Monday, January 26, 2009

Prevent the Flu!

Flu and pneumonia together constitute the sixth-leading cause of deaths in the United States. As the cold and flu season is in full swing, we once again turn our attention to a review of the virology, epidemiology, clinical manifestations, treatment and prevention of influenza. Technically, influenza is caused by viruses that belong to the Orthomyxoviridae family.

The viruses are further classified according to the differing composition of their nuclear proteins into three types:

Type A--can cause potentially severe illness leading to widespread epidemics and pandemics. The rapidly changing virus affects such animals as pigs, horses, seals and whales.

Type B--symptoms are usually less severe than for Type A. This strain only affects humans but can cause widespread epidemics leading to hospitalization and, in some cases, death.

Type C--usually causes mild or asymptomatic illness with minimal impact on public health.

Within a few days of exposure symptoms are usually manifested as respiratory illness characterized by drainage, cough and sore throat. These respiratory symptoms are frequently accompanied by an abrupt onset of such other constitutional changes as fever lasting one to five days, headache, malaise, chills, myalgias and sore throat.

At present, health care professionals are focusing on a possible outbreak of one or more of three major types of influenza epidemic: seasonal flu, pandemic flu and avian flu.

While all are due to a specific medium-size virus, these potential outbreaks differ considerably in their severity and heath care implications.

Each year about 5% to 20% of people in the United States will get seasonal flu symptoms, with the highest percentage of these found among young children.

Vaccines must be reformulated each year to combat the various strains. The CDC determines vaccination priorities and at-risk groups.

The best way to prevent getting the flu is by getting your flu shot (or Flu Mist) each year. Practicing good hygiene, washing your hands with antibacterial soap, covering your coughs and sneezes with the inside of your elbow or a tissue instead of your hand, and staying home from school or work if you think you might be sick are always great measures to take to further prevent the spread of flu.

It is still not too late to get your flu shot for the 2009 flu season; Visit Passport Health.

Thank you to Peter Rubino, Director of Continuing Professional Education at, for the information for this blog.

Monday, January 19, 2009

Major Flu Strain Found Resistant to Leading Drug

Virtually all the dominant strain of flu in the United States this season is resistant to the leading antiviral drug Tamiflu, and scientists and health officials are trying to figure out why.

The problem is not yet a public health crisis because this has been a below-average flu season so far, and because the Tamiflu-resistant strain, one of three circulating, is still susceptible to other drugs. But infectious disease specialists are worried nonetheless.

Last winter, about 11 percent of the throat swabs from patients with the most common type of flu that were sent to the Centers for Disease Control and Prevention for genetic typing showed a Tamiflu-resistant strain. This season, 99 percent do.

“It’s quite shocking,” said Dr. Kent A. Sepkowitz, director of infection control at Memorial Sloan-Kettering Cancer Center in New York. “We’ve never lost an antimicrobial this fast. It blew me away.”

The single mutation that creates Tamiflu resistance appears to be spontaneous, and not a reaction to overuse of the drug. It may have occurred in Asia, and it was widespread in Europe last year. In response, the disease control agency issued new guidelines two weeks ago. They urged doctors to test suspected flu cases as quickly as possible to see if they are influenza A or influenza B, and if they are A, whether they are H1 or H3 viruses.

The only Tamiflu-resistant strain is an H1N1. Its resistance mutation could fade out, an agency scientist said, or a different flu strain could overtake H1N1 in importance, but right now it causes almost all flu cases in the country, except in a few mountain states, where H3N2 is prevalent.

Complicating the problem, antiviral drugs work only if taken within the first 48 hours of infection. A patient with severe flu could be given the wrong drug and die of pneumonia before test results come in. So the new guidelines suggest that doctors check with their state health departments to see which strains are most common locally and treat for them.

“We’re a fancy hospital, and we can’t even do the A versus B test in a timely fashion,” Dr. Sepkowitz said. “I have no idea what a doctor in an unfancy office without that lab backup can do.”

If a Tamiflu-resistant strain is suspected, the disease control agency suggests using a similar drug, Relenza. But Relenza is harder to take; it is a powder that must be inhaled and can cause lung spasms, and it is not recommended for children under 7.

“And we strongly suggest that people get a flu shot,” Dr. Fine said. “There’s plenty of time and plenty of vaccine.”

Exactly how the Tamiflu-resistant strain emerged is a mystery, several experts said.

The flu typically kills about 36,000 Americans a year, the C.D.C. estimates, most of them the elderly or the very young, or people with problems like asthma or heart disease; pneumonia is usually the fatal complication.

Monday, January 12, 2009

Flu Hits Sacramento


An 8-year-old tested positive for flu Wednesday at UC Davis Medical Group in Sacramento – the clinic's first confirmed pediatric case this season.

It was also a signal that flu season is under way.

Health workers say the best advice is to get vaccinated.

The Northern California Partnership for Influenza Prevention was launched in 2004 as a public and private effort to get more people – including children – vaccinated against flu.

Sacramento County Public Health Officer Dr. Glennah Trochet said Wednesday the partnership will convene next week to assess the effort, but early indications show a slight drop in deaths and pneumonia cases.

Lending their expertise for a Q&A about flu season were Dr. Gilbert Chavez of the state Department of Public Health's Center for Infectious Diseases; Trochet; Joann Peters, practice manager of UC Davis Medical Group; and Tom Nelson, a pharmacist at Pucci's Leader Pharmacy in midtown Sacramento.

How do I know I have influenza?
Flu is a respiratory disease, characterized by fever, body aches, runny nose, sore throat, and in children, sometimes diarrhea and vomiting. The same symptoms could be other viral illnesses, such as a cold, but the flu could hang on for up to two weeks.

How is flu season shaping up?
At least some local emergency rooms and clinics are reporting normal or light flu traffic, and statewide, flu outbreaks remain sporadic. But the peak is weeks away.

Should I still get a flu shot?
Absolutely. Flu season can linger through Easter. Afraid of shots? There's a nasal spray that is commonly administered to children, but anyone can get it. You can locate your nearest Passport Health Location here.

Why should children get flu shots?
A fairly new recommendation, vaccinating children keeps them from spreading it around to those who are more vulnerable.

How does the weather affect me, or does it?
The weather doesn't cause viral illnesses. Viruses do. The co-worker hacking away at the desk next to you is more of a threat than a snowstorm. During colder weather, and particularly at large holiday gatherings, people share close quarters, which could mean we are more contagious.

What's the best I can do?
Older people, infants and those with compromised health conditions, such as diabetes, face the greatest risk and should seek medical care and could be prescribed antivirals such as Tamiflu treatment. But for others, don't expect your doctor to give you antibiotics, which aren't effective, or antivirals, which aren't practical for healthier sufferers. Instead, rely on over-the-counter remedies for symptoms. As pharmacist Nelson says, "You can take everything in a pharmacy and get over it in a week, or take nothing and get over it in seven days."

Here are some tips for riding out flu season:

• Cut back on alcohol and smoking, and get plenty of bed rest.

• Stay home and away from others.

• When you sneeze or cough, cover your mouth with a tissue or the inside of your elbow rather than your hand.

• For fever accompanying flu, those 21 or younger should take an alternative to aspirin. Aspirin combined with fever has been linked to Reye's syndrome in children and teens.

• Drink plenty of water, especially young children, who can easily dehydrate.

Thank you to M.S. Enkoji of the Sacramento Bee for this great information.