Influenza has persisted as a prevalent health concern at the University and within the community at large this year, and, with the ongoing COVID-19 pandemic, receiving a flu vaccination remains especially important.
The University set a goal in the fall of 2019 to administer 5,000 flu vaccinations to students by Valentine’s Day. This same goal had been established the year prior. “We surpassed that goal earlier this year” by a couple hundred vaccines, said Vanessa Britto, associate vice president for campus life and executive director of health and wellness.
Although many in the University community are preparing to leave campus due to concerns about the spread of COVID-19, Health Services will continue to operate at this time, Britto said, making the flu vaccine still available for students staying in Providence. “It is not too late to get the (influenza) vaccine.” But she reminded the community that the vaccines are only effective for a given flu season and that new flu vaccines, based on the predicted flu strain, are created every summer.
The University’s Health Services is a “sentinel site,” one of many sites around the country that regularly works closely with the Centers for Disease Control and Prevention to “provide eyes and ears for the CDC.” The University has been participating in this national effort to help the CDC identify the prevalence of flu cases around the country. This information is publicly available through the CDC’s FluView website.
Other illnesses spreading alongside the flu worldwide include the common cold and, this year, COVID-19. A major difference between the symptoms of the common cold and influenza are that common cold symptoms happen gradually while flu symptoms happen abruptly, Britto said. “In a clinical evaluation, (patients report that they) felt fine and then all of a sudden they felt sick. The flu is usually not subtle.”
To stay well this season, Britto reminded students to wash their hands frequently and thoroughly for 20 seconds. “My mantra is, if I can’t remember when I last washed my hands, I wash them.” She also recommended that students and their families invest in a thermometer to monitor their temperature when they feel sick.
There are many resemblances between the symptoms of COVID-19 and the standard flu. Both can cause pneumonia, making it particularly challenging to distinguish between each disease in the elderly, said Stefan Gravenstein, professor of medicine, health services policy and practice and geriatric medicine. Gravenstein is also the principal investigator of a national flu vaccine study of elderly nusing home residents. Nursing home conditions can be conducive to the spread of infectious diseases, as the frailest and most vulnerable of the population reside there in close proximity, he said.
Estimates from the CDC claim that influenza has a 0.1 percent mortality rate while COVID-19 has a 3 percent mortality rate. Gravenstein believes that the mortality rate of COVID-19 is skewed based on the lack of tests that have been completed so far. “Healthy people are not part of the denominator,” making this rate appear higher, Gravenstein said.
While the flu vaccine does not protect against COVID-19, it can confer significant preventative protection against influenza, particularly in elderly populations, Gravenstein added.
But the vaccine takes about two weeks to develop a protective response, said Penelope Dennehy, professor and vice chair of pediatrics and director of the division of pediatric infectious diseases at Hasbro Children’s Hospital.
“We cannot clinically tell the flu from (COVID-19) until it is too late,” Gravenstein said, reminding students, “especially now, if you haven’t gotten the flu vaccine, get it.”
“If people got the flu vaccine, it could help us sort out what is (COVID-19) and what is the flu,” Dennehy said. She added that wearing masks doesn’t protect healthy people. “The purpose of masks is to put them on someone with symptoms so that they can’t infect others, as well as for providers who will be interacting with individuals with symptoms,” Dennehy said. Currently, there is a shortage of masks in the hospital as people have come in and taken them. “We (providers) are having to reuse our masks, unfortunately,” Dennehy said.
Another advantage for the elderly who receive flu vaccines is that “we could also prevent heart attacks that the flu would cause,” Gravenstein said. The vaccine has an efficacy equivalent to preventative measures such as quitting smoking or taking cholesterol-lowering medications, he added.
Gravenstein’s study on flu vaccines compares the impact of two different types of vaccines: the standard influenza vaccine and a recombinant vaccine. The standard vaccine contains four antigens — two for influenza A and two for influenza B — while the recombinant vaccine has three times as much antigen. An influenza antigen is a component of the virus that the body learns to recognize, so if the real virus infects a person, the immune system responds faster to combat it. Another difference between the standard and recombinant vaccines lies in their creation. Gravenstein is currently measuring the health of study participants who received each vaccine using factors such as hospitalization rates.
According to Dennehy, who has been studying flu vaccines as well, “this (flu season) has been … particularly interesting and bad,” with high cases of influenza type B. It was especially problematic for children. “In children, the last time we had high cases of influenza B was in 1991, so most children have no exposure to that virus.” As a result, their immune systems are not as familiar with the antigens for influenza type B as those of the elderly, who have more commonly been exposed to this strain of the flu and have developed a greater immune response to it. Consequently, there has been a higher rate of hospitalizations due to influenza for younger children and a lower one for the elderly this year, Dennehy said. As influenza B cases waned after students returned to classes from winter break, “we’ve now been seeing the typical (influenza) A strain and … H1N1 circulating.” She added that the rise of influenza B cases remains a mystery and that even the “people at the CDC are completely surprised.”
Because flu vaccines are based on scientific guesses about the potential flu strain of the season, they are not as effective as the measles vaccine, for example, which has 95 percent effectiveness, Dennehy added. “Even in a good year when the strains are well-matched, the (influenza) vaccine’s effectiveness is 40-50 percent.” Nevertheless, the flu vaccine typically “makes the disease milder in those vaccinated,” Dennehy said. Last year, over 70 percent of the children who died because of the flu were eligible for the vaccine but didn’t receive it.
“The flu has been around every year, so people are unfortunately kind of used to seeing the flu and often don’t pay (as) much attention to (it) as they should,” Dennehy added.
