Influenza: A Tutorial
How to stay healthy this flu season
By Madhu Reddy, MD
Influenza, also commonly known as "flu," is a widespread viral infection that has afflicted mankind for thousands of years. In fact, Hippocrates described the symptoms of flu among his people more than 2,400 years ago.
Different strains of flu affect people around the globe, and "pandemics" such as the Swine Flu (H1N1) can occur when there's a significant change (called an antigenic drift) in the virus. According to the Centers for Disease Control (CDC), between 5-20% of the US population suffers from seasonal influenza each year, resulting in about 200,000 hospitalizations and 36,000 deaths and impacting our economy to the tune of about $10 billion in lost productivity and treatment costs. Three segments of our population are at greater risk of contracting influenza, including children less than 2 years old, adults over the age of 65, and anyone with a chronic medical condition (such as diabetes or heart disease) or compromised immune system.
Our flu season runs from about October through May, generally peaking in January and February. How can we minimize our own chances of getting the flu in Colorado this winter? And what happens if we do?
First, let’s get clear about what influenza really is, and what it’s not. We talk about the stomach “flu,” which is actually gastroenteritis and not influenza at all, and we often confuse influenza with the common cold. Usually influenza comes on much more quickly than a cold (which can creep up on you gradually), and you’ll typically feel much more sick if you have influenza.
Here are the most common characteristics of each condition.
So now that we've got that straight, I'll use the term "flu" to mean influenza from here on out. Here are the most common questions I get from my patients about the flu, along with my recommendations.
How is the flu virus spread? The most common way is through personal contact, such as shaking hands or being in the room with an infected person. An ill person who sneezes or coughs can spew airborne germs up to 6 feet – germs that can land and live on other people and on surfaces such as countertops, doorknobs, keyboards, and linens for 2 to 8 hours! If you inhale the virus or get it on your hands, then touch your mouth or your eyes, you could become infected.
When are people infectious? The period of infectivity usually begins about a day prior to the onset of symptoms. So you're infectious even before you know you're sick, and it can last for 5-7 days into the illness. The incubation period is short – you will typically become ill within 1-2 days of exposure. When someone has a high fever, the illness is at its peak and they are in the most infectious stage. Children can be infective up to 2 weeks – so take precaution around your grandkids who can be little "flu factories."
Should I get a flu shot? A flu shot will help your body defend against influenza beginning about 2 weeks after it is administered. Most people, especially those over 65 years of age, should have a flu vaccination every year. (If you are currently ill, are allergic to eggs, have had an adverse reaction to flu vaccine in the past, or have Guillain-Barre Syndrome, talk to your doctor first.) Because the flu strains constantly change, the vaccine is formulated to combat the specific viruses anticipated each year. There are several variations on the vaccine, including a high dose (recommended for older adults), a regular dose, and a nasal spray.
Although you can go to a drugstore or pharmacy to get your flu shot, I believe it's best to visit your primary care physician's office. Your doctor knows your medical history, will be aware of any specific concerns, and can administer the vaccine that is best for you.
It is not possible to get the flu from a flu shot. A small percentage of people may experience some side effects, including discomfort at the injection site or mild headache or body aches. These usually subside within a couple of days.
While the vaccine adequately protects the majority of people from getting seasonal influenza, others still get sick for a variety of reasons. So it is possible that you may get the flu even if you have a shot.
What else can I do to prevent the flu? Be extra vigilant about taking common-sense steps to care for yourself during flu season. Besides getting a flu shot:
- Stay away from sick people as much as possible.
- Wash your hands regularly with soap and water (especially after being in public and before eating), for at least 15-20 seconds. The CDC actually recommends that you wash your hands as long as it takes to sing "Happy Birthday" – twice through! Use an alcohol-based antibacterial gel when you're not able to wash.
- Surfaces like door handles, shopping carts, keypads, pens, etc. in public places can be germy. Consider carrying antibacterial wipes with you.
- If you are prone to illness, you may want to use a surgical mask in high-risk settings like airplanes.
- Eat a balanced healthy diet, exercise, get plenty of sleep, and try to keep stress at a minimum.
How do you treat the flu? There is no cure for the flu, so treatment is symptomatic. Use acetaminophen (e.g. Tylenol) or ibuprofen (Advil, Motrin) to treat fever, headache and body aches, lozenges for sore throat, cough syrup for cough, etc. There are two antiviral drugs, Tamiflu and Relenza, which may shorten the duration of the flu (but won't necessarily prevent complications). They are recommended for the high risk groups, including people over 65 years. Your physician can write a prescription for these medications, and it's best to begin using them within 48 hours of becoming sick.
How do I take care of someone with the flu? Be mindful both of helping the ill person get better as well as keeping yourself and others in the household healthy.
- Get a flu shot and follow the other preventive measures listed above.
- Be sure the ill person covers their nose and mouth when coughing, sneezing, and even talking – not with a hand (because anything they subsequently touch can become infected), but with a tissue, handkerchief, or sleeve.
- A surgical mask will protect you from inhaling airborne virus.
- Wash your hands (see above), and have the sick person wash their hands, frequently.
- Regularly disinfect surfaces and objects such as countertops, doorknobs, keyboards, remote controls, children's toys, and faucets with antibacterial wipes or a spray such as Lysol. Sanitize the sick person's dishes and utensils in the dishwasher and launder their soiled linens and clothing in hot water and detergent.
- A sick person should not go to work or participate in other routine activities. They should get as much rest as possible and take it easy even after they start to feel better.
- Be sure the ill person stays hydrated and receives proper nutrition, even if they don't feel like eating.
- Initially, give clear beverages such as chipped ice, popsicles, clear broth, juices, and hot tea.
- Then, follow the BRAT diet – bland foods which are easy to digest: bananas, rice, applesauce, and toast.
- Once they start improving, return to a regular healthy diet as soon as possible to strengthen the immune system.
- Give a variety of healthy foods, especially protein and colorful fruits and vegetables.
- The legendary chicken soup legitimately has a mild healing anti-inflammatory effect.
- Use dairy products cautiously as they may increase mucous in some people.
- Avoid fast food and highly processed junk foods.
When should I go to the doctor? Most people who are generally healthy get through the flu on their own in a week or two. But, in some cases (especially older adults and those with underlying chronic conditions), the flu can cause dehydration, secondary infections like pneumonia, or complications in the heart or nervous system. Watch for the following indications of trouble and, if in doubt, do not hesitate to call your doctor.
- A fever is common with the flu. However, if you feel like you've been getting better for a few days, but then your fever returns, there might be a secondary infection.
- If you become dehydrated due to insufficient fluid intake, you might feel weak, exhausted, dizzy, lightheaded, or be unable to stand. It is possible you may need intravenous fluids.
- Shortness of breath, severe chest discomfort, or coughing up discolored phlegm could be caused by pneumonia.
- Weakness in the legs might indicate a complication of the nervous system.
The bottom line? As always, the best treatment is prevention. Take good care of yourself, wash your hands, get your flu shot, and call your physician with any questions or concerns.