Flu (Influenza)

Contents

Overview

Influenza, or flu, is a respiratory infection caused by a variety of flu viruses. The most familiar aspect of the flu is the way it can "knock you off your feet" as it sweeps through entire communities.

The flu differs in several ways from the common cold, a respiratory infection also caused by viruses. For example, people with colds rarely get fevers or headaches or suffer from the extreme exhaustion that flu viruses cause.

The Centers for Disease Control and Prevention (CDC) estimates that 10 to 20 percent of Americans come down with the flu during each flu season, which typically lasts from November to March. Children are two to three times more likely than adults to get sick with the flu, and children frequently spread the virus to others. Although most people recover from the illness, CDC estimates that in the United States more than 100,000 people are hospitalized and about 36,000 people die from the flu and its complications every year.

Flu Outbreaks

Flu outbreaks usually begin suddenly and occur mainly in the late fall and winter. The disease spreads through communities creating an epidemic. During the epidemic, the number of cases peaks in about 3 weeks and subsides after another 3 or 4 weeks. Half of the population of a community may be affected. Because schools are an excellent place for flu viruses to attack and spread, families with school-age children have more infections than other families, with an average of one-third of the family members infected each year.

Importance of Flu

Besides the rapid start of the outbreaks and the large numbers of people affected, the flu is an important disease because it can cause serious complications. Most people who get the flu get better within a week (although they may have a lingering cough and tire easily for a while longer). For elderly people, newborn babies, and people with certain chronic illnesses, however, the flu and its complications can be life-threatening.

Flu Transmission

You can get the flu if someone around you who has the flu coughs or sneezes. You can get the flu simply by touching a surface like a telephone or door knob that has been contaminated by a touch from someone who has the flu. The viruses can pass through the air and enter your body through your nose or mouth. If you've touched a contaminated surface, they can pass from your hand to your nose or mouth.

You are at greatest risk of getting infected in highly populated areas, such as in crowded living conditions and in schools.

Flu Symptoms

If you get infected by the flu virus, you will usually feel symptoms 1 to 4 days later. You can spread the flu to others before your symptoms start and for another 3 to 4 days after your symptoms appear. The symptoms start very quickly and may include

• Body aches
• Chills
• Dry cough
• Fever
• Headache
• Sore throat
• Stuffy nose

Typically, the fever begins to decline on the second or third day of the illness. The flu almost never causes symptoms in the stomach and intestines. The illness that some call "stomach flu" is not influenza.

Diagnosis

Usually, health care providers diagnose the flu on the basis of whether it is epidemic in the community and whether the person's complaints fit the current pattern of symptoms. Health care providers rarely use laboratory tests to identify the virus during an epidemic. Health officials, however, monitor certain U.S. health clinics and do laboratory tests to determine which type of flu virus is responsible for the epidemic.

Flu Prevention

There are several ways you can keep yourself from getting a flu or passing one on to others.

• Clean your hands. Washing your hands often will help protect you from germs.
• Because flu germs on your hands can easily enter through your eyes and nose, keep your hands away from those areas of your body. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
• If possible, avoid being close to people who have flu. Stay home when you are sick. You will help prevent others from catching your illness.
• If you have a flu, avoid being close to people.
• If you sneeze or cough, cover your nose or mouth.

Handwashing Handwashing with soap and water is the simplest and one of the most effective ways to keep from getting colds or giving them to others. During flu season, you should wash your hands often and teach your children to do the same. When water isn't available, CDC recommends using alcohol-based products made for washing hands.

Disinfecting Flu viruses can live hours on your skin. They also can survive for hours on objects such as telephones and stair railings. Cleaning environmental surfaces with a virus-killing disinfectant might help prevent spread of infection.

Flu Vaccine

The main way to keep from getting flu is to get a yearly flu vaccine. You can get the vaccine at your doctor's office or a local clinic, and in many communities at workplaces, supermarkets, and drugstores. You must get the vaccine every year because it changes.

Scientists make a different vaccine every year because the strains of flu viruses change from year to year. Nine to 10 months before the flu season begins, they prepare a new vaccine made from inactivated (killed) flu viruses. Because the viruses are killed, they cannot cause infection. The vaccine preparation is based on the strains of the flu viruses that are in circulation at the time. It includes those A and B viruses (see section below on types of flu viruses) expected to circulate the following winter.

Sometimes, an unpredicted new strain may appear after the vaccine has been made and distributed to doctor's offices and clinics. Because of this, even if you do get the flu vaccine, you still may get infected. If you do get infected, however, the disease usually is milder because the vaccine still will give you some protection.

Until recently, you could get the flu vaccine only as an injection (shot). In 2003, however, the Food and Drug Administration (FDA) approved a nasal spray flu vaccine called FluMist, which you can get from your health care provider. FDA approved it for use in healthy people aged 5 to 49 years.

You should not use FluMist if

• You have certain lung conditions, including asthma, or heart conditions
• You have metabolic disorders such as diabetes or kidney dysfunction
• You have an immunodeficiency disease or are on immunosuppressive treatment
• You have had Guillain-Barré syndrome
• You are pregnant
• You have a history of allergy or hypersensitivity, including anaphylaxis, to any of the parts of FluMist or to eggs

Children or teenagers who regularly take aspirin or products containing aspirin also should not take FluMist.

Your immune system takes time to respond to the flu vaccine. Therefore, you should get vaccinated 6 to 8 weeks before flu season begins in November to prevent getting infected or reduce the severity of flu if you do get it. Because the flu season usually lasts until March, however, it's not too late to get it after the season has begun. The vaccine itself cannot cause the flu, but you could become exposed to the virus by someone else and get infected soon after you are vaccinated.

Possible side effects.  You should be aware that the flu vaccine can cause side effects. The most common side effect in children and adults is soreness at the site of the vaccination. Other side effects, especially in children who previously have not been exposed to the flu virus, include fever, tiredness, and sore muscles. These side effects may begin 6 to 12 hours after vaccination and may last for up to 2 days.

Viruses for producing the vaccine are grown in chicken eggs and then killed with a chemical so that they can no longer cause an infection. The flu vaccine may contain some egg protein, which can cause an allergic reaction. Therefore, if you are allergic to eggs or have ever had a serious allergic reaction to the flu vaccine, CDC recommends that you consult with your health care provider before getting vaccinated.

Vaccine recommendations.  If you are in any of the following groups or live in a household with someone who is, CDC recommends that you get the flu vaccine.

• You are 50 years of age or older
• You have chronic diseases of your heart, lungs, or kidneys
• You have diabetes
• Your immune system does not function properly
• You have a severe form of anemia
• You will be more than 3 months pregnant during the flu season
• You live in a nursing home or other chronic-care housing facility
• You are in close contact with children 0 to 23 months of age

CDC recommends that children 6 months to 23 months of age get the flu vaccine. Children and teenagers (2 to 18 years of age) should get the flu vaccine if they are taking long-term aspirin treatment as they may be at risk of developing Reye's syndrome following a flu infection (see section on complications in children). They should also get the flu vaccine if they live in a household with someone in the above groups.

Health care providers and volunteers should get the flu vaccine if they work with people in any of the above groups.

Medicine for Prevention.  Although the flu vaccine is the best way to prevent getting the flu, three antiviral medicines also are available by prescription that will help prevent flu infection.

• Tamiflu (oseltamivir)
• Flumadine (rimantadine)
• Symmetrel (amantadine)

Tamiflu is for use in adults and teenagers 13 years and older. Rimantadine and amantadine may be used by adults and children who are 1 year of age and older.

• These medicines help prevent the flu if you take them for at least 2 weeks during the outbreak of flu in your community
• You may use these medicines if you are in close contact with family members or others who have the flu
• You may use them if you are in close contact with people who have been vaccinated but whom you want to give added protection from getting the flu
• You may use either medicine immediately following flu vaccination during a flu epidemic to protect you during the 2- to 4-week period before antibodies (proteins from your immune system that protect you from the flu virus) develop or when a flu epidemic is caused by virus strains other than those covered by the vaccine

Flumadine and Symmetrel have unpleasant side effects. Your health care provider can help you decide which medicine is best for you. You should discuss the flu vaccine and medicines with your health care provider before the flu season begins.

Flu Treatment

Many people treat their flu infections by simply

• Resting in bed
• Drinking plenty of fluids
• Taking over-the-counter medicine such as aspirin or acetaminophen (Tylenol, for example)

Do not give aspirin to children and adolescents who have the flu.

Do not take antibiotics to treat the flu because they do not work on viruses. Antibiotics only work against some infections caused by bacteria.

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Elderberry has shown some helpful results in treating flu from the Influenza A virus.

Medicine for Treatment.  If you do get the flu and want to take medicine to treat it, your health care provider may prescribe one of four available antiviral medicines.

• Tamiflu (oseltamivir) is for adults and children 1 year and older and Relenza (zanamivir) is for adults and children 7 years and older who have an uncomplicated flu infection and who have had symptoms for no more than 2 days. Both treat influenza type A and type B infections.
• Flumadine (rimantadine) helps adults who have influenza type A virus infections. It has no effect on influenza type B virus infections.
• Symmetrel (amantadine) may be taken by adults and children who are 1 year of age and older to prevent and treat type A influenza virus infections. Symmetrel, however, is more likely to cause side effects such as lightheadedness and inability to sleep more often than is Flumadine.

To work well, you must take these medicines within 48 hours after the flu begins. They reduce the length of time fever and other symptoms last and allow you to return to your daily routine quicker.

Flu Complications. You can have flu complications if you get a bacterial infection, which can cause pneumonia in your weakened lungs. Pneumonia also can be caused by the flu virus itself.

Complications usually appear after you start feeling better. After a brief period of improvement, you may suddenly get symptoms.

• High fever
• Shaking chills
• Chest pain with each breath
• Coughing that produces thick, yellow-greenish-colored mucus

Pneumonia can be a very serious and sometimes life-threatening condition. If you have any of these symptoms, you should contact your health care provider immediately to get the appropriate treatment.

Flu complications in children and teenagers.  Reye's syndrome, a condition that affects the nerves, sometimes develops in children and teenagers who are recovering from the flu. Reye's syndrome begins with nausea and vomiting, but the progressive mental changes (such as confusion or delirium) cause the greatest concern.

The syndrome often begins in young people after they take aspirin to get rid of fever or pain. Although very few children develop Reye's syndrome, you should consult a health care provider before giving aspirin or products that contain aspirin to children. Acetaminophen does not seem to be connected with Reye's syndrome.

Other complications of the flu that can affect children are

• Convulsions caused by fever
• Croup
• Ear infections, such as otitis media

Newborn babies recently out of intensive care units are particularly vulnerable to suffering from flu complications.

Types of Flu Viruses. The first flu virus was identified in the 1930s. Since then, scientists have classified flu viruses into types A, B, and C.

• Type A is the most common and usually causes the most serious epidemics
• Type B outbreaks also can cause epidemics, but the disease it produces generally is milder than that caused by type A
• Type C viruses, on the other hand, never have been connected with a large epidemic

Important Flu Pandemics since 1918.

If a flu virus emerges that is either new or has not circulated in many years and if it is able to spread easily from person to person, it could quickly travel around the world and cause serious illness and death for millions of people. This is called a flu pandemic.

The 1918 Spanish flu pandemic is the catastrophe against which all modern pandemics are measured. More than 20 million people were killed worldwide; 500,000 died in the United States alone. This virus was especially quick to kill. So far, the world has not seen a virus that severe again.

In 1957 and 1968, the Asian flu and Hong Kong flu, respectively, invaded the United States. Although hundreds of thousands of people in the United States died, the death toll for each pandemic was not as high as that for the Spanish flu.

In 1976, the United States experienced a swine flu scare. When a new flu virus was first identified at Fort Dix, New Jersey, it was labeled the "killer flu," and health experts were afraid that it would infect people around the world. In fact, swine flu never left the Fort Dix area. Research on the virus later showed that if it had spread, it would probably have been much less deadly than the Spanish flu.

In 1997, another "near miss" pandemic occurred when 18 people in Hong Kong became ill from a new flu virus. Six of the infected people subsequently died. Usually, flu viruses move first from chickens to pigs, and then from pigs to humans. This virus was different because it moved directly from chickens to people. This avian or bird flu never became a pandemic, however, because it didn't easily spread from person to person. In addition, public health authorities ordered the slaughter of all live chickens in Hong Kong.

In 1999, two children in Hong Kong were infected with a flu virus that usually infects birds. They were the first confirmed human infections by this virus, and both children recovered. Although other infections from this virus were reported from China, there have been no cases since April 1999.

In 2003, one flu strain, labeled H5N1, caused two Hong Kong family members to be hospitalized after a visit to China, killing one of them, a 33-year-old man. (A third family member died while in China of an undiagnosed respiratory illness.)

As of January 21, 2005, H5N1 has caused illness in 52 people in Thailand and Vietnam, 37 of whom died. Researchers are especially concerned because this flu strain, which is transmitted by birds and is quite deadly, is becoming endemic in Asia.

Also from 2003 to the present, several other strains of bird flu have caused illness in Egypt, Canada, and the Netherlands.