A recent study found that there has been a rise in insurance claims for obesity-linked illnesses, such as high blood pressure, type 2 diabetes, and sleep apnea. While the results of this study–completed by the nonprofit Fair Health, a national clearinghouse for claims data–is nothing new, it is one of the first to use actual claims data. This is important because claims data shows treatments actually rendered, which can help illustrate the medical costs associated with high obesity rates. Beyond the results of this specific study, though, the fact is that obesity has become a major problem in the United States for people of all ages. Read on to learn more about the American obesity epidemic, what is being done to fight it, and the outlook going forward.

Obesity in America

Obesity is a somewhat mysterious term, so it first bears clarifying. According to the Centers for Disease Control (CDC), a person is obese when his or her Body Mass Index is above 30 percent. BMI is calculated by dividing a person’s height by weight. A BMI above 40 percent is considered extreme or severe obesity. While BMI is a useful tool to help assess health on a basic level, it does not directly measure the amount of body fat a person has.

In 2014, 36 percent of adults in the United States were obese. According to estimates from 2008, obesity cost the nation approximately $147 billion for medical costs. On a more individual level, people who are obese spend $1,429 more on medical costs per year than people of normal weight. Not only does obesity have negative physical effects, but it can also have negative mental effects and lead to depression.

From a demographic perspective, obesity tends to affect certain groups more than others. Non-Hispanic black Americans have the highest age-adjusted rate of obesity, at 48.1 percent. They are followed closely by Hispanics and non-Hispanic whites. The group with the lowest rate of obesity by far is Asian Americans, who have an average obesity rate of just 11.7 percent, which is well below the national average. Additionally, while obesity is on the rise in many demographic groups, middle-aged adults still have higher rates of obesity at 40.2 percent than both older adults and young adults.

Continuing along this same path, for men, there is not much of a correlation between income or education level and obesity. The one exception being that black and Mexican-American men with higher incomes are more likely to be obese than lower income men in the same groups. For women, a more widespread correlation exists–higher income and better-educated women of all races are less likely to be obese than women from the opposite income and education groupings. Geographically, there is a lower prevalence of obesity in states in the West and Northeast of the United States, with those in the Southeast having the highest rates of obesity. The following gives an overview of the facts behind the obesity epidemic:

Factors behind the Obesity Epidemic

So what causes obesity and what led to its rise? While many people may point to a simple lack of self-control to explain the prevalence of obesity, in many cases it is much more complicated than that. One of the major issues is genetics, namely different people absorb, store, and process food differently, which can make them more likely to gain weight.

In the same vein, medical problems that lead to inactivity, such as arthritis, can also contribute to obesity. Similarly, certain medications taken for completely unrelated conditions, such as depression, can cause weight gain. Age and pregnancy can lead to obesity as well, with people’s metabolisms generally slowing down as they get older and some women having difficulty losing weight after giving birth.

In addition to the physical factors, there are also several environmental factors at play. These include access to a place to exercise, knowledge of healthy cooking, and even being able to afford healthy food. Quitting smoking can affect someone’s weight as well, although its potential negative health effects are generally outweighed by its positives. Even a change in sleep patterns can lead to significant weight gain, as they can lead to hormonal changes that affect how food is digested.

Sometimes there are things completely beyond a person’s control, an example being meals at restaurants, which today are four times larger on average than they would have been back in the 1950s. Along with quantity and size, the cost of food also plays an important role in the rate of obesity. Since the 1970s the cost of food as a portion of income has gone down. Nor is all food is created equal, and while all food has gotten relatively cheaper, unhealthy foods tend to cost even less than healthy alternatives such as vegetables. Even if you set aside how healthy cheap food is, the sheer availability of food makes being obese more likely. While factors such as poor diet, family lifestyle, and inactivity can lead to obesity, they are clearly not the only causes.

Efforts to Reduce Obesity

While determining the causes of obesity has been a challenge, actually reducing it has been particularly difficult. However, that failure is not for a lack of trying. The CDC funds programs at the state and local level in an effort to reduce obesity by advocating for a combination of healthy eating habits and an active lifestyle. The CDC’s High Obesity Program provides grants to universities in areas with a high prevalence of obesity that involve a targeted approach to address the issue. Several states and cities have also implemented a range of policies to address health concerns, ranging from taxes on soda and sugary drinks to school nutrition programs.

There are many resources outside the government as well, in the form of non-governmental organizations that are focused on combatting obesity. A number of these organizations–like the Obesity Action Coalition or TOPS Club, inc–echo their government counterparts, preaching that a combination of education, healthy eating, and physical activity is necessary to combat the obesity epidemic.

The accompanying video looks at ways to fight obesity:

Nevertheless, for all the energy these organizations, government and non-government alike, are exerting their efforts seem to be in vain. In fact, despite major efforts in research, clinical care, and the development of various programs to counteract obesity, after more than 30 years there are few signs that suggest the fight against the epidemic is succeeding. While the overall trend has not reversed itself, some targeted efforts have managed to bring about success at the community level.

Going Forward

Obesity is a major factor in predictions that for the first time children growing up today may not outlive their parents. That is because obesity rates and body weights, in general, have skyrocketed over the last 40 to 50 years. From 1962 to 2006 the obesity rate among Americans grew from 13.4 percent to 35.1 percent. The average person today weighs 26 more pounds than he or she would have in the 1950s. A 2005 study found that if obesity trends continue on their current path, the life expectancy gains from the past several decades could flatline or even go in the opposite direction.

This troubling news concerning obesity comes at an especially bad time. With rates already increasing, government programs that target obesity prevention, in particular, could lose federal money. One of the many aspects of the Affordable Care Act involved the creation of a Prevention and Public Health Fund, which provided resources to important prevention programs–including some obesity-related grants–and makes up a sizable portion of the CDC’s total budget. With Congress debating whether or not to repeal the law, such funding could be cut. More than 300 public health organizations signed on to a letter to congressional leaders asking them not to get rid of the fund in January.

Investing in these public health interventions is becoming more important now than ever, as estimates indicate that the obesity epidemic will continue to be a problem in years to come. Two different studies predict that the obesity rate could continue to rise to 42 to 44 percent by 2030.

While this is an American epidemic, and America has the highest percentage of obese people, the United States is not the only place feeling the burden. Roughly 30 percent of the world’s population, or 2.1 billion people, are either overweight or obese. This trend affects both developed and developing countries alike, however, it affects them in different ways. In developed nations, men have higher rates of obesity whereas women in developing countries have higher rates.

Regardless of demographics, though, obesity rates are increasing all over the world much like they are in the United States. Also, like in the United States, preventive measures to reduce obesity have mostly failed. It has gotten to the point now that regions outside of North America and the West actually have the highest rates. Currently, the Middle East and North Africa have the highest adult obesity rates in the world.

Conclusion

While obesity tends to affect certain groups more than others, overall obesity rates have increased significantly in the past several decades. While obesity rates have leveled off among American youth in the past 10 years, they have continued to climb for adults and remain at record highs for both. Unfortunately, many of the attempts to reverse these trends have had little success so far. This is extremely troubling as obesity has gone from a problem to an epidemic.

The impact from rising obesity rates has the potential to be disastrous. Obesity already costs the United States alone hundreds of billions of dollars annually. For nations that cannot afford this level of care, obesity could lead many people to develop obesity-related diseases and complications without any way to treat or address them. While most efforts have failed to reverse the trend, some targeted interventions have been effective. Ultimately, the problem will need to be addressed at a larger scale for rates to decline.

Michael Sliwinski

Michael Sliwinski (@MoneyMike4289) is a 2011 graduate of Ohio University in Athens with a Bachelor’s in History, as well as a 2014 graduate of the University of Georgia with a Master’s in International Policy. In his free time he enjoys writing, reading, and outdoor activites, particularly basketball. Contact Michael at staff@LawStreetMedia.com.

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In an interesting twist of events on Saturday, Robert De Niro, Tribeca Film Festival’s co-founder, decided to pull controversial documentary, Vaxxed: From Cover-Up To Catastrophe, that accuses the Centers for Disease Control and Prevention of covering up the link between vaccines and autism. He initially defended the screening just one day before.

De Niro issued a statement discussing his decision to pull the film:

“My intent in screening this film was to provide an opportunity for conversation around an issue that is deeply personal to me and my family. But after reviewing it over the past few days with the Tribeca Film Festival team and others from the scientific community, we do not believe it contributes to or furthers the discussion I had hoped for.” 

The film’s Director Andrew Wakefield, and producer Del Bigtree said:

“Robert De Niro’s original defense of the film happened Friday after a one-hour conversation between De Niro and Bill Posey, the congressman who has interacted directly and at length with the CDC Whistleblower (William Thompson) and whose team has scrutinized the documents that prove fraud at the CDC.”

The issue at hand here is whether or not De Niro is simply censoring another opinion because it is different than his. Those opposed to the decision argue that it is censorship and believe that this is just another way the media wants to shut down unpopular opinions.

Wakefield, an anti-vaccine advocate and former gastroenterologist (his license has since been revoked by Britain’s General Medical Council, according to CBS News), was the author of a widely discounted study published in the Lancet medical journal in 1998 but was retracted in 2010. The study claimed there was a link between the MMR vaccine and the development of autism, but many organizations, such as the CDC and WHO, have since discredited the claim.

However, where do we draw the line between censorship and saying that these ideas are false and there is no reason to give them validity?

What it comes down to is whether or not the opinions being shared hold some sort of validity, because if it doesn’t, then it is probably wrong. Yet, we find that people still hold these beliefs, and begin to pass them off as true.

If the science says you’re wrong, there is no point to screening this film because the discussion is already over. Would it make sense to show a conspiracy theory documentary about 9/11 or The Holocaust? No, because the discussion is over and there is no reason to argue in circles with someone who believes, despite all evidence, that they are correct.

An open discussion of opinions is a valuable tool for gaining a comprehensive understanding of an issue. However, when some opinions are simply not valid, it gives off a sense of balance in the ideas, which leads to the balance fallacy. This is an issue that reporters face every day–do we give equal weight to both sides as we are taught, even if one side is more valid than another? An example of this is the coverage of climate change. If both sides are given equal weight in a story, this may lead to a false understanding by the public that discounted claims are well supported by professionals or experts in their respective fields.

An example of this is the coverage of climate change. If both sides are given equal weight in a story, that may lead to a false understanding by the public that discounted claims are well-supported by professionals or experts in their respective fields.

The Toronto Star’s Vinay Menon put it well saying:

“This isn’t about free speech. It’s about costly ignorance. It’s about living at a time when diseases like measles were close to eradicated from much of the developed world and then returned. It’s about knowing when a “conversation” is called for and when there is nothing left to say. It’s about drawing a line between bad science and dangerous science.”

Ultimately, the decision to keep “Vaxxed” from the big screen was a wise one.

Julia Bryant

Julia Bryant is an Editorial Senior Fellow at Law Street from Howard County, Maryland. She is a junior at the University of Maryland, College Park, pursuing a Bachelor’s degree in Journalism and Economics. You can contact Julia at JBryant@LawStreetMedia.com.

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Like anything with a life, survival is a germ’s end game. When it faces a challenge, it will adapt. Some germs adapt alarmingly well to the challenge of modern medicine. They’re called superbugs because they’ve evolved to survive the challenges we throw at them, including antibiotics.

Do we have a counterattack against these superbugs? Let’s find out.

Superbugs in the News

Superbugs have been making headlines lately. Here’s what’s happening in case you missed it.

CRE Outbreaks

CRE stands for carbapenem-resistant Enterobacteriaceae, a type of bacteria resistant to carbapenem antibiotics. CRE resists nearly all antibiotics and can cause death in about 50 percent of infected patients because most people who become infected are already sick and have weakened immunity. Most recently, CRE killed two people in an outbreak at the Ronald Reagan UCLA Medical Center in Los Angeles and one person in a Charlotte, North Carolina hospital.

A duodenoscope, a device that drains fluids from the pancreatic and biliary ducts, stands out as the main suspect in the UCLA outbreak. Duodenoscopes probe the body, making infection easier for hitchhiking germs, especially superbugs like CRE. The particular duodenoscope implicated in the UCLA outbreak boasts an intricate design that unfortunately makes it difficult to clean properly even through reprocessing, the multi-step sanitation process designed for reusable devices. So this particular model of duodenoscope picked up some potent CRE that withstood reprocessing and infected several patients.

C.difficile Infections on the Rise

C. difficile infections happen when the harmful bacterium Clostridium difficile (C.diff) overpowers the otherwise harmless and helpful bacteria living in the intestines. Antibiotics kill bacteria, including the good kind that help fight off C.diff, so sick people who have taken antibiotics for long periods of time become especially vulnerable to C.diff. Since C.diff resists antibiotics, once good bacteria succumbs, zero defenses stand between it and the multiplication that causes deadly intestinal infections. C.diff preys on the sick and spreads wildly through hospitals. It ranks as one of the three most common infections acquired in hospitals and still cases are growing. Confirmed C. difficile infections doubled from 2000-2009 according the Centers for Disease Control and Prevention.

In Short, Superbugs Threaten Hospitals

As you can see from the cases above, superbugs thrive in hospitals where sick people with weakened immune systems squeeze together in close contact. Our usual sanitation tricks don’t stop them. Even when healthcare workers practice sanitation that could kill the flu virus, these superbugs stick around, hiding out in bathrooms, hospital beds, and on medical equipment. Since superbugs resist antibiotics, once the inevitable infection does occur, it’s extremely hard to fight and could lead to death. For example, CRE kills almost half the people it infects.

Public health officials working on the UCLA outbreak have sprung to action to contain the spread. They’re finding people who might have been exposed to CRE via use of the potentially faulty duodenoscope. They’ve issued warnings about the devices so other hospitals don’t run into similar problems.

But after two deaths in California and one in North Carolina in 2015 so far, many have asked: how can we prevent superbug outbreaks in the first place?

Preventing Superbug Outbreaks

To fight superbugs, experts recommend combating the antibiotic resistance that produced them in the first place, becoming better at monitoring and controlling them, and developing innovative techniques for prevention and control.

Combating Antibiotic Resistance

The CDC’s report Antibiotic Resistance Threats in the United States, 2013, inspired government action that fights the antibiotic resistance that produces threats likes superbugs. Their recommendations include prevention, tracking, changing antibiotic use, and developing new drugs and diagnostics.

In actual practice, the CDC has encouraged hospital antibiotic stewardship programs, which combat overprescribing and incorrect prescribing of antibiotic drugs. The programs push for evidence-based assurance that antibiotics are necessary and effective for the condition in question. For example, in antibiotic “time-outs,” doctors revisit the need for antibiotics after receiving diagnostic lab results. Often antibiotics are prescribed as a precaution while waiting for medical tests, but this practice encourages doctors to reassess the need for the drugs with medical test results in hand. These programs are voluntary, and so far California is the only state that requires antibiotic stewardship programs by law. Experts, including President Obama’s science advisers, are pushing to make stewardship programs a requirement for hospitals and nursing homes that want to receive Medicare payments.

Additionally, President Obama’s FY 2016 budget shoots to double federal spending to fight antibiotic resistance that would help move the National Strategy for Combating Antibiotic Resistant Bacteria along.

Read More: Are We Doing Enough to Prevent Antibiotic Resistance?

Monitoring the Spread of Superbugs

Tracking is crucial to understanding where superbug infections might happen and what efforts might be needed to control them.

One recommended control measure requires all patients admitted to hospitals be screened for CRE. CRE squats in the guts of many people, but only creates problems when they’re weakened by sickness or too many antibiotics. Knowing who carries CRE would help control potential problems before they happen.

In terms of general tracking, there’s no requirement that state health agencies track and monitor antibiotic-resistant bacteria, but luckily, many of them do. According to an Association of State and Territorial Health Officials survey of antibiotic resistance-related state health agency activity, about half of them collect surveillance data about occurring infections. Federal requirements could lead to all states performing valuable surveillance activities.

Implementing Innovative Practices

Superbugs challenge our sanitation practices and antibiotic use. The race is on to develop new techniques to fight them so we can replenish our defenses instead of relying on old practices. Here are a few new interventions considered for fighting superbugs. Warning…don’t read this while eating.

• Fecal transplants: Nope, that’s not a typo. This procedure is exactly what it sounds like. Fecal matter is collected from an ideal donor and placed into the gut of another individual whose population of good bacteria might have been compromised through antibiotic use. In the case of C.diff, a fecal transplant can replace good bacteria that keep infection at bay. It might seem strange, but the procedure has proven 90 percent effective at curing C.diff infections. These unorthodox transplants work better than many other cures.
• Sanitizing robots: A concentrated hydrogen peroxide solution poses a threat to superbugs. It can be toxic to humans, so at Johns Hopkins University Hospital they’ve enlisted impervious robots to help them sanitize hospital rooms. After a human technician seals the room, a bot blasts the air with 35 percent hydrogen peroxide solution that reaches every inch of the room, even cracks and crevices. A second bot dries up the room so no residue remains. This results in a completely pristine hospital room, medical equipment and all.

• New antibiotics and alternative therapies: Superbugs grow accustomed to existing drugs and we haven’t created new ones that shock their systems. This is partly because 99 percent of living species (plants and fungi) that produce promising new antibiotics will not grow in lab conditions. If they can’t grow in a lab, scientists can’t study them to make them into medicine. Recently, scientists tapped into this 99 percent horde of potential antibiotics by tricking the microbes into thinking they were in a natural environment by stuffing dirt in between two membranes. The extracted antibiotic is known as Teixobactin and has proved successful in battling antibiotic resistant MRSA and TB in mice. It hasn’t been tried on humans yet, but the methods scientists used to grow “ungrowable” cultures in laboratory conditions hold promise for the future.

Antibiotics are also overused in agriculture to treat animals raised in conditions that lead to persistent infection. Hyun Lillehoj, an avian immunologist at the Beltsville Agricultural Research Center, has discovered promising new treatments for diseases affecting poultry that would render antibiotics unnecessary. She’s found promise in using food supplements, probiotics, and phytochemicals to enhance a bird’s natural immunity and ward off infection in the first place.

On a sweeter note, Lund University found promise in the lactic acid bacteria hiding in honey bee stomachs. Lactic acid bacteria contains antimicrobial properties and has proven effective in fighting resistant MRSA. Honey processing kills the good bacteria, so store-bought honey has no antibiotic properties. The researchers reintroduced the natural bacteria into honey and used it on horse wounds. All horses were healed when no other antibiotics or steroids had worked.

Legal Challenges of Superbugs

Superbugs involve a liability hotbed because they’re changing the rules. Healthcare professionals adhere to strict rules and protocols proven to prevent the spread of infection. Unfortunately, following those rules doesn’t prevent the spread of infection from superbugs. So when something goes wrong, who is liable? The new proliferation of superbugs presents a legal problem without precedence. Courts will look at whether a hospital has taken reasonable actions to promote safety, unfortunately with a lack of history in the case of antibiotic resistance laws, what actions might be considered reasonable are not yet clear. Upcoming decisions might afford more clarity.

California Congressman Ted W. Lieu requested a hearing from the Committee on Oversight and Government Reform (OGR) to discuss the sterilization issues with duodenoscope that led to the UCLA CRE outbreak. Family members of affected patients are also filing suits against the manufacturer of the duodenoscope that led to their infections, citing grievances like negligence and fraud. Decisions in these cases could influence future arguments.

Are superbugs under control?

As alarming as recent superbug growth might be, so far the situation is under control. However, the outbreak and C.diff growth calls attention to the need to prepare our defenses for the growing threat of superbugs. Antibiotic resistant germs prey on the weak, making hospitals and nursing homes vulnerable targets for devastation.

The government and medical professionals have jumped on the case with their efforts to combat antibiotic resistance, stop the spread of superbugs, and develop new treatments. While antibiotic resistance presents a challenge, consider how antibiotics themselves have been around for less than a hundred years. While their invention was considered a medical miracle, we surely have more miracles up our sleeves to get past this new challenge.

Resources

Primary

CDC: Lethal, Drug-Resistant Bacteria Spreading in U.S. Healthcare Facilities

FDA: Design of Endoscopic Retrograde Cholangiopancreatography (ERCP) Duodenoscopes May Impede Effective Cleaning

U.S. National Library of Medicine National Institutes of Health: Clostridium Difficile Infection: New Insights Into Management

CDC: Vital Signs: Preventing Clostridium Difficile Infections

California Department of Public Health: The California Antimicrobial Stewardship Program Initiative

CDC: Core Elements of Hospital Antibiotic Stewardship Programs

USDA ARS: Alternatives to Antibiotics in Animal Health

Additional

Network for Public Health Law: Superbug Prevention and Hospital Liability

Kaiser: UCLA Bacteria Outbreak Highlights the Challenges of Curbing Infections

USA Today: Dangerous Infections Now Spreading Outside Hospitals

International Business Times: Drug-Resistant Bacteria A ‘National Security Risk’

US News & World Report: Patients File Lawsuit Against Medical Scope Maker in Hospital Superbug Infection

Washington Post: New Class of Antibiotic Found in Dirt Could Prove Resistant to Resistance

CNN: Superbug Cases Reported in North Carolina; One Dead

Food Safety News: The Search For Alternatives to Antibiotics

Food Safety News: White House Wants to Nearly Double Funding for Antibiotic Resistance Fight

Nature: A New Antibiotic Kills Pathogens Without Detectable Resistance

ASTHO: State Strategies to Address Antimicrobial Resistance

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

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Start saving up your sick days. The Centers for Disease Control and Prevention (CDC) says that the upcoming flu season could be severe. The agency expects influenza A (H3N2) to dominate this year. H3N2 causes more hospitalizations and deaths than other flu types and has mutated since this year’s vaccine was created. Is it time for a quarantine? Probably not. But even if you’re vaccinated, you could be purchasing more tissues than usual from now until March as flu season peaks. I’ll break down what you need to know below.

How bad will it be?

Here’s some perspective: last year’s vaccine was only about 50-55 percent effective and experts estimate we won’t even reach those levels this year.

Here’s why

• Ninety-one percent of recent samples are influenza A (H3N2), an influenza (flu) subtype that typically causes more hospitalizations and deaths than other subtypes. (Don’t worry, I’ll explain subtypes later!)

• Over half of these samples don’t match this year’s vaccine because they’re drift variants; they’ve “drifted” to become structurally different from the H3N2 virus used to create this year’s vaccine. The drift could make this season’s vaccine less potent but it’s certainly not useless. In past flu seasons where influenza A (H3N2) drifted, vaccines were about 40 percent effective in stopping the virus. The vaccine still protects against other flu subtypes that haven’t drifted, like influenza A (H1N1) a.k.a the “swine flu.”

So, what is the flu anyway?

The flu we’re talking about should not be confused with the stomach flu, which is really just slang for gastroenteritis. It’s also not a blanket term for any ailment. You only have the flu if you’ve been infected with the flu virus.

A true flu is a viral infection that preys on your nose, throat, and lungs. The flu sees these mucous membranes as ideal ports of entry. Even innocently rubbing your eyes invites the flu into your body. Once the flu gets in, it causes an infection that leaves your respiratory system hampered and makes you feel generally miserable–sneezing, coughing, weak, and sluggish.

This video from Health 360 explains the flu virus and how it invades your body.

Flu Mechanics

Google a picture of a flu virus and you’ll see a circle covered in spikes, kind of like a balding koosh ball. Just like the koosh ball’s rubber fingers make the toy easier to catch, the flu virus’ spikes make the infection easier to catch. The flu virus would be nothing without its spikes.

The viral protein hemagglutinin (H) makes up most of the virus’ spikes. Hemagglutinin causes red blood cells to stick together (hema is heme molecules found in red blood and agglutinate means to stick together). Hemagglutinin enables the virus to attach to a host cell. Viruses can only spread if they hijack a host cell and replicate within it, so you can see why hemagglutinin’s role in host cell attachment is of the utmost importance…to a virus.

The viral protein neuraminidase (N) makes up the rest of the virus’ spikes. After the virus has infected a host cell and replicated itself, neuraminidase (N) allows the replicated virus to escape the host and infect other cells.

So hemagglutinin (H) assists in infecting the host cell and neuraminidase (N) helps the replicated virus proliferate. They work together to infiltrate as many immune systems as possible. Different subtypes of these viral proteins–Hs and Ns–are behind all of the confusing names for different flu viruses like H3N2, H1N1, etc. Let’s end that confusion once and for all.

H?N?: Naming flu types and subtypes

Three types of flu affect humans: A, B, and C.

• Influenza A: Infects both animals and humans and is usually responsible for large epidemics because of its ability to change.
• Influenza B: Infects only humans and is typically less severe than influenza A.
• Influenza C: Infects humans but is the least severe of all the types.

The ABC’s are the least of your worries in understanding flu names. Naming the flu gets complicated when we look at all of the subtypes of the viral proteins (spikes), hemagglutinin (H), and neuraminidase (N) that we just learned about above.

There are 16 possible subtypes of H and nine subtypes of N that can recombine to form 144 different subtypes of the flu virus that are named based on which H and N subtypes they contain. The influenza A virus dominating this year is named H3N2 because it has the viral protein subtypes H3 and N2 decorating its surface.

Viral proteins also come into play when we’re looking at how this year’s vaccine ended up being mismatched with this year’s dominant flu. Even among the 144 different subtypes, something called antigenic drift can cause different strains to form. The drift changes the structure of the viral proteins H and N to be different enough to befuddle your immune system, but not different enough for separate classification.

For example, this year’s dominant strain of influenza A (H3N2) drifted antigenically from the strain used to create the vaccine. So even if you’re vaccinated, your immune system might respond differently if you’re exposed to the newly drifted virus.

The Drifts and Shifts of the Flu

The flu virus has a sneaky habit of changing and tricking the immune system into letting it pass. The change happens through antigenic drift or antigenic shift. The preceding “antigenic” refers to antigens, which trigger your immune response. So the drifts and shifts produce a virus strain with altered antigens that your immune system will respond to differently. The antigens in this case are the viral proteins H and N. Your immune system responds to the shape of H and N subtypes you were vaccinated with. If those shapes change enough, you could have a problem.

Antigenic Drift

Antigenic drift happens when small changes naturally accumulate over time as a virus copies itself. At first, the drifted virus will be antigenically similar enough that a vaccinated immune system can recognize it. But small changes can compound over time so the shapes of the proteins drift enough that even a vaccinated immune system can’t recognize the drifted virus.

Think of a close friend getting a radically different haircut. She’s the same person, but at first glance you might not realize it because she looks completely different. If a virus drifts enough to create an antigenically different strain, the immune system might not be able to recognize and bind to the new shape of the viral proteins.

The flu drifts adeptly so we need to create a new vaccine every year. Drift is also why you’ll probably get the flu more than once in your life.

Antigenic Shift

An antigenic shift causes fast changes that make completely new H and N viral proteins. The virus is so altered that humans have no immunity to it, even if they were vaccinated. This happens when viruses shift from animal populations to infect humans.

Antigenic shift occurs rarely, but it can be devastating. Pandemics and epidemics like the 2009 H1N1 flu pandemic often happen when a flu virus shifts suddenly. Flu viruses usually shift to humans from domestic pigs and poultry. Don’t worry, this year’s dominant influenza A (H3N2) has only drifted not shifted.

Making a Vaccine

Since it takes so long to develop the vaccine, experts have to pick the virus strain they’ll use months in advance. There’s always a good chance the virus will drift in the interim as it has this year.

Private companies make flu vaccines but are subject to FDA safety and efficacy requirements. The FDA has approved three flu vaccines: egg-based, cell-based, and recombinant flu vaccines. The processes vary, but here are the basic steps:

• The CDC or other Influenza Collaborating Center provides the vaccine manufacturer with the vaccine viruses chosen.
• The viruses replicate in a controlled environment.
• The viruses are extracted from their growth host (eggs or cells).
• The manufacturer kills the virus and purifies the viral antigen to produce a vaccine that will not make people who take it sick.
• The manufacturer tests the vaccine before it goes to market.

Historyofvaccines.org has a great animated walk-through of the process. Check it out here.

Then what?

When you get your vaccine–the flu shot–it kind of tricks your body. Immunity builds when you’re exposed to a pathogen, such as a virus. In most cases you have to get sick to build this immunity. When your immune system fights off a virus once, it keeps a memory of the virus in case it returns.

A vaccination gives you the benefits of exposure and immunity building without making you suffer through the actual illness by exposing you to a harmless version of a pathogen. It won’t make you sick, but your immune system responds like a feisty dog that barks at anyone who knocks on your door. The overprotectiveness eventually pays off. If a harmful version of the virus tries to take you down, your immune system will have an immune memory to use in the fight.

That sounds OK, why doesn’t everyone do it?

There’s just something inherently scary and untrustworthy about getting injections. People come up with many fears and excuses for not getting vaccinated. Take a look at the video below.

And the list continues with NPR’s 32 Myths About The Flu Vaccine You Don’t Need To Fear. The good news? Most fears and excuses for not getting vaccinated are unfounded. The bad news? People don’t care if their fears are unsubstantiated.

Researchers have found that foiling flu vaccine myths doesn’t increase a skeptic’s intent to get a vaccine. It actually reduces it. The study suggests that explaining the facts about vaccines might remind people of why they were fearful of getting them in the first place or even give them new information to worry about. This only solidifies their anti-vaccination stance.

So what are we doing about this flu mess?

The CDC maintains that a flu shot is still the best way to protect yourself, but it also urges doctors to prescribe antivirals to people coming in with flu-like symptoms or those at high risk such as children, pregnant women, and adults 65 and older. Antivirals work best within 48 hours of flu symptom appearance, so most doctors will not wait for a positive test to prescribe them.

Is antiviral resistance a problem?

With doctors prescribing medication without lab test confirmation of the ailment, you might be wondering if antiviral resistance is a concern. Yes, it’s actually an inherent problem since the rapid replication process of viruses leads to mutations that can evade antivirals as well as immune systems and vaccines. Some strains of influenza have already become resistant to drugs that have been on the market for a while like oseltamivir, amantadine,  and rimantadine.

What are the benefits?

Results from past flu seasons and the 2009 H1N1 flu pandemic show that these drugs can reduce potentially devastating effects of influenza. Clinical trials and observation show reductions in symptoms, complications, and deaths from influenza with antiviral use.

All Things Considered, It’s Not So Bad

With its fast and unpredictable changes and complicated subtypes, the flu presents a formidable enemy for modern medicine. Flu shots and antivirals aren’t the perfect weapons, but they’re more effective than entering the battle unarmed. So how bad is this flu season going to be? Probably worse than last year’s, but a pandemic doesn’t seem likely.

Resources

Primary

CDC: Early Data Suggest Potentially Severe Flu Season

CDC: Health Advisory Regarding the Potential for Circulation of Drifted Influenza A (H3N2) Viruses

CDC: Types of Influenza Virus

CDC: How the Flu Virus Can Change: “Drift” and “Shift”

CDC: How Influenza (Flu) Vaccines Are Made

NIH: New Vaccine Technologies

Additional

Mayo Clinic: Influenza Treatments and Drugs

Synapse: “Flu” – Recombinant Genes on the Loose!

Science Daily: Correcting Myths About the Flu Vaccine: Effective?

Virology: Structure of Influenza Virus

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

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