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Why to get a flu shot sooner than later

Bryn Mawr Hospital January 6, 2017 General Wellness By Frederick Kotalik, MD

Question: It used to be we had the “24-hour flu,” which came and went in a day or so. Now if we get the flu it seems to hang on and on. Aside from getting the vaccine and keeping our immune systems strong, what else should we know about the flu this season?

Well first let’s talk about what everyone called the “24-hour flu.” That probably was not influenza but likely one of a series of viruses that can cause you to be achy and feverish.

Influenza on the other hand is a somewhat specific disease syndrome accompanied by classic flu symptoms, including fever, bad headache, cough, achiness, and general malaise that lasts more than one day (frequently four to five days). However, not everyone afflicted with influenza gets symptoms. This can make the diagnosis challenging. In the emergency department, we frequently will take a swab in the patient’s nose and send it for an influenza test which takes 30 to 60 minutes. The people we test are generally higher risk, however, such as older patients with symptoms such as fever and achiness.

While there are common cold viruses that may cause similar symptoms, influenza is caused by a virus with many different strains. This is why flu vaccinations must change from year to year as new strains of flu viruses show up. The Centers for Disease Control (CDC) studies flu strains every year to determine how the virus has changed from the previous year. Vaccines are then modified to address the change. Usually, the vaccines are fairly effective, but not always. The effectiveness against particular strains is not determined until flu season starts.

Some years we see more cases than others and we also see variability in the severity of symptoms, particularly among elderly people, who may come to the ER with symptoms such as wheezing and dehydration, or a condition known as hypoxia (when not enough oxygen reaches the tissues). Other years are lighter, which may be attributed to more people getting vaccinated and a less severe strain of virus thus causing less severe flu symptoms.

If you have significant symptoms and are diagnosed within the first 48 hours of getting the flu, your primary care doctor or ED may recommend an antiviral medication, such as Tamiflu. Antivirals are prescribed less in healthy people, however, and while they can help reduce length of illness (typically only by a day), there can be significant side effects, such as headache, stomachache and vomiting. Because of these known side effects, we generally reserve antivirals for people who are sicker with the disease, potentially even requiring hospitalization.

That being said, everyone is vulnerable to influenza, regardless of how healthy you are. In the United States, we still see 36,000 deaths per year from it. And while certain populations such as babies and the elderly are particularly susceptible, anyone with a compromised immune system or chronic health problems, such as from diabetes, heart or lung disease, asthma or emphysema is generally more at risk or may experience more severe, and possibly life-threatening symptoms of the flu.

My advice is simple: Get the flu shot, the sooner the better. There is such low risk and rare occurrence of serious side effects associated with the shot compared to the risk of severe illness from the flu itself. Also, it’s never too late in the season to get the shot although the peak time for flu is January and the first two weeks of February. By March it’s pretty much gone.

The CDC recommends an annual flu vaccination for all persons aged six months and older, including pregnant women, who do not have contraindications, such as a life-threatening allergy to flu shot ingredients.

Fun fact: As much as our mothers and grandmothers warned us to bundle up in cold weather, there is no scientific evidence of any correlation between staying warm and getting sick. Catching cold or flu is all a function of a person’s own immune system and transmission of germs, not the temperature outside.