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More About the Flu

What Are The Causes of the Flu?

The flu (influenza) viruses. Influenza viruses are divided into three types, designated A, B, and C. Influenza types A and B are responsible for epidemics of respiratory illness that occur almost every winter and are often associated with increased rates of hospitalization and death. Influenza type C differs from types A and B in some important ways. Type C infection usually causes either a very mild respiratory illness or no symptoms at all; it does not cause epidemics and does not have the severe public health impact of influenza types A and B. Efforts to control the impact of influenza are aimed at types A and B, and the remainder of this discussion will be devoted only to these two types.

Influenza viruses continually change over time, usually by mutation (change in the viral RNA). This constant changing often enables the virus to evade the immune system of the host (humans, birds, and other animals) so that the host is susceptible to changing influenza virus infections throughout life. This process works as follows: a host infected with influenza virus develops antibody against that virus; as the virus changes, the “first” antibody no longer recognizes the “newer” virus and reinfection can occur. The first antibody may in some instances provide partial protection against reinfection with an influenza virus.

Type A viruses are divided into types based on differences in two viral surface proteins called the hemagglutinin (H) and the neuraminidase (N). There are 16 known H subtypes and nine known N subtypes. These surface proteins can occur in many combinations. When spread by droplets or direct contact, the virus, if not killed by the host’s immune system, replicates in the respiratory tract and damages host cells.

Is There Any Treatment For The Flu?

Yes. Flu vaccine. Much of the illness and death caused by influenza can be prevented by annual influenza vaccination. Flu vaccine (influenza vaccine made from inactivated and sometimes attenuated [non-infective] virus) is specifically recommended for those who are at high risk for developing serious complications as a result of influenza infection. These high-risk groups include all people aged 65 years or older and people of any age with chronic diseases of the heart, lung or kidneys, diabetes, immunosuppression, or severe forms of anemia.

Other groups for whom vaccine is specifically recommended are residents of nursing homes and other chronic-care facilities housing patients of any age with chronic medical conditions and children and teenagers who are receiving long-term aspirin therapy and who may therefore be at risk for developing Reye syndrome after an influenza virus infection. Influenza vaccine is also recommended for people who are in close or frequent contact with anyone in the high-risk groups defined above. These people include health-care personnel and volunteers who work with high-risk patients and people who live in a household with a high-risk person.

Because the flu is easily spread among children and because many children require hospitalization with the flu, the U.S. Centers for Disease Control and Prevention (CDC) now advises that all children ages 6 to 59 months receive a yearly flu vaccination.

Although annual influenza vaccination has long been recommended for people in the high-risk groups, many still do not receive the vaccine. Some people are not vaccinated because of misperceptions about influenza and the vaccine. They mistakenly perceive influenza as merely a nuisance and believe that the vaccine causes unpleasant side effects or that it may even cause the flu. The truth is that influenza vaccine causes no side effects in most people. The most serious side effect that can occur after influenza vaccination is an allergic reaction in people who have severe allergy to eggs, since the viruses used in the vaccine are grown in hens’ eggs. For this reason, people who have an allergy to eggs should not receive the influenza vaccine. Also, the vaccine is not recommended while individuals have active infections or active diseases of the nervous system.

Less than one-third of those who receive the vaccine have some soreness at the vaccination site, and about 5% to 10% experience mild side effects, such as headache or low-grade fever, for about a day after vaccination. These side effects are most likely to occur in children who have not been exposed to influenza virus in the past.

Nevertheless, some older people remember earlier influenza vaccines that did, in fact, produce more unpleasant side effects. Vaccines produced from the 1940s to the mid-1960s were not as highly purified as modern influenza vaccines, and it was these impurities that caused most of the side effects. Since the side effects associated with these early vaccines, such as fever, headache, muscle aches and fatigue, were similar to some of the symptoms of influenza, people believed that the vaccine had caused them to get the flu. However, influenza vaccine produced in the United States has never been capable of causing influenza. One type of influenza vaccine made with live attenuated influenza viruses has been developed, but this vaccine is made with viruses that can confer immunity but do not cause classic influenza symptoms.

Some people do not receive influenza vaccine because they believe it is not very effective. There are several different reasons for this belief. People who have received influenza vaccine may subsequently have an illness that is mistaken for influenza, and they believe that the vaccine failed to protect them. In other cases, people who have received the vaccine may indeed have an influenza infection. Overall vaccine effectiveness varies from year to year, depending upon the degree of similarity between the influenza virus strains included in the vaccine and the strain or strains that circulate during the influenza season. Because the vaccine strains must be chosen nine to 10 months before the influenza season, and because influenza viruses mutate over time, sometimes mutations occur in the circulating virus strains between the time the vaccine strains are chosen and the next influenza season ends. These mutations sometimes reduce the ability of the vaccine-induced antibody to inhibit the newly mutated virus, thereby reducing vaccine efficacy.

Vaccine efficacy also varies from one person to another. Studies of healthy young adults have shown influenza vaccine to be 70% to 90% effective in preventing illness. In the elderly and those with certain chronic medical conditions such as HIV, the vaccine is often less effective in preventing illness. Studies show the vaccine reduces hospitalization by about 70% and death by about 85% among the elderly who are not in nursing homes. Among nursing-home residents, vaccine can reduce the risk of hospitalization by about 50%, the risk of pneumonia by about 60%, and the risk of death by 75% to 80%. If antigenic drift results in changing the circulating virus from the strains used in the vaccine, vaccine efficacy may be reduced. However, the vaccine is still likely to lessen the severity of the illness and to prevent complications and death.

When Should You Receive The Flu Vaccine?

In the United States, the flu season usually occurs from about November until April. Typically, activity is very low until December, and peak activity most often occurs between January and March. The flu vaccine should be administered between September and mid November. It takes about one to two weeks after vaccination for antibody against influenza to develop and provide protection. Groups at increased risk of influenza complications include:

  • people aged 65 years or older;
  • residents of nursing homes and other chronic-care facilities housing patients of any age who have chronic medical conditions;
  • adults and children with chronic disorders of the pulmonary, cardiovascular, or immune systems, including children with asthma;
  • adults and children who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunosuppression (including immunosuppression caused by medications);
  • children and teenagers (6 months to 18 years) who are receiving long-term aspirin therapy and therefore may be at risk for developing Reye syndrome after influenza; and
  • women in the third trimester of pregnancy or in the early postpartum period. There is some evidence to suggest that women who are in the third trimester of pregnancy or in the early postpartum period may be at increased risk for serious medical complications after influenza infection. Pregnant women who will be in the third trimester of pregnancy between December and April should consult their health-care provider about receiving influenza vaccine during the period from September to mid November.

In addition, the following groups should be vaccinated because if they become infected, they may transmit influenza to people who are at high risk for complications:

  • Physicians, nurses, and other health-care personnel in both hospital and outpatient-care settings
  • Employees in nursing homes and chronic-care facilities who have contact with patients or residents
  • Providers of home care to people at high risk—for example, visiting nurses and volunteer workers
  • Household members (including children) of high-risk people
  • Furthermore, the CDC advises that all children ages 6 to 59 months get a yearly vaccination since each year there are over 20,000 children that require hospitalization because of the flu and flu is easily passed from child to child.

Finally, the flu vaccine may be administered to any person who wishes to reduce his or her chances of acquiring influenza infection. People who provide essential community services should be considered for vaccination to minimize disruption of essential activities during influenza outbreaks. Students or other people in institutional settings, such as those who reside in dormitories, should be encouraged to receive the vaccine to minimize the disruption of routine activities during epidemics. People needing further information regarding the use and availability of the influenza vaccine should consult with their health-care provider or their local health department.

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