December 2006—Winter months bring coughs, sore throats and sniffles. But what if your cold is actually a case of seasonal influenza? With the many health concerns we face in our global world, we sometimes overlook the significant threat posed by “common” illnesses like seasonal influenza. But between five and twenty percent of the U.S. population comes down with the flu each year, many becoming ill enough to land in the hospital.

“This is a serious illness with significant health consequences for many, especially young children and the elderly,” warns Dr. Miles J. Varn, PinnacleCare’s Chief Medical Officer. “It is important that each of us takes all possible steps to help prevent the flu.”

A cold or could it be the flu?
Because the root cause of both the flu and the common cold are respiratory viruses (though the viruses are different), it can be difficult to determine which condition you’re dealing with unless you undergo diagnostic laboratory culture tests within the first few days of illness.

Both present with similar symptoms—cough, tiredness, and body aches. In the flu, however, the symptoms are usually more severe and include fever and headache. The cough also tends to be dry rather than the result of mucus build-up in the lungs and sinuses. Children suffering from the flu can also experience ear infections, nausea and vomiting. People with a cold are more likely to have a stuffy or runny nose than those with the flu.

How the flu spreads
Influenza viruses spread through the droplets released when an infected person coughs and sneezes. Incubation can take between one and four days. Adults are usually infectious for a period that lasts from the day before symptoms flare up to five days after the onset of illness. Children are infectious longer, often more than ten days after onset. In addition, they can spread the virus for up to six days before symptoms appear. People who are severely immunocompromised (for example those with HIV/AIDS and other immunosuppressive diseases or those undergoing chemotherapy) can spread the flu for weeks or even months after the onset of symptoms. Symptoms of the flu usually last only a few days, but the cough and tiredness can hang on for more than two weeks.

Two strains of the influenza virus are responsible for the bulk of cases in humans—influenza A and B. There are numerous sub-types of each form and the viruses constantly mutate, producing new sub-types. The virus enters the body through the respiratory tract. Once there, it begins to replicate in cells in that system, causing inflammation. The virus continues to replicate until the cells essentially burst, releasing thousands of copies of the virus into the bloodstream causing the symptoms associated with the flu. The immune system then produces antibodies tailored to fight the virus that body has been infected with and recovery begins.

All are at risk, but the consequences can be more severe for some Influenza does not discriminate. Everyone is at risk for contracting the virus. In fact, even people who have been vaccinated can contract the flu if the attacking virus is a sub-type that was not included in the vaccine or if they are exposed before the vaccine has had time to stimulate the production of enough antibodies to fight the disease.

The flu presents a greater health danger to several groups. It can worsen the underlying medical conditions of people with chronic health problems including diabetes and other metabolic disease, asthma, pulmonary and cardiac disease, immunosuppressive diseases, kidney disease, and blood disorders including sickle cell disease. The exacerbation of the underlying condition can then lead to bacterial or viral pneumonia. Others considered to be at heightened risk from influenza include:

people over 65
those who live in nursing homes or other chronic care facilities
children from six months to 18 years old receiving long-term aspirin therapy because of the risk of developing Reye syndrome after a flu infection
pregnant women

Prevention is our best weapon
“Prevention is the way to go,” firmly believes Dr. Steven M. Gordon, Department Chair, Infectious Disease, Cleveland Clinic. “And vaccination against seasonal influenza is the best preventive strategy we have available. My message would be, ‘Stick out your arm, get your flu shot.’”

David Perlin, PhD, Scientific Director of the Public Health Research Institute whole-heartedly agrees. “There is no substitute for being vaccinated. This year there are more than 110 million doses of vaccine available, more than ever produced before. Though people traditionally seek their vaccines in October and November, since this has been a light flu season so far, you still have a great opportunity to get vaccinated and reap the protective benefits.”

New vaccine guidelines
The Centers for Disease Control and Prevention (CDC) have changed their recommendations on who should receive the flu vaccine this year. For the first time, they recommend vaccination of all children ages six to 59 months. Others who should be vaccinated include:

women who will be pregnant during flu season
everyone 50 and older
children and teens on aspirin therapy
adults and children with chronic health conditions
people with any condition that makes it difficult to breathe or swallow, for example brain and spinal cord injury, nerve and muscle diseases
those in nursing homes
healthy family members and caregivers in homes with children 5 and under or with a person with a chronic health issue
health care workers

A shot or a spray: vaccination choices
With the addition of a new vaccine called FluLaval, there are now five FDA-licensed vaccines available in the U.S. Vaccines administered by injection contain killed virus which stimulates the body to build immunity against the virus types in the vaccine. There is also a nasal spray vaccine produced under the brand name FluMist. This contains a low dose of attenuated or weakened virus which kick-starts an immune response.

All the vaccines contain three influenza viruses, two influenza A viruses and one B, which have been in circulation in a given year. After vaccination, it takes approximately two weeks for the body to build enough antibodies to protect against the flu.

Neither vaccine will cause you to come down with the flu, though in rare cases if you are vaccinated with FluMist you can transmit the virus to another person. The injectable vaccine is approved for use by people six months and older, while the nasal spray is only for use by those aged 5 to 49 who are in good health. FluMist is also not appropriate for pregnant women. Children under 9 who have never received the flu vaccine before require two doses to build an adequate level of antibodies.

Small side effects, significant health protection
Slight side effects are possible from both forms of the vaccine. The shot can cause redness and tenderness at the injection site, low grade fever, and body aches. The inhaled vaccine can cause runny nose and headache in adults and children. Children may also experience vomiting, muscle aches, and fever while additional side effects for adults include sore throat and cough. Most side effects are mild and subside after a day or two.

“People often forget that these side effects are a normal part of the vaccination process,” adds Dr. Perlin. “But they shouldn’t be deterred from getting vaccinated by these post-effect symptoms. The protection conferred by the vaccine far, far outweighs the discomfort these side effects can produce.”

In addition there is a very, very small risk of developing Guillain-Barre Syndrome, an autoimmune condition that causes muscle weakness and can result in paralysis. “The risks are so small and the benefits are so substantial that I think no one should be dissuaded from getting a flu shot based on (the findings of a recent study),” says Dr. David Juurlink of the Institute for Clinical Evaluative Sciences at the University of Toronto, one of the physicians who took part in that study. “I think basically it’s a no-brainer in almost every circumstance.”

Who should not be vaccinated
There are some people for whom vaccination is not appropriate. You should not seek the flu shot or spray if:

you’ve had an allergic reaction to the vaccine or are allergic to eggs (the medium in which the vaccine is grown)
have ever had Guillain-Barre syndrome or currently have a fever (wait until the fever passes before receiving your vaccine).

Because there is no approved vaccine for children under six months, Dr. William Schaffner, Professor and Chair of the Department of Preventive Medicine at Vanderbilt University School of Medicine recommends cocooning for families with infants. “They should provide a cocoon, or zone of protection, around that very vulnerable young child by vaccinating all the other people in the family, including grandma and granddad who come in for visits, and out-of-home caregivers.”

“In addition to vaccination, good hygiene can help prevent the spread of influenza and other diseases,” notes Dr. Gordon. That includes:

washing your hands often with soap and water or using alcohol-based hand sanitizer
avoiding touching your eyes, nose, and mouth
avoiding crowds during flu outbreaks and
covering your mouth and nose with a tissue when you sneeze or cough.

These precautions cut the risk of those who cannot be vaccinated and add protection for those who can and do get their flu vaccinations.

New prevention tools in development
Researchers around the world are working on new vaccines and novel ways to prevent influenza. In the vaccine arena, researchers are exploring the effectiveness of recombinant vaccine produced by genetic engineering. Scientists isolate one influenza protein, clone it, and grow more of the proteins which are then injected to provoke an immune response. Researchers are also examining the effect of adding adjuvants, substances to enhance effectiveness, to boost the potency of existing vaccines, as well as striving to develop a universal vaccine that would provide years of protection against all strains of influenza.

New technology is speeding up the process or diagnosing and identifying flu viruses, a tool that would be especially valuable in the event of an influenza pandemic. The FluChip, developed by scientists at the University of Colorado at Boulder and the CDC, can distinguish between 72 flu strains, including avian influenza, in less than 12 hours.

Scientists at Emory University School of Medicine and North Carolina State University College of Textiles are experimenting with a way to kill flu viruses and any other viruses and bacteria on surfaces to halt their spread. They’ve developed a special permanent nano-coating that kills or inactivates 99.9 percent of influenza viruses, including avian flu, when the coating is exposed to visible light. They are also exploring using the coating in air filters and anti-viral masks.

An Advocate can help you develop your own prevention strategy PinnacleCare Members can call on their personal Advocate to help develop a comprehensive strategy to protect their family from the flu and other infectious conditions. From ensuring all family members receive needed vaccinations to arranging appointments with top physicians if they fall ill, the Advocate is the key to safeguarding each Member’s health.

To learn more about your family’s own flu risk, email Dr. Denis Pauze, dpauze@PinnacleCare.com.