Israel Prepares for Unusually Severe Flu Season

Flu vaccine has proven ineffective against on of the year's most common strains of flu, placing greater burned on Health Ministry and hospitals nationwide.

Daniel Bar-On

In preparation for what is shaping up as an unusually severe flu season, the Health Ministry has taken the exceptional step of giving the health maintenance organizations the antiviral drug Tamiflu at no cost so they in turn can prescribe it for free to patients who need it.

Normally, Tamiflu is available for free only at hospitals. But because more flu cases than usual are expected this year, the ministry decided to allow the HMOs to administer the drug as well, in order to avoid overcrowding at the hospitals.

The main reason this year’s flu season is expected to be especially severe is that the flu vaccine has proven ineffective against one of the year’s most common strains of flu. According to a statement put out last month by the U.S. Centers for Disease Control and Prevention, this particular strain of the H3N2 virus underwent a mutation that makes it resistant to the vaccine. As a result, CDC experts said, the vaccine reduces the risk of getting a severe enough case of flu to require a doctor’s visit by only 23 percent this year, compared to an effectiveness rate of 60 to 90 percent in normal years.

Nevertheless, medical professionals stressed, getting the flu vaccine is still worthwhile, since it is partially effective even against this strain and also protects against other strains of flu.

In the United States, 45 people have died of the flu so far this year. In Israel, in contrast, the number of flu cases has so far been relatively low, though it has been rising steadily.

The local flu season is expected to reach its peak only in February.

The Health Ministry’s flu monitoring report for January 10 found that of the eight samples in which the H3N2 virus was detected, only in one case did the particular strain of the virus match the one found in the vaccine.

The January 17 report found that in 93.4 percent of samples where H3N2 was identified, the particular strain didn’t completely match the one included in the virus.

Flu can produce severe complications and even be fatal, especially for people in the main risk groups – babies, the elderly and people with weak immune systems. Consequently, in light of the vaccine’s reduced effectiveness, the ministry decided to dispense Tamiflu to the HMOs as well as the hospitals, so that it can be given to people who weren’t vaccinated or for whom the vaccine didn’t work. The drug is most effective when administered in the early stages of the disease, preferably in the first 48 hours after symptoms appear.

The last time the ministry decided to expand the use of Tamiflu was in 2009, due to an outbreak of swine flu.

Every year, about 20 to 30 percent of adults and five to 10 percent of children get the flu. Thus the difference between an effective vaccine and one that is only partly effective can often reach thousands of deaths. A CDC study of flu deaths in the United States from 1976 to 2007 found that they ranged from 3,000 a year in mild years to 49,000 in the worst years.

About 90 percent of the people who die from flu are 65 or older. Death generally occurs because the flu leaves them vulnerable to other diseases, such as severe pneumonia.

The ministry said there have been no reports of people falling seriously ill or dying of flu in Israel so far this year, nor has the number of flu cases been rising rapidly.

“The decision to distribute Tamiflu for free stems mainly from the lessons of previous years, with no connection to the severity of the illness,” it said.