With respiratory infections rampant, experts urge masking and vaccination

During one of the most active flu seasons in recent memory, infectious disease experts at Fred Hutch Cancer Center say many of the public health lessons learned during the COVID-19 epidemic still apply: wear well-fitting masks in crowded indoor poorly ventilated spaces, practice good hand hygiene and get vaccinated. There are three vaccines available to protect against respiratory viruses: flu, COVID-19 and RSV. And no, it’s not too late to get vaccinated this season.

“This is one of the busiest flu seasons in a decade if not longer,” said Steven Pergam, MD, MPH, medical director of infection prevention at Fred Hutch. “There is lots of flu out there and a number of early reported deaths.”  

In February, local hospitals saw a higher volume of patients with flu compared to what was observed in recent years, said Catherine Liu, MD, associate director of infection prevention at Fred Hutch. Cancer patients are particularly at risk of contracting infections. In 2024, Fred Hutch teamed up with Vanderbilt University on a study examining whether transplant patients should get two doses of flu vaccine instead of one.  

“This study found that patients who have had stem cell transplants and are within one year post-transplant should get one dose and follow that a month later with an additional dose,” said Pergam. “We have changed our practice as a result.”

On the COVID-19 update front, immunocompromised people and those over 65 should get a COVID-19 vaccine every six months rather than annually due to waning immunity, said Liu.

The RSV vaccine is a newer offering that is now recommended in a single dose for everyone over 75 and for people 60 and older with underlying conditions, a category that includes people with cancer, lung disease, asthma and kidney disease. The vaccine is also recommended for pregnant people.  

Bird flu — which has killed more than 150 million chickens and infected dozens of people nationally, including one who died — is also making headlines. Four bird flu vaccines have been approved by the U.S. Food and Drug Administration, although the vaccines remain in the national stockpile and have not been distributed. In February, it was reported that federal health officials are reevaluating the multi-million-dollar federal contract funding the development of another novel bird flu vaccine. 

The avian flu virus continues to infect wild bird populations and backyard chickens and cattle. “There have been no cases of human-to-human transmission, but there is potential if someone has seasonal flu, then also gets bird flu. Then the worry is reassortment,” said Liu.  

Reassortment happens when more than one virus infects the same cell and the viruses swap genetic material, giving rise to new genetic combinations that can spur the creation of new viruses.  

Cancer patients should avoid eating undercooked eggs and raw milk. Those who work on farms or have backyard chickens should call public health officials if their chickens get sick.  

“If you are immunosuppressed, have someone else step up to help care for sick chickens,” said Pergam.

A data vacuum

Pergam notes that it’s particularly challenging to evaluate whether this year’s flu vaccine is a good match for the circulating flu strains because the data typically collected and published by the Centers for Disease Control and Prevention is being limited by the federal government.  

“We’re not getting good data from the CDC right now, but we do know there is lot of flu in the community and a lot of people who are unvaccinated and seeing complications,” he said. “Any time we lack access to information, the more vulnerable we become. When we decrease our ability to share data across state lines and across levels of government, it increases the risk of major outbreaks and epidemics.”

Without comprehensive data on a national level, states are operating in silos to protect public health. “We really rely on this data,” said Liu, who referenced CDC data daily during the COVID-19 pandemic.  

“States are being left to make their own decisions without CDC data. Here at Fred Hutch, we are relying on other sources like the Washington State Department of Health and Seattle & King County Public Health Respiratory Virus Dashboard. It’s hard to know what data are missing,” she said. “Are there data we can’t access that is important for us to make decisions in the best interests of our patients?”

Amid the uncertainty, Nancy Davidson, MD, executive vice president of clinical affairs and a breast cancer specialist, urges patients to pursue “commonsense infection control practices.” Davidson holds the Raisbeck Endowed Chair for Collaborative Research.  

Providers at Fred Hutch are once again required to mask because flu activity is so high.

 “We have not required masking of patients or family members although they also often embrace it,” she said. “Just as we did pre-COVID, we are working with patients to minimize risk and maximize vaccination strategy.”