With experts predicting that this year’s flu season will be one of the worst in history, two questions may come to mind.
Is there any medication I can take to feel better if I get the flu? And, are scientists working on a vaccine or something else that will prevent me from getting this nasty illness in the future?
The 2018 flu season has gotten off to an emphatic start.
This week, the Centers for Disease Control and Prevention (CDC) reported that 46 states are experiencing widespread outbreaks of the flu.
Part of the reason is the dominant strain this season, H3N2. It’s a particularly nasty variant of the influenza virus that’s relatively resistant to current flu vaccines. H3N2 is particularly devastating to older individuals.
Usually, flu outbreaks are detected in isolated areas and grow from there. This season, however, is different.
“It just sort of blossomed everywhere at once,” Dr. William Schaffner, chair of the department of preventive medicine at Vanderbilt University Medical Center, told Healthline.
The effectiveness of antivirals
For people diagnosed with influenza, doctors may prescribe an antiviral drug.
These medications, which fight the flu virus directly in the body, differ from antibiotics. Those fight bacterial infections.
The most common antiviral is probably oseltamivir, better known to consumers under the brand name Tamiflu.
Other options include peramivir (Rapivab), and zanamivir (Relenza).
Administration of these antiviral drugs varies, from pills and liquids to powders and intravenous injection.
While no antiviral is guaranteed to defeat the flu, they typically make the illness less severe, lessening the serious complications that can come with the flu.
On its website, the CDC states that the circulating influenza viruses’ antiviral resistance to the three common antiviral medications is “currently low, but that can change.”
It adds that “antiviral resistance can emerge during or after treatment in some patients.”
Schaffner adds that the effectiveness of medications like Tamiflu could be hampered by the fact that this year’s powerful strain is relatively new.
In addition, it seems the main focus of researchers isn’t new medications, but rather the development of more effective vaccines.
Know your vaccines
The traditional standard influenza vaccine protects against three different strains of flu: two A strains and one B strain.
But manufacturers are moving toward improvements in this area, developing a quadrivalent recombinant flu vaccine. That’s in its first season of availability.
The so-called quad vaccine is a logical evolution of the older vaccine. It protects against four strains: two A strains and two B strains.
“Some providers have the traditional vaccine, other providers have the quadrivalent vaccine available,” said Schaffner. “We hope that, within a year or two, they’ll all be quad.”
For older people — who are particularly vulnerable to the H3N2 strain — there are two recommended vaccines.
One is the high-dose vaccine, which is the traditional vaccine but administered at four times the dose.
The second is a standard vaccine with an immune stimulant, known as an adjuvant, added in.
Both of these vaccines tend to be more effective in older people than the traditional vaccine.
One setback this flu season has been the U.S. Food and Drug Administration (FDA) announcing that the live attenuated influenza vaccine (LAIV) — administered via a nasal spray — is no longer recommended because of concerns over its reduced effectiveness.
“The company’s working on it, and we have our fingers crossed that they can provide data showing that the nasal spray vaccine can be used, once again, going forward,” said Schaffner. “It’s not trivial because it really was preferred by pediatricians. They could give it to many children with less fuss than having to give them an injection. We’re all hoping that the nasal spray vaccine will be available again in the future.”
The holy grail
Researchers and manufacturers are constantly having to adapt to new flu strains that become dominant in a given season.
“We know that some strains cause more severe flus than others,” explained Schaffner. “The A strains collectively cause big outbreaks of flu, while the B strains just kind of smolder along and don’t cause epidemics, but they do cause sustained disease.”
H3N2, the big player this flu season, is an A strain. Part of the reason it’s been so devastating — and relatively resistant to vaccines — is that it’s fairly new.
“The new strains are more likely to cause big epidemics because we in the population haven’t had experience with them before,” said Schaffner. “We all have partial immunity to influenza because we’ve encountered both the virus and vaccination in the past. But if a new strain comes up, then we’re all immunologically naive.”
Despite the challenge that a tough strain like H3N2 presents, there’s still room for hope. Schaffner says that multiple stakeholders are working hard at trying to substantially improve the flu vaccine.
“I’d say that over the past five or six years, there’s been more research by the manufacturers, in academic laboratories, and at the National Institutes of Health than there has been in the 40 years previous,” he said.
While flu vaccines in a given flu season have to adapt to the dominant strain, there’s reason to believe that a so-called universal vaccine could someday be possible.
Schaffner describes the flu virus using an analogy.
“The influenza virus has the capacity to mutate its surface proteins. But underneath those surface proteins that change is a kind of stalk protein, on which those surface proteins live. It’s a little like thinking of a lollipop. The lollipop flavors change, but the stick on which you hold the lollipop is the same,” he said.
In short, if a vaccine could target the stalk protein rather than the surface protein, researchers might be able to create a more effective universal vaccine.
Schaffner says multiple laboratories are researching this kind of vaccine — and that if or when it’s developed, it could be a true game changer.
“It would change everything about how we deliver influenza vaccine. For example, we might only have to be vaccinated every 5 or 10 years to boost our immunity, and we could vaccinate year-round,” he said. “That would permit us to vaccinate a larger and larger proportion of the population, such that we wouldn’t just get individual protection, but we would really begin to be able to interrupt transmission of the virus. We would get community protection, and that would change our whole approach to influenza protection.”
“That’s still the holy grail of influenza research,” concluded Schaffner. “We’re not there, but we’re inching toward it.”
Until then, in the midst of a rough flu season, medical professionals advise patients to follow the CDC guidelines.