December's holidays coincided with something far less pleasant: a sharp uptick in flu cases in Pennsylvania and New Jersey. Brace for more. Flu season typically doesn't peak until later in January or even February.
To make things worse, other respiratory and gastrointestinal viruses are also making people miserable and tend to thrive in the winter months, when folks gather inside.
"It's not just influenza we should be worried about," said Tina Tan, state epidemiologist for the New Jersey Department of Health.
Doctors pointed out that the most recent flu season in Australia, often a harbinger for the United States, was particularly nasty, with far more people than usual getting sick. It's too early to tell how bad the season here is likely to be, but this year's dominant strains of the virus tend to result in significant symptoms.
"This flu season potentially is going to be a very bad flu season," said John Russell, director of the family medicine residency program at Abington Hospital-Jefferson Health.
Through the end of December, flu had killed six people in Pennsylvania and one unvaccinated 4-year-old in central New Jersey. Rachel Levine, Pennsylvania's acting secretary of health, said the state's numbers were not unusual for this point in the season. She said there were 148 deaths attributed to flu last year.
While flu is most dangerous to the elderly and people with underlying health problems, it can also kill healthy children, as the case in New Jersey illustrates. Nationally, 12 children have died during this flu season. Julia Sammons, medical director of the department of infection prevention and control at Children's Hospital of Philadelphia, said parents should see a doctor quickly if a child with flu symptoms — sudden onset of high fever and muscle aches, cough, and sore throat — has fast or labored breathing, is not waking up or drinking, or is confused or overly irritable.
Doctors recommend that everyone 6 months and older get a flu shot each year because the virus and its complications can lead to hospitalization and death. "The best thing that people can do to protect themselves and their loved ones is to get a flu shot, and it's not too late to get a flu shot," Levine said.
The U.S. Centers for Disease Control and Prevention says it takes about two weeks for the vaccine to take full effect. If started quickly, antiviral medicines can help flu patients by shortening the course of the disease and reducing the intensity of symptoms.
As of Dec. 30, Pennsylvania's Health Department was reporting widespread flu. Data from laboratories, hospital emergency departments, and other medical offices "all indicate that the flu activity increased sharply from past weeks," it said. In its Dec. 30 report, released Wednesday, New Jersey said there was high flu activity in the middle of the state, while flu remained moderate in South Jersey. Positive flu tests and visits to emergency departments for flulike symptoms jumped.
Nationally, the CDC's most recent flu report covered the week ending Dec. 23. It also showed big increases in reported flu with the highest activity in the South, Midwest, and on the West Coast.
Respiratory syncytial virus, or RSV, which can look — and feel — a lot like the flu, is actually more common than flu at the moment, Sammons said. It's nothing to sneeze at. RSV can make babies, especially preemies, and people over 65 very sick. Rhinovirus, which causes the common cold, has rivaled RSV in numbers this season, according to surveillance in New Jersey.
Sammons said RSV season tends to start and peak about a month earlier than the flu.
Unfortunately, winter is also the best time for stomach bugs. Doctors are seeing plenty of norovirus, a fast-spreading gastrointestinal illness often associated with outbreaks on cruise ships. However, it does most of its damage on land. One in 15 Americans gets it each year, Russell said.
"It was a really, really bad season for gastroenteritis and norovirus, the winter vomiting virus," Russell said. "Probably more than any other year, I heard of people having to reschedule things around the holidays because people in the family were sick." He said the virus often waylays multiple family members. It is typically a 24-hour bug that starts with vomiting and progresses to diarrhea.
"That seems to be cresting," Russell said. "We're starting to see the flu come to town."
Things may be calmer in South Jersey, where Alex Zaslavsky, a medical director for Patient First, works. He sees patients in Cherry Hill, Voorhees, and Sicklerville. So far this winter, he's mostly seen people with lingering sinus congestion after a cold. He has not encountered much flu or norovirus yet.
Preventing the spread of norovirus is particularly challenging. It spreads through fecal-oral contact but touching droplets of vomit that may lurk on surfaces can also do the trick. You can try isolating sick family members and do a lot of cleaning, but the virus is hardy and people who've gotten sick can shed the virus for weeks after their symptoms are gone, Sammons said.
People with respiratory illnesses should cover their coughs and sneezes.
Everybody should be washing their hands — a lot — this time of year. "Hand hygiene is really the cornerstone of prevention of all communicable diseases," Sammons said.