A Knight in Dragonland

Dr. Tosi, whose practice is so busy that I use it as a local epidemiological barometer, told me yesterday that he had his first positive Influenza A case of the season in the office. Usually we’ve started to see more cases by now. Hopefully this means we’re going to have a milder flu season this year, but it may just mean that the peak will hit later. With kids back in school sharing their germs and the cold dry air we’re having now, conditions are just right for influenza transmission. You can check out the official influenza activity watch at the CDC influenza site.

According to the current guidelines, all children between 6 months and 5 years and all those who care for children in that age range (or younger) should receive the influenza vaccine. Adults over 50 should also get vaccinated, and anyone between 5 & 50 with a chronic medical condition such as asthma, heart disease, renal failure, diabetes or neurological conditions should also be vaccinated. Healthcare workers and their families should be vaccinated as well.

Let me clear up a common misconception … influenza does not usually involve vomiting and diarrhea (gastroenteritis). While such illnesses are commonly called “the stomach flu”, they are not caused by influenza. Influenza is a respiratory illness presenting with nasal congestion and dry cough, although often the dominant and debilitating features are high fevers, headaches and muscle pain. Flu has the nasty tendency to cause prolonged high fevers … usually 3 to 5 days, but sometimes up to a week, often with temps of 103+.

There are treatment options available … if you get to your doctor within 48 hours of symptom presentation, and if you have insurance. Illinois Medicaid won’t cover Tamiflu (oseltamivir) or Relenza (zanamivir), the only treatments recommended by the CDC.

According to my Epocrates Rx, a course of Tamiflu costs $84.99 and a course of Relenza costs $63.99. Amantadine is covered on the public aid formulary, but the CDC does not recommend the use of amantadine or its cousin rimantadine since resistance rates to these antivirals are so high as to make the drugs nearly useless. The adamantane derivatives are also ineffective against Influenza B, while Tamiflu and Relenza have activity against A & B.

None of the available antiviral therapies are spectacular. At best, they might reduce symptom severity somewhat and shorten the course of the illness by a day or two. Their best use may be for chemoprophylaxis … using the drug in a “healthy” contact who is exposed to the flue. This use may prevent a high risk individual from acquiring the flu if they are exposed to a sick family member.

If your child is otherwise healthy, often the best (and only) solution to the flu is some TLC, lots of fluids and ibuprofen (NO ASPIRIN!!!) every 6 to 8 hours. Be on the lookout for the development of secondary bacterial infections, however. If your child seems to be getting better and then takes a turn for the worse, you should definitely seek medical attention. Ear infections are a common secondary infection associated with influenza in children, and bacterial pneumonias are frequently the cause of influenza-related deaths.

Influenza is estimated to kill an average of 36,000 Americans every year. These deaths are mostly among the elderly, but a few hundred children die each year as well. Many deaths could be prevented if a comprehensive vaccination strategy were instituted. Such a strategy would also reduce the loss of work days and productivity, increase winter school attendance rates, reduce hospitalizations & medical office visits and reduce the use of antibiotics (which are often prescribed to flu sufferers out of misrecognition or to treat secondary bacterial infections).

Get your flu shots while they’re still available!