The flu
The news reported that classes in public schools in the National Capital Region were suspended because of a rise in influenza-like illnesses (ILI). This was later followed by an announcement that the suspension was also meant to include safety checks because of the recent earthquakes. The Department of Health (DOH) recently stated that there was no flu outbreak.
Mixed messaging resulting from a lack of coordination regarding health concerns always brings about a certain level of alarm. It doesn’t help matters to point fingers, which only adds to the confusion, or worse, to the noise by making generalizations from baseless assumptions. If there are lessons to be learned from the pandemic and the recent events, they are the importance of being prepared and gathering the right information from credible sources.
To provide clarity, let’s define influenza and influenza-like illness. Influenza is a specific viral infection, while influenza-like illness is a broader term that encompasses symptoms that resemble the disease and are caused by other viruses, such as the respiratory syncytial virus and rhinovirus, to name a few. Common manifestations may include fever, cold, sore throat, cough, headache, and body malaise. Testing is needed to identify and confirm the presence of the virus, either through the use of rapid antigen kits or multiplex molecular assays.
ILI is a notifiable disease. The DOH, in coordination with the Research Institute for Tropical Medicine, which is our national reference laboratory, is the responsible agency tasked with routine surveillance and virologic confirmation of ILI cases and is part of the WHO Global Influenza Surveillance and Response System laboratory network. This piece of information may be of use to those who may be wondering where the numbers cited by the DOH are coming from, and to provide a form of assurance that we are capable of detecting both circulating and new influenza strains. There are limitations, such as delays or underreporting, but keep in mind that not all patients with ILI come for consult or are tested. Fortunately, there are diagnostic tests available, as mentioned above, that are readily available in several institutions but come with a considerable cost. Pooling these data together may help bridge the gap for a better picture of the incidence of influenza and other viruses that are circulating in the community.
In a study by Lucero et al., an analysis of national influenza surveillance data from 2006 to 2012 showed that influenza cases may occur throughout the year, but are more commonly seen from June to November, reflecting seasonality. The Philippine Society for Microbiology and Infectious Diseases (PSMID) Flu Task Force Report released last Oct. 17, included data from all age groups and was collated from the surveillance reports of infection control committees of four tertiary hospitals in Metro Manila. Among 6,000 individuals who were tested through rapid antigen kits or multiplex PCR assays, the influenza positivity rate rose from 39 percent in August and September to 42 percent in the first week of October. This means that for the majority who presented with ILI symptoms and were tested, a considerable number were due to influenza, which is indicative of ongoing community transmission.
Questions have arisen regarding treatment with antivirals and preventive strategies. Maybe you have heard that the supply of oseltamivir is running low, and people are doubting the importance of vaccination after they fell ill, even after receiving the vaccine.
To address the first concern, in general, oseltamivir, an antiviral, is indicated for those who are hospitalized or at severe risk for complications or progression of the disease, such as the very young, the elderly, and individuals who are immunocompromised. It is imperative that a physician’s advice is sought for proper assessment.
With regard to vaccination, in line with local recommendations, it must be administered before the start of the influenza season, ideally in April to May. While no vaccine claims to be 100 percent effective, vaccination provides benefits against severe complications and hospitalization, especially if the circulating strains match those that are included in the vaccine. Strains may vary from year to year, and immunity wanes. This is the reason why annual flu vaccination is warranted.
Advisories not only from PSMID but also from the Pediatric Infectious Disease Society of the Philippines have been released. While the latter is a guide to clinicians, both societies uphold the importance of vaccination and adherence to infection control measures.
If you have not been vaccinated and are eligible, there is still time for you to get one. If you are feeling ill, refrain from reporting to work or school or going to crowded places. Wash your hands and cover your cough or wear a mask if needed. You can transmit the virus 24 hours before manifesting symptoms and continue to shed the virus until the seventh day of illness or longer if you are immunocompromised.
Get enough rest and stay hydrated. Seek consult if needed.
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