It's the Flu Season, Give Me Your Best Guess

If you have not already heard through the news outlets, October 1 was the beginning of the influenza (flu) season. This is hugely important to everyone in not just the United States but also throughout the world. The 1918 influenza pandemic caused the deaths of over 500 million people throughout the world, from the H1N1 virus. This was one-third of the world’s population.

The flu is a highly contagious respiratory illness caused by Influenza A and B. Most often, the flu virus is spread through air droplets expelled by a cough or sneeze within a six-foot area. The virus lands on the face and nose and gets inhaled into the lungs. Less often, respiratory secretions that have landed on drinking glasses, desktops, and doorknobs, transferred by a person to their face or nose, cause the flu. The primary vector, the person who has contracted the flu, sneezes and does not cover their mouth. The virus enters the body and does what it does best. Its job is to multiply, invade and spread.

The virus attacks the body through the respiratory tract. The symptoms of the flu are very similar to a cold, but more severe. Coughing, sneezing, headache and chest discomfort are seen in both a cold and flu. The flu comes on suddenly with high fevers for several days and severe body aches. The body aches can be so severe that getting out of bed is a challenge. The next manifestation can lead to a life-threatening pneumonia. Going to your physician or local pharmacy and getting the flu shot now has a high likelihood of preventing you from getting the flu.

The high-risk patient populations for the flu are: 65 years of age and over, pregnancy, children less than 5 years of age, people with asthma, heart disease, stroke, diabetes, HIV/AIDS, and cancer, and children with neurological disorders. People over 65 account for 70-90% of the deaths each year and 50-60% of the seasonal influenza hospitalizations.

Each year’s flu vaccine will protect against 3-4 different virus strains that have been researched for a year. These three or four viruses are what research from the World Health Organization and the CDC suggests will be the most likely contagions of the upcoming flu season. The 2019-20 vaccine has 4 virus strains that have been updated from the 2018-19 vaccine. It contains Influenza A/Brisbane, A/Kansas, Influenza B/Victoria and B/Yamagata virus components.

The process behind what viruses are in the vaccine is a fascinating process. There are actually two vaccines that are manufactured for the world: one each for the northern and southern hemisphere. The World Health Organization (WHO) collects virus samples from 100 national centers in 100 countries. The viral samples come from Atlanta (CDC), London, England (Francis Crick Institute), Melbourne, Australia (Victoria Infectious Diseases), Tokyo, Japan (National Institute for Infectious Diseases) and Beijing, China (National Institute for Infectious Diseases). The WHO evaluates and monitors the spread of viruses throughout the world. With this information, recommendations are made for each region of the world. The CDC will do global surveillance looking for patterns of viral spread, new viral strains and what virus vaccines are available for the public. This is a “best guess” recommendation. This is the reason you may see bigger outbreaks in a flu season than expected. Last year was one of those seasons where there was a massive spike in pneumonia and flu outbreaks earlier this year.  Based on the National Center for Health Statistics (NCHS) mortality surveillance data available on October 17, 2019, 4.7% of the deaths occurring during the week ending October 5, 2019, were due to pneumonia and influenza.

The designated pharmaceutical companies start producing the flu vaccine in January. It takes about 6 months to make the flu vaccine. The companies will use vaccines they have in their supplies and only put one or two flu strains in the shot until they get the word which additional strains will be added to make it a tri or quadrivalent vaccine from the CDC.

There are three different types of flu vaccine: egg-based, cell-based and recombinant. Most of the vaccines are inactivated virus shots. One of the vaccines is a nasal spray that is a live attenuated virus mix. The virus mix is injected into the egg-based or cell-based medium and allowed to grow. The virus is then inactivated or allowed to be a live attenuated (low in virulence). Neither of these vaccines cause the flu as most people think. One of the patient populations who cannot receive the nasal live attenuated vaccine are people who have weakened immune systems that cannot fight any form of infection.

Even if you have an egg allergy it is recommended by the CDC to get the flu vaccine. The chances of getting a severe reaction in an egg allergic person, per the CDC, are 1.3 per 1 million. If a person has a severe egg allergy, it is recommended that they go to their physician’s office to get the flu shot. The office will have the necessary medications and experience to treat a severe allergic reaction if it occurs.

If you get the flu, common sense and some over-the-counter medications do help with the symptoms. First things first, stay away from work or school. You are highly contagious and your co-workers will not appreciate you being around them. Hydration, rest and symptom relief is critical. For fevers, aches and pains, use acetaminophen (Tylenol), ibuprofen (Motrin) or naproxen (Aleve) at the recommended doses. Maximum doses per day of acetaminophen is 4000 mg, ibuprofen is 3200 mg and naproxen is 1000 mg.

There are prescription medications that if taken within 48 hours of first symptoms will shorten the time you are sick and will decrease flu symptoms. The CDC recommends baloxavir marboxil (Xofluza), oseltamivir (Tamiflu), peramivir (Rapivab), or zanamivir (Relenza). Some of these medications are taken for 5 days. Baloxavir marboxil (Xofluza) is a single-dose regimen. Oseltamivir (Tamiflu) or zanamivir (Relenza) can help prevent the flu in someone who has been exposed. Back in the 1980s, an anti-Parkinson’s medication named amantadine was shown to be effective against all influenza A strains. Amantadine was shown to also cause resistant influenza A strains. Amantadine was prescribed during the seasonal flu season on a chronic basis for prophylaxis against the flu.

Hand hygiene is also important during the seasonal flu season. If you can sing “Happy Birthday” while hand washing with soap and water, you are doing a great job. When soap and water are not available, hand sanitizers can kill influenza but not all viruses.

I highly recommend that all pilots get the flu shot and maintain constant hand hygiene. Most insurances cover the cost of the flu shot; some, minus a minimal fee. The flu could be potentially harmful to you or anyone you are exposed to. Please heed my words. If you are unlucky to have gotten the flu, take at least a week after all the symptoms are done to even consider getting back up flying. I got my flu shot today. I bypassed the candy gift for getting my flu shot and had my apple instead. 

Larry M. Diamond, PharmD, CFII
Larry Diamond has a Doctor of Pharmacy Degree and has been a pharmacist for 37 years. Larry’s pharmacy practice has been as a Clinical Pharmacy Specialist in Cardiology, Orthopedic Surgery Specialist and most recently Clinical Pharmacy Coordinator. He is a CFII, a pilot for 33 years and has been an AOPA member since 1984.

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