Influenza Update - General and Local Perspective
January 6, 2015
There is much to be said about the flu, and each passing year there seems to be new quirks to this commonly and underestimated virus. I wish to very briefly discuss our takes on the flu in broad terms and then add some local and personal perspectives on prevention and management of the more severe type A Influenza.
Influenza has an interesting life cycle and it’s ability to mutate innately and through animals. This year the changes are of the smaller variant and there is some cross immunity, but it does seem to be a severe substrain that has now evolved into an epidemic in many states, including Texas. Advances in supportive care over the decades and vaccine technology have simply been amazing in lowering the number of deaths. Still, Influenza accounts for 20,000-70,000 death annually in the United States, depending on the season.(ultimately due to pneumonia).
The dominant strain this year is H3N2, that causes classic and severe symptoms, and by the time mutations were known it was too late in the production of the vaccine to make changes. This doesn’t mean, however, that it’s not worth becoming vaccinated or that there is not some protection. And half the circulating flu is covered by the vaccine and those who are vaccinated seem to have milder cases. Getting the flu vaccine consistently on an annual basis is very helpful, especially the younger you begin. Our antibody response unfortunately decreases as we age so those who get the vaccination annually are more likely to respond. What if you think you might have already had the flu this year, should you still get vaccinated? Yes. It’s already January, should I get the flu vaccine? Yes.
Now for some more local and personal observations and opinions regarding the flu and it’s management. From the perspective of seeing otherwise healthy and younger people die or come close to it from Influenza, I find it tragic that it is still lightly regarded among too many in our numbers. We treat a fairly young and healthy population, so most people will survive the utter misery that is Influenza. We know already that children under five, the elderly, those who are immunosuppressed, have asthma and related conditions, pregnant, post-partum, the obese and many others among other subpopulations are already at higher risk. It seems each year we discover new subpopulations at risk, too late to be of help to those that succumbed.
I am not speaking from a public health perspective now and may receive some hate mail from those in that field, but my experiences and reading have made me more than a little leery of being overly selective in who to treat with medication and who to manage symptomatically only with the flu. I practice with an eye towards the individual as my ethics and personal bent demand of me. Our bodies react to the flu immunologically in varying degrees individually and depending on the strain, but in general it gears us up to the fight the virus, often at the expense of fighting bacteria our bodies clear on our own. At the peak of the virus some of those immune cells we depend on can become dangerously low and should we aspirate dangerous organisms such as MRSA that colonize many of our upper airway tracts, a rapidly fatal pneumonia can ensue in a very short period of time, frequently too late for medical help. Fortunately, the most common Influenza related bacterial complications are not that deadly, but it is impossible to know which otherwise young, healthy person will be the one to succumb. It is tragic when a healthy high school student or a young mother/wife dies of flu related pneumonia because it is preventable with universal vaccination and prompt, early and aggressive treatment with antivirals and the appropriate antibiotics.
I will end with a lighter but related note, the management of fever. When you have the flu you can expect to run high fevers, that is indeed natural. However, beyond feeling awful many of us become more easily dehydrated as we are not as disposed to drinking fluids as we should. I personally am not a fan of the alternating Tylenol and Ibuprofen when fevers are greater than 101 – 101.5. For one, the dosing regimen of every four hours for Tylenol and 6 hours for Motrin can be hard to keep up with and is not as effective. I find that for the initial 48 hours after diagnosis it is far easier to combine both medications, and studies have proven that it is both safe and effective. I recommend taking both on awakening, 6 hours later, then about bedtime. This leads to an easier dosing schedule which you are more likely to remember, faster and longer reduction in fever, less misery and dehydration. For children I recommend 15mg/kg on the Tylenol and 10mg/kg on the Ibuprofen, adults and adolescents greater than about 140 pounds, 1000 mg of Tylenol and 600-800mg of Motrin three times a day for two days maximum serves well.