President's Podcast: An update on respiratory illness season

Tina Tan: [00:00:07] Well. Hello everyone. Welcome to the Let's Talk ID podcast. I'm doctor Tina Tan. I'm president of IDSA. And joining me today is Dr. Brendan Jackson. He's director of the Office of Readiness Response and Operations at the CDC National Center for Immunization and Respiratory Diseases. And he's with me today to discuss the respiratory illness season. So welcome, Dr. Jackson. It is such a pleasure to have you.

Brendan Jackson: [00:00:37] No, thanks for having me.

Tina Tan: [00:00:39] Our pleasure. So, you know, as you know, a respiratory disease system, illnesses are now really starting to rev up. So what are the current respiratory viral illnesses that are circulating in the US?

Brendan Jackson: [00:00:53] Well, I'll start with sort of the big three that we track most closely that cause the most severe outcomes, those being Covid, flu and RSV. And I would say actually, interesting, compared to the past two seasons, we're at a bit lower levels than where we've been at this equivalent time point. But those past two seasons were early seasons, and RSV and flu activity, like you noted, are right in line with where they've been for some pre-pandemic seasons. So I'll say in terms of the three, RSV is probably furthest along. It's now causing moderate levels of disease activity, especially among young children. And, you know, sort of following the typical pattern for RSV, it sort of started in the far south and southeast of the country and has worked its way up kind of north along the eastern seaboard, and it's now making its way to the rest of the country. In terms of flu, it's been kind of steadily increasing from low levels now for several weeks, and it is getting towards more low to moderate levels at this point, but still a lot of room to move. So still time to get vaccinated there.

Brendan Jackson: [00:01:50] Covid is a bit of a surprise for us right now. We know that Covid the season is not fully established. It's not entirely seasonal, right? It never like goes away entirely through the year. There's a summer wave. We had a pretty good size summer wave this year. There's often a fall slump, and compared to the past two years, we're a bit later coming out of that fall slump. But just the data that's just coming out now is showing. That's kind of turning the corner and heading upwards. So I think what that means for folks is that the past two years, we've seen a peak in disease activity pretty much on New Year's Day right around that time. And we're on course to have a later peak than that into January or February or so. So just to keep an eye out for that now, in terms of other illnesses that were of course watching, there's always rhinovirus and enterovirus out there. Those are pretty high levels at this point, typical for the season. Influenza is out there, and one that I know a lot of people have been paying attention to, not a virus, but mycoplasma, the cause of walking pneumonia. That's been a huge issue this past fall, especially in some of the youngest children who aren't usually quite as much at risk of that, typically.

Tina Tan: [00:02:54] And with these new Covid subvariants that are emerging, do you think this is going to prolong the respiratory viral illness season?

Brendan Jackson: [00:03:03] We've been keeping a really close eye on those variants. I would say they're sort of very much in line with what we've seen in previous years in terms of how much things are changing. So there's always going to be new variants and changing, as you pointed out. I would say right now, the vaccines are still a really good sort of match, if you will, for Covid. In terms of what variants are out there right now, pretty much always there's going to be changes because there's got to be something that drives that increased transmission, etc. And so this FCC that's out there right now and some of the other smaller ones, they're relatively small changes from what's in the vaccine strain right now. But like you said, they're the new ones out there, and they're going to be what's driving the new transmission unless something big comes along.

Tina Tan: [00:03:41] Well I'm glad you brought up the issue of vaccines, because the question that we get all the time is, how important is it to get vaccinated against these illnesses that we have vaccines for? And is it ever too late to get the vaccine? And is it safe to get all the vaccines in a single visit?

Brendan Jackson: [00:04:01] Really important questions there. So vaccine is an excellent way to increase that protection against severe disease. To put this in context. Last season, there were over a million people hospitalized and over 100,000 died from these three diseases put together. And I know the clinicians out there, especially the pediatricians, know what a major issue RSV is for infants, the leading cause of hospitalizations in infants. And that's not just among respiratory diseases. That's not just among infectious diseases. That's across the board, which, again, the pediatricians know all too well that those vaccines for all those diseases can reduce that risk by half or more. So if you haven't gotten vaccinated this fall, or your patients haven't, it is not too late. It's absolutely still time to get it. As we talked about, levels are still at a relatively low level and now is the time to do that, especially with the holidays coming up and as we head into peak season now. Just as a reminder about who's recommended to get these vaccines for Covid and flu. They've made it as simple as possible. If you're six months or older, just go ahead and get those vaccines. Now, certainly some people are going to have more benefit than others if they're at greater risk for a variety of reasons, whether they're whether older age or immunocompromised or other underlying conditions, that's going to be especially important for them. I do want to do a special call out about pregnant women because for flu, for example, they are at higher risk of complications for flu. But for all three of these diseases, getting vaccinated during pregnancy protects the baby after birth, and that's a big deal.

Brendan Jackson: [00:05:24] For Covid for example, infants have as high rate of Covid hospitalizations as people in their 60s and 70s. I don't think a lot of people realize just how high that risk is right there, and that vaccination during pregnancy can really bring that down. Now to your questions about is it too late? Again, I just want to emphasize it is not too late to get those vaccines and also that you can go ahead and get them all in one visit. I got my flu and Covid shots together at the same time. If people are concerned, they can always space them out. But just remember, the bigger risk is that you're going to miss out on that protection because you don't come back. And that's often what happens if people decide to space them out. So oftentimes it's better just to go ahead and get them together. You can always talk with your health care provider about that if it's a concern. I also just want to mention there's other strategies people have to help protect themselves in addition to vaccination. There's treatment especially for flu and Covid that once you get treated early in illness, if you're at higher risk, it can reduce the risk of severe disease. For flu, it can shorten your duration of illness. There's also just, you know, fundamental public health actions like hand hygiene, taking steps for cleaner air, which was underscored during the pandemic. And even, you know, for people who choose wearing a mask or using testing to help guide what's going on, know.

Tina Tan: [00:06:37] Those are some great tips for individuals to basically explain to their patients. But one issue that comes up a lot in the adult population has to do with, I don't want to get all the vaccines at one time. Are you have any tips on how we can alleviate concerns in these patients about getting all the vaccines at the same visit? Because if you don't give all the vaccines at the same visit, if you can. The problem is, is that many times they're not going to come back and get the other vaccines.

Brendan Jackson: [00:07:12] I don't know that I've got any special tips that you all in the clinical audience would know otherwise, other than to say flu and Covid vaccines have been studied extensively together, and there's good data to show that they are safe, effective together. There's less data available for RSV with those other vaccines, but all indications are that should be completely fine. There's lots of people who are getting those together. There's really no indication that's an issue. And what we do have a strong indication for is, as you pointed out, if you miss out on those that protection, that's a 50% reduction in risk or more, depending on the type of vaccine that you are missing out on trying. You know, in public health, so often we need to make the best option, the easy option. And this is a chance to just do that easy option. If you're worried about sort of having that sore arm or feeling a little run down, you can always take some ibuprofen or something like that afterwards to kind of calm things down or schedule at a time where you maybe have a day to kind of recover a bit more if you need to, and just kind of get that all out of the way at once.

Tina Tan: [00:08:05] So in the adult population, can you basically give some guidance as to who would be considered as a high risk group for developing severe disease if they don't get vaccinated?

Brendan Jackson: [00:08:18] Right. I think one, it's important to note that anyone can be affected by these diseases and sometimes even develop severe outcomes. It's not always predictable, although certainly some groups are at higher risk and there are some differences by disease. But put broadly, older adults by far are sort of some of the highest risk groups. That's especially true for Covid and RSV. But it's true across the board. And you said adults, but just emphasizing young children, especially those infants, can be at greater risk. Pregnant women for flu especially. And then again, people with compromised immune systems and certain underlying conditions as well. So I'll just give an example for for RSV. The recommendation now is that everybody 75 and older should just go ahead and get an RSV vaccine. Importantly, if you got one last year, you don't need one again this year. It's not like it's something you need to get every year at this point. What's changed now is that for people 60 to 74. Now for RSV vaccines. They're recommended to get it if they have certain underlying conditions like heart or lung conditions. Again, that weakened immune system, or if they live in a nursing home, since that's often indicative of greater risk for other reasons. And the other thing I'll just note is for children, their risk is certainly, I know you're talking about adults, but for children the risk is lower overall than than for older adults, for example. But they are still at risk for severe outcomes. I'll point out, last season, over 200 children died from influenza.

Tina Tan: [00:09:37] I'm glad you brought up the issue of nursing homes, because I think many people sometimes don't remember that the residents of those nursing homes are at increased risk for severe disease should they get one of these diseases. So do you have some tips on how some of our listeners could approach that issue? And, you know, remind the nursing homes that they really should be vaccinating all of their residents?

Brendan Jackson: [00:10:07] Yeah, I think one of the most important things is to be vocal about it, especially that's so important coming from a physician or other health care provider to talk about that. Whether you can help arrange with vaccination visits, sometimes that may involve a connection with your state or local health department, who may be able to help arrange that as well. We unfortunately, are seeing sort of lower rates of vaccination, especially for Covid vaccines in nursing homes, than probably people of the equivalent age who are not in nursing homes. There's a lot of structural issues that go into that. We see a huge variability by state, but there are some states who have been able to have those networking and bringing those different groups together to be able to drive those vaccination rates to protect their residents much, much higher. And that can be independent. They're not necessarily in states that you might expect to have overall high vaccination rates. It can just it's often dependent on having those connections and people being vocal.

Tina Tan: [00:11:01] Excellent point. And we know that for some patients, accessing health care and vaccines is very challenging. How can we make these vaccines more accessible to people?

Brendan Jackson: [00:11:12] Absolutely. It's an issue, I think, a positive development that we have seen over the past few years, that is that pharmacies have been able to give more and more vaccines, and it's an easy place for people to get to. I think one concern that some of us have been having around that is that we've been seeing a decline in the number of vaccines that are offered in physician offices, and that's a problem, too, because people often will go to their healthcare provider. But if it's not available there, they may not make that extra trip to the pharmacy. And so really trying to ensure that as much as possible, vaccines are available at different providers offices. And it's not necessarily just primary care if you're a specialist and can offer that vaccine, that can make a big difference as well. Certainly the uninsured folks are going to have some of the hardest time getting some of these vaccines. There was something called the Bridge Access Program this past year, which provided free Covid vaccines to uninsured, that the funding for that has run out. There is still some additional support available through health departments and also through federally qualified health centers or other health centers like that. So check with your doctor's office, the pharmacies, these community health clinics, sometimes even workplaces and schools and religious centers, just to find those places. It is not, unfortunately, always easy for people who do not have insurance. You know, I think this underscores the fact that there's probably a need for some sort of federal program that that provides vaccines for the uninsured and analogous to the vaccines for children program, that vaccines for children's program provides no cost to vaccines to millions of children, nearly half of whom roughly half of whom are uninsured in this country. And a similar program for adults would provide a lot of protection.

Tina Tan: [00:12:45] That would be wonderful if we could establish something like that. Do you know of any of the health departments might be, you know, putting together, say, like a vaccine campaign so that they can get some of the uninsured vaccinated?

Brendan Jackson: [00:13:02] It really depends on the state. There's some that have more resources and are able to do quite a bit, and others who just don't have the resources to do that. So you really have to check with your individual state or local health department unfortunately.

Tina Tan: [00:13:12] I know you brought up mycoplasma early on, but you know, we also are experiencing a pertussis outbreak now when people get sick with these respiratory illnesses. Do you have any suggestions on how some of the providers should be going about testing these individuals for these different potential organisms?

Brendan Jackson: [00:13:35] Yeah, it's not my main area of expertise, but I do know that considering treatment early can make a big difference there. From a pediatric background, infectious disease background, I wonder if you would speak a bit more to that from your experience?

Tina Tan: [00:13:45] So from my experience, I mean, as you know, with pertussis, if you don't identify that a person has it and they're not treated for it, they are able to spread the disease for the next 3 to 4 weeks after they got the disease. So it's really important if someone presents to you, usually with a prolonged cough, that you think about pertussis as a possible cause of that, because we know that a lot of adult care providers really don't think about pertussis in prolonged cough. And we know that adults tend to be one of the greatest sources of transmission of the disease to others in the community. And people also need to remember that they need to prophylax contacts of individuals that have pertussis, because that's the way that we can control the disease. But more importantly, people need to be up to date on their vaccinations and be up to date on their pertussis vaccines.

Brendan Jackson: [00:14:49] Great points, thank you.

Tina Tan: [00:14:50] Are there other tips that you can provide to our listeners with regards to the different viruses that are going to be causing the majority of the infections this season?

Brendan Jackson: [00:15:03] Well, I would say at the risk of infringing copyright, winter is coming. So this is the time to take action to get protected with vaccines. Have a plan to get treatment if you're at higher risk. Reach out to those family members who are going to be at higher risk and make sure that they they have done the same. We need to be as protected as possible going into the season. I think another thing I want to emphasize is that the stakes are higher now for each fall and winter virus season than they were before the pandemic. And it's simple math, right? We had two major viruses causing problems flu and RSV. Families of viruses, technically, but you know what I mean. And now we have three with the addition of Covid. So Covid we're not in the emergency stage anymore. But you add that on top of what was what could already be a pretty bad season for flu and RSV, you can end up with a really bad season. To put that in context, 2017-2018 was a pretty bad flu season overall. A lot of hospitalizations, very busy health clinics and the like. Basically now even a moderate season for all three of the viruses viral groups together is as bad as a bad season in the past. And so that's what we're really keep an eye out. We saw that with the quote unquote tripledemic season a couple of years ago with major strain on health care, and we're really hoping to avoid that this year.

Tina Tan: [00:16:13] And any tips on individuals who present to their physicians and they say, you know, I don't want vaccine X because I get sick anyway. The best example is the flu vaccine, because people will say, well, I don't want the flu vaccine because I get flu anyway.

Brendan Jackson: [00:16:30] So we've got some great materials on our website about how to how to address that. But I also want to point to the "wild to mild" campaign. And at first when I saw this, I kind of laughed. I mean, you see, the graphics are great. So take a look on our website here. The idea is that, you know, even if you're not going to end up in the hospital, getting laid out in bed for a week with the flu is absolutely no fun at all. You feel terrible. That's a pretty mild illness. You get that vaccine ahead of time. It may you may still get the infection, but it's going to generally be a whole lot more mild, a whole lot more manageable. You're getting back to your normal life sooner. School work. You may need to wear a mask for an extra couple days just to help protect others at those holiday gatherings, maybe reduce that risk of spreading the disease as well. Go from mild to mild. Check out the graphics that are associated with it. They're hilarious. At least from the perspective of a public health nerd like me.

Tina Tan: [00:17:17] That's great. I mean, I took a look at that. That is a fantastic site to look at because it has very important information that is presented in an easy to understand manner. So that is wonderful. That's wonderful.

Brendan Jackson: [00:17:34] Consider getting one of those graphics and putting that up in your office. It's a very eye catching and I think very patient friendly.

Tina Tan: [00:17:39] Absolutely. Any other advice you might want to give?

Brendan Jackson: [00:17:44] Just wishing everybody a happy and healthy holiday season.

Tina Tan: [00:17:47] Same here. And thank you so much, Dr. Jackson, for speaking with me about this. This has been great. You've provided a lot of very informative information and you too have a wonderful holiday season.