Vaccines, continuous advancement key to stopping future influenza outbreaks

Mar 24, 2018

As the current fatal flu season winds down, how to handle the next is on many public health officials’ minds.

Pediatrician Dr. Howard Markel is a social and cultural historian of medicine, public health and epidemics and director of the Center for the History of Medicine at the University of Michigan. He spoke with "Take Care" to discuss his research and how it can be used to prevent future flu outbreaks as bad as this season’s.

"Between a universal vaccine and better, quicker methods of making flu vaccine...I'm confident that we will perfect the system."

Since “outbreak” and “epidemic” have been used to describe this flu season, Markel said it is important to distinguish between the two terms that are often seen as synonymous but are actually quite different.

“An outbreak is really a generic kind of a word,” Markel said. “It doesn’t have a real public health definition attached to it. It simply means there’s a case or a number of cases of a particular contagious disease in a particular area at that time. An epidemic is having more episodes of that disease than you expect in a normal year.”

By those definitions, Markel said this year’s flu season could be considered an epidemic.

“We’re seeing more cases of H3N2 strain than we predicted and that we have seen in the past,” Markel said. “It did spread throughout the United States quite quickly.”

Markel said this year’s flu epidemic is slightly worse than the past 10 to 20 years, with a total of about 128 pediatric deaths thus far.

He said in an average flu season, 25,000 to 50,000 people die from the winter seasonal flu, clustered mostly around the very old and very young. These populations, Markel said, generally have immunological difficulties that make them more susceptible.

This is especially why it is important to get the flu vaccine regularly, Markel said.

“I can’t emphasize enough how important it is to have a flu vaccine every year,” Markel said. “Even this year, where we don’t have H3N2 protected as much in that flu strain, it still covers you against a lot of strains of flu and is worth taking.”

The good news, he said, is that this year’s influenza season did not cause nearly as much damage as seasons several decades ago because of advancements in awareness and modern medicine.

Markel said the worst influenza outbreak was in the 1918-1919 season when it spread around the world. It was a particularly deadly strain, and most people at that time did not have a sufficient immunological defense for that strain. In America alone, there were 500,000 to 650,000 deaths from the flu that season, equivalent to about 1-2 percent of flu cases.

Now, Markel said the traditional case fatality rate is .01 percent or less thanks to developments in a more effective and widespread vaccine.

"There are sometimes side effects to vaccines, but the risk of taking a proven, safe vaccine are infinitesimal to the risk of getting the disease that vaccine is preventing against."

The reason why the effectiveness of the flu vaccine fluctuates is largely because of the process used to create it, Markel said. He explained the world’s leading flu experts get together about six months before flu season begins, look at the flu strains going on south of the equator and make their best guess that those same strains will come in the winter to the northern hemisphere. From there, it takes up to six or more months to make all these allotments of flu vaccine, especially since the process involves growing the vaccine in millions of chicken eggs.

“This year, the prediction was not nearly as accurate as it has been in the past,” Markel said. “We’re getting better about these predictions, to be sure, and we’re also developing faster methods of making flu vaccine so that decision can be made not six months, but hopefully five, four, three and two months down the road. And that’s where a lot of the technology is going.”

In addition to this current focus on development, an issue on many American’s minds is the prospect of a universal flu vaccine. Markel said this has been sought after for a long time, but there is still more work to be done.

“[The universal flu vaccine] has been the Holy Grail for some time,” Markel said. “It’s hard to have every single strain in a vaccine because it increases the volume of fluid you have to put into somebody’s muscle…But that is being worked on, and my hope is that will be the case. Between a universal vaccine and better, quicker methods of making flu vaccine…I’m confident that we will perfect the system.”

One of the things that can counteract progress in this area is the increased spread of influenza due to modern travel advancements like jet planes, Markel said. The biggest issue he sees as a pediatrician is people who do not like or trust vaccines.

“To be sure, no vaccine is perfect,” Markel said. “There are sometimes side effects to vaccines, but the risk of taking a proven, safe vaccine are infinitesimal to the risk of getting the disease that vaccine is preventing against…These have been tested at an incredible rate, and they are remarkably safe things.”

Markel said there are also obstacles to advancement on a monetary level.

“Various public health officers at the municipal, state and federal levels in the United States are remarkably talented, professional and dedicated people,” Markel said. “Budgets have been cut on a ridiculous level to these various public health agencies, and they continue to be. And that, frankly, is more than silly. It’s downright dangerous.”

Markel said that just as funding to a fire department would not be cut simply because of a lack of fires in recent years, funding for public health agencies should not be cut due to a decrease in particular illness. That, he said, is exactly when another outbreak will come back.

“We need to prevent and think about infectious diseases 24 hours a day, seven days a week, 365 days a year,” Markel said. “An outbreak anywhere can easily go everywhere, and that means we need to be on guard.”