Influenza cases on campus spiked over winter term

by Kyle Mullins | 4/2/19 2:10am

3-29-19-dickshouse-adrianrussian

Dick’s House diagnosed 63 cases of the flu in 2019, which is more than double the number of any of the previous three years.

by Adrian Russian / The Dartmouth

If you were stricken with the flu this winter, you were not alone on campus. Dick’s House diagnosed 63 cases of the flu in 2019 — over double the number of any of the previous three years — according to director of clinical medical services Ann Bracken.  

There were 23 cases of influenza in the winter of 2018, 29 cases in 2017 and 18 cases in 2016, according to Bracken. Bracken cautioned that the numbers only reflect the winter and that there may be more cases this spring. 

The cause of the spike in cases is unclear. According to the Office of Institutional Research, the number of students on campus this winter was only marginally higher than previous years. 3,731 students were enrolled, compared to 3,714, 3,595 and 3,634 for the previous three winters. 

New Hampshire Bureau of Infectious Disease Control chief Beth Daly said that last year’s flu season was the worst in several years, with more cases and over 60 deaths statewide, the highest on record. This year’s season, however, is comparatively mild. 

“This year was not as severe so far as last year,” Daly said. 

She cautioned that the season is not over yet and that there has been a bit of an increase in recent weeks that is “concerning.”

Bracken suggested that part of the increase in cases diagnosed may have been due to a change in policy at Dick’s House that removed the $45 charge for a flu test. 

“Because we had so many people with positive flu tests, we really felt that we needed to make the test have no charge so that we could make decisions about rooming patients,” Bracken said, citing concerns about patients in the infirmary spreading the flu accidentally. 

She also pointed out that sometimes “clusters” of diseases show up on college campuses, such as the outbreak of hand, foot and mouth disease in the fall of 2018 and a 2002 conjunctivitis outbreak that she said was so severe the Centers for Disease Control and Prevention became involved. 

According to Bracken, all but one of the diagnoses this year have been the influenza A strain of the flu virus. One case was influenza B. 

The CDC states on its website that virtually all flu outbreaks are caused by either influenza A or B viruses, as influenza C infections are typically more mild and influenza D only affects cattle. 

Bracken said that influenza A had been more common this year nationally. However, she added that “last year, we had more B in the spring, so maybe we will have more B [going forward].”

According to Bracken, Dick’s House administered flu vaccines for 1,265 undergraduate students and 662 graduate students in the fall. She added the vaccine was “fairly effective” this year nationally, “more so than last year.” 

She noted, however, that the number of vaccines administered only reflects students who were vaccinated by Dick’s House, so students who were vaccinated with their local physicians or by other medical facilities were not counted. Bracken said she was also unable to determine the effectiveness of the vaccine on Dartmouth’s campus in particular, because the data available to Dick’s House is limited. However, she estimated that roughly half of students diagnosed with the flu had not been vaccinated. 

In February, the month with the most cases, Dick’s House tested 76 students for the flu, 38 of which tested positive, Bracken said. 

“We typically test if it’s not clear why [a] person is so sick, if the student really wants to be tested, but primarily if we’re debating on whether we’re going to treat or not,” Bracken said. 

Some students who tested positive were prescribed antiviral medication. However, not all students were treated if the window for treatment had already closed, if the student did not want to take medication or if the student was “generally healthy and [didn’t have] chronic health conditions,” Bracken said.

“Their immune system is competent and they can usually get better [without treatment],” Bracken said of the latter category. 

The most common antiviral medication prescribed was Tamiflu, but Bracken said that because Tamiflu can cause nausea, some students are less likely to take it.

“Tamiflu might reduce the duration of the illness,” Bracken said. “The evidence is about a half a day to a day … If people are experiencing nausea, they might elect not to take the medication because they don’t want to feel sicker.” 

She also said that a new medication called Xofluza, which requires fewer doses than Tamiflu and is associated with less nausea, recently became available and was chosen by several students. However, it is not covered by all health insurance plans and costs twice as much. 

“When people’s health insurance ... help defray the costs, people might choose that,” Bracken said. 

She added that the College’s health insurance plan covers Xofluza. 

Despite the higher number of cases, Bracken said the infirmary at Dick’s House was able to offer beds to students who wanted to stay overnight. 

“The infirmary was busy — happily busy,” Bracken said. 

She added that infirmary traffic was increased by several cases of gastroenteritis, a viral gastrointestinal illness that causes diarrhea, vomiting, cramps and occasionally requires IV fluids to be administered. 

Danielle Fang ’20 was diagnosed with the flu after being tested. She said she had not been vaccinated for the flu ever before, was prescribed Xofluza, and also took Tylenol and Advil to control symptoms. 

“I felt like it was pretty bad this year,” Fang said. “There were constantly people getting sick on campus.” She said she felt that there was “always someone” sick with the flu on her floor. 

Bracken attributed the number of cases to a combination of stress, lack of sleep and exposure to germs. 

“That’s just the perfect recipe to get sick with the flu,” she said. 

Daly emphasized that the flu season is not over yet. 

“People should still be taking precautions: washing their hands, staying home when they’re sick and they can actually still get vaccinated,” she said. “It takes about two weeks for your body to develop the antibodies after being vaccinated. It’s not too late, because we will continue to see influenza activity in our state into May.”

Julian Nathan contributed reporting.