Flu Inoculation Schedule

What, Exactly, is the Flu?
     The Flu is an infection of the respiratory tract caused by the influenza virus.  There are three types of this virus, labeled types A, B and C.  The yearly spread of the influenza virus typically occurs during the winter months and may be associated with flu epidemics.  During these epidemics, up to 40% of the people living in a given community may develop a case of the flu during the time span of a few weeks.
     Flu Symptoms are often more severe than cold symptoms.  In addition, people with lung disease or weakened immunity, and the elderly are prone to severe and possibly fatal complications from the flu. 
     The proteins that coat the flu virus change constantly.  As a result, our immune systems do not recognize-and therefore cannot protect us from-new strains.  These new strains circulate around the world every few years, causing frequent, widespread epidemics.  This shifting nature of the virus, plus the danger of life-threatening complications from the infection, combine to make the flu a major public health threat.

How Does One Catch the Flu?
     Unlike colds, which are most likely spread by direct contact, the influenza virus is mainly spread by airborne transmission.  When a person who has the flu sneezes, coughs, or even speaks, they fill the air with microscopic droplets that are literally filled with flu particles.  These droplets are so small that they remain suspended in the airways, it invades the cells in its new host and starts reproducing itself rapidly.

Symptoms
     A mild case of the flu may seem very much like a common cold.  More often, the flu is associated with the sudden onset of headache, fever, chills, muscle aches, malaise (an overall lousy feeling), cough and sore throat.  These symptoms typically begin in such an abrupt fashion that people can recall the exact time that they got sick.  In the majority of cases, people with the flu recover fully within one week.  However, many people, particularly the elderly, develop persistent weakness after a case of the flu.  This weakness can last for many weeks.

Prevention
     Since the late 1940s, the flu vaccine has been the best way to prevent influenza or lessen its severity.  Because the virus undergoes constant change, new vaccines are developed yearly to protect the public from the most recently isolated viral strains.
     Like most vaccines, the flu vaccine is given as an injection, or shot.  For maximal protection for the duration of the flu season, the best time to receive the vaccine is from early October to mid-November.  However, the vaccine can be given to children and adults at any point during the flu season, even after the influenza virus has begun to spread in the community.

The following groups should receive the flu vaccine:

Groups at Increased Risk for Influenza-Related Complications
1) Persons 65 years of age and older.  People in this age group should also receive the pneumococcal vaccine, which helps protect them against the most common type of bacterial pneumonia.  These two vaccines can be given at the same time without increasing the risk of vaccine side effects.  Unlike the flu vaccine, the pneumococcal vaccine should only be given once in a lifetime.
2) Residents of nursing homes and other chronic-care facilities.
3) Adults and children with chronic heart of lung disease, including asthma.
4) Adults and children who have required regular medical care or hospitalization during the preceding year because of a chronic illness.
5) Children and teenagers, age 6 months to 18 years, who are receiving long-term aspirin therapy.  These individuals would be at risk for the serious disease known as Reye syndrome if they developed the flu while taking aspirin.
6) Pregnant women who will be in their second or third trimester of pregnancy during the influenza season.

Groups That May Transmit Influenza to High-Risk Persons
-Physicians, nurses and other healthcare workers.
-Employees of nursing homes and chronic-care facilities who have contact with the residents.
-Visiting nurses and volunteers who provide home care to people at high risk.
-Children and others living with people at high risk.

Other Groups
-Persons infected with HIV.
-Students and soldiers.  People living in institutional settings, such as schools and colleges may be considered for vaccination to minimize their risk of getting ill during an outbreak.
-General population.  Anyone who wishes to reduce his or her chances of acquiring influenza infection is eligible for the vaccine.

Who Should Not Be Vaccinated?
     People allergic to eggs.  The viral material used in flu vaccines is grown in eggs.  As a result, anyone with a history of egg allergy (manifesting as hives, skin swelling and blanching, allergic asthma or anaphylaxis, a life-threatening even involving a sudden drop in blood pressure and difficulty breathing) should either not receive a flu vaccine or should undergo desensitization under a physician's guidance before receiving the vaccine.  People with an acute illness with fever should not be vaccinated until they recover. 

Side Effects and Adverse Reactions to Flu Shots
     The vaccine is made from inactivated virus. Therefore, no one can catch the flu from a flu shot.
     Some people - less than one out of three - will develop soreness around the injection site for one to two days.  Fever, malaise and muscle aches occur infrequently.
     These side effects are more common in people who have never had the flu and never received the vaccine. They tend to develop six to twelve hours after the injection and can last for one to two days.
     Immediate reactions, such as hives, welts, wheezing and difficulty breathing, and even anaphylaxis may occur because a person is allergic to the vaccine. Fortunately, such reactions are rare.

On the Horizon
     A nasal spray vaccine is currently being developed for use in both adults and children and may become available for use within the next few years.
Treatment
     The influenza vaccine can help prevent or decrease the severity of many cases of flu caused by influenza types A and B. Two anti-viral medications, amantadine (e.g., SYMMETREL®) and rimantadine (e.g., FLUMADINE®), can also help prevent the disease or speed the recovery process (for influenza type A only).

General treatment guidelines are as follows:
     Prevention, with vaccination or medication, is the most important measure.  The preferred medication to relieve the aches and fever associated with flu is acetaminophen (e.g., TYLENOL®). Acetaminophen is less likely to irritate the stomach than aspirin and other non-steroid anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Motrin® IB or Advil®).
     For multiple symptoms such as congestion, cough and nasal discharge, several agents in combination may be used.
     When treatment is started within the first 48 hours of developing the flu caused by influenza type A, both amantadine and rimantadine can help people recover from the illness more quickly. This may permit a more rapid return to normal activities. Treatment started later than 48 hours after the onset of the illness is less likely to be effective.
     Blocked nasal passages, nasal discharge and post-nasal drip are best treated with a combination of a decongestant and an antihistamine. There are many over-the-counter flu remedies that contain both of these ingredients.
     The newer, non-sedating antihistamines do not appear to be as effective in relieving flu symptoms as the older medications in this class. While these older antihistamines, such as diphenhydramine (e.g.,Benadryl®) and chlorpheniramine (e.g., Chlor-Trimeton®) tend to cause drowsiness, they are more likely to relieve nasal congestion and cough.
     Bed rest and increased fluid intake is advisable for at least the first four days or more, if the fever persists.
     Return to full activity should be delayed until after the symptoms are gone, especially if the illness is severe.

Follow dosage instructions on all product labels.

Complications
     The most serious complication of influenza is pneumonia-an infection of the lungs. The influenza virus can cause pneumonia itself, or by bacteria that are able to enter the lungs because natural defenses have been weakened by the flu. Anyone with persistent symptoms beyond three or four days merits medical attention. In addition, marked difficulty breathing or chest pain associated with coughing at any point during the illness should prompt a visit to the doctor.
     Reye syndrome is a severe illness that can follow use of aspirin-containing products for viral infections. It tends to affect children, and has been associated with influenza A and chicken pox. Reye syndrome affects the liver and the brain, and is fatal in roughly 10% of cases. A child's risk for developing this disease is markedly lowered by avoiding aspirin use whenever they have a viral infection.

The Flu in Children
     School-aged children and adolescents develop flu symptoms that are similar to those experienced by adults. In general, children do tend to have higher temperatures than adults, in the range of 103 to 105f. In preschool children and infants, influenza causes an illness that is difficult to distinguish from other respiratory viral infections. Influenza can be prevented in both normal children and in those with chronic diseases by immunization each fall.
     In infants, any episode of fever should prompt a call to the doctor. In older children, a physician should be consulted whenever flu or cold symptoms persist for more than a few days. In general, if you have any question about your child's health, consult a physician.
     In some cases, physicians will recommend treatment with anti-viral medication (amantadine or rimantadine). In all cases, the goal is to make the child as comfortable as possible with the use of medications to lower fever and relieve pain.
     Acetaminophen (e.g., Children's TYLENOL®) is preferred. Pediatric ibuprofen (e.g., Children's Motrin® or Children's Advil®) is a suitable alternative for these symptoms.
     Aspirin should not be used in children below 18 years of age because it may play a role in causing Reye syndrome.
     Nasal decongestants and antihistamines may be used briefly to relieve nasal symptoms. Use of these medications should be discussed with your child's physician.
     Unless a child has a complication of the flu, such as pneumonia or an ear infection, antibiotics will not be helpful.

Flu Myths
     The "stomach flu." This is a misleading term. Influenza can cause stomach distress in roughly one out of three patients. However, this is rarely the main symptom of the flu. In children, other viruses are the most common causes of nausea, vomiting, and diarrhea. In adults, viruses, bacteria and food poisoning (ingesting toxins produced by bacteria in contaminated food) are the usual causes of these symptoms.
     Catching the flu from a flu shot. This cannot happen. While influenza vaccines can cause some side effects, such as fever and soreness at the injection site, one cannot develop an infection from the influenza virus as a result of being vaccinated. 
     Environmental exposure and the flu. Flu epidemics occur during the winter months (in the United States) because that is when the virus is spread across the country. It has nothing to do with being outside in cold weather. However, the risk of pneumonia is increased by cold exposure. So it's a good idea to bundle up.

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