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The Flu Epidemic 2012-13
by John I. Yam, M.D.    ::   Thursday, February 07, 2013

What's the difference between the common cold and the influenza?

  • Both are caused by viruses.
  • Colds are caused by cold viruses, & there are more than 200 cold viruses.
  • Influenza is caused by influenza viruses. For the purpose of discussion “fluâ€? here refers to the influenza virus.

When is the typical flu season?
The typical flu season is from (early November to end of March), but this can vary.

Why is the flu likely to be worse this year than the last 2 years?

  • Influenza started October 1,2012, one month earlier than usual this flu season, which means it has more time to spread. So far it’s wide-spread in 44 States.

What are the symptoms of the flu?
Flu symptoms are the same as the common cold, such as fever, headache, stuffy nose, sore throat, and cough, fatigue, muscle aches, etc., except symptoms generally are more severe. Most people recover in several days, but symptoms may last for 3-4 weeks.

Is the Flu dangerous?

  • The CDC estimates that about 200,000 are hospitalized & up to 49,000 people die from the flu in this country every year. In the 2009 swine flu (H1N1) pandemic, more than half a million people died in the world.
  • As of 2-1-13, in the US, there are 648 deaths & 26,000 hospitalized related to the flu. There are 28 reported deaths from the flu in WA State.
  • Older individuals & those with chronic medical conditions (such as asthma, diabetes, or heart disease), pregnant women and young children are at higher risk of developing even more serious complications.

How does the flu virus spread?

  • Flu virus is highly contagious. Cold & flu transmission is mainly through hand touching rather than respiratory route.
  • Interesting report putting “coldâ€? patients in room with healthy people. Hand washing rates after using bathroom among men and women (35-65%). Frequency of touching face (3 times)/hour.
  • Cold and flu viruses can last for hours on objects such as toilet handles, water faucets, door knobs.
  • Virus shedding occurs 24 hours before onset of symptoms, peaks during first 3 days of illness, and usually stops after 7 days.
  • After contact with the virus, flu symptoms occur after 1-4 days (av 2 days) (incubation period).

How is the diagnosis of flu made?

  • Diagnosis is usually made in a doctor’s office by a rapid diagnostic test that takes about 10 minutes. The problem is that the sensitivity of the tests varies (45-90%). Therefore treat as flu if suspect flu, esp in high risk patients.
  • Other tests such as fluorescent antibody staining, virus culture & serologic diagnosis is not useful in the office setting.

Which kinds of viruses are there in this years flu vaccine?

  • Every year academic physicians around the world gather together flu information and decide which flu virus is likely to cause problems and incorporate these viruses into the flu vaccines.
  • The current (2012-2013) flu vaccine contains 3 strains:

    1. A/California/7/2009(H1N1)
    2. A/Victoria/361/2011 (H3N2)
    3. B/Wisconsin/1/2010

Who should get the flu vaccine? Are there people at higher risk than others of getting complications from the flu?
Everybody over age 6 months should get vaccinated, especially those at higher risks:

  • Highest priority is pregnant women. Changes in immune system, heart & lungs during pregnancy increase risk of Cx. Flu during pregnancy also increases the risk of miscarriage and prematurity. Protective flu antibodies passes from mom to baby.
  • Children 6 months to age 5 years.
  • People age 50 & over.
  • People with chronic health problems, such as diabetes, asthma, kidney or liver problems, etc.
  • Health care personnel.
  • Children on chronic aspirin therapy at risk of Reye’s syndrome.
  • American Indians and Alaska Natives.
  • Household contacts of people at high risk (above).

Who should not be getting the flu vaccine?

  • Vaccine are produced in eggs. Therefore those with severe egg allergy should not get the flu vaccine.
  • Should avoid vaccination when having a cold or while on drugs that suppress the immune system.
  • Infants under age 6 months.
  • Pregnant women should not get the live virus vaccine.
  • Pregnancy is NOT a contraindication to the flu vaccine, although some physicians do not give the vaccine during the first trimester.

How many kinds of flu vaccine are there this year?

  • Trivalent inactivated vaccine (TIV). For 6 months old and older. With or without mercury (thimerosal)

    (High dose TIV, containing 4 times as much antigen, for 65 and over).
    (Intradermal TIV. For 18 to 64 years of age)

  • Live attenuated intranasal influenza vaccine (LAIV). For healthy people 2-49 years who are not pregnant.

How effective are the flu vaccines?

  • Immunity to the flu develops approx. 2 weeks after immunization.
  • Inactivated virus vaccines generally are (70-80%) effective for healthy individuals. Less in children under age 24 months & older individuals.
  • Live attenuated vaccine has (86-96%) efficacy.
  • Immunity is lower in those who is sick when the flu shot was given.
  • Children 8 years & under have lower immune response to flu vaccine, so they should get 2 doses one month apart, unless they had been previously vaccinated.
  • Duration of protection – one year. Therefore only one dose is needed per flu season.

Do I need to worry about mercury in the flu vaccine for my baby?
WA State law prohibits the use of thimerosal or mercury-containing vaccines under 36 months of age and in pregnant women, although there’s no evidence it cause any harm.

What should I do if I have the flu?

  • Get lots of rest, drink plenty of fluids, control fever and aches with acetaminophen or ibuprofen. Many OTC medications may be helpful to reduce symptoms, but if you have hypertension or other chronic illnesses you should check with your doctor before taking these medications.
  • See your doctor if your symptoms are more than mild or if you are a high-risk individual.
  • Specific flu medications – tamiflu, Relenza (for 7 yo and over). These shorten the duration of illness when used within 48 hours of onset of symptoms. These should be used for those with severe symptoms or at high risk of complications.
  • Treatment of complications. Antibiotics, etc.
  • Alternative treatments. There are insufficient scientific evidences that these work, including zinc, vitamin C, Echinacea, garlic, etc. There is some evidence that honey may be helpful in relieving cough ( but do not give under age one year).

What can be done to prevent the flu?

  • If you get sick with flu-like illness, you should avoid spreading the virus:

    1. stay home for at least 24 hours after your fever is gpe.
    2. Practice proper cough and sneeze etiquette to prevent the spread of germs.
    3. Wash your hands regularly.
    4. Avoid touching your eyes, nose or mouth
  • Adequate rest, balanced diet, and regular exercises help improve your immune system.
  • Flu vaccines.
  • Clean your hands before & after eating, after using the restroom. The simple act of hand washing is the single most important means of preventing the spread of virus infections ( sec). Alcohol-based cleaning gels are almost as effective as washing with soap and water.
  • Avoid rubbing your nose, eyes and mouth, since viruses can easily enter through these places.
  • Avoid exposure to people with colds or who are sick. Avoid crowds of people during flu outbreaks, especially if you’re older, or have babies and small children in your family.
  • Masks may be helpful, & is very popular in China during the cold season, although the CDC indicates that no studies have definitively shown that mask use by either infected patients or health-care personnel prevents influenza transmission. N-95 masks not necessarily better than regular surgical masks.
  • Tamiflu can also be used for prevention of the flu after exposure. For high risk individuals.
  • There are no definite scientific evidence that the following are helpful in preventing the flu – Airborne, vitamin C, Echinacea, zinc.

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