First, the bad news: There's a flu epidemic every winter, and there's no reason to think this season will be any different. Millions of Americans will get stay-in-bed sick and tens of thousands will likely die: In the bad season two years ago, the official death toll hit nearly 80,000. Already this fall, a 4-year-old in California has died.
Now for the good news.
1. This year is likely to be better than last year.
It's not guaranteed, but the latest tracking from Australia says the flu season there — which can presage ours — has been long and high-volume but it describes the severity this year as "low," based on ICU admissions and deaths.
And though it's impossible to predict, under the law of averages we can expect the coming flu season to be shorter than last year's unusually long one, says Dr. Larry Madoff from the Massachusetts Department of Public Health. "We sort of had two full seasons in a row" extending long into last spring, he says. "That's why it was so prolonged, because we had first one strain and then another."
2. No need to feel guilty for not having already gotten vaccinated.
If you've felt pangs because you ignored pharmacy vaccine ads or bypassed a clinic this summer, you can rest easy. Dr. David Shay, a medical officer at the CDC, says October is the ideal time to get vaccinated.
"The evidence is still evolving," he says, about whether summer is in fact too early to get a flu vaccine, particularly for older adults, because the immunity it confers may wane by the time flu tends to peak in late winter.
"I would just emphasize that now is the time," Shay says. The CDC recommends that the subset of young children who need two doses get their vaccines as soon as possible to be able to get the second dose by the end of October.
3. There's a whole bouquet of vaccine options this year, including two no-needle versions.
The CDC lists a half dozen vaccine types, including FluMist, the nasal spray that needle-haters between ages 2 and 49 may choose. (Parents of needle-haters everywhere, rejoice!)
The CDC also mentions Afluria, a vaccine that can be given with a typical syringe or using a futuristic-sounding "jet injector" called "PharmaJet Stratis" that uses a high-pressure stream rather than a needle. (Parents of needle-haters, hold your rejoicing: At this point, the jet injector is not recommended for people under 18.) The CDC expresses no preference among the many different vaccines, and lays out a full array of the options here.
4. New vaccine technologies continue to develop, including egg-free forms.
Flu vaccines have traditionally been grown in chicken eggs, but now there are two main newer ways to make them: they're known as "cell-based" vaccines and "recombinant DNA" vaccines.
They're good news for most people with egg allergies (details here) and seem to be good news for others as well. Dr. Shay from the CDC says it appears that in some years, the adaptations needed to grow the vaccines in eggs may make them less effective against the virus. The vaccine makers "don't have to make those kinds of alterations to grow them in either the recombinant systems or the cell-based systems," he says.
Also, if there's a pandemic and it's urgent to make a lot of a new vaccine quickly, production can be ramped up more rapidly without eggs, Shay says. The majority of vaccines are still made with eggs, he adds, but the other types are on the rise.
5. Older adults have two strong vaccine options — and they've been using them.
Older people need stronger vaccines because their immune systems need more of a boost. Their flu vaccine options include two that Shay describes as "great": A high-dose vaccine and a vaccine that uses an adjuvant, or enhancer.
"Uptake of the high-dose vaccine has been very rapid," he says, meaning "care providers are getting the message that this is an alternative that likely offers improved responses" and better protection.
6. For kids, virtually all the vaccines this year protect against four strains.
For technical reasons, the older-adult vaccines are "trivalent," meaning they protect against three strains of the virus. But all the regular-dose flu vaccines for younger people this year are quadrivalent, protecting against four strains.
Shay says that's particularly good news for children who haven't had much exposure yet to flu viruses: "They tend to get more severe illnesses with influenza B," and it's hard to predict which B strains will predominate. In the quadrivalent vaccines, "We have both of them. So it's another way to help make sure we've got our bases covered."
7. If you do get sick, there's a new antiviral medication you can take.
The CDC recommends four prescription antivirals for use this season: brand names Tamiflu, Relenza and Rapivab, and a new one, Xofluza, which has a different mechanism of action.
Xofluza looks promising, Dr. Madoff from the state DPH says, because it appears to be as effective as Tamiflu but also to cut the duration of "viral shedding" — or spreading germs — "which is important in terms of the spread of flu."
Most of all, "it's good to have something new" in the arsenal, Madoff says, particularly if viruses develop resistance to the existing drugs. Xofluza was approved last year for patients 12 and older who have had flu symptoms for less than 48 hours. All the antivirals need to be used promptly after symptoms develop.
It looks like Xofluza will be widely available: CVS, for example, says it will stock it, along with "Tamiflu and the generic antiviral that makes up a significantly large majority of the flu antiviral scripts occurring during flu season."
8. Whether the vaccine matches the dominant strains of flu well or not so well, it's way better than nothing.
Every year, vaccine authorities do their best to choose which strains of the virus to target with the vaccines, trying to predict which will be most prevalent, but it remains an imperfect science. It's just too early to tell how well this year's vaccine will match the virus. Noteworthy this year is that vaccine choosers put off their call on one virus type — the nasty H3N2 — for a month to discern better which strains were circulating.
Dr. Shay says one thing is clear: Several big studies have found that "in a typical flu season, we can expect that receipt of a flu vaccine will prevent from 40% to 60% of illnesses compared to those who are not vaccinated." So the take-home message is: "50% isn't great but it's better than 0%," the prevention benefit of skipping the vaccine.
9. And we do seem to be getting closer to a one-and-done flu vaccine.
Federal scientists have begun testing a possible "universal vaccine" against flu in a few dozen people, checking how safe and effective it could be.
The beauty of a universal vaccine would be not just that we wouldn't need to get a new vaccine every year, but that it could protect us against the novel strains of the virus that keep infectious disease types up at night. The experimental vaccine has the catchy name H1ssF_3928, and researchers hope to begin sharing results next year.
10. Soon we won't have to fear mosquitoes for a while.
OK, I'm stretching to get to 10 pieces of good news about flu. But we're coming to the end of a frightening Eastern equine encephalitis season: the mosquito-borne illness has killed three people in Massachusetts. Once we get to the first hard frost, health officials say, many mosquitoes will die off, reducing concerns about EEE.
Now, instead of mosquitoes, it's our fellow humans we have to fear. In Massachusetts, four children died from flu last year, along with probably hundreds of adults. At least we all tend to know the rules for avoiding and limiting flu. So wash your hands, cover your cough, stay home if you're sick.
And one final bit of good news: The communication by public health officials continues to improve as well. Dr. Madoff says Massachusetts will enhance its weekly flu reports this season by including how severe the flu is, and the CDC has one heck of a frequently asked questions list here.