Familiarity Should Not Breed Complacency with Influenza

There is a deadly infectious disease about to pounce on the US populace and I have already seen some early cases, yet no alarm bell has sounded. As you can probably guess, the disease I am referring to is influenza. 

A few weeks ago, during one of my occasional shifts in my hometown ED, I diagnosed a case of influenza B in a patient with shortness of breath using the poorly sensitive rapid antigen test that is widely available. The patient was admitted and placed on Tamiflu (oseltamivir). This season, I have sent several rapid antigen tests all of which were negative on similar patients. This fact likely means that many flu cases are not being diagnosed because the rapid test is just not good enough to detect all cases. CDC data suggests that 6% of tests are positive at this time and, thus far, there has been one pediatric death from flu in North Carolina.

At the start of the flu season stutters and sparks herald the first exploits of the virus in the current season and, judging by the experience of the Southern Hemisphere, we may have another severe season. 

In the ICU portion of my career, I have been involved with the management of individuals who present with fevers, cough, chills, and muscle aches and end up in the ICU because of severity. Such individuals clearly fit the case definition and hence should be appropriately tested. While the more sensitive PCR test results are pending in those with severe symptoms or comorbidities--especially pregnancy (or if rapid antigen tests are used) Tamiflu should be started empirically.

While people are clamoring over Ebola and many are being ruled out for this infection, the familiar--but by no means tame--influenza virus may go undetected because it is not tested for with enough frequency or is tested for using obsolete technology. To compound the problem, Tamiflu is woefully underused despite its capability to lessen severity as is the influenza vaccine.

As the current flu season evolves, familiarity should not breed complacency.