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How Flu Strains are Selected for the Seasonal Flu Vaccine Each Year

March 14, 2018 6 comments
SereseMarotta_FamiliesFightingFlu-300x300by Serese Marotta, Chief Operating Officer of Families Fighting Flu 

 

The Centers for Disease Control and Prevention (CDC) recommends that everyone ages 6 months and older, with rare exception, get an annual flu vaccine. But did you ever wonder how the flu strains are selected for the seasonal vaccine every year?

A lot more goes into the decision than you might think!

Seasonal flu vaccines contain three (trivalent) or four (quadrivalent) flu strains. Because flu is a complex, dynamic virus that is constantly changing, there are more than 100 monitoring centers in over 100 countries located across the globe that monitor flu activity on a year-round basis to identify which flu strains are circulating.

These centers receive and test thousands of influenza virus samples from patients. They then send representative virus samples to five World Health Organization (WHO) Collaborating Centers for Reference and Research on Influenza, located in Atlanta, GA (i.e., the CDC); London, United Kingdom; Melbourne, Australia; Tokyo, Japan; and Beijing, China. The surveillance data gathered from these samples, along with other information, are used to make a recommendation on which flu strains should be included in the upcoming year’s seasonal flu vaccine.

Contrary to popular belief, the flu vaccine is not just based on last year’s flu viruses. Three general sources of information are considered in the selection of flu strains for the seasonal flu vaccine:

 

  • Surveillance data represents information gathered from the influenza monitoring centers that collect virus samples from patients. Experts use this information to determine which flu strains are circulating and where.
  • Laboratory data refers to antigenic characterization of the flu viruses in a laboratory, which simply means the identification of specific molecular structures on the influenza virus that are recognized by our immune systems and elicit an immune response. The antigen is the “invader” (i.e., in this case, the flu virus) that causes our immune systems to launch an attack through the formation of specific antibodies. Antibodies are what our bodies produce following flu vaccination so that it’s properly “armed and ready” to recognize and fight that specific flu virus if and when we’re exposed.
  • Genetic characterization of flu viruses may also be considered in the selection of vaccine strains. This refers to “mapping” of the genetic codes that make up each flu strain, which allows the experts to monitor changes in circulating flu viruses.
  • Data from clinical studies on vaccine effectiveness are also considered.

With this robust amount of data in hand,  the WHO then meets twice per year to make a recommendation for flu vaccine strains for the upcoming season: once in February to recommend flu strains for the Northern Hemisphere seasonal flu vaccine, and again in September to recommend flu strains for the Southern Hemisphere seasonal flu vaccine. But it doesn’t stop there! Each country then considers the WHO recommendation, reviews the available information, and makes their own decision on which flu strains to include in their country’s seasonal flu vaccine.

In the U.S., once the WHO makes their recommendation for flu strains for the upcoming year’s seasonal flu vaccine, an advisory committee from the U.S. Food and Drug Administration (FDA) meets in February or March to review the WHO’s recommendation and supporting information and vote on the final selection of flu strains. The role of the FDA is an important one, because once the flu strains are selected, the FDA produces materials in their laboratories that are critical for actually producing the flu vaccines. For instance, the FDA provides vaccine manufacturers with the seed viruses and the potency reagents needed to ensure that flu vaccines made by one manufacturer are similar to those made by another. The FDA also conducts quality control measures by ensuring that batches (referred to as “lots”) of flu vaccines released by the manufacturers meet appropriate standards and reflect the correct genetic composition.

Following the selection of flu strains for the seasonal vaccine and receipt of the appropriate materials and information from the FDA, private sector manufacturers begin the process of making the vaccines. All flu vaccines in the U.S. contain the same flu strains, i.e., the flu vaccine available in New York contains the same three or four flu strains as the vaccine that’s available in California. And it’s important to remember that all flu strains (influenza A or B) can be potentially dangerous, regardless of an individual’s health status, and are capable of causing serious illness, hospitalization, or even death.

Influenza is a vaccine-preventable disease that has the ability to affect all of us around the world, which is why it remains such a pressing global public health issue. Seasonal flu vaccines may not be perfect, but given the complexity of flu viruses and their ability to change and mutate frequently, the U.S. does have a solid, scientifically-based approach for flu vaccine development. While much research and development is being done for a universal flu vaccine, the possibility of this technological advancement is still many years off.  In the meantime, let’s not forget all the hard work and research that goes into helping to protect us with the currently available seasonal flu vaccines. And if you’re wondering “why bother” with a flu vaccine that may be substantially less than 100% effective, let’s remember that something is better than nothing, especially when it comes to your life or the life of a loved one.

More in-depth information on how flu strains are selected for the seasonal flu vaccine every year are available from the CDC and FDA


FFF logo_R copyAbout Families Fighting Flu:  Families Fighting Flu (FFF) is a national, nonprofit, 501(c)(3) volunteer-based advocacy organization dedicated to protecting the lives of children and families by helping to increase annual influenza vaccination rates, especially among children 6 months and older and their families.  Our members include families whose children have suffered serious medical complications or died from influenza, as well as healthcare practitioners and advocates committed to flu prevention.  In honor of our children, we work to increase awareness about the seriousness of influenza and to reduce the number of hospitalizations and deaths caused by the flu each year.

Is This Season’s Flu More Severe Than Usual or Just Highly Active?

January 13, 2018 10 comments

At this point in the flu season people often wonder if all the media hype is part of an orchestrated effort to panic people about flu, or if it is really signaling serious concern.

There are lots of flu stories in the news these days.  From reports of  74 Californian’s who’ve died from flu – five times the number seen at this point last year – to 13 school districts in TX closing due to the high number of flu cases among students, we’re left to wonder….

Is this year’s flu season more severe than usual or just highly active at the moment?

A recent CDC media briefing has helped clarify the following concerns regarding the latest flu activity in the U.S.: 

Right now, flu is widespread everywhere.  

One of the most notable differences between this season and others is in relation to the geographic spread of flu. This is the first time over the course of 13 years of surveillance data that the entire nation is experiencing widespread flu at the exact same time, as can be noted by the color of CDC’s flu surveillance map below.

FluWeeklyReportActivity is severe right now.

 

One of the ways the CDC tracks influenza activity is to record the number of lab confirmed cases of flu and hospitalizations by week. What they’ve noted is a very rapid increase in the number of people seeing their healthcare providers for flu diagnosis, along with a rapid rise in the numbers of people being hospitalized with lab confirmed flu. For instance, this week’s surveillance data indicates that there’s been 22.7 hospitalizations per 100,000 people in the U.S., which is up considerably from the 13.7 number recorded last week.

So far this season, influenza A (H3N2), has been the most prevalent strain in circulation. Unfortunately, historically it is often the strain linked to more severe illness, especially among children and older individuals above the age of 65. Interestingly enough, the current flu surveillance observations seem to be in line with two more previous H3N2 dominant seasons; the 2014-2015 and 2012-2013 seasons.WHOPHL02_small

Additionally the hospitalizations so far this season seem to be in line with other H3N2 predominant seasons, with the highest rates among those over the age of 65, those between 50-64, and children under 5 years of age.

Flu can cause mild disease in some, but severe disease and death in others.

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Sadly, there have been as many as 30 pediatric deaths so far this season. While children are at great risk, there are plenty of reports of otherwise healthy adults who have been hospitalized or died from flu this season.

Peak season may have started early, but there are many more weeks to go.

Speaking to the media on behalf of the CDC on Friday, Dr.  Jernigan explained,

“If we look at the timing of the season, even if we have hit the top of the curve or the peak of the seasonal activity, it still means we have a lot more flu to go.”

He went on to suggest that there will likely be at least 11 to 13 more weeks of elevated influenza activity this season, before activity begins to subside. Even though it can take about two weeks for protection from vaccination to set in, Dr. Jernigan explained that we still have a lot of flu season to get through and that vaccination efforts should continue as long as influenza viruses are circulating.

While we are seeing a lot of H3N2 circulating now, we are also seeing H1N1 show up in states that have already had H3N2 activity. And we know that B viruses also tend to show up later in the season. Each of these strains are covered in the vaccine, so flu vaccination now can still help to prevent, or lessen the severity of flu throughout the remainder of the season.

Vaccination is our best defense.  

While flu vaccination is far from perfect, it remains our best defense. Not only can it help prevent flu, but it can also help lessen the severity of symptoms if a vaccinated person does end up getting infected.  This can reduce the chances of an individual being hospitalized or dying from flu.

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In fact, a recent study showed that influenza vaccination reduced the risk of flu-associated death by 65% among healthy children and by 51% among children with underlying high-risk medical conditions. Another study indicated that many older adults benefit from repeated flu vaccination. When getting vaccinated in both the current and previous seasons, the study found flu vaccination was 74% effective in preventing ICU admissions in older individuals and 70% effective in preventing deaths among older adults.

Manufacturers are reporting that they’ve shipped more than 151 million doses of flu vaccine this season, so there shouldn’t be a problem finding a flu vaccine in your area.  Simply refer to the flu vaccine finder for assistance.

We won’t know preliminary flu vaccine effectiveness until February.  

Read more…

Most Popular Posts of 2017 Address Flu, Vaccine Safety, Disease Outbreaks and Maternal Vaccines

December 27, 2017 Leave a comment

As we look back at the success of the Shot of Prevention blog this past year, we’re especially grateful to our blog readers, contributors and subscribers.

Whether you’ve shared a post, shared your story, or shared your expertise, we recognize that our growth and success would not have been possible without your support. Thanks to you, our posts are helping people to make important immunization decisions for themselves and their families.

In these final days of 2017, we hope that you will revisit the top ten posts from the past year and share them with others in your social networks.  

1)  3 Things I’ve Learned Since Losing My Son To Flu

JoJo as Spiderman copy

 

It’s been eight years since Serese Marotta of Families Fighting Flu lost her five-year-old son, Joseph, to the flu. She’s not the same person she was eight years ago. Today, she sees things through a different lens as a bereaved parent. Losing a child is devastating, but she feels a responsibility to pass on some of the lessons she’s learned through her personal tragedy, which she does in her article here.

 

2)  10 Things Parents Who Don’t Vaccinate Their Kids Should Know

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In some cases, children who have suffered with a preventable disease were unvaccinated.  This could be the result of parents who did not have access to certain vaccines, parents who willfully refused a particular vaccine, or it could because they were too young to be fully vaccinated. After Riley Hughes passed away in the arms of his parents when he was just 32 days old, his parents made it their mission to educate people about the dangers of whooping cough, and promote the need for vaccination. In a plea to parents who still choose not to vaccinate, Riley’s mom posted the following list of “things to know” here.

 

3)  Even With All Our Modern Medicine I Watched My Sister Die From Flu

lizaLiza was healthy and only 49 years old when she contracted flu. She sought medical care early. She was cared for at a good hospital in a major city.  She had no other infections. And she was unvaccinated. To say that her death was a surprise to her brother is an understatement.  And yet her brother, Dr. Michael Northrop is a pediatric intensive care physician. His story traces the clinical course of Liza’s illness, and expresses the grief he felt as he helplessly watched his sister  succumbs to an illness that even modern medicine can’t always save us from. To read his story, click here.

 

4) Take It From This Mom, The Flu Is No Joke

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After her four-year old daughter is rushed to the emergency room, she writes a warning to others.  “The words just the flu need to be eradicated from our lexicon. Because this? This is the flu. There’s no ‘just’ about this. It was terrifying. It was the most helpless I’ve ever felt as a mommy. And it was potentially deadly.  All because I was too busy to get our flu shots.” Read the full story here.

 

5) Flu Vaccine Benefits Go Beyond Effectiveness of One Strain

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Amid speculation about how effective the flu vaccine will be this year, Dr. LJ Tan addresses some of the public’s most prominent concerns. He starts with a basic explanation of flu and flu vaccines, discusses the factors that play into vaccine effectiveness, and addresses rumors about this year’s flu vaccines. To gain a better understanding, read more here.

 

6) How My Sister Helped Save My Daughter From Whooping Cough

As a Medical Director responsible for Community Health and Prevention at Intermountain Healthcare in Salt Lake City, Utah, Tamara Sheffield is a huge advocate for SOTI_Pertussis_FBimmunizations. She is especially appreciative of maternal immunizations, which she considers one of today’s most promising new preventive health strategies. But her reasons go beyond her professional understanding of how maternal flu and Tdap vaccines pass on protective antibodies to newborns. Her surprising story ends with a twist involving her own daughter who nearly died from whooping cough when she was just three weeks old. Read it here.

 

7) Multiple Vaccine Oversight Committees Ensure Our Public Safety

While 2017 brought a lot of uncertainty about health services in this country, Dr. Dorit Reiss, Professor of Law at the University of California Hastings College of Law, explains 178_NFID_Vaccine_Safety_infograms_2_FINALwhy the public should remain confident in vaccine safety. In this post she reviews the specific ways in which vaccine safety is regulated in the U.S., and the oversight committees that monitor vaccines pre and post licensure. Her scrutiny explains that it would be hard to hide a problem if one existed, and that when problems do occur, they are quickly discovered and addressed. To learn more about vaccine safety oversight, read the full post here.

 

8) Why Should Vaccinated Individuals Worry About Measles Outbreaks

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With various measles outbreaks reported across the U.S. and the world in 2017, it’s important to understand why vaccinated individuals should be concerned. Many people mistakenly think that vaccinated individuals are not at risk during outbreaks. However, when it comes to infectious diseases like measles, one person’s decision not to vaccinate can negatively impact the health of others and this post explains how.

 

9) Five Things I’ve Learned About Vaccines Through 21 Years of Parenting

HowHerdImmunityWorksWe’ve all received plenty of unsolicited advice about how to care for our children. However, when making health decision for our families we should rely on evidence based research and credible information from reputable sources. In this post, I share five of the most important things I’ve learned about vaccines through my journey as a parent and immunization blogger. Spoiler alert: it begins with science and it ends with action.

 

10) Five Things Expectant Parents Need to Know About Vaccines in Pregnancy

SOTI-PregnancyCoverFBWhile well-meaning friends and family will provide a constant stream of advice on what to do and what to avoid while pregnant, all this information can be overwhelming. Expectant couples should rely on credible medical sources such as the CDC, the American College of Obstetricians and Gynecologists (ACOG), and the American College of Nurse Midwives. This blog post reviews the 5 things these trusted organizations say about the flu and Tdap vaccines routinely recommended during pregnancy. Learn more here.

 

We hope you have found our content to be engaging and informative.  We have exciting changes planned for Shot of Prevention in 2018 in hopes of engaging even more people in these important immunization conversations in the years to come.  

If you have suggestions for topics you would like us to address in 2018, or you would like to contribute a guest post for publication, please email shotofprevention@gmail.com.

Also, if you want to receive important immunization news and join in our online discussions, be sure to “Like” our Vaccinate Your Family Facebook page, follow our @ShotofPrev Twitter feed and subscribe to Shot of Prevention by clicking the link on the top right of this page.

Thanks again for your continued support and best wishes for a happy and healthy new year!

How One Man is Credited With Saving 8 Million Lives a Year  

November 17, 2017 Leave a comment

Saving 8 million lives a year may seem like a stretch, but not for Dr. Maurice Hilleman.

Hilleman_scope2Hailed as one of the world’s greatest scientists, Dr. Hilleman helped develop 9 of the 14 routinely recommended vaccines in the U.S. And in 1957, he was the first person to successfully predict an influenza pandemic when he read of an outbreak occurring in Hong Kong. This led him to develop a vaccine for the U.S. that likely saved hundreds of thousands of lives. His life spanned one of the most productive periods in vaccine innovation, and since Dr. Hilleman was right in the middle of it, his life story is truly inspiring.  Fortunately for science enthusiasts, it is now the focus of a new vaccine-related documentary, HILLEMAN: A Perilous Quest to Save the World’s Children.

Developed as part of the Vaccine Makers Project, produced by Medical History Pictures and sponsored by the Vaccine Education Center at Children’s Hospital of Philadelphia (CHOP), the film includes exclusive interviews with Dr. Hilleman and his peers, rare archival footage, and 3-D animations.

The film is meant to not only introduce Dr. Hilleman and his amazing accomplishments, but to also describe the incredible scientific discovery and effort required to create safe and effective vaccines.

Over the last several months, the film has been shown by institutions such as the Smithsonian’s National Museum of American History, the National Foundation for Infectious Diseases, and the Bill & Melinda Gates Foundation. HILLEMAN has also been featured at immunization coalition conferences and national professional meetings, including the American Academy of Pediatrics, National Association of School Nurses, National Science Teachers Association, and National Association of Biology Teachers.

To complement the film, the Vaccine Makers Project has developed comprehensive educational materials for elementary, middle, high school and college students. 

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Educators are encouraged to utilize this flexible curriculum in whole or part to support learning objectives related to infectious diseases, the immune system, and how humans fight disease through technologies such as vaccines.

The Vaccine Makers Project has also collaborated with Families Fighting Flu (FFF) to present an eight-minute excerpt of HILLEMAN: A Perilous Quest to Save the World’s Children to remind families of the importance of annual influenza vaccines. Families Fighting Flu has made the film a central component of its fall awareness efforts. According to Serese Marotta, Chief Operating Officer of Families Fighting Flu,

“Every year, we remind families of the importance of influenza vaccination, often with members of our organization sharing their own personal experiences. This year, we hope that by sharing the film clip along with our personal stories, even more families will be compelled to prioritize influenza vaccination for themselves.”

Visit the Vaccine Makers Project to view a list of upcoming film screenings, gain access to the free educational materials, or to make an inquiry about the project.

For more information about influenza, visit the Vaccine Education Center at Children’s Hospital of Philadelphia for an in-depth look at the flu vaccine and an influenza fact sheet.  And visit the Families Fighting Flu website to read stories of families who have been adversely affected by flu, view flu facts and download the Community Toolkit and other educational materials

3 Things I’ve Learned Since Losing My Son to Flu

October 18, 2017 10 comments
By Serese Marotta, Chief Operating Officer, Families Fighting Flu

 

JoJo as Spiderman copy

Today is a hard day for me – it’s been eight years since I lost my five-year-old son, Joseph, to the flu.

I’m not the same person I was eight years ago. Today, I see things through a different lens as a bereaved parent. I am more compassionate, more empathic, and (generally) more understanding and patient. Losing a child is devastating, but I feel it’s my responsibility to pass on some of the lessons I’ve learned through this personal tragedy.

So here’s what I want every parent to know:

1.  Every parent wants what’s best for their children.

I’ve come to realize that vaccination is a sensitive issue for many people. Some parents believe in vaccination, while others do not. But what we all agree on is that our decisions are motivated by our desire to protect our children.

Whether it’s a post on social media, or a televised interview on the news, we often witness a difference of opinions regarding the risks and benefits of vaccines.  However, we all make the choices we do with the information we have because we want to do what we THINK is best for our children. The disconnect occurs when we don’t agree on the validity of the information that’s available to us.

It’s not really the people that are divided, it’s actually the incorrect information on vaccines that we have allowed to divide us.

As parents, we are so overwhelmed with the sheer amount of information out there, that sometimes it’s difficult to determine what’s true and what’s false. That’s why when I have conversations with people who are hesitant, or even opposed to vaccines, I find it’s best to listen to their concerns and start a mutually respectful dialogue. Attacking one another won’t help. We need to combat vaccine misinformation by providing the correct information. I don’t want a single parent to risk their child’s life, or their own, simply because they didn’t have the correct information about vaccines.

So here’s what I know for sure; across the globe, millions of children have died due to infectious diseases and continue to do so. Sadly, most of these deaths could be prevented with vaccines.  My son’s death certificate states “complications of H1N1”. I know for a fact that my child died from influenza. I also know, based on the available data from the Centers for Disease Control and Prevention (CDC), that 1,472 children have died from influenza in the United States since 2004. And I know that the flu vaccine has been safely administered in the U.S. for more than 50 years.

How do I know this? Because I made sure I got the facts and I trust the science.

2. Flu vaccines save lives.

We have vaccines for a reason. Vaccines are not created for common, non-life-threatening ailments. The fact that there is even a flu vaccine should be enough to indicate the dangers of flu. Before Joseph died, I never would have thought in a million years that flu was a threat to my healthy child. I have always vaccinated myself and my children, including for flu. Joseph passed away due to H1N1 flu, which was not included in the seasonal vaccine in 2009. The H1N1 vaccine did not become available in our community until two weeks after Joseph passed away. I do believe that if he had been vaccinated for H1N1, Joseph would likely still be here today.

Flu does not discriminate – it does not care if you’re young or old, rich or poor, healthy or immunocompromised. It’s important for people to know that flu can be a serious, even deadly, disease for anyone. Before Joseph died I was more scared of him getting hit by a car or kidnapped by a stranger. Death from flu was not even on my radar. Now I know more about flu than I ever wanted to.

During the 1918 flu pandemic, 20 to 50 million people lost their lives. Every year in the U.S., upwards of 56,000 people lose their lives due to flu, including approximately 100 children. As parents, we do everything we can to keep our children safe. So why wouldn’t we protect them from the flu, too?  The flu can kill even a healthy individual. But those who are vaccinated are much less likely to die from flu.

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3.  Grief is not a linear process.

Read more…

101 Empty Chairs

June 23, 2017 1 comment

By Serese Marotta, Chief Operating Officer, Families Fighting Flu

Sadly, the Centers for Disease Control and Prevention (CDC) have reported that the 2016/2017 flu season has now claimed the lives of more than 100 children. 101 to be exact.  This statistic is hauntingly familiar – three of the past five flu seasons also claimed the lives of more than 100 children.

101 Pediatric Flu Deaths

Sometimes we forget what these numbers really mean.

It means that 101 families had to bury their beloved children; 101 families have to listen to the deafening sound of silence left by their lost loved ones; and 101 families now have empty chairs at their dinner tables every night.

I paint this picture because I know how these families feel. They’re probably thinking the same thing I did after my son died from the flu – how did this happen and what could I have done to prevent it? 

Unfortunately, unless flu has personally touched your family like it has mine, chances are you’re not all that worried about flu.  You may even think it’s just a bad cold. Well, as the mother of a child who lost her five-year old son to flu, I’m here to tell you, “Not so“.

According to the CDC, flu kills more Americans every year – up to 56,000 people – than any other vaccine-preventable disease.  Since 2004, when the CDC started reporting pediatric flu deaths, 1,466 children – many of whom were otherwise healthy – have lost their lives to flu.

Flu is that infectious disease that seems to fly under the radar. While everyone is focused on the latest outbreak of measles, mumps, pertussis or meningitis, flu is that one disease that we know we will have an outbreak of each and every year.  As prevalent as flu is, it still manages to creep up like a quiet thief in the night, stealing our loved ones right out from under our noses.  And yet when it does, we wonder why we never saw it coming.  Flu has killed millions of people worldwide – and it will continue to do so for the foreseeable future.

So what can we do to protect ourselves and our loved ones from influenza each year?  Annual vaccination.

Studies show that flu vaccination can reduce the likelihood of death and hospitalization from flu in people of all ages.  Yet, less than half of Americans get their annual flu vaccine.   Read more…

Even With All Our Modern Medicine, I Watched My Sister Die From Flu

February 1, 2017 8 comments

By Michael Northrop, M.D.

 

lizaIn December, 2009 my sister Liza died of influenza.

She was previously healthy and only 49 years old.  She sought medical care early. She was cared for at a good hospital in a major city.  She had no other infections. And she was unvaccinated.

To say I was surprised is an understatement.  And yet, I’m a pediatric intensive care physician.

As a clinician, it’s easy for me to trace out the clinical course of Liza’s illness. The physiology of organ failure, mechanical ventilation and critical illness are familiar to me in the same way that your daily work is to you. It’s the human side that I still haven’t come to terms with. The part where you watch your sister die over the course of three long weeks while you stand helpless.  The part where you listen to a physician tell your family that they are out of options.  The part where you know that they are right and you realize that influenza is sometimes too much to handle, even with all our modern medicine.

That part is much harder to process.

Her symptoms started with fever, but progressed to vomiting after a few days. She went to the urgent care clinic twice over the course of a few days before ending up in the emergency department of the local hospital.  She had begun to experience difficulty breathing, and the emergency physician noted that the oxygen saturation in her blood was very low.  They put her on oxygen, and an x-ray revealed that both her lungs were filled with fluid. A condition that led to her being diagnosed with pneumonia.

You see, your lungs are supposed to have air in them. They should look like sponges. Pneumonia is just the term we physicians use to describe the situation when fluid, infection, and inflammation fill those little air spaces in the sponge.

Pneumonia can come from viruses or bacteria. If your pneumonia is caused by a bacteria, you can get antibiotics to kill the bacteria.  However, if your pneumonia is caused by a virus, like influenza, there is not much we can do but ride it out and wait for your own immune system to clear it.  The simple fact is that we just don’t have very good medications for viruses. Tamiflu can be prescribed and it might slow down the virus, but it doesn’t kill it or stop it.

So, they did the only thing they really could do, and started her on IV Tamiflu.  She was moved to the intensive care unit downtown, and within the next few hours she struggled to breathe and her oxygen saturations continued to fall. She had to be placed on a ventilator, and the hope was that her lungs would recover after a few days. After all, it was ‘just the flu’.

We never did get to speak with her again.  

Read more…