Flu activity spikes in Pennsylvania, New Jersey and Delaware as new variant threatens a longer season

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Flu activity in the Greater Philadelphia region has reached high or very high levels immediately following the winter holidays, federal and state data shows.

Local hospitals and health systems are reporting an increase in visits to outpatient offices and emergency departments among children and adults with fevers, coughs, breathing issues and in some cases, vomiting and other gastrointestinal symptoms.

A new variant, or subclade, of the virus that is circulating worldwide now seems to be driving much of the uptick in cases in the United States, public health experts say, a possible indicator of a bad and prolonged influenza season.

“It may mean that that tail may go longer than we expect,” said Dr. Henry Fraimow, an infectious disease specialist at Cooper University Health Care in New Jersey. “So, there’s still [a] benefit to getting your flu shots now, because we just don’t know how long this season is going to last.”

A post-holiday rise of infections

During the week of Thanksgiving, flu activity in Pennsylvania, New Jersey and Delaware ranged from minimal to moderate.

But infection rates have risen “rapidly” and “sharply” in a matter of four weeks, according to surveillance data at the U.S. Centers for Disease Control and Prevention.

More than 14,300 positive flu tests were reported to the Pennsylvania Department of Health in the week ending Jan. 3. That’s compared to about 1,690 total cases reported during the week ending Nov. 29.

The number of new hospitalizations in New Jersey jumped to more than 550 people during the week of Christmas, a record number of flu-related admissions in recent years.

A majority of patient test samples are coming back positive for influenza Type A, H3N2. Scientists have narrowed it down to subclade K, which has been dubbed a “super flu” variant despite no evidence to date showing it causes more severe infection, Fraimow said.

Current seasonal flu vaccines do include some protection against H3N2 variants and “it seems like the vaccines are still doing their job this year,” Fraimow said. But he acknowledged that many people are becoming infected even after immunization.

The American Academy of Family Physicians and the American Academy of Pediatrics recommend flu shots for everyone 6 months and older.

“If we’re looking at the traditional measures of how the vaccines are really judged, which is keeping people out of the hospital and preventing death, they seem to be working,” he said. “But maybe not working in preventing disease in people who usually don’t get the flu.”

Subclade K has caused a prolonged influenza season in other parts of the world, including Australia and New Zealand. The countries saw an abnormal second wave of infections leading up to Christmas, which occurs during their summer months.

“Knowing that it’s doing weird things elsewhere may give us more reason to at least pay a lot of attention to what’s happening here,” Fraimow said.

Treatments for flu and when to see a health provider

Doctors and nurses at St. Christopher’s Hospital for Children in Philadelphia are seeing more young kids, including infants and toddlers, come into their emergency room and clinics with fever, breathing issues and dehydration.

That includes children who already struggle with asthma and are experiencing complications due to respiratory infections, said pediatrician Dr. Rita Guevara, who sees patients in outpatient clinics.

“We have been seeing younger children with breathing issues to the point where they need to escalate care to the ER,” she said.

Families can often manage flu infections at home with over-the-counter fever reducers, rest and plenty of hydration, including both water and other liquids like electrolyte sports drinks.

“It’s okay if kids don’t want to eat when they’re sick, but they absolutely have to keep up on their fluid intake,” Guevara said.

Children should be drinking enough to still need regular bathroom breaks and infants and toddlers should still make about two to three wet diapers within a 24-hour window, she said.

When flu is the suspected culprit, as opposed to another virus or bacteria, Guevara said antiviral medications can be very effective in reducing the severity and longevity of illness when given within 48 hours of symptoms starting.

Health experts recommend that parents and children seek professional help if symptoms become severe, including high fevers and signs of dehydration. Kids who appear to get better, but then suddenly get worse again, may be experiencing complications, Guevara said.

“You can start with the flu virus and that can weaken your immune system, making you more susceptible to getting a bacterial infection on top,” she said. “We do see some children that end up needing antibiotic treatment for bacterial infections when everything started with the flu.”

Concerning changes in breathing is also another red flag and cause for more care, Guevara said.

“They’re allowed to cough. We love coughing, because it brings up mucus and it helps clear the passages. You’re not allowed to be struggling to breathe,” she said. “If a child is working hard to breathe, they’re belly breathing, the flaring of their nostrils, they’re sucking in in their neck and between the ribs, that child needs to be seen.”

Kids may also show other signs of a worsening illness, including excessive fatigue and painful body aches that go beyond the level typically seen. Guevara encourages parents to act on their “Spidey senses” when caring for their sick children.

“We don’t know your child as well as you do, so we are partnering with you to tell us, ‘This is not my child, they are not okay,’” she said.

Health experts also recommend preventative measures like frequent hand washing, masking and cleaning of commonly used surfaces, as well as staying home from work, school, day care and other social settings when feeling sick.