In the peak season of influenza, what can I do besides drinking more hot water？
[Editor’s note]
It’s the flu season again, and you are surrounded by "pathogens". Have you been recruited recently? This old article in RUC News Workshop will help us understand the flu cases and their harm at this time last year. In order to avoid the recurrence of the tragedy in the article "Middle-aged Beijing with Influenza", how should we deal with the menacing flu virus?
Zhang Li, a student at a university in Beijing, recalled that the day before she got the flu, "she changed into a light down jacket without a hat, and everything else was the same as usual." The next morning, Zhang Li felt very tired. She took a temperature of 38.7℃ and had a low fever. She took a cold medicine and fell asleep. By 7 o’clock in the evening, Zhang Li felt cold, weak, slightly tinnitus, and her temperature had soared to 39.8℃, so she quickly took a taxi with her friends to the hospital and hung up the emergency room. The emergency hall was crowded that night, and Zhang Li waited for a long time before she heard the nurse give her number.
In fact, the emergency rooms of many hospitals were overcrowded that night, and most of the patients were diagnosed with the flu. According to the data of China CDC, since the winter of 2017, the level of influenza activity in China has risen rapidly, and the number of patients in respiratory departments in many hospitals across the country has suddenly increased, even overloaded.
After winter, respiratory departments in many hospitals across the country are overloaded.
Zhong Shijie, director of the Department of Health Care of Guangzhou Provincial Hospital of Traditional Chinese Medicine, said that since December 2017, the number of patients has increased by 20-30% than usual, and there are more than 3,000 cold patients who come to the hospital every day, accounting for about 30% of the number of outpatients.
Since December 2017, the emergency department of Hunan Children’s Hospital has received more than 1,000 consultations every day, and more than 80% of them are upper respiratory tract infections.
According to the results of influenza surveillance in China CDC, in the first week of 2018, the percentage of influenza-like cases in the southern provinces of China in the total number of outpatient and emergency cases (ILI%) was 6.0%, which was higher than the same period in 2015-2017.
The influenza epidemic situation in southern provinces showed a downward turning point in the third week of January 2018, and then the level of influenza activity in the whole country continued to decline.
Source: China CDC.
According to the Beijing Municipal Center for Disease Control and Prevention, in the 45th week of 2017, the number of influenza cases in November increased by 82% compared with the previous month. The peak came in December, and the number of flu cases counted every week doubled.
Li Xuechao, deputy director of the Second Department of Maternal and Child Health Hospital in Qinhuangdao City, Hebei Province, said that on December 24, the number of outpatients in the hospital reached a new high-700 in emergency and 300 in outpatient. The main symptoms of patients are fever, and pneumonia and upper respiratory tract infection account for more than two thirds.
The results of influenza surveillance in China CDC show that in the first week of 2018 (January 1-7), the percentage of influenza-like cases reported by sentinel hospitals in northern provinces accounted for 5.8% of the total number of outpatient and emergency cases (ILI%), which was higher than that in the same period of 2015-2017.
The northern provinces showed a downward turning point in the first week of January 2018, and then the level of influenza activity in the whole country continued to decline.
Source: China CDC.
However, not every patient can recover smoothly like Zhang Li. China CDC pointed out that the number of severe cases and deaths of influenza this winter has increased sharply compared with previous years.
According to the incidence and death data of legal infectious diseases released by China CDC, the number of influenza cases nationwide was 27,731 in November 2017, and it soared to 121,800 in December 2017, far higher than the same period in 2016 (the number of cases in November 2016 was 20,800, and the number of cases in December 2016 was 38,313).
Source: China CDC.
Source: China CDC.
Source: National Health Planning Commission
Source: National Health Planning Commission
According to the data of China National Influenza Center, the influenza activity in the southern and northern provinces of China was at the peak level in winter at the end of 2017, and the main influenza virus detected was Yamagata strain B virus.
Human influenza virus can be divided into three types: A, B and C, which are the pathogens of influenza. Among them, influenza A virus is the most susceptible to mutation, which can infect people and many kinds of animals, and is the main pathogen of human influenza. H1N1 and H3N2 in influenza A virus have been prevalent in people for a long time.
On January 9, 2018, Jiao Yahui, deputy director of the Medical Administration and Hospital Authority of the National Health and Family Planning Commission, said at the press conference of the National Health and Family Planning Commission that the dominant strain prevalent this winter has not become the dominant strain for many years, resulting in the lack of immune barrier and the increase of susceptible population, which is one of the reasons for the high incidence of epidemic this winter.
Some experts also pointed out that the current domestic trivalent influenza vaccine does not include the type of Yamagata B, so the trivalent influenza vaccine widely promoted in China last year did not work, which is one of the reasons for the rapid spread of the epidemic.
In 2017, "vaccine miss target", vaccine is still the best prevention method.
The World Health Organization believes that the most effective way to prevent influenza is vaccination. The purpose of using vaccines is to provide immune protection for as many people as possible before exposure to pandemic influenza virus. Vaccination is especially important for people with high risk of severe influenza complications and contact with high-risk individuals.
Safe and effective vaccines have existed and been used for more than 60 years. When the epidemic virus is consistent with the vaccine virus, influenza vaccine is the most effective. Influenza viruses are constantly changing, so the network of national influenza centers and WHO cooperation centers around the world will continuously monitor the popular influenza viruses and make predictive recommendations for the dominant influenza strains in the next influenza season in February and September each year. Vaccine manufacturers generally make influenza vaccines according to the predictions of the World Health Organization.
But the World Health Organization’s prediction can’t guarantee 100% accuracy. Among the dominant strains predicted by GISRS (Global Influenza Surveillance and Response Network) in the northern hemisphere this year, Yamagata strain of influenza B, which was prevalent in winter in China last year, was not included, and the vaccine had no protection against this type. Therefore, for the widespread epidemic of yamagata influenza B virus, the trivalent influenza vaccine widely implemented in China last year did not work. In medical terms, this is called "vaccine miss-target".
The United States and Europe also suffer from "off-target". China News Service reported that the outbreak of influenza B yamagata in the United States and Europe has killed more than 100 people, making it the most serious influenza in the past decade.
However, even if the epidemic virus is not completely consistent with the vaccine virus, the influenza vaccine can still provide protection for healthy adults. A new study published in the Proceedings of the National Academy of Sciences entitled "Even a’ bad’ flu vaccine can save 61,000 lives: study" shows that if the coverage of the vaccinated population accounts for 40% of the total population, even if the curative effect is not good, the flu vaccine can still save thousands of lives.
It is worth noting that influenza vaccine has the best vaccination time. After vaccination, it takes about 2-4 weeks for a person’s body to gain immunity. According to the World Health Organization, vaccination in October and November can ensure immunization before the arrival of the epidemic season. Of course, even if the best time is missed, vaccination can provide protection.
Therefore, it is particularly important to vaccinate as many people as possible.
Influenza vaccine has been neglected and the vaccination rate is very low.
Although the World Health Organization has repeatedly pointed out that influenza vaccination is the best way to prevent influenza, most people in China are not "cold" about influenza vaccination. The data shows that in 2017, the China Institute for the Verification of Pharmaceutical and Biological Products (hereinafter referred to as the Central Inspection Institute) issued a total of about 29 million influenza vaccines. According to the statistics of China’s total population of 1.39 billion, taking into account the number of unfinished and expired return and damage, the vaccination rate in China is less than 2%.
China CDC and multi-local CDC sampled 9673 people in Sichuan and Henan, and found that 4381 people were unwilling to get flu vaccine. More than 30% of these people are "worried about the quality and safety of vaccines"; 26.5% are "not familiar with influenza vaccine"; 17.8% think that "vaccination can’t reduce the possibility of getting flu"; And "the flu is a minor illness and does not require vaccination" accounted for 5.0%. In addition, some people said that "I don’t know about the flu vaccine" and "the cost of vaccination is high", which leads to reluctance to vaccinate.
So what’s the situation abroad?
According to CDC (Centers for Disease Control and Prevention; According to the data of Centres for disease and prevention, as of December 15, 2017, 150.3 million doses of influenza vaccine have been distributed in the United States, and it is expected to reach 166 million doses in the whole flu season from 2017 to 2018. In 2017, the vaccination rate of the whole population in the United States was 38.6%, including 38.8% of children and adolescents and 38.5% of adults. In other words, China’s current influenza vaccination rate is only 1/20 of that of the United States, which is equivalent to the vaccination level of the United States in the early 1980s. In contrast, with the gradual improvement of domestic economic conditions and the gradual increase of medical and health investment, there is still huge room for improvement in influenza vaccination rate in China.
Source: CDC, USA.
Source: CDC, USA.
At present, the global vaccine supply is facing uneven geographical distribution and insufficient production. 90% of the global influenza vaccine production capacity is concentrated in some countries in Europe and North America, and their population accounts for only 10% of the global population, and the maximum vaccine production can not meet the expected demand of the World Health Organization’s strategic action plan to deal with pandemic influenza.
As for the domestic vaccine market, before that, there were trivalent influenza vaccines (including two kinds of influenza A and one kind of influenza B) in the domestic market, and then National Medical Products Administration approved the application for production registration of tetravalent influenza virus split vaccine. The tetravalent influenza virus split vaccine approved for marketing this time contains not only the virus of common trivalent influenza vaccine, but also BY influenza virus, which is also the main virus strain prevalent in China’s influenza season in 2017-2018.
In 2009-2010, affected by the outbreak of influenza A, the number of batches of domestic influenza vaccines reached a peak of more than 60 million, and then began to fall back and stabilize at 30-40 million. On the one hand, the influenza epidemic was controlled, and on the other hand, the influenza virus was mutating every year. Every year, the vaccines were developed for the prevalent strains of that year, which caused the research and development of manufacturers to lag behind. Coupled with the influence of the new GMP standard, the number of batches of domestic influenza vaccines showed a trend.
In 2017, more than 29 million influenza vaccines were issued nationwide, an increase of more than 4 million compared with 2016, with a year-on-year increase of nearly 20%. In 2017, with the outbreak of the epidemic and the enhancement of people’s awareness of vaccination, influenza vaccines have bottomed out.
Source: clove garden "Insight database"
According to the World Health Organization, the current vaccine market faces three challenges: to produce enough high-quality vaccines in a short period of time to meet global demand after the start of the pandemic; To provide fair access to vaccines; And to ensure that there is sufficient capacity to deliver vaccines to all communities.
In cooperation with representatives of major stakeholders in the field of influenza vaccine and immunization, the World Health Organization adopted the Global Influenza Vaccine Action Plan in 2006 to meet these challenges. At another meeting held in May 2006, the World Health Organization formulated a global action plan to increase the supply of pandemic influenza vaccine. Participants called for better development of vaccine production capacity in developing countries, especially for developing countries that are currently building vaccine production facilities.
Aiming at the population coverage of the World Health Organization, increasing the use of seasonal influenza vaccine is undoubtedly the most effective way to increase the production of pandemic influenza vaccine. However, it may take four to five years to achieve a significant increase in vaccine production through this approach.
A week later, Zhang Li finally recovered from the flu. However, not everyone is as lucky as her in this fierce and worst flu storm in ten years. At the end of 2017, the article "Middle-aged Beijing under the Flu", which exploded the circle of friends, told a story: a 60-year-old tough-hearted father-in-law in Northeast China, because he didn’t listen to his children’s advice, didn’t wear a shirt to open the window and caught a cold, and went his own way and didn’t seek medical treatment in time. Twenty-nine days after the onset of the disease, he was infected by an unknown virus caused by a cold. Even though he spent 1 million yuan in the ICU ward of a third-class hospital in Beijing, he was not saved.
Similar tragedies have something to do with our contempt for the flu. How to face up to the possible harm of influenza and take a series of preventive measures for this is a problem that we should pay attention to.
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