Nine people from Nashville and its surrounding counties have died from complications of the flu so far this year, and deaths are also being reported from the Cumberland Region.
With the same strain in wide circulation that caused a pandemic in 2009, health officials in Tennessee are urging more people to get flu vaccinations.
"We're in the midst of a substantial influenza year," said Dr. William Schaffner, a Vanderbilt University infectious disease professor who tracks cases in Nashville and seven neighboring counties as part of a cooperative agreement with the U.S. Centers for Disease Control and Prevention.
Schaffner said the nine deaths from flu complications occurred in hospitals where cases were laboratory-confirmed. Cookeville Regional Medical Center, which is outside the Vanderbilt surveillance area, has also reported two deaths from flu complications of people aged 39 and 36. The Tennessee Department of Health, which tracks only pediatric deaths and deaths of pregnant women from complications of the flu, is investigating reports of deaths that have yet to be confirmed.
People die from the flu every year, but the nine deaths in the eight-county area at this point in the season is "noteworthy," Schaffner said.
The predominant virus in circulation this year is H1N1, which first emerged in 2009. In Tennessee, 15 deaths among children younger than 18 occurred during the 2009-2010 season, which compares to two or three deaths during a typical flu season, said Dr. Kelly Moore, director of immunizations for the Tennessee Department of Health.
"We didn't have the benefit of a vaccine back in 2009," Moore said. "We have kept this particular strain in our vaccine ever since 2009. This season's vaccine contains it."
She stressed the importance of getting vaccinated as soon as possible. For the first time this year, people can choose between the traditional vaccine that protects against three strains of the influenza virus or a new version that also guards against a fourth strain. There also is a high-dose version available for senior citizens as well as a preservative-free form for people who worry about thimerosal exposure.
All nasal-spray vaccines are preservative-free and so are some injectable ones, Moore said.
All versions of the vaccine protect against H1N1.
"This particular strain is harder on young adults and children than it is on the elderly," Moore said.
Last year, the predominant strain was H3N2, which was harder on people 65 and older, she said. This year's vaccine also protects against the H3N2 strain.
The Tennessee Department of Health is removing an economic obstacle to people who have not yet gotten vaccinated. Officials this week decided to offer free vaccinations to people who cannot afford to pay for them.
Moore urges people to get vaccinated as soon as possible — especially pregnant women. Only about half of pregnant women nationally get a flu shot, Moore said, citing CDC data. Although that's better than the 10 percent rate before the 2009 pandemic, she said, expectant mothers who opt against a vaccine are putting themselves and their babies at risk.
"We lost a lot of pregnant women during 2009," she said. "That got everyone's attention."
Studies since then have shown that flu vaccines reduce the risk of preterm births and low-weight babies. There is also evidence that expectant mothers who get vaccinated pass along some immunity to their newborns, Schaffner said.
Although a flu vaccine typically takes two weeks to provide the best level of protection, the body starts building immunity earlier, Moore said.
Schaffner said others at high risk for flu complications, such as the elderly and people with heart disease, lung disease or compromised immune systems, should contact their health provider when symptoms of the flu first emerge.
"That will reduce the severerity of the infection if we can begin promptly," Schaffner said.
Healthy people who get sick should also be aware of complications, Moore said. Pneumonia may be present when a relapse occurs, she said.
"Pneumonia typically follows your influenza illness by four or five or six days," she said. "You have the flu, you start to get better, then all of a sudden you backslide. You start to feel a lot worse again. That could be a sign of bacterial pneumonia."