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Influenza — this year’s viral ‘box of chocolates’

January 31, 2020 by Kimberly Drake

When Forrest Gump said, “Life is like a box of chocolates, you never know what you’re gonna get,” he summed up in one sentence life, love, and apparently, the seasonal flu virus. According to the Centers for Disease Control (CDC), this year’s box of viral delights includes the appearance of an unexpected flu bug strain that isn’t a match to the 2019-2020 influenza vaccine, and a more ominous non-flu virus from China called 2019-nCoV.

This year’s “chocolate-covered cherry” flu bug is the B/Victoria virus, and it hasn’t been the predominant strain since the winter of 1992-93. Usually, the influenza B strain circulates near the end of the flu season, but this year, it has taken the lead much earlier, which has caught the medical community by surprise. According to the CDC’s latest report, nationally, while B/Victoria accounts for a higher number of cases, it is followed closely by A(H1N1) pdm09 viruses and other strains of A and B in low numbers. Because it’s not the typical chocolate found in the box, B/Victoria can hit children harder than adults, who have most likely already been exposed to it at some point in their life.

So far, flu activity is high in most states, and the CDC has received reports of 54 flu-related deaths of children this season, with 37 deaths related to influenza B viruses, and 17 linked to influenza A. Where does Wisconsin stand in this flu fight? The latest data from the Wisconsin Department of Health reports one pediatric flu-related death so far, with high levels of flu activity throughout most of the state.

Unfortunately, this season’s vaccine is only a 58% match to this strain of flu, which isn’t unusual, as influenza viruses are continuously changing through a natural process known as antigenic drift. According to the CDC’s Vaccine Effectiveness Fact Sheet, observational studies reported a vaccine efficiency of 52% during seasons when the vaccine and circulating viruses were well-matched, and an effectiveness of 36% when the circulating viruses were antigenically drifted. The CDC says, “it is not possible to predict how well the vaccine and circulating strains will match in advance of the influenza season, or how this match may affect vaccine efficacy. However, even when circulating influenza viruses are drifted in comparison to the vaccine, people may still receive some protective benefit from immunization.”

Luckily, for those who happen to pick up the wrong chocolate out of the box and come down with the flu, almost all of the flu viruses tested this season are susceptible to the four FDA-approved influenza antiviral medications recommended for use in the United States.

Are there any alternative ways to prevent or treat the flu?

Aside from vaccines and antiviral drugs, one alternative with some potent anti-flu research behind it is elderberries. Studies show the substances present in these berries may stop the influenza virus from entering and replicating in human cells. According to the February 2019 Journal of Complementary Therapies in Medicine, an analysis that looked at the effects of elderberries, taking into account vaccination status and other factors, found supplementation with elderberry substantially reduced upper respiratory symptoms, such as those encountered during a bout of the flu. Scientists note that the use of elderberries could be a potentially safer alternative to prescription drugs for routine cases of the common cold and influenza.

Studies also show the old-fashioned remedy of chicken soup may hold merit. Research published in the American Journal of Therapeutics found that a compound in chicken soup called carnosine seems to “go together like peas and carrots” with your immune system and can help fight off the flu. These results follow a previous study published in the journal Chest, which suggested that chicken soup has an anti-inflammatory effect and may ease symptoms of upper respiratory tract infections.

Other preventative actions, including gargling with saltwater, Listerine or green tea, or flushing the nasal cavity with saline, have failed to garner support from the scientific community. The school of thought behind these methods is that because the main port of entry for flu viruses is through the mouth and nose, “rinsing” these orifices would, in theory, dislodge germs upon entering the body. Although not proven scientifically, some people swear it works.

And just when we’ve figured out what kind of chocolates are in this year’s assortment, in comes a bonbon of a whole new flavor. On Jan. 21, the CDC confirmed one case of a novel coronavirus (2019-nCoV) from Wuhan, China, in the United States with five total cases confirmed as of Jan. 27.

Coronaviruses are a family of viruses, some of which cause respiratory illness in people and some causing disease in animals. According to the Wall Street Journal, this strain most likely originated in a wild animal food market in Wuhan, and, “although Chinese authorities have yet to identify the precise origin of the current outbreak, a study released by the Wuhan Institute of Virology, based on patient samples, found a 96 percent genetic match with a bat coronavirus.” The CDC says, “While severe illness, including illness resulting in several deaths, has been reported in China, other patients have experienced mild symptoms. Although there is a level of concern about this virus, the CDC continues to believe the immediate risk of 2019-nCoV to the American public remains low at this time.”

Sometimes, for no particular reason, the flu season is like a Whitman’s Sampler chocolate assortment gone awry, with most of the box containing “candy” you didn’t expect, and most certainly didn’t want. And although this season has proven to be a box of chocolates, at least now we know exactly what we’re gonna get, and what might be coming, so we can adjust our prevention and treatment strategies to match what we face.  

Kimberly Drake can be reached at [email protected].

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