A Surprising New View Of Flu: Rethinking The 1918 Pandemic

Giving treatment to influenza patient at the U.S. Naval Hospital. New Orleans, Louisiana, Circa 1918. (Navy Medicine/Flickr)

Giving treatment to influenza patient at the U.S. Naval Hospital. New
Orleans, Louisiana, Circa 1918. (Navy Medicine/Flickr)

By Richard Knox
Guest Contributor

Ever since 1918, the world has wondered why a novel flu virus touched off an explosive pandemic that killed as many as 50 million people – most of them healthy young adults — and whether it could happen again.

Flu researchers today report some surprising news: They say the 1918 virus was no super-bug. Instead, its deadliness had to do with how very different it was from the flu viruses circulating 25 or 30 years before, when the young adults of 1918 were first exposed to the flu.

Indeed, the new study says it’s that first childhood exposure that determines how people will fight off – or fall prey to – every other flu virus they will encounter in a lifetime.

That’s a very different way of looking at flu, both pandemics and regular seasonal outbreaks.

Much of the current emphasis is on the virus itself. Scientists around the world are doing controversial “gain-of-function” experiments – adding and subtracting pieces of genes from flu strains to see what mutations make some viruses so virulent.

Instead of focusing on flu virus itself, authors of a paper published Monday in the Proceedings of the National Academy of Sciences say scientists and public health experts should pay attention to the vulnerabilities of different age groups to any new flu virus – and how those immune gaps might be filled in by targeted vaccine strategies.

“Childhood exposure seems to give kick-ass immunity to that kind of flu virus for many, many decades,” says evolutionary biologist Michael Worobey of the University of Arizona, the paper’s lead author. Continue reading

CDC: Flu Vaccine Virtually Ineffective For Those Over 65

After all that public health nagging about getting a flu shot, it turns out this year’s vaccine was not only just 56% effective against the virus for those over 6 months old, according to the CDC, but it was virtually ineffective for folks over 65, a particularly vulnerable population.
flu shot

USA Today reports on today’s CDC’s update:

This season’s flu vaccine was almost completely ineffective in people 65 and older, which could explain why rates of hospitalization and death have been some of the highest ever recorded for that age group, according to early estimates released Thursday by the Centers for Disease Control and Prevention.

For people under 65, getting vaccinated this season reduced the need to go to the doctor for the flu by one-half to two-thirds. Continue reading

Flu Season Sorbet, Or The Frozen Hot Toddy

A dram of whiskey (Wikimedia Commons)

A dram of whiskey (Wikimedia Commons)

Old-timers know this remedy well: When you feel a bug coming on, you boil up some water and add honey, lemon and whisky — variations can include cayenne pepper — and voila, a germ-fighting Hot Toddy. You down it, you sweat through your clothes, you change them, you go to bed and wake up good as new. (That’s the theory, anyway. This isn’t exactly an evidence base, but it seems to work for my dad.)

Now, ABC news reports that the age-old Hot Toddy is being offered as a sorbet billed as soothing for flu sufferers:

Enter Jeni’s Splendid Ice Creams. The Ohio-based company’s Influenza Sorbet won’t cure the flu, but it will definitely make you feel better, said Jeni Britton Bauer, the company’s founder and president.

The Influenza Sorbet contains honey, ginger, orange juice and lemon juice. And if that weren’t enough, it also has Maker’s Mark bourbon and cayenne pepper. Continue reading

More On Google Flu Trends: Brilliant Predictor Or Cautionary Tale

In case you missed this excellent post on whether ‘Google Flu Trends’ is prescient or wrong, you’ve got a second chance to hear the details today on Radio Boston.

The segment features MIT computer science graduate student Keith Winstein (and my former colleague at The Wall Street Journal) exploring what might account for the dramatic divergence between Google’s flu data and the official CDC flu numbers. “This could be a cautionary tale about the perils of relying on these “Big Data” predictive models in situations where accuracy is important,” Winstein said in an interview with CommonHealth.

Here are some more of his thoughts:

The issue that’s interesting from the computer science perspective is this: Google Flu Trends launched to much fanfare in 2008 — it was even on the front page of the New York Times — with this idea that, as the head of said at the time, they could out-perform the CDC’s very expensive surveillance system, just by looking at the words that people were Googling for and running them through some statistical tools.

It’s a provocative claim and if true, it bodes well for being able to track all kinds of things that might be relevant to public health. Google has since launched Flu Trends sites for countries around the world, and a dengue fever site.

So this is an interesting idea, that you could do public health surveillance and out-perform the public health authorities [which use lab tests and reports from ‘sentinel’ medical sites] just by looking at what people were searching for.

‘It is often a problem with computers that they only tell us things we already know.’
Google was very clear that it wouldn’t replace the CDC, but they have said they would out-perform the CDC. And because they’re about 10 days earlier than the CDC, they might be able to save lives by directing anti-viral drugs and vaccines to afflicted regions.

And their initial paper in the journal Nature said the Google Flu Trends predictions were 97% accurate…

That was astounding. However, it is often a problem with computers that they only tell us things we already know. When you give a computer something unexpected, it does not handle it as well as a person would.

Shortly after that report of 97% accuracy, we had that unexpected swine flu, which was a different time of year from the normal flu season, and it was different symptoms from normal, and so Google’s site didn’t work very well.

[Carey asks: And the accuracy went down to 20-something percent?]

To a 29 percent correlation, and it had just been 97 percent. So it was not accurate. Continue reading

Doctor’s Dispatch: Three Unusual Aspects Of This Year’s Early Flu


The flu is hitting early and hard this year in Massachusetts and elsewhere.

We share the official data as it comes out. (See that rocketing red 2013 line in the CDC chart above.) But now for a fresh dispatch from the medical trenches — that is to say, in this case, the infectious diseases division of Mount Auburn Hospital. Dr. Robin Colgrove, a virologist by training, underscores that he’s passing along purely anecdotal reports — but they may provide early warning for both doctors and patients. We spoke today; his observations, lightly edited:

Clearly we’re seeing a lot more flu a lot earlier than we usually do. A few other things are unusual this year.

1. Despite the vaccine

It seems to us that we’re seeing more confirmed cases of influenza, using the rapid antigen test, in people who’ve been vaccinated than we would normally see. I was speaking about this at grand rounds the other day and among the primary care doctors in the audience, a number were saying the same thing.

Dr. Robin Colgrove

Dr. Robin Colgrove

Those cases have been mostly mild cases and it may be they have partial protection from the vaccine. (Flu vaccine efficacy has been controversial among researchers for quite some time. In ideal conditions with young healthy people, it may be 80-90 percent effective, but when epidemiologists look at the real world, the numbers have been much lower, maybe 50-60 percent efficacy.) Even in the best years, some people who get vaccinated also get influenza, but they are probably less likely to have severe and prolonged illness.

2. Atypical symptoms

A related point: There seem to be more people this year with atypical symptoms. Clinicians tend to be good at identifying flu: an abrupt high fever and severe malaise, and upper and lower respiratory symptoms. That pattern in the middle of a flu outbreak is almost always flu. Now we’re seeing people [who test positive for flu] with no high fever, maybe scratchy throats, possible gastro-intestinal symptoms. Continue reading

Health Officials Report First Flu-Related Death In Boston This Year

An influenza virus

From the Boston Public Health Commission:

A Boston man in his forties is the first death linked to influenza this year in the city, the Boston Public Health Commission said today. The patient had underlying health conditions.

“It is with great sadness that we have learned of the death of a Boston resident from illness associated with the flu. We extend our deepest sympathy to his family and friends,” said Barbara Ferrer, executive director of the Boston Public Health Commission.

Boston health officials recommend that everyone take the following steps to reduce their risk of illness: Continue reading

Boston Health Commission: Sharp Rise In Flu, Young People Hardest Hit

Flu cases are up, particularly among children under five

The Boston Health Commission reports that flu cases are sharply up, particularly among young kids. Here’s the report on the Commission’s web site:

BOSTON – Influenza-like illness in Boston has been increasing steadily for the past three weeks, with children under the age of 5 accounting for a disproportionate share of cases, Boston Public Health Commission officials said today.

Emergency room visits for flu-like illness increased 91 percent – from 1.1 percent of all visits the week ending Dec. 4 to 2.1 percent during the week ending Jan 8, officials said. All age groups except adults 65 and older are showing increased influenza-like illness, but the greatest rise has been among children less than 5, in whom influenza-like illness accounted for nearly 7 percent of all emergency department visits in that age group.

“If we’re seeing this level of flu activity in children, then adults are likely to soon follow,” said Dr. Anita Barry, director of the Infectious Disease Bureau at the Boston Public Health Commission. “Influenza often starts in a community in children, then spreads to adults.”

Commission officials, analyzing data Boston hospitals are required to report to them, also found a significant increase in the past two weeks in laboratory confirmed influenza cases. Of confirmed cases, 21 percent were in people younger than 5, and 15 percent in 5-to-17 year olds.

Continue reading