This year's particularly nasty flu season has doctors and researchers worried about what's ahead.
Though the number of outbreaks in Florida has declined in recent days, the first six weeks of 2018 saw soaring numbers of flu patients in emergency rooms, urgent care clinics and doctors' offices — and at rates that far exceeded the last three years. More people than expected died from influenza and pneumonia, including six children. And this year's shot was only 36 percent effective against the two main flu strains, compared to 40 to 60 percent in past seasons.
Does this mean it's going to keep getting worse? Will we ever be able to stop it? What is the future of the flu?
The answers are a decade away at best, some researchers say.
"The one thing about flu that you can count on, is that it will be unpredictable," said Dr. Nicole Marie Iovine, a physician and professor at the University of Florida who specializes in infectious diseases. Iovine said UF Health in Gainesville saw twice as many positive cases of the flu this year than the last busy season in 2014-15.
"The reason that the flu vaccine doesn't protect us more right now is because the virus is like a moving target," she said. "It's mutating constantly, to the point that the common strains we see at the beginning of the season will be different from the ones we see at the end of the season. If you caught the flu last year, you could catch the same strain again this year, because at the molecular level, it's not really the same virus at all."
That's the biggest problem scientists face when trying to come up with a more potent vaccine.
Each year, the World Health Organization, which is made up of 200 labs around the world, decides which strain of flu it will focus on for prevention for the upcoming season. That happens in spring, near the end of every season. The next step is growing the virus and generating an antigen that will produce an immune response.
After that, the resulting vaccine is manufactured and distributed worldwide. Injections begin generally in September.
But because of how long it takes to mass produce the vaccine for the current year, there's no time to tweak it if early in the season it's proving not to be effective, said Dr. Brigitta Mueller, the chief patient safety officer at Johns Hopkins All Children's Hospital in St. Petersburg.
"We have a little bit of an advantage in that the season starts in the Southern Hemisphere, so we can see how bad it will be in places like New Zealand and Australia," Mueller said. "So we were not surprised that it was a bad season this year. But because the vaccine is made so early, we cannot change it. It comes down to a lot of guess work a year out, trying to predict what the flu season is going to look like."
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It doesn't help either that researchers are using "outdated methods" to develop the vaccine, Mueller said.
"We use chicken eggs to grow the virus. It's a cumbersome way, but there's been no better way developed to make them. How fast we can make the vaccines is really impacted by that," she said.
That's why funding and research seems to be mostly targeted at developing a universal flu vaccine, said Dr. Jill Roberts, an assistant professor with the University of South Florida.
Right now across the globe, scientists are researching at least 40 universal vaccine candidates. In the U.S., a bill by Sen. Edward Markey, a Democrat from Massachusetts, asks for $1 billion from the federal government to fund flu vaccine research. But most of the studies that are already underway are in their infancy and many years away from yielding a vaccine that could be offered to the public.
"The way the vaccine works now is it's only good for one year. There's a massive push to create a universal vaccine that would target parts of the flu that can't mutate," Roberts said.
Just as unpromising are the few options available to flu patients. Because of high demand this year, supermarkets had trouble keeping shelves stocked with Tamiflu, one of the only treatments available to lessen the symptoms of influenza. While it's not a cure, it can reduce the flu's severity and duration.
"It works best when given right away, basically 24 hours or less after contracting the flu," Iovine said. "The longer out you go, the less effective it will be. Once the virus has taken hold, there's not much you can do. Unfortunately this is true of most viruses."
She added: "We still don't have a good treatment option for the common cold, let alone the flu."
Researchers in Japan have developed a new flu medicine called Xofluza, which supposedly can stop the virus in 24 hours, Roberts said. The drug has been approved in Japan, but it could be years before it makes it to the U.S.
"To stop it in 24 hours," she said, "that means the virus can't spread. To stop that heightened immune response is key. That's what kills patients."
While large amounts of money and effort have been aimed at curing and preventing the flu, no surefire plan has emerged just yet, Iovine said.
"Five years, 10 years is optimistic," she said of the research timeline. "We are definitely several years away from anything that might be more critical."
So physicians say that public health campaigns are still important to get the word out about prevention.
"A lot of people heard that the flu shot wasn't very effective this year, so they chose not to get it at all," Roberts said. "Which is just not true. I think one day it should be mandatory for people in high-risk groups to get the flu shot. Like health care workers and children's day care workers. Most hospitals make it mandatory."
Of the six children who died in Florida from flu-related illnesses this season, the majority were unvaccinated, according to department of health data. This is a trend that physicians are seeing across the country.
"That's the biggest concern we've seen this year, parents who generally don't vaccinate their children against anything at all," Mueller said. "We're seeing a resurgence of certain diseases which are preventable, like Measles, because of this."
Contact Justine Griffin at firstname.lastname@example.org or (727) 893-8467. Follow @SunBizGriffin.