Flu season is starting to snowball in Washington, picking up in the past few weeks and only expected to worsen this month.
Influenza cases began to increase here in mid-December, coming a few weeks later than in other parts of the country. But by the week of Christmas, flu emergency and outpatient visits had risen sharply — and continue to remain high, worrying state public health leaders especially following the federal government’s unprecedented decision this week to drop some U.S. childhood vaccine recommendations.
It’s a tumultuous moment in U.S. children’s public health that Washington state and local officials are trying to shield from residents, but it’s still too soon to know how much, if at all, access to vaccines and people's interest in them will shift.
“Despite the changes in federal recommendations, which are really not based in any new science or new data, childhood immunization remains a really important part of public health,” said Dr. Tao Sheng Kwan-Gett, the state health officer.
It’s still important, for example, for many people to get their flu shot.
“If you haven’t gotten vaccinated for the flu yet, now is a good time to do it,” Kwan-Gett added.
Flu activity is currently high in Washington, and proving to be particularly severe for older adults and children. By the end of December, the state’s most recent update, 22 people in Washington had died from flu complications. Fifteen flu outbreaks had occurred in long-term care facilities.
Outpatient visits for flu-like symptoms rose throughout December, from about 1.9% of visits to 4.2% — totaling more than 10,000 patients in the past month, according to the state’s report. These patients might not have received laboratory flu tests, so their illnesses could have been due to flu, COVID-19, RSV or another respiratory virus.
In the week ending Dec. 27, more than half of flu patients at outpatient clinics were children or young adults. Nearly 21% of clinic patients were infants to 4 years old, while about 37% of patients were between 5 and 24 years old. About 10% were over 64.
Emergency room visits for flu-like symptoms are also up throughout the state, especially in Central Washington, per the report. Last week, the state saw about 3.6% of hospital emergency visits due to the flu, compared to about 3.4% the previous week — and less than 1% at the end of November.
Kwan-Gett pointed to a new strain of influenza A, a mutated version of the H3N2 virus known as subclade K, that’s likely responsible for the bump in flu cases.
“It has mutations that make it different enough from the influenza A H3N2 components of this season's vaccine, that the vaccine may be less effective at preventing infection,” Kwan-Gett said. “However, we still believe that the vaccine has value … in reducing risk of severe illness.”
Among those who have died from the flu this season, most were 65 or older. This season’s total so far, 22, has surpassed last year’s toll at this time, which was 11. In all, the flu killed about 507 Washingtonians last season, and reflected the historic deadly spread throughout the country.
No children have died from the flu so far this season.
While there’s been an uptick in emergency visits over the past month, numbers have not yet hit last year’s levels.
Since mid-December, King County’s hospital emergency visits for flu have increased, and emergency visits for respiratory illness in general in King, Snohomish and Pierce counties have surpassed their transmission alert threshold — meaning there’s substantial flu, RSV, colds and coughs going around.
The transmission alert threshold for King, Snohomish and Pierce counties is set at 14%. Crossing it also brings back masking in most hospitals and health clinics, said Dr. Sandra Valenciano, health officer of Public Health — Seattle & King County.
As of last week, about 16% of emergency visits in those three counties were due to acute respiratory illness, according to the most recent King County public health data, updated Wednesday. The week before that, about 16.5% of hospital emergency patients in the area had respiratory symptoms.
“It’s going to look like it’s plateaued,” said Valenciano, who started her role last summer. “But I’d caution you to take that with a grain of salt.”
Medical visits might be put off or delayed during the holiday season, due to things like school vacation and people traveling, Valenciano said. It might be a couple of weeks before it's clear how much respiratory disease continues to circulate in the community.
With news of the federal childhood vaccination schedule change, Valenciano said it's hard to say whether that announcement will necessarily have an impact on vaccine uptake and coverage. We’ll be monitoring for sure.”
After the Centers for Disease Control and Prevention on Monday announced plans to cut the number of vaccines it recommends for every child, public health experts and pediatricians in Washington challenged and objected to the change.
The West Coast Health Alliance, a multistate public health coalition that includes Washington, said the federal decision wasn’t based on changes in vaccine safety and effectiveness, and therefore did not follow established procedure.
The alliance said it didn’t expect the changes to affect insurance coverage this year.
Now, the CDC will recommend vaccines for children against 11 diseases, cutting broad recommendations for protection against flu, rotavirus, hepatitis A, hepatitis B, RSV and some forms of meningitis. Vaccines against those diseases are only recommended for certain high-risk groups, or if their doctors recommend them in “shared decision-making.”
“It’s important to note the changes in federal recommendations don't change many of the important pieces of vaccine access and policy here in Washington,” Kwan-Gett said.
In King County, the flu vaccination rate is running slightly below last season. About 31% of residents have received their flu shot so far this season, compared to above 33% in early January last year.
About 25% of Snohomish County residents have received their flu shot so far this year, per the state.
Valenciano, of Public Health — Seattle & King County, said her department is working on vaccine uptake in the next few months, along with answering questions around recent federal policies and correcting vaccine misinformation.
“We’re trying to do as much as possible to help the community drown out that noise and be able to know they can trust us in public health,” she said. “It’s OK to have questions. It’s OK to ask your provider, ’Why does this benefit me?’ But it is so important to make sure they're getting real, trusted, credible info.”
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