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The ABCs of cold and flu season

Karen Miller and Howard Manly

People often confuse the flu with the common cold. That’s a mistake.

“They’re completely different viruses,” said Dr. Richard D. Zane, professor and chair of the Department of Emergency Medicine at the University of Colorado School of Medicine, formerly the vice chair of the Department of Emergency Medicine at Brigham and Women’s Hospital. “The symptoms can be similar, but those of the flu are more severe. The fever can be higher and of longer duration. Exhaustion, fatigue, and aches and pains are more pronounced with the flu.”

Influenza, more commonly referred to as the flu, is a contagious virus that attacks the respiratory system — nose, throat, bronchial tubes and lungs. Anyone is susceptible, but some people are at higher risk of developing serious complications. Small children, the elderly, those with weakened immune systems or certain chronic medical conditions can be hit hard by pneumonia and other infections.

These complications can be deadly.

Although flu-related deaths vary from year to year, according to the Centers for Disease Control and Prevention (CDC), as many as 48,000 succumbed during the 2003-2004 flu season. That’s more than the estimated number of deaths every year from breast cancer.

“It’s not an entity to be taken mildly,” said Dr. Nancy Norman, Medical Director of Integration at Massachusetts Behavioral Health Partnership, formerly the chief medical officer of the Boston Public Health Commission. “Some people have the attitude — I’m young, I’m healthy — and don’t pay attention to it. Yet some of these very people died of complications.”

There are three types of influenza virus — the As, Bs and Cs. Influenzas A and C can infect animals as well as humans, while Influenza B circulates among humans only. Type A is more serious and the cause of deadly worldwide pandemics, including H1N1.

But the flu virus is forever changing. It mutates, establishing a slight variation of its previous form.

It is this variation that causes problems when developing vaccinations against the disease. Seasonal flu vaccine typically contains two strains of A and one of B virus, but scientists can only estimate which types and subsets will circulate each year.

“It’s hard to be 100 percent correct,” said Zane. “But that’s not a reason to not get a vaccine. Even if wrong, the symptoms are much less severe.”

The CDC estimates the effectiveness at closer to 60 to 90 percent. Regardless, the vaccination helps reduce the risk and severity of the illness should it strike.

When asked if flu shots are necessary, Zane quickly responded, “Unequivocally yes. It protects you and prevents the virus from spreading.”

Flu viruses spread easily — usually through a sneeze or cough of an infected person. When a person with the flu sneezes, they are in effect launching the virus into the air — and into the vicinity of anyone around them.

Sometimes a person can become infected by touching something that harbors the flu virus — like a keyboard or doorknob — and then putting their hand to their face, allowing easy entry of the virus through their nose, mouth or eyes. Fortunately, the virus cannot live for extended lengths of times on non-living surfaces; they require a host, such as a person or animal, in order to survive.

It is not always necessary to seek medical care when you get the flu. Most often, you can treat yourself at home. Drink lots of fluids, get plenty of rest and use over-the-counter pain relievers, such as ibuprofen (active ingredient of Advil) and acetaminophen (active ingredient of Tylenol), to reduce body aches. With rest, fluids and anti-fever medications, most people are fine.

But some symptoms warrant medical treatment. “Not being able to keep food down is one of them,” said Zane. Very high fevers, shortness of breath or chest pain are other symptoms. Headaches, especially in the presence of neck pains, should also be evaluated.

In some cases, the doctor may recommend an antiviral medication. These drugs treat influenza A and B and can shorten the illness by one or two days and reduce the severity of symptoms. Antivirals are frequently recommended for high-risk people. There is one hitch — you have to start the regimen within 48 hours of the onset of symptoms.

The best approach is to prevent the seasonal flu’s onslaught. First, get an annual flu shot. They are available now at doctors’ offices, clinics and many local pharmacies. The best time to get a shot is when the vaccine is first available — usually in September. But if you miss September, you’re not too late. You can still get the shot even beyond January.

A reason to get vaccinated sooner rather than later is to give the body enough time to make antibodies against the seasonal flu. This process is not immediate; it usually takes a couple of weeks. If you wait too long, it is possible to become infected before the body has had enough time to arm itself.

Doctors recommend that everyone be vaccinated. However, some groups are particularly targeted — young children, pregnant women, those 65 and older, those with chronic conditions like diabetes and heart disease, and people who live with or care for sick people. Health professionals are inoculated every year for the safety of their patients.

An additional approach is to get the virus before it gets you. That’s when personal hygiene comes into play. Fortunately, heat and various chemicals, such as alcohol, iodine, hydrogen peroxide and chlorine, can destroy influenza viruses. Detergents and soaps work wonders.

Washing your hands is one of the most effective ways to avoid the flu infection. And a quick dip under water does not do the trick. You need to lather up with soap and wash for at least 20 seconds. Rinse well, dry off your hands thoroughly and turn off the faucet with a paper towel.

Washing your hands once or twice a day does not suffice. Wash often — before and after handling food, after using the toilet, after sneezing or coughing — following any activity that fosters the growth of germs.

Being away from a sink is no longer an excuse for not washing your hands. Hand gels that contain at least 60 percent alcohol are now readily available and can be used in the absence of soap and water.

Get rest, avoid crowds and exercise. Exercise does not prevent infection, but it boosts your immune system so you can ward off severe symptoms.

If you become a statistic, do your part to prevent spreading the flu. Cover your mouth with a tissue when you sneeze or cough and throw the tissue away. Cough into your elbow if a tissue is not available. If you cough into your hand without the use of a tissue, wash your hands. Surfaces you touch after an unprotected sneeze — including another person — can become contaminated.

If you’re already infected, you are a public health hazard. Stay home and concentrate on getting well instead of sharing your illness. The CDC recommends staying away until your fever is gone for 24 hours without the benefit of fever-reducing medications. Keep in mind that the infectious period for the flu ranges from a day before symptoms surface to about four or five days after they occur.

“Do what your parents told you to do,” said Norman. “Cover your mouth when you cough. Use a tissue and throw it away. Wash your hands and not only when you’re in the shower.”  

This article has been updated. It was first published in October 2009.