Not a good combination – deadlier strain and a vaccine that is a bit mismatched. Early data suggests that the current 2014-2015 flu season could be severe. The CDC announced late last week that it recommends immediate vaccination for anyone still unvaccinated this season and recommends prompt treatment with antiviral drugs for people at high risk of complications who develop flu.
So far this year, seasonal influenza A H3N2 viruses have been most common. This strain of the flu is known for more severe flu illnesses, hospitalizations, and deaths. For example, H3N2 viruses were predominant during the 2012-2013, 2007-2008, and 2003-2004 seasons, the three seasons with the highest mortality levels in the past decade. All were characterized as “moderately severe.”
Increasing the risk of a severe flu season is the finding that roughly half of the H3N2 viruses analyzed are drift variants: viruses with antigenic or genetic changes that make them different from that season’s vaccine virus. This means the vaccine’s ability to protect against those viruses may be reduced, although vaccinated people may have a milder illness if they do become infected. During the 2007-2008 flu season, the predominant H3N2 virus was a drift variant yet the vaccine had an overall efficacy of 37 percent and 42 percent against H3N2 viruses.
Depending on the formulation, flu vaccines protect against three or four different flu viruses. Even during a season when the vaccine is only partially protective against one flu virus, it can protect against the others.
Influenza viruses are constantly changing. The drifted H3N2 viruses were first detected in late March 2014, after the WHO recommendations for the 2014-2015 Northern Hemisphere vaccine had been made in mid-February. At that time, a very small number of these viruses had been found among the thousands of specimens that had been collected and tested.
A committee of experts must pick which viruses to include in the vaccine many months in advance in order for vaccine to be produced and delivered in time for the upcoming flu season. There is always the possibility that viruses will drift during that time.
Those at high risk from influenza include children younger than 5 years (especially those younger than 2 years); adults 65 years and older; pregnant women; and people with certain chronic health conditions such as asthma, diabetes, heart or lung disease, and kidney disease.