Flu Season Begins in the Southwest

The Centers for Disease Control and Prevention (CDC) is reporting widespread flu activity in the Southwestern US, from California to Texas. Other states have regional or local activity, but the Midwest and East Coast remain largely virus-free so far, reporting only sporadic flu transmission.

When it hits us - and it will - is there any way to prevent or ease symptoms of the illness, especially for those who didn't receive flu shots when they were widely available?

Symptoms
Influenza is a respiratory infection caused by a virus. Even though it's very common - especially from mid-November through March - influenza, commonly called "the flu," probably gets blamed for more than its fair share of ills.

In general, influenza 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.

Nausea, vomiting and diarrhea are not typical symptoms of the flu, but might accompany influenza infection, especially in children. Even though the term "stomach flu" is widely used, 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.)

Preventing the Flu
The simplest and surest way to avoid getting the flu is to be vaccinated against it. Until recently, vaccination meant getting an injected vaccine. Fortunately - especially for people who don't like to receive shots - in 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.

Preventive methods such as frequent hand washing or avoiding contact with other people are generally helpful in avoiding illness, but less effective in stopping a flu outbreak once it has begun. 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.

Whether you've received a flu vaccine or not, it's a good idea to make good use of antiviral wipes and lotions to prevent germ transmission from hands, telephones, and other surfaces. Wash hands frequently, and don't touch your mouth, nose, or eyes - all common routes for germ transmission. Use tissues or your arm to cover coughs or sneezes.

High-Risk Populations
According to the CDC, influenza is associated with more than 200,000 hospitalizations and 36,000 deaths nationwide each year. In general, anyone who wants to reduce their chances of getting the flu can get vaccinated, but flu-related complications are much more likely to develop among the elderly and people with chronic health problems. This is why the CDC's Advisory Committee on Immunization Practices (ACIP) recommends that people who are at high risk of having serious flu complications or people who live with or care for those at high risk for serious complications should get vaccinated each year. These groups include:

• People 65 years of age or older. (Because nearly one-third of people 50 to 64 years of age in the United States have one or more medical conditions that place them at increased risk for serious flu complications, vaccination is also recommended for all persons aged 50 to 64.)
• All children 6 to 23 months of age.
• Adults and children with diabetes or chronic diseases of the heart, lungs, or kidneys.
• People living in long-term care facilities and group homes.
• Health care workers.
• Women who will be pregnant during the flu season.
• Those with weak immune systems due to situations such as cancer chemotherapy or HIV infection.
• People with any condition that can compromise respiratory function or the handling of respiratory secretions (that is, a condition that makes it hard to breathe or swallow, such as brain injury or disease, spinal cord injuries, seizure disorders, or other nerve or muscle disorders.)
• Children 6 months to 18 years of age who are on long-term aspirin therapy.

People in these groups should make a special effort to receive the flu vaccine as soon as it becomes available in their area. Wisconsin residents who still want to be vaccinated should first check to make sure their health care provider has flu vaccine on hand - shortages have been reported, and many clinics, such as those of the Wisconsin Visiting Nurse Association, have already been stopped for the year. If you have trouble finding a location that's still offering flu vaccinations, try contacting your local Health Department.

Vaccination Side Effects
The most common side effect of injected flu vaccination is soreness at the site of the injection - flu vaccine is typically administered to adults in the arm and to children in the thigh. Some people (especially children who have not previously been exposed to the flu virus) may experience fever, tiredness or sore muscles. These side effects may begin six 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.

The most common side effects of nasal-spray flu vaccine in children can include runny nose, headache, vomiting, muscle aches, and fever. In adults, side effects can include runny nose, headache, sore throat, and cough. Fever is not a common side effect in adults receiving the nasal-spray flu 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 three FDA-approved oral prescription medications available in the US - amantadine (brand name Symmetrel), rimantadine (Flumadine), and oseltamivir (Tamiflu) - that can lessen the severity and duration of the illness.

In addition, zanamivir (Relenza), also an anti-viral drug, is available for those aged 7 years and older for the treatment of uncomplicated influenza virus. Relenza is a powder that is inhaled twice a day for five days from a breath-activated plastic device called a Diskhaler. Relenza has not been shown to be effective, and may carry risk, in patients with severe asthma or chronic obstructive pulmonary disease (COPD). Clinical studies showed that for the drug to be effective, patients needed to start treatment within two days of the onset of symptoms.

(Please Note: The CDC has recently announced an unexpected finding: Over the past three years, the frequency of drug resistance to amantadine and rimantadine rose from 1.9% in 2004 to 14.5% during the first 6 months of the 2004-05 influenza season. For the 2005-06 season, viruses isolated from patients in 23 states have been tested at the CDC and an unprecedented 91% have been resistant to amantadine and rimantadine. On the basis of these results, the CDC is providing an interim recommendation that neither amantadine nor rimandatine be used for the treatment or prevention of influenza in the United States for the remainder of the 2005-06 influenza season. During this period, oseltamivir or zanamivir should be selected if an antiviral medication is used for the treatment of influenza.

All of the antiviral drugs are different in terms of who can take them, how they are given, any dosing changes based on age or medical conditions, and side effects. Your health care provider can help decide whether you should take an antiviral drug and which one you should use.

Like the injected vaccine, the issue with the nasal spray is availability - particularly with Tamiflu, which might have the potential to act against avian influenza H5N1. (Although some recent reports have deemed it largely ineffective against H5N1.) For this reason many doses have been sidetracked to government sources and supplies to the general public have been limited.

Easing Flu Symptoms
If you missed your chance to receive a flu vaccine and start experiencing symptoms - pounding head, muscle aches, temperature higher than 100°, fatigue - what do you do? 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 to 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 sufferers 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

Information provided by the US Centers for Disease Control and Prevention (CDC) and the National Institutes of Health/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.