The 2018 flu: What baby boomers need to know


woman sick in bed with thermometer

Flu season is in full swing. By now you probably know someone who has had it, or currently has it, or is about to fall victim in the next few days. What you may not know is that more baby boomers are hospitalized with the flu than infants this season, which is quite unusual.

We made it our business to pull together all the information we could find from the U.S. Centers for Disease Control (CDC), research papers, medical websites, and news reports to give you (almost) everything you need to know about the 2018 influenza virus—what it is, the symptoms you may experience, how to protect yourself, how to be prepared, and what to do if you get it. And we looked especially at how this flu season might impact those of us who are over the age of 60.

First, this is not medical advice. If you feel any of the symptoms related to the flu (see below) you should call or see your doctor pronto. The operative word for this season’s flu is “act quickly.”

Second, the best way to avoid the flu, or dilute its symptoms, is to get the flu vaccine for this year and take the other steps described below. (CDC can help with its Flu Vaccine Finder.)

And third, this is not everything you need to know about the flu, but it does gather most of the available information in one place. if you want to read more we provide some helpful links throughout.

What is seasonal influenza?

Seasonal influenza— “the flu”— is a serious, contagious respiratory infection in humans. It spreads easily from person to person, circulates worldwide, and can affect people in any age group.  “The flu” is shorthand for several viruses that may vary from year to year. Although they can be detected year-round in the United States, flu viruses are most common during the fall and winter–influenza activity often begins to increase in October, peaks between December and February, and can last as late as May.

CDC: Peak Month of Flu Activity, 1982-1983 through 2015-2016

https://www.cdc.gov/flu/about/season/flu-season.htm

Which viruses are circulating this year?

Two types of seasonal influenza viruses are circulating this year, types A and B, which travel around the world causing seasonal epidemics of disease.

The viruses contributing to the 2017-2018 flu outbreak are subtypes of A and lineages of B. Only influenza type A viruses are known to have caused pandemics, which occur when a new influenza virus emerges and spreads worldwide and most people do not have immunity to it. The World Health Organization (WHO) notes that viruses that have caused past pandemics typically originated from animal influenza viruses and crossed over to become human subtypes.

These are the four viruses erupting around the world in 2017-2018.

  • A(H3N2), also called Aussie flu, is a typical seasonal flu strain but it tends to be more difficult to control. According to researchers from the University of Glasgow, H3N2 viruses typically cause more hospitalizations and deaths in older people, there are difficulties in producing effective H3N2 vaccines, and there’s more than just one H3N2 variant to consider, which makes it hard to treat.
  • B/Victoria and B/Yamagata (or Japanese flu) are strains of influenza B that often circulate simultaneously during the same season. B viruses generally are less serious than H3N2, but more contagious. Symptoms of Yamagata and Victoria flu are similar to those of seasonal flu. B viruses rarely create pandemics, although they can cause local epidemics. For example, this winter the B/Yamagata virus is dominant in the United Kingdom.

These viruses first emerge in eastern Asia around March and move on to Australia and New Zealand during their winter, which is summer in the Northern Hemisphere. The flu spreads across Asia to Europe, reaching North America six to nine months later. Once it hits, flu season can last up to seven months.

The chart below from the CDC shows the progression of the flu season in the United States beginning in September 2017. It shows A/H3N2 is the dominant virus during this season, although there was a spike in B/Yamagata cases since mid-December. The chart is updated weekly. You can see the most recent status by clicking here.

CDC status chart of 2018 flu virus
https://gis.cdc.gov/grasp/fluview/fluportaldashboard.html

When symptoms appear: Do I have a cold or the flu?

The rule used to be that if you have a fever you have the flu. This year that line has blurred. You can have the flu AND YET have no fever.  The flu is different from a cold. The flu usually comes on suddenly. Many people who have the flu are sick for 7 to 10 days or longer, and it’s not unusual to experience symptoms like a persistent cough and fatigue for weeks after.

The common cold also is a viral infection, but usually not as serious as influenza. The Mayo Clinic lists signs and symptoms of a cold, which usually appear one to three days after exposure, and which can vary from person to person:

This chart from the CDC compares the symptoms of cold versus flu.

CDC chart that compares flule and cold symptoms

The descriptions sound benign but make no mistake, the flu can open the door to pneumonia—where air sacs in the lungs fill with fluid, making breathing difficult—and sepsis—when the body’s immune system turns on itself. Sepsis can lead to tissue damage, organ failure, and death. Signs of sepsis can include fever, hypothermia (lower than normal body temperature), rapid heartbeat, rapid breathing, confusion or unconsciousness, swelling, and high blood sugar.

Why Boomers should be concerned

Because human immune defenses become weaker with age, people 65 years and older have had the greatest risk of serious complications from the flu compared with young, healthy adults. The CDC estimates that more than 70 percent of seasonal flu-related deaths have occurred in people 65 years and older; between 54 percent and 70 percent of seasonal flu-related hospitalizations have occurred among people in that age group. So, influenza is often serious for people 65 and older.

This year is somewhat different. There are more adults aged 50-64 who are becoming exceptionally ill this flu season—their numbers are still behind the 65+ age group but have surpassed the number of children affected.

Why are older adults getting so sick this year?

Flu experts believe that a person’s first flu exposure imprints itself on the immune system, which plays a key role in fighting off infections. In a study published in Cell Reports, Harvard researchers provide insights on how a person’s first infection with the influenza virus teaches the budding immune system to fight against that first strain of flu we encounter.

The team found that viruses circulating around the time of the person’s birth were likely responsible for eliciting the initial immune response involving antibodies that bind viral hemagglutinin. In other words, the person probably caught the flu as a small child, which led to the production of antibodies against hemagglutinin that were important in later immune responses against other seasonal influenza strains. (Sciencedaily.com)

However, if you catch a different strain then that first exposure it is less helpful. An article in Business Insider notes that may be what’s happening to older adults this year: the H3N2 strain didn’t exist until 1968, after most boomers were born. That year a global pandemic killed more than a million people around the world. But boomers had likely picked up an H2N2 virus as their imprint when they were infants, and therefore did not develop immunity to the H3N2 virus circulating this year.

As you can see on the chart below, the number of people 64 years and older with the H3N2 virus far outpace those with the other viruses this year.

2018 flu virus infections by type and age group

The 2017-2018 flu vaccine is designed to protect against the circulating viruses.

Based on research conducted by health organizations around the world, including the CDC in the United States, in February 2017 the World Health Organization (WHO) recommended that the 2017-2018 “trivalent” flu vaccine for the Northern Hemisphere seasonal flu vaccine protect against three of the influenza viruses that began circulating in early 2017: A (H1N1) virus, A (H3N2) virus, and B/Victoria viruses.  A “quadrivalent” vaccine protect against the same viruses as the trivalent vaccine plus the B/Yamagata virus.

The CDC acknowledges that in general, current flu vaccines tend to work better against influenza B and influenza A(H1N1) viruses. Because the A(H3N2) virus mutates both as it circulates and during vaccine production (they are grown in eggs), changes in influenza A(H3N2) viruses tend to be more likely to result in antigenic changes than other influenza viruses and may reduce their potential effectiveness against circulating influenza viruses. Still, the flu vaccination may reduce flu illness severity, so while someone who is vaccinated may still get infected, their illness may be milder.

CDC advises the single best way to prevent seasonal flu is to get vaccinated each year.

Our immune systems become weaker as we age. The influenza vaccine can provide protection.

Our immune systems—a complex network of cells, tissues, and organs—are not what they were when we were in our 20s.  We produce fewer T cells, which form the memory of our immune system. The immune cells we do have don’t communicate with each other as well, so it takes longer to react to harmful germs. The body also produces fewer white blood cells, which can slow healing. There is no set age for when an individual’s immune system begins to weaken, and there is no test to give you a reading on the state of yours.

It’s important to remember that people who are 65 and older are a diverse group, one that includes people who are healthy and active and have responsive immune systems, as well as those who have underlying medical conditions that may weaken their immune system and their bodies’ ability to respond to vaccination.

The World Health Organization (WHO) and the CDC recommend that adults over the age of 50 receive the trivalent influenza vaccine. Although immune responses may be lower in the elderly, vaccine effectiveness has been similar in most flu seasons among older adults and those with chronic health conditions compared to younger, healthy adults.

It is not to late to get the flu vaccine. Be aware, though, that it takes about two weeks to become fully effective. (Flu Vaccine Finder)

Vaccine Options if You’re Age 65 and Older

  • The regular flu shot (standard dose of the trivalent)
  • The high-dose flu shot (double dose of trivalent)
  • The quadrivalent flu shot (a new four-strain version)
  • An egg-free shot called Flucelvax for those who have egg allergies

Consider getting a “high-dose” vaccine.

Vaccines need new T cells to be effective. James M. Steckelberg, M.D., writes on the Mayo Clinic website that “in response to a regular flu shot, older people produce 50 to 75 percent fewer antibodies, which protect against the vaccine antigens, than do younger adults.” High-dose flu vaccines can compensate for this difference. “In addition,” Dr. Steckelberg notes, “one study found almost 25 percent fewer cases of proven influenza in adults age 65 and older who took the high-dose vaccine compared with those who took the standard-dose vaccine.”

Currently there are two FDA-approved high-dose vaccines for people age 65 and older. Fluzone High-Dose is made up of the three flu strains mentioned above but contains four times as much flu virus antigen as a regular flu shot, which creates a stronger immune response. An October 2017 post in HuffPost noted that a 2013 clinical trial showed it to be 24 percent more effective than the regular-dose vaccine at preventing flu in seniors.

The FLUAD vaccine contains an added ingredient called adjuvant MF59 to help create a stronger immune response. In a 2012 Canadian observational study, FLUAD was 63 percent more effective than a regular flu shot. FLUAD™ is only licensed and approved for persons aged 65 years and older.

The CDC does not recommend one vaccination over the other, and to date, there have been no studies comparing the two vaccines. There is much more information about the seasonal flu influenza on the CDC website.

Misconceptions about flue vaccine and illness

 Ways the flu can become deadly

One way is directly from the virus itself, which can cause such overwhelming inflammation in a person’s lungs that they die due to respiratory failure. The lung tissue becomes damaged to the point where it becomes impossible for enough oxygen to pass into the person’s blood. When death occurs this way it usually happens very quickly.

You can get the flu more than once. Ten days or two weeks, sometimes even longer than two weeks after the initial attack by the virus, you begin to feel better and think you’ve recovered.  But then you become ill again. You may have the flu—again—because there are several viruses that make up the flu season.  For example, you’ve been sick with the A/N3N2 virus. Then the flu symptoms return. But this time it might be one of the B viruses, not a return of the A/H3N2. It’s not a common occurrence, but with a flu season that lasts for several months it is quite possible. Plus, B viruses tend to peak after the A viruses, so your chance of being exposed increases later in the season.

Or your feel better/sick again experience might be the result of a “superinfection.” Superinfections can be caused by bacterial infections that usually develop while your body is fighting off a virus. Generally, the bacteria that cause super infections are in or are on our body already. However, when we are fighting off a virus our immune systems become weakened and bacteria can invade our lungs or sinuses and cause a super infection.

The most dangerous and lethal super infections are secondary pneumonias that typically develop after the flu. Flu-related bacterial infections lead to an average of 500,000 deaths worldwide each flu season. Secondary pneumonia develops after you are recovering from the flu. Death from secondary infections takes a bit longer than death from the virus itself — usually about a week or so — because it takes a while for the secondary infection to set in.

People who are sick with the flu also can experience multiple organ failure throughout their body due to sepsis, which can lead to death. Despite extensive basic research and clinical studies, the pathophysiology of sepsis is still poorly understood.

News reports this season have mentioned “cytokine storms” as a possible cause of death in some flu cases. In these cases, the body’s response to the virus is an over-exuberant, uncontrolled immune response that attacks the lungs, filling them with fluid. The severity of a body’s response to disease is the result of the interplay between the robustness of the virus and the host body’s resistance. When the infection is mild, the body’s response is moderate, so the disrupted homeostasis is restored rapidly. However, for other viruses like the H1N1 and the H3N2 that cause pandemics, the immune response can become hyperactive, resulting in an excessive inflammatory reaction known as the cytokine storm phenomenon. The severe inflammation can cause damage to lung tissue, fibrotic healing, severe capillary damage, and persistent organ dysfunction. Inflammatory cytokines can spill over into the circulation and result in systemic cytokine storms, which are responsible for multi-organ dysfunction. It is unclear why these patients have this terrible response, but it may be a genetic predisposition.

When to call a doctor or 911

Although we may be active and young at heart, if you’re over 60 you’re in a high-risk group for the flu. It’s best to contact your doctor early in your illness. CDC recommends that people at high risk for complications should get antiviral treatment as early as possible, because benefit is greatest if treatment is started within 2 days after illness onset. Treatment with antiviral drugs can mean the difference between milder or more serious illness possibly resulting in a hospital stay (or death).

Antiviral drugs are available in pill, liquid, inhaled powder, or intravenous solution forms. They not sold over-the-counter—you must have a prescription from your doctor or health care provider. Antiviral drugs can lessen symptoms, shorten the time you are sick, and reduce the risk of complications. Antiviral drugs, which fight the flu virus in your body, are different from antibiotics, which fight against bacterial infections.

The CDC recommends three FDA-approved antiviral drugs to treat flu this season. Your doctor will advise you about the best choices for your condition.

  • oseltamivir (available as a generic version or under the trade name Tamiflu®)
  • zanamivir (trade name Relenza®)
  • peramivir (trade name Rapivab®)

Go to the ER if:

  • Your fever climbs to 103° F or higher
  • You can’t catch your breath, or have trouble breathing while at rest or with slight exertion
  • You can’t keep fluids down
  • If there’s blood in the phlegm you’re coughing up
  • If you can’t think clearly and your speech is slurred
  • If you’re too weak to stand

Get emergency help if you have pain or pressure in the chest or abdomen, sudden dizziness, confusion, or severe vomiting. These can be signs of complications.

If your flu symptoms ease but then return—especially with fever and cough—go to the ER. This can be a sign of secondary infection.

Are there other ways to prevent the flu?

The National Center for Complementary and Integrative Health, part of the National Institutes of Health, states flatly, “There is currently no strong scientific evidence that any natural product is useful against the flu.” That said, there are steps you can take to support your immune system.

Get a good night’s sleep. A well-rested body will be able to support a stronger immune system.

Eat a diet high in fruits and vegetables, which are sources of essential micronutrients. As a report on boosting immunity by Harvard Medical School notes, “Like any fighting force, the immune system army marches on its stomach.” Include fermented foods and foods with probiotics. While the further investigation is needed, one study published in 2017 in Nature found that “the presence of certain lactic acids in the gut appeared to have a valuable role in protecting the body against influenza viruses. The lactic acid the scientists were using was a strain called Lactobacillus casei DK128, which they isolated from the Korean fermented vegetable delicacy kimchi. They used a version of it on mice and found it was actually pretty effective in fighting flu.” Fresh garlic also helps support the immune system.

Avoid close contact with sick people. Try to stay six feet away from an infected person. If someone coughs or sneezes on you, you may become infected with the virus through aerosolized droplets that travel through the air. Prevention.com recommends holding your breath for 10 or 15 seconds and avoid inhaling deeply until you are in fresh air again. Wearing a surgical mask in close quarters, like the subway or an elevator, can be effective at blocking traveling virus droplets.

Avoid touching your eyes, nose, and mouth. That includes biting your nails. Viruses love your mucus membranes.

A 2015 study from Virginia Tech noted that the drier the air, the more preserved and effective virus “droplets” become. If humidity is over 50 percent and under 98 percent, viruses have a much lower rate of survival in the air

Wash your hands often with soap and water. Soap up between your fingers and your thumbs and scrub for about 20 seconds. Use hand sanitizers as back up.

Clean and disinfect surfaces and objects that may be contaminated with flu viruses. Place kitchen sponges in the microwave and heat on high for a minute. Wipe remotes, doorknobs, light switches—anywhere germy hands might have been.

Get plenty of moderate exercise, “even though a direct beneficial link hasn’t been established [to your immune system] it’s reasonable to consider moderate regular exercise to be a beneficial arrow in the quiver of healthy living.”

What to do if you “come down with the flu”

Stay hydrated. Water is fine, electrolyte beverages are better if you start to become dehydrated. Herbal tea with honey can soothe a sore throat. If you feel nauseated, try taking small sips of liquids or ice chips. You are getting enough fluid if your urine is pale yellow, almost colorless.

Try a bowl of soup. Whether chicken soup is a cure is up for debate. But it will help you get more liquids in your body and provide you with gentle sustenance when you don’t feel like eating. The vapors from the bowl also can help a stuffy nose.

Get plenty of rest. If you have severe flu symptoms lay off exercise and chores until you feel better. Rest helps your body fight infection. Read a book. Binge watch a series you have been meaning to see. Or just curl up on the couch.

Crank up the humidity. Bane of hot summer days, humidity is your friend if you have the flu. Turn on the shower and sit in the bathroom for a few minutes, inhaling the steam. Or use a steam vaporizer or a humidifier—but make sure it’s clean. Or drape a towel over your head and lean over a steaming bowl of water to open clogged nasal passages. A drop or two of peppermint or eucalyptus oil in water can help break up phlegm.

Ease headaches with a warm compress. Placing a warm, damp cloth across your forehead and nose can relieve headache or sinus pain.

Treat coughs with throat lozenges.

Gargle with salt water. It helps get rid of the thick mucus that can collect at the back of the throat, especially after you’ve been lying down, and can also help ease stuffy ears.

Take care of your nose. Neti pots are used to irrigate your nasal passages. Salt water is poured into one nostril and allowed to drain out of the other one. It may help reduce the risk of sinus infections. If you’re not up for the neti pot routine, use saline nasal sprays to keep your nasal passages moist.

Be prepared: stock your pantry now with supplies you might need later

  • Thermometer to track your fever. There are several types to choose from, each with benefits. Vive Health posted a list of what they consider the 10 best ones.
  • Drinks with electrolytes like Gatorade and Powerade, although they’re high in sugar. Electrolyte concentrates and powders like LyteShow and Ultima [https://www.amazon.com/slp/electrolyte-powder/v8jag7oa9d7j9mf] are sugar free. Just add to water and stir.
  • An expectorant for chest congestion. Mucinex, or an herbal cough suppressant like Loquat Respiratory Syrup, and herbal teas with honey.
  • Cough drops and throat lozenges.
  • Nasal decongestant, like Sudafed, or the equivalent, pseudoephedrine, for stuffy noses and sinuses.
  • Antihistamine for runny noses– Allegra, Claritin or Zyrtec.
  • Studies show that homes kept at 40-60% relative humidity are likely to have fewer flu viruses lingering in the air and on surfaces like sink faucets, door handles, and countertops.
  • Oscillococcinum, a homeopathic remedy popular in Europe. Take at first sign of symptoms.
  • Tissues, at least two boxes.
  • Disinfecting wipes.
  • Soap for washing hands. Hand sanitizer, pocket size (keep one in your coat pocket) and pump containers for rooms in your apartment/house.
  • Liners for your wastebaskets. Discard used them frequently.
  • Soup. The best are homemade, but stock a few boxes of prepared soup, like Pacific Organic Chicken Noodle Soup Reduced Sodium, which was judged best canned/boxed soup by Eat This, Not That!

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