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Decoding the Symptoms: Influenza

What causes the flu?

Every year, 5 to 20% of Americans become sick with the flu. This illness is caused by a highly contagious family of influenza (“flu”) viruses that live in human respiratory droplets and are transmitted from person to person through the air and on surfaces that have been touched by individuals with the flu. Flu viruses can live outside the human body for up to 48 hours. They cause inflammation and irritation of the respiratory tract as well as infection that can travel through the blood stream, producing symptoms that include fever, headache, body ache, fatigue, cough, runny nose and sore throat.

Flu viruses are constantly mutating, which makes it tricky for our immune systems to recognize and kill them quickly. For this reason, new vaccines must be developed each year to take into account emerging strains of the virus and teach our immune systems how to target the current season’s invaders.

How can I reduce my risk of getting the flu?

Because the flu has no cure, the best “treatment” is to avoid getting it in the first place. The most important ways to avoid coming in contact with flu viruses include:

  1. Hand washing – Wash your hands with warm water and soap each time you come in contact with a person who has the flu or with a surface that they may have touched. Door knobs, counter tops, computer key boards, elevator buttons and bathroom surfaces all receive high hand traffic. Alcohol-based antiseptic gels are an alternative (and portable) way to disinfect hands during a busy day in public places. Kids can learn to keep their hands clean with disinfecting wipes and gels as well.
  2. Avoiding contact with those who have the flu – When possible, don’t visit sick relatives and friends who have influenza and do your part to prevent spreading the flu by staying home from work (and keeping kids home from school) during the most infectious stage of the illness (i.e. when a fever is present).
  3. Cleaning surfaces & covered coughs – If a loved one or friend that you live with has the flu, keep the surfaces they touch clean. Use disinfecting wipes and sprays to kill flu viruses on contact. Ask them to keep a safe distance from others when possible and to cough/sneeze into the crook of their arm or into a tissue rather than into the air that others might breathe in.
  4. Vaccines – The most effective way to prevent the flu is to get a flu vaccine each year. Although vaccines are not 100% effective at preventing the flu, they can greatly reduce your chances of catching it.

Why do I need a new vaccine each year?

Since flu viruses change their protein “coats” each year, scientists have to develop new vaccines that can teach the immune system how to recognize new viral strains. Researchers keep a close eye on new flu mutations that develop across the world and customize vaccines to protect us from the strains that are most likely to infect people in the U.S. in a given year.

Can vaccines cause the flu?

No, flu vaccines contain no live virus and cannot cause the flu. However, people sometimes mistakenly believe that they caught the flu from the flu shot because the vaccine takes 10 to 14 days to take effect. People who are exposed to the flu virus in the 10 to 14 days before their immune systems are prepared to fight the illness might confuse the timing of the flu infection with the flu vaccine.

When should I contact a healthcare professional?

Although the flu can be a life-threatening disease, most cases can be managed with comfort measures, including over-the-counter (OTC) symptom relievers, without needing to contact a healthcare professional. However, it’s important to recognize when you or a loved one has a potentially serious case of the flu. I like to think of flu symptoms in terms of colors of increasing concern: green is for common, non-concerning symptoms; yellow is for people who are at higher risk for severe symptoms; and red requires immediate consultation with a healthcare professional. If you have any concerns about symptom severity or feel that you or your loved one could be at risk for serious complications, of course you should always consult with your healthcare provider. Here is my summary of flu risk levels:

Green – You probably don’t need medical intervention if you are a generally healthy person between the ages of 6 months and 65 years. Symptoms are mild to moderate: low grade fever, achiness, runny nose, dry cough, fatigue – improving within a week to 10 days.

Yellow – You should consult a healthcare professional for symptoms that seem more severe than expected and for fevers that last longer than 3 to 5 days. This especially goes for pregnant women, babies less than 6 months old, adults over age 65, people with compromised immune systems (such as cancer, HIV, auto-immune disease), people with diabetes, heart disease, lung disease, chronic kidney or liver disease and nursing home residents.

Red – You should contact a healthcare provider right away for symptoms including: delirium (not acting/speaking normally), difficulty breathing, chest pain, shortness of breath, bluish or purplish lips, high fevers lasting for more than 3 to 5 days, fainting, inability to hold down food or fluids. Signs of dangerous dehydration include yellowish or leathery skin, decreased urination and confusion. Sometimes children will have no tears when they cry.

What are my OTC treatment options for the flu?

While OTC medications are designed to make recovery from the flu more comfortable, they cannot cure the illness or shorten its course. Symptom relievers fall into four general categories and can be customized to your or your loved one’s particular needs:

  1. Pain medicines/Fever reducers: Pain medicines containing active ingredients such as ibuprofen and acetaminophen can reduce fevers, body, and headaches associated with the flu.
  2. Cough medicines:  Cough suppressants are helpful if your cough is keeping you awake at night, or if your chest and belly are becoming uncomfortably sore from coughing. Dextromethorphan is the most common OTC active ingredient in cough medicines. There are additional cough suppressants (that may include codeine, for example) that are available by prescription only. Never give an OTC cough medicine to a child under the age of 4.
  3. Mucus thinners:  Sometimes flu viruses trigger the body to produce a large amount of thick mucus. If you feel that you are having trouble coughing out the mucus because it is too thick, medications with the active ingredient guaifenesin can is helpful. Guaifenesin is not recommended for children under the age of 4 years.
  4. Decongestants: If your nose is stuffed and making it difficult for you to breathe, decongestants can help to reduce the swelling of membranes in your nose.  When the membranes shrink, the mucus output is reduced and an individual is able to breathe through the nose better. Pseudoephedrine and phenylephrine are the two most common active ingredients in OTC decongestants. There are also nasal decongestant sprays available, and they should not be used for more than 3 days at a time. Phenylephrine and pseudoephedrine are not recommended for children under the age of 4.

Always follow instructions on the Drug Facts label to make sure you and your children take the right dose of medicine and be sure to use the dosing device that comes with the product. Remember to check the active ingredients contained in each OTC formulation (if you take more than one at a time) because they may contain duplicate drugs that could lead to inadvertent overdosing.  Only take a medicine with ingredients that treat your specific symptoms.

In Conclusion: Take Home Tips

  • Get an annual flu vaccine, especially if you’re in a higher risk group for flu complications
  • Wash your hands frequently and keep anti-bacterial gel handy during flu season
  • Read Drug Facts labels on OTC flu symptom relievers to avoid accidental over-dosing, noting special dosing instructions for children and babies
  • Have your healthcare professional’s contact information handy and call for “yellow and red” signs/symptoms
  • Make your own flu kit – OTC symptom relievers, thermometer, cooling/heating pads, hydrating fluids such as sports drinks, and antiseptic sprays and gels

Meet Our Experts

Val Jones, M.D.

Dr. Val Jones is an award-winning author and blogger, a regular guest on ABC News, and CEO of Better Health. She also sees patients part time at DocTalker Family Medicine in Vienna, V.A.