Flu update 2010

Division of Internal Medicine and Adult Primary CareSeptember 20, 2010

Michael Wagner, MD FACPChief, Internal Medicine and Adult Primary Care

for educational purposes only

HISTORYNET.com

“Horse-drawn carts plied the streets with a call to bring out the dead in the city where bodies lay unburied for days. The afflicted died by the thousands, and survivors lived in fear. But this wasn't medieval Europe being stalked by the Black Death. This was Philadelphia, October 1918, and the city was under siege from a new variant of one of mankind's oldest specters: influenza.”

1918 Spanish Influenza Outbreak: The Enemy WithinBy Christine M. Kreiser

50-100 million deaths from 1918 flu epidemic

Goals of our talk

• Review 2009 flu season• What is the flu?• What does the flu virus do to our bodies?• What are the symptoms?• Why is it potentially so life threatening?• Flu vaccination• How can you prevent it (getting and giving)?• What are the treatments?• What are the warning signs to watch for?• Does it affect certain populations differently?

2009 flu season review

• Emergence of 2009 H1N1 influenza virus

• First viral pandemic in more than 40 years

• The 2009 H1N1 virus will probably be spread during the 2010-2011 flu season

• 12,000 flu related deaths• > 90% deaths occurred in

people < 65 years old

Deaths attributable to pneumonia and influenza

Impact according to age

What is the flu?

• Virus• Two major categories

– Influenza A– Influenza B

• Immune response determined by external covering– Hemagglutinin– Neuraminidase

What does the flu virus do to our bodies?

What are the symptoms?

• fever (usually high) • headache • extreme tiredness • cough • sore throat • runny or stuffy nose • muscle aches, and • nausea, vomiting, and

diarrhea, (much more common among children than adults)

from CDC

Why is it potentially so life threatening?

• Most people recover without any specific therapy within a few days to 2 weeks

• Some people will develop a secondary infection as a result of the flu– Pneumonia (pneumococcal and staph/MRSA)– Bronchitis– Sinus and ear infections

• People with certain chronic medical conditions may get worse with the flu

– Asthma– COPD– Congestive heart failure

• Certain populations are at higher risk to complications– Over 65 years old– Pregnant women– Young children

Flu vaccination

• Contains– Inactivated virus– Antigens from 2009 H1N1, H3N2, and Influenza B

• Recommendations– Everyone over the age of 6 months should be vaccinated– People over 65 years old may receive high dose preparation

(Fluzone High-Dose®) instead of regular flu shot– Children 6 months to 8 years old may need to receive two doses

• Effectiveness– When the vaccine is well matched for the actual viruses that

circulate the vaccine is 70-90% effective– Even if the circulating virus are not exactly as what is in the

vaccine, the vaccine can provide some protection if the virus are related

Influenza recommendations for children 2010-

2011 season

How can you prevent it (getting or giving)?

• Six simple steps to reduce the spread of the virus– Avoid close contact– Stay home when you are sick– Cover your mouth and nose– Clean your hands– Avoid touching your eyes, nose or mouth– Practice other good habits like: plenty of sleep, physical activity,

drink plenty of fluids, eat nutritious food and manage stress

• You may be infectious from 1 day before onset of symptoms to 3-5 days later

• Spread by small water droplets created when we cough, sneeze or talk.

What are the treatments for the flu once you have it?

• Antivirals– 2 drugs recommended for 2010-2011 flu season

• Tamiflu® (oseltamivir) – pill or liquid (age > 1 year)• Relenza® (zanamivir) – inhaled powder (age > 7yrs)

– Indications• Best if started within 2 days of symptom onset• Hospitalized• Risk factors for complications• Most people will not needed to be treated with antivirals

– Benefit• May decrease symptoms by 1-2 days

– Duration of treatment: 5 days– Side effects

• GI, dizziness, sinusitis• Confusion and abnormal behavior

Supportive care for the flu

• Stay home and rest• Avoid close contact with well people in your house• Drink plenty of fluids and other clear liquids in order to

stay hydrated• Treat fever and cough with medicines you can buy over

the counter– Fever: acetaminophen or ibuprofen– Cough: Consult pharmacist, humidifier, cough drops

• If you get very sick or are pregnant or have a medical conditions that puts you at higher risk, call your doctor.

Warning signs – reasons to call your healthcare provider

Children• Fast breathing or trouble

breathing • Bluish skin color • Not drinking enough fluids • Not waking up or not interacting • Being so irritable that the child

does not want to be held • Flu-like symptoms improve

but then return with fever and worse cough

• Fever with a rash

Adults• Difficulty breathing or shortness

of breath • Pain or pressure in the chest or

abdomen • Sudden dizziness • Confusion • Severe or persistent vomiting • Flu–like symptoms that

improve but then return with fever and worse cough

Are their certain groups that are more at risk?

• Elderly > 65 years old• Pregnant women• Children younger than 2 years old (2-4 year olds also at

higher risk compared to older children)• People with certain chronic medical conditions

– Asthma/COPD– Heart failure– Diabetes– HIV

• People younger than 19 years old taking chronic aspirin therapy

Summary

• Flu vaccination– Indicated for all people 6 months and older

• If you are sick with the flu– Minimize contact with others and keep hydrated– Seek medical advice:

• If you have one of the risk factors listed previously, or• Fever and cough return after initially getting better

• Practice – Good hand washing– Covering mouth and nose when cough and sneezing

Death, taxes and the flu…

Additional resources

• The American Experience on PBS – The 1918 flu outbreak– http://www.pbs.org/wgbh/amex/influenza/

• Historynet.com– http://www.historynet.com/1918-spanish-influenza-outbreak-the-

enemy-within.htm

• CDC– http://www.cdc.gov/flu