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Flu hospitalizations have been rising steadily since December and have hit levels not seen since the H1N1 flu outbreak in 2009-10.

(Washtenaw County Health)

Nine people have died from flu-related illness in two Ann Arbor-area hospitals as the region deals with a strong outbreak of the infectious disease.

Older patients are being hit hardest in this year's influenza outbreak and Washtenaw County Public Health officials say it is the worst the region has seen since the H1N1 "swine flu" outbreak in 2010.

"In some ways it's an epidemic that we know is going to happen every year," Washtenaw County Public Health spokeswoman Susan Cerniglia said. "But that doesn't mean we can totally control it."

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Hospitalizations are already more than double an average season and it is unclear whether the current outbreak has peaked yet in the region. There were 78 hospitalizations of county residents during the week ending Dec. 27, and 214 people have been hospitalized throughout the season.

"We expect every year to have around 100 hospitalizations, and we're already looking at over 200 as of Jan. 2," Cerniglia said.

"This year our rates are very high. We had more than 70 hospitalized cases last week, where in a normal year our peak weeks only hit the mid-20s."

Four of the nine flu-related deaths in the region occurred at the University of Michigan Hospital and five were at St. Joseph Mercy Hospital.

The Washtenaw County Public Health department reported that four of the nine deceased were Washtenaw County residents and no children who live in the county have died as a result of the illness this year.

This map by the Centers for Disease Control shows, for the week ending Dec. 27, the flu was widespread in 43 states, up from 36 a week earlier.

The Centers for Disease Control and Prevention in Atlanta has declared the flu to be "widespread" in Michigan and 42 other states and Michigan was one of 29 states to be designated as having the highest level of influenza-like illness activity.

"Activity in Michigan is widespread and I think it's been particularly bad in southeast Michigan as opposed to other parts of the state," St. Joseph Mercy medical director of infection control and prevention Dr. Anurag Malani said.

Cernliglia said the higher prevalence has led to increased communication between the public health department and those focusing on patient care across the county.

"This kind of event does trigger our epidemiologists to send specific information to healthcare providers so they can make sure they're giving recommended advice in terms of vaccination and what's circulating," Cerniglia said.

"Our monitoring goes on when we have activity level whether it's low, moderate or high, but high activity definitely triggers more information to go to our healthcare providers so they are very well informed about what's going on across the county."

Cerniglia and health officials at hospitals around the county said the dominant strain in cases that required hospitalization was influenza A H3N2. Unlike the H1N1 strain that caused the pandemic five years ago, this virus is more likely to impact older patients.

Nearly three quarters of all hospitalizations of Washtenaw County residents have been adults aged 65 and older and all four county residents who have died from the disease were at least 55 years old.

"Last year there was much more equal distribution in the different age groups," Malani said.

"This year, in concordance with what the state health department is reporting, we're really seeing most of the cases come from the more elderly population. There have even been a number of outbreaks at long-term care facilities that we've been aware of."

Prevention remains the same



Despite the increased prevalence of the illness this year, the prevention techniques being stressed by county public health officials and doctors at the University of Michigan and St. Joseph Mercy Hospitals are the same as every other year.

"Cover your cough, wash your hands, stay at home if you're ill and get vaccinated," Malani said.

"All of those things are important year in and year out."

Emily Davey, Ann Arbor, gets a dose of the flu shot from nurse Kathy Webster inside the Washtenaw Intermediate School District Building.

Physicians and epidemiologists are continuing to stress the importance of the flu vaccine as this season progresses, despite the fact that the shot has been shown to be less effective in combatting this year's most common strain, the H3N2.

"All of the vaccines have at least three strains and many have four," Cerniglia said.

"Sometimes we have a predominant strain early on and then it can shift a bit, so it's important to get vaccinated if you have not been already. The vaccine still offers some protection against the dominant strain and could protect you against other strains that might pop up as the season goes on."

Trinity Health spokeswoman Laura Blodgett said in an email that more than half of those hospitalized for the flu at St. Josephy Mercy in Ypsilanti had not been vaccinated this year. He added that a vaccination can help decrease the severity of the disease even if it is contracted.

The University of Michigan said there is still "plenty of flu vaccine available" and encourages patients to contact clinics and offices to arrange for vaccination. A variety of pharmacies in the region also stock the vaccine and Cerniglia said there has not been a countywide shortage.

If someone does display flu-like symptoms - which include a fever of 100 or higher, cough, sore throat, runny nose, chills, fatigue, vomiting - Cerniglia said it's important that they are examined quickly by a doctor and given antiviral medication as soon as possible.

"They can be effective, but they have to be given early, within the first couple of days," she said.

"It's especially important for patients who are susceptible to complications to be given antivirals early in the course of treatment so that they can have a more significant impact."

Easier times ahead?

Despite the severity and early peaking of the flu in the area this year, Malani was hopeful that the worst of the outbreak could be in the rearview mirror.

"I think the good news is that the numbers do look like they're coming down a little bit," he said.

"Thus far it looks like we peaked over Christmas, but those numbers are very preliminary."

Cerniglia said the data collected by the county does show the spread of the disease starting to level off, but she warned that there could be a second peak in the future.

"We might expect to see higher hospitalizations with school back in session as we see greater spread there and people returning to work after vacations," she said.

Malani said St. Joseph has seen 285 inpatient hospitalizations due to flu this season while UMHS spokeswoman Shantell Kirkendoll said the health system has seen 471 confirmed flu cases and 200 of them have led to hospitalization.

Both hospitals have been discouraging sick visitors from coming to visit patients, and the University of Michigan has instituted a "healthy visitor policy" that includes restrictions on who can visit patients who are exhibiting flu-like symptoms.

Ben Freed is a general assignments reporter for The Ann Arbor News. Email him at benfreed@mlive.com and follow him on twitter at @BFreedinA2. He also answers the phone at 734-623-2528.