How to survive this flu season: Q&A with the experts

Plain Dealer staff By Plain Dealer staff The Plain Dealer
on January 11, 2013 at 5:00 PM
FLU_SEASON_OHIO.JPG View full size Ohio's flu-associated hospitalizations continue to climb at much higher rates than they did during the last two flu seasons.  

Is it too late to get a flu shot?

No. Get one today. This flu season has arrived early and hit hard in Northeast Ohio and around the country.

The Ohio Health Department has confirmed one flu-related child death in the state in the current influenza season. There have also been reports of adult deaths linked to the flu, but Ohio doesn’t tally adult deaths because there are often underlying health conditions involved.

This week, Plain Dealer reporter Brie Zeltner brought two experts together on to answer questions about the flu. Here are excerpts from the session with Dr. Frank Esper, a pediatric infectious disease specialist at University Hospitals Rainbow Babies & Children's Hospital, and Dr. Melissa Osborn, an infectious disease expert at MetroHealth Medical Center.

Q: If you get a flu shot, can you still get the flu this year?

Osborn: This year's flu shot is a pretty good match to the strains circulating, so the protection is pretty good, about 90 percent. It's easy to confuse the common cold with flu symptoms, so it's a good idea to go to your doctor if you're concerned about symptoms you may get. Your doctor can do a test for flu to see if that's the case.

Q: Why can't you get a flu shot when you're sick?

Esper: If you have a mild cough/cold, then it’s still OK to receive vaccinations. And yes, even receiving the flu vaccine after you truly had the flu is still beneficial. The reason: The flu vaccine prevents three strains of influenza. If you get the flu from one strain, a vaccine will protect you from the other two strains

Q: Should you get a flu shot if you are pregnant?

Esper: We encourage all pregnant women to receive an influenza vaccine because they (the moms) are at risk for very severe disease. It also helps the child because any antibodies mom makes when she is vaccinated is given to the baby while mom is carrying him/her. Newborns cannot receive influenza vaccines until they are six months of age, so they are dependent on everyone around them being vaccinated to prevent spread of this virus.

Q: How do you feel about the flu shot while pregnant and the risk of autism for the fetus? Should pregnant women ask for the mercury-free shot?

Esper: Autism scares a lot of families. This has been looked at many times in many studies; there is no link between vaccines (influenza) and autism. There are many formulations of influenza vaccine, each with different compounds (mercury, etc). You can ask what your physician has on hand.

Osborn: Pregnant women should definitely get the flu shot to protect them and their newborn. I agree with Dr. Esper's comments about autism and the vaccine formulations.

Q: I am concerned about the flu vaccine, especially for my 3-year-old. Does it inhibit natural immunity?

Esper: No, the influenza vaccine does not inhibit any natural immunity against influenza or any other germ. The vaccine is basically trying to replace “getting the real thing” by stimulating the immune system into making protective antibodies without the child getting sick.

Q: Is it true people who get the flu shot also have fewer upper respiratory infections?

Osborn: The flu shot only protects against influenza. Unfortunately, you'll still be susceptible to all the other respiratory viruses out there. On average, school-age children get six to eight upper-respiratory infections per year, more if they're in day care. If you're a parent to someone in this age group, chances are you'll get them.

Q: I had a flu shot. Over the last few days I have had some mild discomfort and muscle aches, but not actual sickness. Is this typical?

Esper: Mild muscle aches are likely your body’s response to the vaccine. Mild muscle pain is commonly associated with the flu shot -- most often at the area of vaccination but it can occur elsewhere on the body. It’s just your body taking in all the vaccine and preparing the immune system to prevent the real disease. It is very mild and goes away usually within 24 hours.

Osborn: I'm not sure how long ago your flu shot was. If you got it just before you started having the aches, it's possible that you had been exposed to the flu and were already about to get it at the time of the shot. It takes about two weeks for a person to develop full immunity to influenza after getting the flu shot. If you got your flu shot a few months ago and are now feeling achy, there are several possibilities. If it continues or if you start to develop a fever, seek the advice of your primary care doctor.

Q: Are there indicators that differentiate the flu from other illnesses and are evidence that you need to get to a doctor, especially if you are old or young?

Osborn: The most common symptoms that separate the flu from the common cold are muscle aches and fatigue, and higher fevers. Both colds and the flu have runny nose, sore throat and a cough. It can be hard to know when to go to the doctor and when to just stick it out at home. Things that should definitely prompt a visit to a health care provider are shortness of breath, trouble breathing or chest pain. If you're unsure, call your doctor's office and explain the symptoms, and they can recommend a course of action or other things to watch out for.

Q: I recently had walking pneumonia. Would having this help me be more immune to other flu viruses?

Esper: Depends. “Walking pneumonia” is a vague term. Sometimes it’s one of these viruses; sometimes it’s a bacterium (Mycoplasma). Every time you have an infection your immune system is better prepared for the next encounter. However, if you become sick with Germ A ... it likely will not protect you from Germ B. This is why people can get confused with terms like “walking pneumonia” or a “flu-like illness.” So many germs cause the same problem.

Q: How long does the flu take to run its course?

Osborn: Usually the flu gets better within a week.

Q: How common is it for the flu to morph into pneumonia? What are the warning signs?

Esper: When influenza (or any virus) stays in the nose/throat we call it a cold. When the virus drops down into the lungs, we call it a pneumonia. Influenza however is notorious for causing really bad super-infections. Influenza causes a pneumonia. Your body responds to this infection and a second germ (a bacteria like staph or strep) then sneak in and cause a very severe (sometimes life-threatening) pneumonia. When you look at all the deaths attributed to influenza; many did not die from influenza itself but the second “super-infection.”

Osborn: Pneumonia from the flu is most likely to happen in patients who have some other underlying disease, such as asthma, COPD (emphysema), diabetes, or in the very old or very young. Influenza itself can cause pneumonia, or someone can get bacterial pneumonia on top of influenza. Both can be very serious. In both types, warning signs would be worsening cough (sometimes after initial improvement), shortness of breath or difficulty breathing, chest pain, and mucus production. Fevers and chills can be worse as well.

Q: What would be your top recommendations for care at home that will speed recovery?

Esper: From a pediatrician's standpoint, encouraging drinking fluids is the best thing, especially with young children. Don’t worry as much about eating solid foods, as they are not going to grow during their illness. Fluids keep them from getting dehydrated, which is a real problem.

Also in my experience, treat the fevers and the child looks a lot better. They are much more likely to vomit if they have a fever (and thus may get dehydrated as above). When they fever breaks they feel and look better.

Osborn: There's not much that will speed the recovery from the flu. Some people who are at high risk for complications can take a prescription antiviral medicine that will reduce duration. Your doctor can determine if that's right for you. For those who aren't at high risk, drinking plenty of fluids, and using over-the-counter flu remedies can help alleviate some of the symptoms. Within three to four you should start to feel better and begin to resume normal activity.

What can be done to prevent the flu?

Q: How effective is eating greens regularly in warding off the flu?

Osborn: A good diet is important for overall good health. Greens contain a lot of antioxidants and vitamins. There is nothing specific that will ward off the flu, but I would recommend making them (greens) a part of a well-balanced nutrition plan.

Esper: Agree with above. It is well known that good nutrition helps prevent all severe infections, not just influenza.

Q: I noticed the disinfectant wipes I have only mention type-A virus. The news indicates a type B going around. What measures (apart from hand washing, etc.) will take care of type B?

Osborn: The disinfectant wipes, as well as hand sanitizers, will work against type B as well. Washing your hands (or using hand sanitizer) is the best protection against getting the flu. One strain of type B is also included in the flu shot this year.

Q: Can someone please explain vitamin D's important role in activating your immune defenses against infectious diseases like the flu?

Osborn: There's a whole body of literature out there on vitamin D now and its role in various disease states. I think the jury is still out on how it contributes to various states of health and illness. Because virtually everybody has low vitamin D levels, it's been hard to establish cause and effect. Research is ongoing.

Q: How do public health officials actually measure cases?

Osborn: There are a number of ways that the public health officials measure how bad the flu season is. . . . ER visits and hospitalizations only pick up the bad cases. But they also look at how many kids are absent from school, and how much over-the-counter flu medicine is being bought at the local drug store. While these things don't measure actual numbers of cases, it gives an idea about whether things are getting better or worse. Some agencies also measure activity by the number of times people google “influenza.”

Esper: The state and federal cases are collected every week by calling the hospitals (not all but a representative sample) and asking for their flu numbers. They then extrapolate what’s going on in the region. Now we miss a lot because we don’t catch a lot of people who “tough it out.” We are most interested in the severe cases (the ones who present to the hospital or are admitted).