Flu Time Again, with a Twist: Vaccine by Nasal Spray

Influenza, commonly called "the flu," gets blamed for more than its fair share of ills. Just about any ailment we come down with, especially during this time of the year, is usually called the flu. In reality, those winter bugs – with their aches and pains, nausea, fever and vomiting – are rarely caused by influenza.

Influenza is a actually a respiratory infection caused by a number of viruses that are widespread from mid-November through March. The flu viruses that cause human epidemics are categorized into types Influenza A and Influenza B, based on their structure.

In general, flu viruses will cause a more severe illness than other infections such as the common cold. Unlike a cold, which usually begins slowly and often runs its course without a fever, flu symptoms typically include a sudden headache with a dry cough, muscle aches, fatigue, chills and a fever (usually 100ºF to 103ºF in adults or even higher in children). Flu sufferers might also experience a sore throat and a runny or stuffy nose.

Although nausea, vomiting and diarrhea are not typical symptoms of influenza infection, they sometimes accompany the flu, especially in children. In spite of the wide use of the term "stomach flu,” most gastrointestinal illnesses are caused by organisms other than influenza viruses. (Often the culprit is found in contaminated food, which by some estimates sickens 76 million Americans every year.)

This Year, Flu Vaccine Comes in Injection or Spray
Preventive methods such as frequent handwashing or avoiding contact with other people are helpful in avoiding illness, but are largely ineffective in stopping a flu outbreak. Influenza virus spreads easily and can be transmitted through the air or on surfaces; this means you can acquire the flu just by breathing the same air or touching the same objects as someone who has the flu.

The simplest and surest way to avoid getting the flu is to be vaccinated against it. Until recently, this meant getting an injected vaccine. Fortunately – especially for people who don’t like to receive shots – we have a new option this year. In June of 2003 the Food and Drug Administration approved FluMist, a flu vaccine that’s sprayed into the nose, for healthy people between the ages of 5 and 49.

Both the injected and the nasally-administered vaccines contain pieces of influenza viruses. These components cause the immune system to build defenses and provide protection against the real virus when it enters the body. Injected flu vaccine is made from killed flu viruses, while FluMist contains live (but very weak) viruses. This means there is a theoretical chance that the spray vaccine could cause the or spread the flu in children under 5 years of age, pregnant women, people over 50 years of age, or those who are weakened by illness or medical treatments.

According to the Centers for Disease Control and Prevention (CDC), influenza is associated with more than 100,000 hospitalizations and 36,000 deaths nationwide each year. Because flu-related complications are much more likely to develop among infants under 6 months of age, people older than 50 and those weakened by health problems or medical treatments, the CDC’s Advisory Committee on Immunization Practices (ACIP) urges these groups to receive the vaccine as soon as possible. They include:

• People 50 years of age or older; particularly those over age 65.
• People living in long-term care facilities and group homes.
• Adults and children with diabetes or chronic diseases of the heart, kidneys or lungs (including asthma).
• Children and adolescents (age 6 months – 18 years) who are on long-term aspirin therapy.
• Health care workers and other caregivers who could spread the flu to people in their care.
• Women who will be more than three months pregnant during the flu season.
• Those with weak immune systems due to circumstances such as cancer chemotherapy or HIV infection.

At times there have been shortages of flu vaccines in the US, but that’s not the case this year. There is plenty of vaccine to go around and there haven’t been problems or delays in delivery thus far.

Side Effects Typically Minor
The most common side effect of injected flu vaccine is soreness at the site of the shot – it’s usually given to adults in the arm and to children in the thigh. Other than that, the side effects of flu vaccination by injection or spray are similar. Some people (especially children who have not previously been exposed to the flu virus) may experience fever, tiredness or sore muscles. These side effects can begin 6 to 12 hours after vaccination and might last for up to two days.

One important warning: because chicken eggs are used as part of the flu vaccine production process, people who are allergic to egg protein should not receive the vaccine.

Antiviral Medications
If you realize you are coming down with the flu and can visit your health care provider within the first two days of symptoms, there are several prescription medications – amantadine, rimantadine, zanamivir, and oseltamivir – that can lessen the severity and duration of the illness.

Easing Flu Symptoms
What to do if you missed your influenza vaccine and come down with the flu bug? Your head is pounding, your muscles ache, the thermometer reads 101° and you’re too tired to get out of bed. Most of us already know the answer to this one: stay in bed, drink plenty of fluids and take advantage of pain relievers like acetaminophen or ibuprofen. (Because of its association with a rare condition called Reye Syndrome, aspirin or aspirin-containing products should never be given children who are recovering from viral illnesses such as flu or chickenpox.)

People who have the flu usually see their symptoms improve in two or three days, although the fatigue and cough can linger for two weeks or more. In most cases recovery is complete, but some people develop serious medical complications such as pneumonia. If your illness becomes worse or refuses to clear up, or if you have new or severe symptoms, you should see your health care provider. For most of us, it’s a waiting game – though it might feel like an eternity, you should feel considerably better in a few days.

Eileen Early, RN, BSN
HealthLink Editor
Medical College of Wisconsin Office of Clinical Informatics

This article includes information from the US Centers for Disease Control and Prevention, the US Food and Drug Administration and the National Institute of Allergy and Infectious Diseases.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.