Feature Article: Flu Happens. Then What?

Last influenza season was one of the most severe in recent history — with 172 pediatric deaths. Approximately 80 percent of those deaths occurred in children who did not receive a flu vaccine. While the influenza vaccine is not perfect, it’s important to remember that someone who received a flu vaccine and still gets the flu is likely to have a shorter or less severe illness compared with an unvaccinated person.

Unfortunately, because of low vaccination rates and the imperfect influenza vaccine, vaccinated people might still get the flu. So, what should you know if influenza enters your house?

What to consider at home

Most people with the flu, particularly those who got an influenza vaccination, will have a mild illness and not require medical care or antiviral drugs. If you think you have the flu:

• Get plenty of rest.
• Drink plenty of fluids.
• Return to work or school only after being fever-free for at least 24 hours.
• Stay home — Not only does this help with rest, but it also aids in decreasing the spread of influenza.

However, some people are at greater risk for complications and hospitalization when infected with influenza, including:

• Children younger than 5 years old — especially those younger than 2 years old.
• Adults older than 65 years of age.
• Children or adults with underlying or chronic conditions of the heart, lungs, endocrine system, kidneys, liver or metabolic system. The CDC offers a comprehensive list of high-risk factors for influenza.
• Children with household members who have compromised immune systems, such as family members receiving chemotherapy for cancer.
• Pregnant women.

Those at increased risk should seek medical attention if they suspect infection with influenza. Early medical attention may provide an opportunity for treatment with antiviral medications or other specific advice depending on the individual’s situation.

Even though you may be caring for someone with influenza at home, it is important to know and recognize the emergency warning signs of influenza illness regardless of risk factors or vaccine status.

Infants

• Being unable to eat
• Trouble breathing
• No tears when crying (a sign of dehydration)
• Significantly fewer wet diapers than normal (another sign of dehydration)

Children

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that they don’t want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash

Adults

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms that improve but then return with fever and worse cough

What is available if you seek medical care

If you seek medical attention for influenza infection, a first step is usually confirming the influenza infection. This is done with a “rapid flu test,” which detects genetic material of the virus from a nasal swab within 15 minutes.

The test helps healthcare providers determine whether to administer antiviral treatments, such as Tamiflu^®, Relenza^® or Rapivab^®. Infants as young as 14 days and pregnant women can take Tamiflu or its generic version. A newer antiviral medication called Xofluza^®, approved by the Food and Drug Administration in late October, offers a single-dose option for people 12 years of age and older with flu symptoms for less than 48 hours. Generally, antivirals are most effective when taken within 48 hours of beginning symptoms. If administered properly, antivirals have the potential to:

• Shorten the duration of influenza infection
• Lessen the symptoms
• Prevent those at high risk from developing serious, life-threatening complications

Flu in the future

The search for a universal influenza vaccine is ongoing. Because the virus mutates during and between seasons, it has been difficult to create a vaccine that is effective for several years.

One recent study in mice has shown promise, although it is too early to tell if it will work in people. Surprisingly, the study began with llamas. Researchers used the genes that coded for four different antibodies from llamas to create a combination antibody that was effective against at least 60 types of influenza, including both A and B types. Creating antibodies that are effective against different types of influenza has not been achieved previously. The vaccine candidate was administered as a nasal spray.

Other universal influenza vaccine approaches include:

• Using epitopes, which are short stretches of viral protein that are common to multiple influenza strains to generate antibody responses.
• A live influenza virus developed in the lab that uses our understanding of which genetic mutations in the virus trigger protective immune responses.
• DNA-based vaccines that produce protection against regions of influenza virus that do not change between different influenza viruses.

In addition to these specific approaches, scientists continue to look at different ways to administer the vaccine, different dosing patterns, and various adjuvants that could also improve existing or new influenza vaccines.

Additional influenza vaccine resources

If you are interested in finding out more about existing influenza vaccines or influenza disease, the VEC offers a variety of written materials and videos regarding influenza.

Materials to read

• Influenza: What You Should Know — English | Spanish
• A Look at Each Vaccine: Influenza

Videos

• Reintroduction of Intranasal Flu Vaccine and Recommendations for Use (with article) — These two videos and short article feature Dr. Paul Offit, VEC Director, discussing the reintroduction and recommendation of the nasal spray influenza vaccine.
• How Are Strains of Influenza Chosen for the Annual Vaccine? — In this video from the VEC’s Science Made Easy series, Dr. Offit explains how healthcare authorities determine which strains of influenza virus to include in the annual vaccine.
• Why Can’t We Make a Better Flu Vaccine? (with article) — This news brief video explains the challenges in making influenza vaccine year to year and the obstacles to a universal flu vaccine.
• Can a Flu Vaccine Give you the Flu? — This brief video examines the misconception that influenza vaccine can cause influenza.
• Are There Vaccines that Children with Allergies Need to Avoid? — This video discusses potential allergens in vaccines and precautions you can take to protect against allergic reactions.
• Why Doesn’t the Influenza Vaccine Work for More than One Year? — This short video explains why we need an influenza vaccine each year.
• Antigenic Drift: How the Influenza Virus Adapts (ANIMATION) — This digital animation from The Vaccine Makers Project illustrates how season and immediate mutations enable influenza to escape immunity.
• Influenza excerpt from HILLEMAN: A Perilous Quest to Save the World’s Children (FILM CLIP) — This excerpt from the documentary film tells the story of how scientists helped prevent a global influenza pandemic in the 1950s.