COVID-19 and Flu and Monkeypox, Oh My!

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By: Millennial Doctor, Lindsay Morrison, MD, MSCI

It’s that time of year when the air turns crisp, the leaves begin to fall, and seasonal influenza or “flu” once again becomes widespread in the places we work, live, and socialize with our friends. Given the recent epidemics of COVID-19 and Monkeypox, the approaching annual flu season may have slipped your mind.

Lindsay Morrison, MD, MSCI, cares for patients at Georgia Infectious Disease in Atlanta, Georgia.

Flu Symptoms

Each year, between 3-11% of Americans contract the flu, and the burden the disease brings is huge. 

While people with respiratory illnesses such as asthma or chronic obstructive pulmonary disease, and those with immunocompromising conditions remain at the highest risk for severe illness, even more mild flu cases are extremely unpleasant. They result in fevers, muscle aches, fatigue, and of course, the classic cough and runny nose. 

Contracting the flu can also put you at risk of developing bacterial pneumonia afterward.

When is cold and flu season?

The flu season months are typically October through April, but the 2021-2022 flu season was atypically longer. In fact, it included two distinct waves of people becoming infected. 

Overall, however, the 2109-2020 and 2020-2021, post-COVID-19 pandemic, flu season months have been milder. This is suspected to be due, in part, to people changing their behavior to prevent infections, such as wearing masks. 

With the focus on infection prevention becoming increasingly less common, the 2022-2023 flu season may not follow this pattern.

Prevention of Influenza

The flu shot gets a bad reputation for being ineffective. Compared to some other available vaccines such as Hepatitis B that may be true, but it’s the best way to prevent getting the flu (other than wearing a mask). 

For the purposes of this article, the flu shot I’m referring to is the inactivated influenza vaccine. 

I recommend the flu shot to anyone who is eligible to receive it. This means anyone 6 months or older who does not have an allergy to the vaccine or its components is eligible. Note that if you have a severe egg allergy you may receive the flu shot but in a monitored setting; if you have a mild or moderate allergy, you do not need to be monitored following your vaccine. The “high dose” flu vaccines are recommended for those 65 years of age and older

Both types of flu shots for the 2022-2023 flu season months are widely available at low or no cost. 

It’s true that the flu shot varies in how effective it is at in the prevention of influenza from one year to the next. Much of this depends on the predominant strains in a given year, and the flu shot being better at preventing some strains than others. For example, between 2012 and 2022 the flu shot’s effectiveness ranged from 19-58%.

But the true benefit of the flu shot is its ability to make the symptoms of the flu illness caused by the influenza virus less severe than they would be without the shot. 

A study from 2021 on patients hospitalized with the flu demonstrated that those who were vaccinated with the flu shot had a 26% less chance of needing intensive care and 31% less risk of dying than those who were not vaccinated.

COVID-19, Monkeypox and the Flu

This year, yet again, we are faced with the twin threats of Influenza and COVID-19. To top that off, the Monkeypox epidemic continues.

How can you protect yourself from COVID-19?

Two words: get vaccinated! An updated, bivalent booster is now available from both Moderna and Pfizer and contains additional protections for the current, dominant COVID-19 variants, BA.4 and BA.5. 

The bivalent vaccines contain two types of mRNA whereas the previous, monovalent vaccines, contained only one. The bivalent vaccine may be used to complete your COVID-19 primary series of two vaccines and a booster or as a booster dose to an already completed primary series of three vaccines. Currently, the COVID-19 vaccines are widely available.

How can you protect yourself from Monkeypox?

At the time of writing this article, Monkeypox remains primarily within the gay, male community, and vaccination is recommended within this community. 

While the infection is typically not severe it can be painful and take a long time to resolve. Those with immune-compromising conditions or who take immunosuppressant medications are at risk for more severe illness. 

Two vaccines are available ACAM2000, a single-dose vaccine, and Junneos, a two-dose vaccine. The ACAM2000 is not recommended for people who have  immunocompromising conditions including HIV, or those who are pregnant or breastfeeding. Vaccine availability varies by state but are likely available at your county health department.

How to Time Your Vaccinations

The number of seasonal vaccinations you need to get can be intimidating. I recommend getting the flu shot in early fall, September or October. If you have not yet received your COVID-19 booster you may get this at the same time. Injection site discomfort, redness, and mild flu-like symptoms are potential side effects of these vaccines.

If you are currently ill with any type of infection, you should wait until your symptoms are improving before getting any vaccinations, including the flu shot, unless instructed otherwise by your healthcare provider.

Finally, if you have a history of an allergy to any of the vaccines mentioned above please consult your healthcare provider before receiving the vaccines.

For more information check out the CDC website including the “Fluview,” where a plethora of high-quality data, including weekly flu updates, is available.

 Flu Season FAQ

What causes the flu?

Influenza viruses cause the flu, which infects the nose, throat, and sometimes the lungs.

There are four types: human influenza A, B, C and D. Influenza A and B viruses are what cause seasonal flu almost every winter in the United States. 

Influenza A viruses are the only influenza viruses known to cause flu pandemics, unlike Influenza C which typically causes mild illness and is not thought to cause human epidemics. Influenza D primarily infects cattle, not people. 

How contagious is the flu?

The flu spreads from person to person mainly by the tiny droplets that people infected with the virus produce when they cough, sneeze or talk, and then land in the mouths and noses of other people close by. 

Therefore, people who have the flu are most contagious in spreading these droplets in the first 3-4 days after their illness begins. The problem is some people may not realize they are sick yet. 

According to the Centers for Disease Control and Prevention, some healthy adults may be able to infect others starting the day before their own symptoms develop and up to 5 to 7 days after becoming sick. Even more concerning, young children and people with weakened immune systems, might be able to infect others for an even longer.

How long does it take to get over a viral infection?

Well, it depends on the virus! For the flu, uncomplicated signs and symptoms typically resolve after 3-7 days for the majority of people, while a cough and feeling weak and just unwell in general, can persist for more than 2 weeks. 

By comparison, other viral infections, such as Hepatitis B and C viruses and HIV, can be persistent or remain in the body in an inactive form, all lasting for years.

Why does the flu have a season?

Good question. While the flu virus can be detected year-round in the United States, the flu virus typically circulates and shows high levels of activity during the fall and winter.

The flu virus also circulates more effectively in cold, dry environments making the winter its optimal time to spread.That’s why there is a flu season, and usually the season “peaks” (has the highest percentage of respiratory specimens testing positive for the flu virus) between December and February.

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