Board of Health Report – September 6, 2023

School is back in session and fall is around the corner. The question on many people’s minds is what kind of respiratory forecast is predicted for this fall and winter? Should we worry about the new COVID variant we are hearing about? Will we see a tripledemic of flu – RSV- COVID-19 this year?

Let’s review what we’re currently seeing in our region as far as infections, what is predicted this season, and what we can do to stay healthy this fall and winter.

Flu

  • Flu infections are minimal in the Miami Valley at present. Throughout the US, we are seeing a few hundred cases a week right now.
  • Last year, we saw cases begin to climb in October and peak in December. Last year’s flu vaccine was a very good match to the circulating strains and significantly decreased visits for outpatient medical care as well as hospitalizations and deaths.
  • Predictions from the CDC at this point are that we may expect a flu season this year of typical severity. An early peak of flu activity is possible again this year. The timing and peak of flu activity is difficult to predict, with uncertainties of how well this year’s vaccine will match the circulating flu vaccines, the number of people who will get the flu vaccine, and the continuing impact of COVID on circulating flu viruses.
  • Influenza vaccination remains an important tool for the prevention of potentially severe respiratory illness. September and October are the best times to get a flu vaccine for protection throughout flu season. Flu vaccines are recommended for everyone ages 6 months and older.

RSV

  • RSV infections are low in the Miami Valley at present as well.
  • We saw a reduction in RSV cases during the COVID-19 pandemic. Previous to COVID-19, we usually saw the highest number of RSV cases in the December-January-February timeframe. Last year, RSV season was unusually early and severe, with cases peaking in November and December, placing hospital strain on Dayton Children’s Hospital.
  • This year, the CDC is predicting a more typical range of RSV severity than last year, however the timing and severity of the RSV season is hard to predict and depends upon a lot of variables, including:
    • The impact of COVID on circulating RSV viruses
    • The amount of immunity acquired from last year’s severe RSV season
    • The impact of new vaccines and monoclonal antibodies against RSV.
      • A new monoclonal antibody- Beyfortus is available for all infants aged 8 months and under and high-risk infants ages 8-19 months. This is not a vaccine, but an antibody protein that provides an extra layer of defense to fight RSV infections and protect infants lungs. Studies show it reduces the risk of hospitalization and healthcare visits for RSV in infants by about 80%.
      • A new RSV vaccine will be available for pregnant persons. When administered between 24 and 36 weeks of pregnancy, the vaccine triggers the development of antibodies that are passed on to the newborn. These antibodies can decrease the baby’s risk of hospitalization from RSV disease for about the first six months of the baby’s life when they’re extremely susceptible to infections like RSV. Expectant families are encouraged to contact their obstetricians for further information on the availability and accessibility of this vaccine.
      • Finally, for RSV, two new vaccines are available for individuals who are aged 60 and older, in consultation with their healthcare provider- Abrysvo and Arexvy. They can protect against severe disease from RSV by over 80%. Like the flu vaccine, RSV vaccine for these adults is ideally administered before the end of October.

COVID-19

  • While we have less information about the current number of cases in the population than we did in the past, with home testing and decreased reporting of cases, we are able to gauge the level of circulating COVID using other measures, such as hospitalizations, variations in the amount of COVID virus present in wastewater sampling, and demand for COVID tests and treatments. In our region, as in other parts of the United States, we currently see increases in COVID-19 using these indicators, although the levels remain well below where they were last year.
  • If has been over a year now since the last COVID-19 vaccine was released. A new COVID vaccine is in production by Pfizer, Moderna, and Novavax to more closely match the variants circulating now and is expected to be approved and available later this month that will help to prevent severe illness and stimulates our immune cells to provide protection in a way that is safer than getting an infection.
  • We know that the virus that causes COVID-19, is constantly changing and accumulating mutations in its genetic code over time. These mutations are monitored by the CDC and other health organizations around the world.
    • The variant in the news right now is called BA.2.86. It is a subvariant, or type of Omicron, and has been given the name “Pirola”. Pirola samples have been identified in infected people and wastewater samples in several countries and at least 4 states in the US in a short amount of time.
    • Although the number of cases is small (28+), Pirola is being watched by experts because it has a lot of mutations in the spike protein (30+). The spike protein is an important way the vaccine enters and infects human cells.
    • This variant is currently being studied in the laboratory to help understand how the immune system may interact with this virus. According to the CDC, based on current information, the tests we have to detect COVID and the medications we have to treat COVID continue to be effective with Pirola. We don’t have any evidence that Pirola causes more severe disease, hospitalization, or death. At this time the numbers are low, and we do not know if the Pirola variant can bypass some types of immunity we have gained from infection and vaccines. This is an area of ongoing scientific investigation. There is currently no evidence that Pirola is causing more severe disease.
    • Importantly, at this time, the increase in hospitalizations in the United States is likely driven by XBB lineage viruses (including EG.5, Eris), not Pirola. The XBB lineage viruses are similar to the formulation of the COVID-19 vaccine which will be available later this month. Currently, the CDC says the updated vaccine is expected to be effective at reducing severe disease and hospitalization.

Tripledemic

Tripledemic is a term to describe the high level spread of flu, RSV, and COVID-19 that creates strain on healthcare systems. This is difficult to predict, because it depends on so many factors, including-

  • Whether the peaks for all 3 viruses coincide.
  • The presence of an unusually severe influenza season.
  • A new widespread COVID-19 variant that escapes the immune protection we have built up from infections and vaccinations.

Even though there are unknowns heading into the winter, we know how these viruses spread and there are many actions we can take to stay healthy and reduce our chances of getting sick with the flu, RSV, or COVID-19 and to prevent spreading these infections to others, including:

  1. Get vaccinated and stay up to date with recommended vaccines.
  2. Cover coughs and sneezes.
  3. Wash your hands frequently
  4. If you choose to wear a mask, wear a high quality one that fits over your nose and mouth.
  5. Stay home if you are sick.
  6. Get tested if needed.
  7. Consult your health care provider for questions about treatment, and symptom management.

By taking these simple precautions, we have our best chance of a healthy fall and winter!

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