but if it prevents you from getting really sick.
“We don’t mind if you are stuck on your couch chicken souping yourself back to health over the next two to three days. That’s OK. We still call that a win if the vaccine is helping you stay on your couch instead of in a hospital bed.”
For those who haven’t yet gotten a flu shot, there’s still time.
Flu season lasts several months, and sometimes has several peaks due to different strains of flu. But the sooner you can get your vaccine, the sooner you can get protected, because it takes two weeks after the shot for the immune system to get the full boost.
Meanwhile, what should parents do if they suspect their child has the flu?
Esper said that although virtual appointments would be perfectly fine for older children or those with mild symptoms, babies under three months and any child that has signs of labored breathing or dehydration or has any preexisting conditions should be seen in person, and parents should prioritize that over staying out of waiting rooms full of sick children.
“There are times when you really need to put eyes on a patient,” said Esper.
So far, unlike other states, hospitals in Cleveland and across Ohio have managed to keep pediatric beds open by being proactive and staying ahead of the curve said Esper, and he and his colleagues are hoping that through vaccinations and public awareness about this year’s risks for children they can keep it that way.