DUR: Influenza 1999-2000
Viral influenza infections are responsible for significant morbidity and mortality worldwide. In the United States alone, an average of 20,000 flu-related deaths occur annually and estimates of the economic loss range from $3-5 billion each year, and reach as high as $12 billion.
The flu is a respiratory disease that has its greatest impact on traditionally high-risk groups including the elderly, the very young, those with certain chronic medical conditions (such as asthma and chronic obstructive pulmonary disease) and the immunocompromised, though individuals outside these groups still suffer substantially.
The primary prevention for the flu in any season is vaccination. Based on assessments by the Center for Disease Control (CDC), vaccination for influenza is severely underutilized, partially due to public misconceptions, including the idea that the vaccine can cause the flu. Use of vaccination is especially important in health care providers, the high-risk groups mentioned above and their close family members.
Two new influenza treatments (neuraminidase inhibitors) are available this year, but they are only effective in reducing the duration of the flu by about 1 to 1.5 days. The protective effect only occurs in those who actually have the flu virus (A or B) and who start treatment within the first 48 hours of initial symptoms. Similarly, early treatment is needed if amantidine or rimantidine are used for treating influenza A.
Current Situation
During this current flu season, regular monitoring performed by
the CDC has found nothing to suggest a pandemic. However, all
but a handful of states in the U.S. are reporting some level of
flu activity. Furthermore, during the week ending November 6,
1999, the proportion of all deaths due to flu/pneumonia was
greater than the established threshold limit (7.4 percent vs.
6.5 percent) for the 7th week in a row.
In the Medi-Cal population, it is too early in the flu season to report any definitive outcomes. While the flu has a considerable secondary impact, the statistics that are easiest to track and count are the rates of flu-related diagnosis. This gives a narrower view of the overall impact of influenza but still allows for comparison. Last year, during the period from October 1998 to May 1999 (typically considered the flu season), over 4,000 recipients were diagnosed with the flu or flu with pneumonia and over 28,000 recipients were diagnosed with the flu and accompanying illnesses other than pneumonia. This contrasts with the period from May to October 1999 (typically considered outside the flu season). In this period, only 990 recipients were diagnosed with the flu or flu with pneumonia and just over 7,500 recipients were diagnosed with the flu and accompanying illnesses other than pneumonia. This difference in flu-related illness illustrates that influenza has a substantial impact on the Medi-Cal population.
Role of the Provider
The changing features of illnesses related to influenza, as well
as the new treatment options available, make the role of the
health care professional an increasingly vital one. Activities
in this changing role include education and advocacy. Providers
should educate recipients by presenting current ideas on the
prevention and management of influenza-related illness while
also discrediting current misconceptions. Providers should also
use disease management tools such as vaccination, especially in
high-risk groups. The impact of influenza on the population is
enormous and providers need to assume leadership now more than
ever.
Resources for Current Information
Center for Disease Control – Influenza Web site:
www.cdc.gov/flu/
Journal of the American Medical Association – Web site:
http://jama.ama-assn.org/
Dr. Tim Albertson contributed to this article.