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The Perfect Storm

By Karen Kier
Pharmacist on behalf of the ONU HealthWise team

The movie The Perfect Storm starring George Clooney and Mark Wahlberg depicted the sinking of the Andrea Gail boat off the coast of New England. The commercial fishing boat was out on a final mission looking for swordfish when a catastrophic storm hit in 1991. The boat and the six crew members disappeared in 30 to 40-foot waves.  Many family members of the crew were not pleased with the movie’s depiction of the accident, but ultimately lost the lawsuits brought against the studio. 

A perfect storm is a rare combination of circumstances or events that together form a catastrophic or powerful event.  This was the case for the Andrea Gail. Evidence about the influenza (flu) season in the Southern Hemisphere is indicating problems for our flu season in the United States.  Are we heading into a perfect storm?

Globally, there are two flu seasons. One in the Southern Hemisphere, which is followed by a flu season in the Northern Hemisphere.  The World Health Organization (WHO) each year provides a recommendation on the composition of the flu vaccines for both hemispheres. Within the US, the CDC makes the recommendation for the composition of the flu vaccine as part of the Northern Hemisphere.  This year the CDC and WHO recommendations are the same. 

There are multiple manufacturers and different mechanisms for the development of the vaccine, but all of them contain the same four recommended strains.  The vaccines are quadrivalent, meaning they contain two strains of influenza A and two strains of influenza B.  Flu vaccines can be developed as an egg-based immunization or they can be manufactured from a cell culture or be recombinant based.  This provides options especially if someone has a serious egg allergy. 

The flu vaccine is recommended for those 6 months of age and up.  For those over the age of 65, the current recommendation is to receive one of three vaccines, which provide either a higher level of antigens (stimulate immune system) or an adjuvant to stimulate the immune system. An adjuvant is an ingredient added into the vaccine producing a higher immune response.  

The three vaccines recommended for 65 years and older are Fluzone High-Dose, Fluad, or Flublok.  Fluzone and Fluad are egg-based and Flublok is a recombinant vaccine.  Flublok and Fluzone High-Dose contain more antigen and Fluad contains the adjuvant. These vaccines contain the same four strains as the standard dose. These vaccines have shown an increased protection by 24% over standard dose vaccines in those 65 years and older in a New England Journal of Medicine study.  

Timing of the flu vaccine is very important. A study showed a 14% reduction in hospitalization in those 65 years and older if they received their flu shot in September.  A typical flu season starts spreading in October with a peak in cases occurring in December, January, and February.  It takes two weeks after receiving the vaccine for it to take full effect for protection from the flu.  Keep that in mind when timing your vaccine.  Now would be a good time to get the flu shot for protection in October.  The flu vaccine provides protection for about six months.  So, the protection should last through the peak winter season.  

The flu vaccine protects from just more than the flu.  Evidence from a 2021 JAMA Neurology study demonstrated a two times higher risk of getting Parkinson’s disease 10 years after having an influenza infection.  The flu vaccine can help to reduce the risk.  The flu can increase the risk of having a stroke or a heart attack within one week of being sick.  A study published in Neuroepidemiology provided strong evidence for a reduction in these events when individuals received the flu vaccine.

The flu vaccine can be given on the same day as a COVID-19 vaccine including the new bivalent vaccine.  When the COVID-19 vaccines were first administered, we did not recommend the vaccine be given at the same time with any other vaccine.  This information has changed and we can now provide both in one visit.  

Why the perfect storm related to the flu?

The Southern Hemisphere flu season is before the Northern Hemisphere season.  This provides an indication of what flu will look like in the United States. Australia in the Southern Hemisphere is experiencing the worst flu season in five years. Australia is reporting a twindemic this year with a surge of COVID-19 with the flu.  

In evaluating the Southern Hemisphere data, the public health experts at Johns Hopkins are calling these viral surges a perfect storm.  The three contributing factors were identified for the early peak season in Australia, which was almost two months earlier than they normally experience.  The second factor was the rapid spread of the flu virus because a large portion of the population was not vaccinated yet.  The last contributing factor was the surge in Omicron COVID-19 including over 47,000 new cases per day overlapping with the flu.  

Avoid the perfect storm! Come see us at ONU HealthWise for more information on the bivalent vaccines and the influenza vaccine.

ONU HealthWise is offering COVID-19 vaccines as well as flu shots Monday through Friday from 10:00 a.m.-5:00 p.m. The bivalent COVID-19 vaccine is available. Clinics are Monday through Friday from 4:00-6:00 p.m. Please call the pharmacy for an appointment outside of those times or to get more information. 

ONU HealthWise Pharmacy