The US flu season this year has been the worst since the 2009 H1N1 pandemic. The percentage of outpatient visits for influenza-like illnesses (ILI) reached the third highest level in the last 15 years. From October 2017 to March 2018, more than 100 children died from the epidemic. Meanwhile, schools in Hong Kong were closed one week early before the Chinese New Year break to mitigate the flu outbreak, as two child deaths had already been recorded.

Global overview of the flu season

In temperate climates, seasonal epidemics occur mainly during winter. The most prevalent strain globally this season is influenza A strain H3N2, apart from other strains such as H1N1 and influenza B. The season is particularly severe in North America, like Australia’s flu season last year. In Europe, a mixed activity was observed with an increase of flu-related deaths in the elderly. In East Asia, B strains predominated across the region, while H3N2 also contributed significantly in some places. The Hong Kong outbreak has led to a hospital crisis with increasing ILI cases. Beds were added as more patients were admitted than the original capacity and nurses were overworked due to staff shortages.

In Malaysia and other tropical regions, influenza manifests year-round. There are increased reports between April and July, and November and January, likely due to winter flu seasons in the northern and southern hemispheres and travellers from the regions carrying the bug into Malaysia. Flu is also frequently mentioned in the media as it is not an uncommon disease here.

Are we prepared?

The HK crisis raised concerns about our preparation in dealing with flu outbreaks. During the 1918 influenza pandemic, 500 million people were infected, resulting in 50 million estimated deaths. A flu season is considered an epidemic when there is a higher occurrence of typical flu cases than average. Meanwhile, a flu pandemic occurs when there is a worldwide spread of a new influenza strain.

With 100 years of experience post-1918 pandemic, we have more tools and knowledge at our disposal to handle influenza outbreaks, but a severe pandemic will put a strain on the healthcare system. The government needs to have a well-prepared pandemic emergency plan to deal with increased needs for staff, antiviral medications, and infrastructure such as ventilators, beds and IV bags. The public should also be educated on influenza prevention, whether by vaccination or basic health etiquette like hand hygiene and wearing a mask.

Severe complications from flu

Flu may seem like a common cold, but it can have more severe symptoms and lead to worse complications, especially in people who are at higher risk like adults over 65, children below 4 years, people with heart or lung diseases, people with compromised immunity, and pregnant women. Complications include viral or bacterial pneumonia, dehydration, and ear or sinus infections, especially in children. Long-term medical conditions, like congestive heart failure or asthma, can deteriorate due to flu. Other complications include inflammation of the heart, brain or muscle tissues, and multiple-organ failure. These can lead to hospitalisations, and in some cases, death. High-risk groups should not neglect any flu symptoms and need to consult the health professionals.

Prevention by vaccination

To control the spread of influenza, a high-rate of vaccination among the population is necessary. The National Immunisation Programme does not include flu vaccine, but anyone older than 6 months is recommended to get annual flu shots, especially the high-risk groups. Annual vaccination is needed for the best protection as flu viruses constantly mutate, and the body’s immune response from vaccination declines over time, making it necessary to update the formulation of the flu vaccine.

Other precautions include practising basic hygiene etiquettes. Sick people should stay at home, have a lot of rest, and drink plenty of water. Travellers who are going to a country with an on-going flu season are recommended to get vaccinated two weeks before travel, to let the vaccine immunity take effect. In fact, people with flu should not be travelling! In case of a pandemic, vaccines might not be available initially, but specific vaccines for the new strain can be produced faster and easier today. Of course, the ideal solution is to come up with a universal flu vaccine that protects against all or most strains of flu, with protection that lasts longer or for life.

The 2009 H1N1 worldwide pandemic has left an impact in Malaysia when more than 12,000 cases were reported. The effect could have been worse, if not for our National Influenza Pandemic Preparedness Plan (NIPPP). Regardless, the next pandemic may hit harder. There needs to be more studies and surveillance on flu prevalence in Malaysia for better planning, and the effort to increase public awareness of flu prevention has to continue.

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