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Hungary Flu Season Shows Worst Start Of The Past 14 Years
On the 41th week of 2024 (7-13 October), 210,400 people turned to the doctor with acute respiratory infections, including 20,400 people with flu-like symptoms, according to data by the National Centre for Public Health and Pharmacy (NNGYK). The former figure dropped from 228,000 on the 40th week, while the latter jumped from 18,600.
A short-term comparison (for the last three flu seasons) shows that the number of patients with ARI was slightly higher in 2022/23, but much lower a year ago.
The share of flu-like symptoms in ARI was 8.2% on the 40th and 9.7% on the 41st week, the highest ratios in the past three seasons.
We also have data for ARIs and flu-like symptoms per 100,000 population, although a long-term data series is available only for the latter.
These both show that the current season of respiratory infections is the worst in many years.
In the current flu-season, the surveillance service monitors the occurrence of influenza-like illnesses and acute respiratory infections based on data provided by 1,304 general practitioners and general paediatricians, which is the lowest figure in the NNGYK's publicly available database. The trend is not reassuring (see chart below).
A total of 248 samples were tested on the 41st week, of which 73 came back COVID-19 positive, i.E. They detected coronavirus in about 30%% of the samples. This compares with 26% a year ago, but then only 54 samples were tested and 14 showed the presence of SARS-CoV-2.
165 people with severe acute respiratory infection (SARI) were hospitalised on the 41st week, of whom 19 (or 11.5%) required intensive care. Both The respective figures for the 40th week of 2023 were 154 people in hospital, and 17 (11.0%) in ICUs.
Further breakdown shows that 103 people (62.4% of SARI patients) were hospitalised with coronavirus infection, down from 116 a week ago and fewer than 110 (65.1%) a year ago.
Of the 165 people in hospital with SARI, 31 (18.8%) were aged two or younger, while 99 (60%) were 60 and above. Also, 83 (78.6%) of the 103 COVID-19 patients were over 60 years of age.
A year ago, of the 169 people in hospital with SARI, 27 (16%) were aged two or younger, while 103 (60.9%) were 60 or older. Also, 85 (77.3%) of the 110 COVID-19 patients were over 60 years of age.
The age breakdown of people seeking medical help with ARI and flu-like symptoms are shown below, including a comparison with data a year ago.
The majority of ARI patients belonged in the 0-14 age group throughout the flu-season last year, while the share of people going to the doctor with flu-like symptoms was the highest in the 15-34 age group up to the 2nd week of this year when the youngest were in majority until the 40th week bar a couple of weeks towards the end.
Here's a heat map of the ARI and flu age breakdowns for last year.
Vaccinationone of the most important tasks in the preparation for the flu season is to organise and administer free flu vaccinations,
the NNGYK said in a press release last week.
The flu shots have already started to be delivered and are expected to be available in GP offices and occupational health clinics across the country from the end of October.
The vaccine becomes fully effective two to three weeks after the jab, and their efficacy lasts for months. The virus constantly changes that is why new shots are developed every year.
As in last season, 949,000 doses of the 3Fluart flu vaccine are available for the at-risk group of people aged 3 years and over, to be used free of charge this season.
Based on the experience of the past decades, the spread of influenza viruses in Hungary is observed from the end of November and usually reaches epidemic levels in January, so it is recommended to get the flu vaccine before the outbreak starts, i.E. In November or December.
Vaccination against influenza is particularly recommended for people over 60 years of age, the chronically ill, health and social workers and pregnant women.
The lowest number of flu vaccinations administered in the last 14 years was in the 2023/2024 season.
According to aggregate data available at the NNGYK, a total of 594,465 people over the age of three received free flu vaccination, of whom 442,943 (74.5%) were aged 60 or over. While this percentage may seem high, and it is in fact the highest since the 2018/19 flu season, another comparison paints a gloomier picture.
The actual number of shots administered to Hungarians aged 60 and above was by far the lowest in the past six flu seasons. (We have asked the NNGYK for the time series going back 14 years and we'll update our charts as soon as we get the data.) If we look at the share of the elderly vaccinated as a percentage of their own age group, we also have the lowest figure (17.5%) of the past six years. So, it's all a matter of what you want to emphasise really.
The 'improvement' highlighted by the authority stems from the fact that while the number of 3Fluart shots administered in 2023/24 plummeted 50% from the 2020/21 peak during the covid pandemic, the number of shots administered in the 60+ age group went down by "only" 38%. The respective decreases compared to 2018/19 (i.E. A "normal" year) were 17.3% and 13.3%.
Influenza ends 'rule' of pertussisOn the 41st week of 2024, 24 suspected cases of whooping cough were registered by GPs in Hungary, according to the latest weekly report from the National Centre for Public Health and Pharmacy (NNGYK). It confirmed the clinical diagnoses with microbiological tests in 7 cases and diagnostic tests still ongoing in the remaining patients.
The 41st week is the sixth week in a row that caused a positive surprise, as experts projected a rise in the number of suspected pertussis cases due to the start of the school year and the consequent increase in social contacts.
The number of suspected pertussis cases reported for the 40th week brings the cumulative number to 978 this year, an outstanding figure compared to previous years when only a few cases were found in Hungary. This is strange, because the high rate of vaccination has meant that GPs have generally encountered these diseases mostly in textbooks, and very seldom in practice.
Portfolio has previously reported in several articles that the most vulnerable group is infants. They were also the group with the highest incidence on the 41s week. In the first 41 weeks of this year, 206 of all suspected cases, practically one in five, were infants, but the prevalence in the 40-49 age group is also rather high. If we look at a wider age group of children between 0 and 14 years of age, they make up 42.9% of all cases this year (420 in total), while up to 19 years the share is 52.8% (516 cases).
Cover photo (for illustration purposes only): Getty Images
Worst Whooping Cough Outbreak In A Decade Has Infected Thousands
Whooping cough is spreading nationwide at the highest levels since 2014. There have been about 17,500 cases this year — more than four times as many compared to the same time last year — and four confirmed deaths. And experts are concerned that the outbreak could worsen in the fall and winter months.
"More children are going back to school now, [which leads to] greater exposure," said Dr. Eric Chow, the chief of epidemiology and immunization at Public Health – Seattle and King County. "We're coming up on the kind of winter season when people are spending more time indoors with other people."
The disease is most dangerous to babies: One in three who get it require hospitalization.
Whooping cough cases are especially high right now on the West Coast.
King County has seen more this year than any year since 2015 — "and the year isn't even over yet," Chow said, adding that the county is still seeing new cases every week.
Experts say there are a number of possible explanations for the size of the current outbreak.
Doctors are testing for whooping cough more, so they're identifying more cases.
It's possible that the bacterium that causes the disease has mutated.
Also, people got behind on their vaccines during the pandemic, and they haven't caught up.
"One of the challenges that we have with [the vaccine that protects against whooping cough] is that it is a five-dose series over the course of the first six years of a child's life, so it does require regular visits to the primary care," Chow said.
And, Chow said, not everyone can get to the doctor regularly.
But access isn't the only problem.
"There still is a lot of vaccine hesitancy and anti-vaxxers out there who will not vaccinate their kids," said Dr. Tina Tan, a pediatric infectious disease physician at Northwestern University and the president-elect of the Infectious Diseases Society of America.
For the first couple of weeks, whooping cough looks like a mild cold, but then the coughing fits start.
Babies who get it "are going to be whooping when they cough," Tan said. "And they may cough, cough, cough, cough, cough, and then look like they're not breathing at all."
Tan said those pauses in breathing are life-threatening, and a sign that it's time to go to the hospital.
Whooping cough can also lead to pneumonia and other complications.
But babies can't get their first dose of the vaccine that protects against whooping cough, also called pertussis, till they're two months old.
"That's why it's important for pregnant women to get the pertussis vaccine when they're pregnant," Tan said, "so that you can protect your baby for the first two months of life until they're old enough to be vaccinated themselves."
Even before the pandemic, only about half of pregnant women got the pertussis vaccine. Now, that number is even lower.
In King County, of the 12 babies who have been seen with whooping cough this year, none of their mothers got the shot during pregnancy.
Dr. Chow, with Public Health – Seattle and King County, said that's a missed opportunity.
"Sometimes you require a kind of sit-down conversation with the patient who may be a little bit more hesitant or may have encountered misinformation," he said, "so it just requires a longer time to build trust and rapport."
Also, not all ob/gyns offer the vaccine in their offices, and some people don't have the bandwidth to go to a pharmacy for a shot.
At a playground in King County's White Center neighborhood, Kay said she has two kids, who are 12 and four years old, and she's always been hesitant about vaccines.
Kay declined to give her last name because she's concerned about revealing private medical information.
"With Covid, it even made it even more scary, because everybody started coming out saying, 'The covid shot's not actually good for you,'" Kay said. "So I was like, 'Maybe the other vaccines are bad too.' And then I went down the rabbit hole of looking up kids who have supposedly gotten vaccinations and passed away."
Experts say vaccines are very safe and can prevent diseases that once killed or harmed many babies, children, and adults.
Kay eventually got her 4-year-old daughter the shots required for daycare, but nothing else.
"It's hard for me to get child care, and it's just easier for me to say, 'OK, just give me whatever she needs, just to get her into school,'" Kay said.
So her daughter did get the required whooping cough vaccines — but not any Covid shots, which are not mandated.
Aaron Sittinghorse was at the same playground with his 3-year-old daughter. He said the pandemic had the opposite effect on his thoughts about vaccines.
"It opened up my eyes to how important they are," he said, "and so now, I'm a believer in vaccines. It's important, even if it's not for yourself, but for everybody around you."
Sittinghorse said he saw on the news that there's a whooping-cough outbreak right now, and it worries him a little — but not too much, because he and his family are up to date on their vaccines.
Winter Flu: Should We Expect The Worst?
Each flu season is different and very difficult to predict but having a vaccine is still recommended
Now the flu season is upon us, should we expect the worst?
If speculation based on the recent flu outbreak in Australia is to be believed, then yes. But are these fears unfounded?
Australia has witnessed its worst flu outbreak for over a decade - more than twice the usual level.
In most people, seasonal flu infection is unpleasant but relatively harmless. But for some - the elderly, very young and those with asthma, diabetes or heart disease - flu can prove fatal.
That's why we immunise against flu.
Current vaccines contain two different strains of influenza A and one or two strains of influenza B.
But there are lots of strains circulating around the world and these are constantly evolving.
This means that choosing which strains to use in the vaccine is not easy. This decision is left to a global network of scientists who painstakingly analyse thousands of viruses to try to second-guess which viruses will dominate.
Despite their best efforts, these predictions don't always work.
Have virus strains mutated?
According to Dr John McCauley, director of the WHO Collaborating Centre for Reference and Research on Influenza at the Crick Institute UK, one influenza A strain in particular has been causing some problems: "What happened to the H3N2 viruses, which have been with us ever since 1968, is that they've just kept evolving and changing.
"There's been an increased impact since new varieties came out in 2013-14 and I think we're still seeing their effects around the world."
Could the raised levels of flu activity seen in Australia over their winter months be because the H3N2 virus strains had mutated and were no longer similar to the vaccine strain?
Dr McCauley doesn't think so: "Is there any evidence for antigenic drift? The answer to that is marginal for this year and last year, whereas when these viruses first came along in 2013-14 that was clear-cut."
And that's a conundrum. The virus used in the vaccine should have protected, yet for some reason, in some parts of the world like Australia, it was failing.
This led scientists to question whether the way the vaccine was made was affecting its ability to generate virus-killing antibodies.
How is the vaccine made?
To make the adult vaccine, virus is grown in hen eggs but this can also lead to virus mutation.
And recent studies have suggested that antibodies raised by these mutant egg-grown H3N2 vaccine viruses are unable to kill viruses that are infecting humans.
But, as Dr McCauley pointed out, it isn't just down to the way the virus is grown: "For the attenuated vaccine, which is also grown in hens' eggs, the protection was good."
H3N2 is a type of influenza A virus currently circulating in humans
So it seems not so much how the virus is grown, but whether it is killed or attenuated.
For the killed virus we know that protection is associated with antibodies, but these target the virus proteins that mutate when the virus is grown in eggs.
Although we still don't fully understand how the attenuated vaccine works, we do know that this vaccine is able to stimulate another part of the immune system - the group of white blood cells known as killer T cells.
How could T cells help?
Sarah Gilbert, professor of vaccinology at Vaccitech Ltd and the Jenner Institute, University of Oxford, says T cells can be beneficial.
"The good thing is that T cells target proteins in the flu virus that are very well conserved, so we don't have the problem of the targets for the immune response constantly changing, but the challenge is to bring the flu-targeting T-cells back up to levels that are protective."
The theory goes that immunity arising from T cells won't be affected by mutations that occur during natural evolution of the virus or when the virus is grown in eggs.
Prof Gilbert and her team have just embarked on a clinical trial that uses a safe version of the smallpox vaccine to deliver influenza proteins in the hope that this will boost the level of flu-killing T cells and protect against infection.
The elderly and the very young are most at risk from flu
"It's a really good year to test our vaccine if the normal inactivated vaccine doesn't perform as well as hoped," Prof Gilbert told BBC News.
The scientists hope that the additional vaccine component will work its magic in three ways - by raising T cells that target parts of the virus less likely to mutate, by increasing the number of strains that can be targeted by antibodies raised by the standard vaccine and also by increasing the amount of antibody produced.
But what of the forthcoming flu season - should we brace ourselves for an upturn in cases?
If I were a betting man, and given what we have just witnessed in Australia, then I would say the chances are high. However, each flu season is different and very difficult to predict.
What I can say though, with absolute confidence, is that before every flu season it is extremely important for those most at risk to get immunised.
What are influenza viruses?
Winter flu warnings: Should I worry?
NHS told to brace itself for bad flu season
Seven die of flu at Australia nursing home
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