Flu Season 2024-What You Need to Know to Stay Healthy

Flu Season 2024: What You Need to Know to Stay Healthy

As the holidays approach, so does flu season. It’s the perfect time to brush up on key facts about influenza. Is the flu really that big of a deal? How can you protect yourself and your loved ones from getting sick? And if you do become ill, what are your treatment options? Let’s break down the latest data and evidence to help you make the best decisions for yourself and your loved ones.

Flu Facts

The flu is a seasonal illness that peaks in the colder months, typically between late December through February. The Centers for Disease Control and Prevention (CDC) estimate 34 million to million to 75 million cases of influenza in the U.S. between October 2023 to April 2024. Of these cases, 380,000-900,000 people were hospitalized.¹ The broad estimates are because not everyone who has the flu or dies of the flu gets tested or hospitalized.

Influenza is the 9^th most common cause of death in the United States,² but is particularly dangerous for at-risk populations, including:

• Children under 5 — especially under 2
• Adults over 65
• Pregnant women
• People with chronic health conditions.^3-7

The rapid spread of flu is attributed to the fact that each person with influenza will infect 1.3-2.0 more people,⁸ with the highest rate of infection occurring within same households.⁹

Influenza is more than just a health issue—it has a significant economic impact on both the healthcare system and the economy at large. In the United States, the annual cost of flu-related medical visits, hospitalizations, and lost productivity is estimated at $11.2 billion.​¹⁰ So, to answer the question, “Is influenza really that big of a deal?” Yes, it absolutely is.

Staying Healthy

There are several ways to stay healthy during flu season. The most effective way is to get vaccinated, but many people are hesitant about vaccines and choose not to get one. Let’s spend a little time talking about the vaccine.

To understand the vaccine, it’s important to know how influenza behaves. As previously mentioned, flu season occurs during cold months. When it’s summertime in the Northern Hemisphere, the Southern Hemisphere is experiencing its flu season. As the virus bounces back and forth between the two hemispheres, it changes its appearance slightly. Viruses aim to replicate, so they genetically change as they pass between different people. This is because our immune systems “learn” what the viruses look like and will immediately stop them. However, if a virus can change what it looks like, it can evade our immune system.

The reason a flu vaccine is recommended every year is because scientists predict what the virus will look like for the upcoming season and then create vaccines accordingly. These vaccines allow our immune systems to “see” what the expected flu strains will look like, so we can stop them when we are exposed. According to a study from the United Kingdon, last season’s vaccine effectiveness was 63%-65% among children, 36%-55% among adults aged 18-64, and 40%-55% among adults over 65.¹¹ The CDC reported 2023-2024 vaccine effectiveness as 52%-67% in children and 33%-49% in adults 18 and older. The coverage for influenza B was outstanding but not so much for influenza A.¹²

Many people will argue against getting the vaccine because, even when they do, they still end up with the flu—and guess what, they’re right. Some people will still get the flu, but their symptoms are less severe and last for a shorter period of time.^13-15 I happen to be one of those people. I am exposed to the flu at least 20 times per day when working in the emergency department during flu season. I’ve gotten the flu vaccine every year since 2006, and in that time, I’ve had the flu five times and was sick for only two days each time, compared to the average of seven days.

However, it’s not just about reducing symptoms for those who get vaccinated—it’s also about protecting those who are most vulnerable. Last year, there were 200 pediatric deaths from influenza, and sadly, 80% of those children were not vaccinated.¹  This highlights the critical role that vaccination plays in preventing severe outcomes and deaths among children. While vaccination may not offer complete immunity, it significantly reduces the risk of severe illness and death, particularly for the most vulnerable.

For those concerned about vaccine safety, the vaccine is very safe. The most common adverse effects are injection site pain, low-grade fever, and headache.^16-18 Serious adverse effects can occur, though they are rare. Anaphylaxis can occur in individuals with severe egg protein allergies, as many of the vaccines are made using eggs—though there are egg-free formulations that reduce this risk tremendously. A rare neurological disorder called Guillain-Barre Syndrome (GBS) has also been reported after the flu vaccine. In this condition, an individual’s immune system attacks the nerves, leading to muscle weakness and, in severe cases, paralysis. The flu vaccine can increase the risk of getting GBS by 1.7 fold.¹⁹ BUT—and this is a big but—GBS is extremely rare at baseline, with a 0.001%-0.002% chance of occurrence. Getting the flu vaccine increases this to 0.0017%-0.0034%, which is still incredibly low.

While vaccination is the most effective way to stay healthy, there are other ways to protect yourself:

• Hand hygiene: Washing your hand with soap and water for at least 20 seconds is a highly effective way of preventing the transmission of influenza and other viruses. When soap and water are unavailable, alcohol-based hand sanitizers containing at least 70% alcohol are effective. (You only need 60% for flu but 70% for COVID, so go with 70%).
• Mask Wearing:  Wearing masks and avoiding crowded indoor spaces during flu season can reduce the risk of inhaling respiratory droplets and spreading the virus.
• Avoid Close Contact: Stay away from people who are sick and stay home if you’re feeling unwell to prevent spreading the illness to others.

Treatment Options

The CDC and the Infectious Disease Society of America both recommend the use of antivirals for treating influenza, but I think the evidence supporting this statement is weak. Antiviral medications such as oseltamivir (Tamiflu) are marketed as miracle drugs that will make your symptoms go away and spare you from hospitalizations, but that isn’t true. Studies demonstrate taking these medications within 48 hours of symptom onset can improve symptoms 16.8-29 hours faster in adults and 29 hours faster in children compared to taking nothing at all but make no difference in hospitalizations or death rates. They may also increase nausea, vomiting, and headache. ^20-22

There is one scenario where both medications are beneficial: reducing viral shedding. As mentioned, the highest rate of influenza transmission occurs within households. These medications reduce the number of viruses shed from someone who is sick.^9,23 So, if you have the flu and have a vulnerable family member living in your household, you may want to consider taking one of these to decrease the chance of spreading the virus, in addition to isolating yourself.

Managing Symptoms at Home

When dealing with the flu, several home remedies can help alleviate symptoms, support recovery, and keep you comfortable while your body fights off the virus.

• Hydration: Staying hydrated is critical when you’re ill, especially in the setting of a fever which causes fluid loss through sweating. Hydration helps maintain mucous membrane function, which is essential for clearing the respiratory tract.²⁴ Water or a half-water, half-electrolyte solution mixture is recommended. Avoid alcohol or caffeine, as they cause further fluid loss.

• Rest and Sleep: Rest allows your body to put energy into fighting the infection. Sleep boosts the immune system and aids recovery.

• Warm Saltwater Gargles: Gargling with warm salt water can soothe a sore throat, reduce swelling, and help clear mucus.²⁵ Mix ½ to 1 teaspoon of salt into a cup of warm water. Gargle small amounts and spit until the cup is empty. Do this three times/day.

• Honey: Honey is a proven cough suppressant. It has outperformed over-the-counter cough remedies²⁶ and is safe to use in children older than 1 year of age. (Do not use in children under 1 year of age due to the risk of botulism). Mix ½ to 1 tablespoon of honey into warm decaffeinated tea or hot water with or without lemon. You can also take a tablespoon on its own, similar to how to take cough medicine.

• Chicken Soup: Chicken soup has mild anti-inflammatory properties²⁷ and helps clear nasal passages.²⁸ An added bonus is it will help keep you hydrated, and it’s delicious!

• Humidifier Use: Cool mist humidifiers add moisture to the air, which helps prevent your nasal passages and throat from drying out. Use one while sleeping.

When to Seek Medical Care

While most cases of the flu can be managed at home, certain symptoms warrant a visit to a healthcare provider:

• Difficulty breathing or shortness of breath.
• Chest pain or pressure.
• Severe dehydration, such as not being able to keep down fluids.
• High fever that doesn’t improve with medication.
• Confusion or sudden dizziness.
• In children: trouble breathing, bluish skin color, or not waking up or interacting or any other concerning sign or symptom.

Don’t hesitate to reach out to a doctor if you or your child’s symptoms seem severe or are worsening. Timely intervention can make a big difference, especially for those at higher risk.

Final Thoughts: Now Is the Time to Get Vaccinated

With flu activity just starting to pick up, late October and early November are ideal times to get your flu shot. Getting vaccinated now will ensure that you’re protected throughout the peak of flu season, helping to reduce your risk of serious illness and protecting those around you. In line with practicing what I preach, my family and I got vaccinated this year.

Remember, while this information is meant to educate and empower you, it’s always best to consult with your healthcare provider for medical advice tailored to your specific needs. A conversation with your doctor can help you navigate the flu season with confidence.

References

1.             Centers for Disease Control and Prevention. Influenza Activity in the United States During the 2023–2024 Season. Updated September 25 2024. Accessed October 23, 2024. https://www.cdc.gov/flu/whats-new/flu-summary-2023-2024.html

2.             Ahmad FB, Cisewski JA, Anderson RN. Leading Causes of Death in the US, 2019-2023. JAMA. 2024;332(12):957-958.

3.             Principi N, Esposito S. Severe influenza in children: incidence and risk factors. Expert Review of Anti-infective Therapy. 2016;14(10):961-968.

4.             Near AM, Tse J, Young-Xu Y, Hong DK, Reyes CM. Burden of influenza hospitalization among high-risk groups in the United States. BMC Health Services Research. 2022;22(1):1209.

5.             Abdullahi H, Elnahas A, Konje JC. Seasonal influenza during pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2021;258:235-239.

6.             Wang X, Li Y, O’brien KL, et al. Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study. The Lancet Global Health. 2020;8(4):e497-e510.

7.             Centers for Disease Control and Prevention. People at Higher Risk of Flu Complications. Updated October 3, 2023. Accessed October 24, 2024. https://www.cdc.gov/flu/highrisk/index.htm

8.             Chowell G, Miller M, Viboud C. Seasonal influenza in the United States, France, and Australia: transmission and prospects for control. Epidemiology & Infection. 2008;136(6):852-864.

9.             Welliver R, Monto AS, Carewicz O, et al. Effectiveness of oseltamivir in preventing influenza in household contacts: a randomized controlled trial. Jama. 2001;285(6):748-754.

10.          Macias AE, McElhaney JE, Chaves SS, et al. The disease burden of influenza beyond respiratory illness. Vaccine. 2021;39:A6-A14.

11.          Whitaker H, Findlay B, Zitha J, et al. Interim 2023/2024 Season Influenza Vaccine Effectiveness in Primary and Secondary Care in the United Kingdom. Influenza and Other Respiratory Viruses. 2024;18(5):e13284.

12.          Frutos AM. Interim Estimates of 2023–24 Seasonal Influenza Vaccine Effectiveness—United States. MMWR Morbidity and mortality weekly report. 2024;73

13.          Casado I, Domínguez A, Toledo D, et al. Effect of influenza vaccination on the prognosis of hospitalized influenza patients. Expert review of vaccines. 2016;15(3):425-432.

14.          Deiss RG, Arnold JC, Chen W-J, et al. Vaccine-associated reduction in symptom severity among patients with influenza A/H3N2 disease. Vaccine. 2015;33(51):7160-7167.

15.          Godoy P, Romero A, Soldevila N, et al. Influenza vaccine effectiveness in reducing severe outcomes over six influenza seasons, a case-case analysis, Spain, 2010/11 to 2015/16. Eurosurveillance. 2018;23(43):1700732.

16.          Trombetta CM, Gianchecchi E, Montomoli E. Influenza vaccines: Evaluation of the safety profile. Human Vaccines & Immunotherapeutics. 2018;14(3):657-670.

17.          Pillsbury AJ, Fathima P, Quinn HE, et al. Comparative postmarket safety profile of adjuvanted and high-dose influenza vaccines in individuals 65 years or older. JAMA network open. 2020;3(5):e204079-e204079.

18.          Woo EJ, Moro PL. Postmarketing safety surveillance of quadrivalent recombinant influenza vaccine: Reports to the vaccine adverse event reporting system. Vaccine. 2021;39(13):1812-1817.

19.          Juurlink DN, Stukel TA, Kwong J, et al. Guillain-Barré syndrome after influenza vaccination in adults: a population-based study. Archives of internal medicine. 2006;166(20):2217-2221.

20.          Jefferson T, Jones M, Doshi P, Spencer EA, Onakpoya I, Heneghan CJ. Oseltamivir for influenza in adults and children: systematic review of clinical study reports and summary of regulatory comments. Bmj. 2014;348

21.          Ison MG, Portsmouth S, Yoshida Y, et al. Early treatment with baloxavir marboxil in high-risk adolescent and adult outpatients with uncomplicated influenza (CAPSTONE-2): a randomised, placebo-controlled, phase 3 trial. The Lancet Infectious Diseases. 2020;20(10):1204-1214.

22.          Hanula R, Bortolussi-Courval E, Mendel A, Ward BJ, Lee TC, McDonald EG. Evaluation of oseltamivir used to prevent hospitalization in outpatients with influenza: a systematic review and meta-analysis. JAMA Internal Medicine. 2024;184(1):18-27.

23.          Hayden FG, Sugaya N, Hirotsu N, et al. Baloxavir marboxil for uncomplicated influenza in adults and adolescents. New England Journal of Medicine. 2018;379(10):913-923.

24.          Oakley E, Borland M, Neutze J, et al. Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial. The Lancet Respiratory Medicine. 2013;1(2):113-120.

25.          Sallih MAEBM, Abu Bakar MZB. Randomised controlled trial of salt solution (sodium chloride) mouth wash vs thymol glycerine usage in sore throat with non bacterial pharyngitis. Journal of Complementary and Alternative Medical Research. 2019;8(1):1-5.

26.          Abuelgasim H, Albury C, Lee J. Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis. BMJ Evidence-Based Medicine. 2021;26(2):57-64.

27.          Rennard BO, Ertl RF, Gossman GL, Robbins RA, Rennard SI. Chicken soup inhibits neutrophil chemotaxis in vitro. Chest. 2000;118(4):1150-1157.

28.          Saketkhoo K, Januszkiewicz A, Sackner MA. Effects of drinking hot water, cold water, and chicken soup on nasal mucus velocity and nasal airflow resistance. Chest. 1978;74(4):408-410.