What you must know about influenza

While it’s the novel H1N1 influenza virus, also known as swine flu, that has been getting the bulk of the attention from policymakers, health officials and the media, it’s important not to lose sight of the importance of protecting yourself and your family from seasonal influenza, especially if members of your family are living with chronic health conditions like asthma, diabetes, heart or kidney disease or immune system problems.

“Taking preventive measures including receiving a flu shot and practicing good hygiene are simple steps we can all take to help prevent the spread of the flu,” says PinnacleCare’s Chief Medical Officer Dr. Miles J. Varn. “These steps are proven measures for reducing the risk of seasonal flu and health officials also recommend many of these easy, common sense practices as potentials tool for slowing the spread of the novel H1N1 influenza which experts predict may become more prevalent in the fall.”

Flu basics

Seasonal influenza, which most commonly occurs during the fall and winter in the U.S., is an infectious disease caused by a range of influenza viruses. Each year, according to the Centers for Disease Control and Prevention (CDC), between 5 and 20 percent of the U.S. population is infected with an influenza virus and 200,000 people end up in the hospital due to complications of the flu.

Viruses are categorized into three strains—influenza A, influenza B and influenza C. Type C usually only causes a mild respiratory infection, while types A and B are responsible for more severe forms of the disease. While type C has historically been a fairly stable or unchanged virus, types A and B change frequently and new strains develop. That means although you may have had the flu last year, you could still contract a new strain this year which is why physicians recommend an annual flu shot rather than a one-time inoculation like you receive for diseases like chicken pox.

The symptoms of influenza can include:

• High fever
• Headache
• Muscle aches and pains
• Dry cough
• Nasal congestion
• Fatigue
• Chills
• Sore throat
• Diarrhea and vomiting (more common in children than adults)

What makes diagnosing the flu more difficult is that many other common infections share some of these symptoms. A definitive diagnosis of influenza can be made through lab tests performed during the first two to three days of the illness.

Are you at greater risk from the flu?

For most people, influenza does not present a significant health threat. For some people, however, there can be serious complications caused by the flu such as bacterial pneumonia and encephalitis (infection and inflammation of the brain) and the worsening of chronic health conditions. These complications can result in hospitalization or, for about 36,000 Americans each year, death.

People at an increased risk for complications from seasonal influenza include children under age 2, people over age 50, people who live in nursing homes or other long term care facilities, pregnant women, people with weakened or suppressed immune systems and those with chronic heart, lung, kidney, liver, blood or metabolic diseases such as diabetes. Some evidence also suggests that children on long term aspirin therapy may also be at increased risk for complications.

Prevention is the foundation of your flu-fighting strategy

The most basic form of prevention is to get vaccinated against seasonal influenza. In fact, studies cited by the World Health Organization found that for healthy adults, vaccination can prevent 70 to 90 percent of influenza-specific illness. For the elderly, vaccination reduces the severity of illness and the occurrence of complications by up to 60 percent and deaths by 80 percent. There are some groups of people for whom vaccination is not appropriate, so consult your physician about your specific health situation before you make a decision about getting vaccinated.

In addition to getting an annual flu vaccine, there are a range of steps you can take to guard yourself from the disease. Frequent, thorough hand washing with soap and water is the frontline defense. Alcohol-based hand sanitizers are also effective for killing the virus on hands. It may seem obvious, but many people do not take adequate time washing their hands. To ensure you’re washing your hands long enough, experts say the process should last about 15 seconds or as long as it takes to sing “Happy Birthday” or a chorus of “Row, Row, Row Your Boat.”

Other essential prevention tips include:

• not coughing or sneezing into your hands but rather into a tissue which you immediately throw away
• not touching your eyes, nose or mouth which are the common entry points for the virus
• limiting contact with others who are sick
• staying home from work, school and other public places if you become ill (you can be contagious a day before symptoms appear and for three to seven days after you become sick)
• practicing immune-boosting healthy habits including good nutrition, regular exercise, drinking enough fluids and getting adequate sleep

Some people at higher risk for complications may also be prescribed anti-viral medication proactively to protect against the flu. Anti-viral medications do not cure you, but may limit the severity and duration of your illness.

For most people, treatment for the flu includes bed rest, lots of fluids, and symptom relief with over-the-counter medications to reduce fever, decongest nasal passages and control coughs when appropriate. In some cases, your physician may prescribe an anti-viral medication, but to be effective, you must start taking these drugs within two days of the appearance of your first symptoms.

Preparing for the novel H1N1 virus

At the start of the summer, the World Health Organization (WHO) declared the new flu strain, novel H1N1 or swine flu, to be a global pandemic. That declaration was based on the widespread nature of the disease not its severity. To date, approximately 140 countries have reported cases of this strain of influenza and, according to WHO statistics dated August 6, 2009, the H1N1 virus has caused 1,462 deaths worldwide. As a comparison, the CDC estimates that approximately 36,000 people die annually from complications of the “seasonal flu”.

All of the prevention tips listed for seasonal flu can also help lessen the risk of this new strain, although the vaccine for seasonal flu does not protect against novel H1N1. Vaccine trials are currently in progress and health officials in the U.S. expect the new vaccine to be available sometime this fall. As with seasonal flu, people with this virus may be contagious from a day before falling ill to five to seven days after symptoms appear.

As vaccine production ramps up, the CDC announced that vaccination priority should be given to pregnant women, people who live with or care for children under 6 months old, healthcare and emergency medical services personnel, people between the ages of 6 months and 24 years old (because unlike seasonal flu, novel H1N1 seems to cause more serious illness in young people), and people ages 25 through 64 who are at higher risk because of chronic health disorders or compromised immune systems.

Illness with the novel H1N1 flu has ranged from mild to severe. While most people have recovered without medical treatment, there have been hospitalizations and deaths caused by the disease. Most of those who died had health problems, including diabetes, heart disease, asthma, kidney disease, suppressed immune system, neurocognitive and neuromuscular disease, and pregnancy, that placed them at higher risk.

One difference between this virus and seasonal flu is that, to date, people over the age of 64 do not appear to be at increased risk, perhaps due to the fact that many of them have antibodies to the virus. People younger than 25, however, have been more seriously affected by the H1N1 strain. In general, however, people believed to be at higher risk from this virus are the same as those at increased risk from seasonal flu.

Treatment for the novel H1N1 flu may involve the anti-viral drugs oseltamivir or zanamivir, though health officials have stated those recommendations may change as more data on the effectiveness of these drugs on the virus is gathered. Physicians have been advised to use careful clinical judgment when prescribing these medications for people who are not at increased risk from the flu because the benefits of the drugs may be modest for most people. People at higher risk and groups most likely to be exposed to the virus such as health care workers, may be given these drugs preventatively.

One other thought to bear in mind is that many countries have begun screening travelers for the novel H1N1 virus. If the screening staff believes you may have been exposed to the virus or you have flu-like symptoms, you may be isolated and required to undergo a rapid flu test and medical exam. If you test positive for the virus, you may be hospitalized and/or quarantined. The best advice is not to travel if you are sick with any flu-like symptoms.

To learn more about the steps you should take to protect yourself against this new strain of influenza as well as seasonal flu, you can talk with your PinnacleCare health advisor.

Additionally, PinnacleCare is pleased to inform you that we will be hosting a webinar with MAB member and infectious disease specialist, Dr. David S. Perlin, Director of The Public Health Research Institute Center at the International Center for Public Health in Newark, New Jersey, on Tuesday, October 13th. An invitation will be sent via email separately.

“As with many contagious diseases, the best prevention is often the simplest,” reminds Dr. Varn. “Practice good hygiene and, when appropriate, employ social distancing techniques such as not shaking hands and avoiding crowds to limit your potential exposure to the flu. If you develop influenza, you should remain at home until you have not had fever for 24 hrs.”