The Flu

This is a revised and updated version of an article I wrote several years ago.  It has been revised for the 2008-2009 flu season, but the flu doesn’t change that much, so it’s still a miserable experience that is best avoided, if possible.

In the past several years we have seen lots of confusion surrounding the influenza illness and the vaccine.  Influenza causes anywhere from 20,000 to 40,000 deaths annually. Children and the elderly are especially at risk for severe cases requiring hospitalization, and 90% of flu deaths are seen among those over 65. The first cases of flu are usually seen in mid-October, and can continue until May. The strains responsible for the flu evolve each year, may change as the season progresses.

So what exactly is the flu? The true flu is caused by the influenza virus, either type A or type B. It usually causes fever, headache, achiness, and sometimes stomach upset and sore throat. The winter is full of various illnesses, and most are not the flu. The flu shot only protects against influenza, and does not prevent colds and other illnesses. The influenza virus is tricky, it evolves and changes each year, just enough that immunity to the previous year’s strain isn’t good enough to prevent illness this year. Every February the FDA picks 3 strains that they think are most likely to cause illness the next winter. Then the vaccine manufacturers rush to produce vaccine. They need to grow the vaccine in chicken eggs, process it, test, package and distribute it before it arrives in my office.

The flu shot is an inactivated vaccine. That means there is no live virus, and you cannot catch the flu from getting the shot. Sometimes people can react to the vaccine itself and get flu like symptoms, but they don’t have the flu. It also means that we can give other vaccines at the same time without compromising the efficacy of either vaccine. The flu nasal spray is a live vaccine, and you can get the flu from that, although is it rare and usually very mild when it does occur. It is only indicated in people aged 5 to 49 who are otherwise healthy and have no illnesses that may compromise their immune systems. Because it is a live vaccine, you must wait a month before having another live vaccine (the shingles vaccine Zostavax would be an important example). Adverse reactions are extremely rare.

Who should get the vaccine? The United State Centers for Disease Control (CDC) issues guidelines annually as to whom they recommend having the vaccine.  This year, for the first time, they recommend everyone be vaccinated. The CDC has also issues guidelines as to who is most at risk (to either themselves or the rest of the population) and highly recommends they get vaccinated. Children between the age of 6 months and 5 years, healthcare workers, adults over the age of 50, and anyone in between that has any medical condition which make them more susceptible to the flu or it’s complications fall into that group.

So, what about Tamiflu? Tamiflu is one of 2 antiviral medications (the other being Relenza, which is inhaled) that is effective is decreasing the length of illness in flu infection. The older antivirals, including amantadine, are not longer effective - there is too much resistance. Influenza is a virus, so antibiotics are not effective. When started within 48 hours of onset of symptoms, the antiviral medications will usually only shorten the duration of illness by 1-2 days in healthy individuals. Once someone is ill it’s certainly worth treating, but the best way is to prevent the illness in the first place. That’s where the flu shot comes in, especially since there have already been some flu strains resistant to Tamiflu identified.

When should I get my shot? The optimal time for vaccination is in October and November. The illness usually peaks between December and March, but can go through May. It only takes a few weeks to develop an antibody response, so even getting the shot during the flu season can be helpful.

And now please excuse me, but I have to whine… Given the current health insurance climate, physicians often lose money on administering vaccines. The big chains usually collect the full fee from the patient; we have to bill insurance and take what they give us. Economically vaccines are a loser for us, and many physicians have stopped offering them for that reason. If the current climate continues, I’m sure many more will stop. Maybe that’s not a bad thing, but I consider offering vaccines an important service we offer the community.

The flu can be a very serious illness, so please take it seriously!  I hope you will all consider getting vaccinated.  And if you think you may have the flu, please come in to the office ASAP, as the longer you wait, the less likely it will be that we can help you.