The 2017-2018 influenza season is off to a roaring start. According to the CDC’s most recent Weekly U.S. Influenza Surveillance Report, every state in the U.S. except Hawaii is reporting widespread flu activity. (For comparison to last year at this time, click here.) Hospitalization rates are high, as are visits to primary care medical offices. Every flu season brings severe illness and premature death to young and old, rich and poor, sick and healthy, and this year is no exception; already, 2o pediatric deaths have been blamed on influenza infections and complications.
The H3N2 influenza strain appears to be the most prevalent one circulating in North America right now. This strain is typically more virulent and more severe than the other strains that also circulate during flu season, and finding a perfect vaccine for it has been difficult. Right now, it is estimated that this year’s flu vaccine is approximately 10-30% effective for preventing influenza H3N2, although, importantly, it appears to be significantly more effective in preventing the other three influenza strains that are known to circulate each winter. (The modern quadrivalent influenza vaccine protects against four strains — two “A” and two “B” — that are predicted to show up and cause serious morbidity and mortality.) Susan Abram explains why the H3N2 strain — unique in that it contains avian (bird), swine (pig), and human flu virus DNA — is so hard to immunize against:
In general, influenza viruses are always mutating, but the H3N2 virus is especially cunning, some scientists say. It’s not an alien shape shifter, but some scientists say it mutates so quickly so that vaccine makers can’t quite catch up to it.
Here are a dozen pointers to weather the “flu storm” this (and every) year:
1. Get a flu vaccine! It is not too late to receive this proven health- and life-saver. Even though we’d all like to see more effective vaccines against influenza (particularly against H3N2), the fact is that even getting a sub-par flu vaccine will likely prevent you from experiencing the most severe impacts of influenza and its complications if you do come down with the flu.
2. If you do get the flu, you are going to feel very sick for more than just a couple of days. Fever, chills, headache, nasal congestion and cough, sore throat, joint and body aches, decreased appetite, fatigue and lethargy. Typical flu symptoms in unvaccinated people last a long time, too — usually 5-7 days before abating. Therefore, see point #1.
3. Antibiotics do not treat flu symptoms. Do not take them unless prescribed by your doctor for a specific bacterial complication like an ear infection or pneumonia.
4. Antiviral medicines like Tamiflu are expensive, have significant side effect profiles (two 2009 studies showed half of children taking Tamiflu experience side effects including headaches, insomnia, nightmares, nausea, and stomach aches), and are only effective (shortens the course by a day or so) if started in the first 48 hours of flu symptoms. Unless a patient is at high risk for developing complications, it is unlikely antiviral medications will be offered as a treatment option. (Another reason to get a flu vaccine every year.)
5. If you need help with treating the symptoms of influenza, call your doctor’s office for advice. At Pediatric Alliance, every office has staff well-trained in giving comforting, practical, evidence-based advice, including when to come see the pediatrician in the office or when to travel to the emergency department for medical attention.
6. Unless your doctor or pediatrician recommends a trip to the emergency department — or unless you are especially worried about your or your child’s breathing, hydration, or degree of symptoms — the emergency department (or urgicare facility) is generally not the place you want to go. Emergency rooms are typically crowded with people suffering all sorts of maladies; making it a more infectious atmosphere for patients and staff by going to the ED when it isn’t necessary puts everyone at greater risk. Instead, call your doctor or pediatrician first.
7. If a parent believes their child is sick enough to be seen by the pediatrician, then parents should speak these words to the telephone triage staff: “I want my child to be seen in the office today.” Because of the volume of calls doctors’ offices get regarding the flu this time of year, a parent may need to say this more than once.
8. DRINK LOTS OF FLUIDS, warm and cold. Drinking at least 1 cup (8 ounces) of fluid every hour is a reasonable goal for children and adults. Mix it up and make it fun — water, 100% juice, tea, hot chocolate, soup, milk shakes, popsicles, and smoothies.
9. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) at appropriate doses and intervals should help some symptoms. Over-the-counter cold and cough medicines will probably not help and shouldn’t be used unless a doctor or provider specifically recommends it. Cold and cough medicines are almost never advised for children due to their ineffectiveness and potential for nasty side effects. NEVER GIVE A CHILD ANY MEDICINE CONTAINING ASPIRIN (ACETYLSALICYLIC ACID) TO TREAT INFLUENZA.
10. STOCK UP NOW on supplies of food, drinks, and medicine now, because…
11. If you are feeling sick with flu symptoms, DON’T GO OUT IN PUBLIC! Stay home from work. Keep your kids home from school if they have a fever or significant nasal congestion or coughing. Chances are that you work with someone (or your child goes to school with a classmate) that has an underlying health condition putting them at high risk for complications from influenza. (The point of flu vaccine, by the way, is to not only protect you from getting dreadfully ill, but also to protect other vulnerable family members, friends, neighbors, and perfect strangers like me from getting sick or dying from the flu.)
12. WASH YOUR HANDS WITH SOAP AND WATER! Antibacterial gels and foams are not as effective as simple old-fashioned hand washing.
Be careful out there!
(Image: Centers for Disease Control and Prevention)