ASK THE DOCTOR: The flu blues
By Dr. JIM MITTERANDO
The Patriot LedgerConcerns about this year’s influenza(flu) season have been sparked by recent media coverage of an earlier flu season, vaccine shortages and deaths of several young people. No evidence yet exists to suggest that this flu strain is more virulent than other strains that have caused past epidemics or that this season's flu is worse than those of the past. Naturally, people are concerned about a possibility of a replay of the deadly 1918 flu epidemic that, fortunately, has not been seen since.
The flu kills 36,000 Americans on average each year including about 800 people in Massachusetts. Most deaths involve the elderly or the ill. These numbers seem alarming but, in fact, are a small percentage of the 250 million U.S. population. The risk of dying from influenza for a healthy child or adult is less than 1 in 100,000 people. This risk is far less than the chance of dying in an automobile accident.
Influenza has become more widespread this past week in Massachusetts with no epidemic yet observed. The Massachusetts Department of Public Health(DPH) predicts the peak of flu season will probably be in January. For further flu developments check the DPH website at http://www.state.ma.us/dph/ and the CDC(Centers for Disease Control) at http://www.cdc.gov.
Symptoms of flu are similar to the common cold, but more intense: fever, headache, body aches, extreme fatigue, cough, and sore throat. Children may have symptoms - nausea, vomiting or diarrhea - that are not common for adults.
The flu is different from the “stomach flu” which describes gastroenteritis involving nausea, vomiting and diarrhea with no cold symptoms. The flu is a respiratory disease and not a stomach or intestinal disease.
If you do come down with the flu, stay home to prevent further spread of the disease. People may be infectious several days before symptoms begin and are contagious while symptomatic (average 5 to 7 days).
Most people with the flu do not require medical evaluation or treatment. Usual treatment consists of bed rest, medications to relieve pain and reduce fever, and plenty of fluids. The illness generally resolves within 7 days. Follow up with your doctor if you do not improve after 4 or 5 days or if you develop signs of pneumonia that could include a new fever developing days after the initial illness, shortness of breath or rapid breathing.
The flu is a viral illness, not a bacterial illness therefore it doesn't respond to antibiotics. Antiviral medications-Symmetrel (amantadine), Flumadine (rimantidine), Tamiflu (oseltamivir), and Relenza (zanamivir)- may shorten the duration of the illness by a day and may reduce the symptoms. These drugs need to be taken within the first 48 hours of the illness to be effective. I only recommend these drugs in people who have a high risk of complication from the flu or may have a severe case of influenza. Healthy children and adults do not need these medications that may have side effects, may be costly and may not be covered by insurance.
Testing for influenza is generally not required. There are rapid flu tests available but most doctors’ offices do not use them because they are not very accurate and do not change treatment.
Basic principles of prevention include:
- Frequent handwashing to avoid spread of disease
- Avoid crowds during an epidemic
- Consider getting a flu vaccine especially if you are over 65 or have health problems
One of the biggest myths about the flu shot is that it can give you the flu. The shot is made with the killed virus, so it cannot cause the flu. The most likely side effect from the flu shot is a temporary sore spot on the arm where the shot is given.
The flu vaccine generally provides immunity to the flu 70-90% of the time when the correct flu virus is predicted for that season. Picking the right flu strain for the vaccine involves some scientific guesswork because the influenza virus changes from year to year. Unfortunately, the flu virus circulating this year is different than what was chosen for the vaccine. As a result, it is not known how effective this year’s vaccine will be. Current rough estimates put the vaccine at 20-40% effective in preventing this year’s flu and should at least provide some protection by reducing flu symptoms.
Flu shot supplies are pretty much exhausted for this season which has increased interest in the new nasal-spray flu vaccine, FluMist, which is still available in limited supplies. This vaccine is made from a weakened, live flu virus and may only be given to healthy people between the ages of 5 and 49- the ages least likely to experience flu complications. People with asthma or with suppressed immune systems cannot use it. You may get mild flu-like symptoms with this vaccine since it is a live vaccine.
Insurance companies recently decided to cover this more costly vaccine after routine vaccine supplies ran out. Few pharmacies or doctors carry this vaccine. Like this year’s flu shot, the nasal spray may only provide limited protection this winter since the flu strain circulating is different than the one in the vaccine.
Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.
Copyright 2003 The Patriot Ledger
Transmitted Tuesday, December 23, 2003