U.S. health officials have asked clinicians to help lessen the impact of an exceptional respiratory virus season on seniors and other vulnerable Americans.
In a health advisory released Friday, the Centers for Disease Control and Prevention recommended that clinicians be ready to prevent, test for and treat spiking cases of influenza, respiratory syncytial virus (RSV) and the common cold, and watch for an expected uptick in COVID-19. Two years of COVID-19 as the dominant respiratory disease has thrown off seasonal timing of others and left more people at risk of severe disease, they said.
“Currently, the U.S. is experiencing a surge and co-circulation of respiratory viruses other than SARS-CoV-2,” the advisory stated. Co-circulation of these respiratory diseases “could place stress on healthcare systems this fall and winter,” its authors wrote.
There are early signs that influenza is causing more severe illness in older adults than in previous years, for example, with more related hospitalizations at this time of year than seen in a decade.
As of Oct. 29, influenza hospitalization rates for adults aged 75 years and older were higher than they were in the 2021-2022 season, and appeared to be trending upward. The CDC expects continued high-level circulation of influenza viruses throughout the remainder of fall and the winter.
Overall, “we’re seeing the highest influenza hospitalization rates going back a decade,” said Jose Romero, MD, director of CDC National Center for Immunization and Respiratory Diseases, at a Friday press conference.
In the Southeastern United States, influenza A H3N2 viruses, associated with severe flu seasons, have accounted for 20% of positive flu tests. And there is a greater proportion of H1N1 viruses in the mid-Atlantic and Midwest, Romero reported.
RSV and COVID a threat
The agency has also raised cautions about RSV, which began an uncharacteristic rise in the spring that included an increase in RSV-associated emergency department visits and hospitalizations. Currently, some regions are already near the seasonal peak levels typically seen in December or January, it reported.
A spike among young children has been particularly notable this fall, but the disease can also put seniors at high risk of adverse outcomes. The latest signs indicate that infection levels may be plateauing in some areas of the United States, the CDC noted. Rhinovirus/enterovirus infections, which cause common cold symptoms, have also spiked early but may be reaching a plateau as well.
Meanwhile, the CDC asked clinicians to keep COVID-19 on their radars, with infections expected to follow the same rising pattern this winter as they did in the 2021-2022 season. A decline in COVID cases and hospitalizations that began in August has slowed in recent weeks, with new daily cases up 4.7% compared to the prior week, according to the CDC’s COVID data tracker. The weekly average for new hospitalizations has declined 1%, but the seven-day average for deaths decreased 3% when compared to the prior week.
At the ready
Clinicians should focus on prevention in the form of “prompt vaccination” for flu and COVID-19 for eligible patients who are not up to date, the CDC recommended.
For flu, this season’s updated influenza A(H3N2) vaccine component appears to be a close match to the circulating virus, suggesting that it should offer protection against those viruses to date, its health advisory noted. Updated COVID-19 booster shots also protect against both the ancestral SARS-CoV-2 virus and the predominant omicron BA.4 and BA.5 subvariants that cause COVID-19.
Early treatment with antivirals for both flu and COVID-19 should be employed early in the disease process, and clinicians should be ready to make use of prophylactic and therapeutic monoclonal antibodies against the disease as well, the CDC said.
The new health advisory recommended that clinicians consider diagnostic testing to guide treatment in certain cases, and refer patients to education for respiratory diseases, including more information about RSV for seniors.
The full November 4 health advisory can be found on the CDC’s website.