Flu (influenza)

What is it?

Influenza (the flu) is a respiratory infection. It is caused by the influenza virus. Influenza typically is spread by air or by direct contact from one person to another. Influenza virus is very contagious.

Most influenza cases occur during epidemics. Epidemics usually peak during the winter months. A particularly widespread and severe epidemic is called a pandemic.

Compared with other viruses, influenza can strike remarkably large numbers of people in a relatively short time. In the developed nations, up to 10-15% of the people get the flu each year. During severe epidemics, a greater fraction of the population gets sick.

The most common types of influenza virus are A and B. Influenza A is the one usually responsible for the annual epidemics. Most people get multiple flu infections during their lives. With many other types of infections, having the disease once protects against a second infection. That is because the body's immune system remembers the returning virus. It attacks it immediately, and rapidly eliminates it.

With influenza, the virus usually has mutated (changed) somewhat since the first infection. The change is enough to fool your immune system. As a result, the immune system responds slowly. By the time the immune response is in full gear, millions of the body's cells are already infected.

Symptoms

Flu can cause a variety of symptoms. They can be mild or severe. Symptoms and illness severity depend on the type of virus, your age and overall health.

Although it is a respiratory virus, flu can affect other body systems. This makes you feel sick all over. Symptoms can include any or all of the following:

• Chills
• Moderate to high fever (101 to 103° Fahrenheit)
• Muscle aches
• Headaches
• Fatigue
• Cough
• Sore throat
• Runny nose
• Diarrhea
• Dizziness.

Dangerous complications, such as pneumonia, can develop from flu. The influenza virus can be the direct cause of pneumonia. But also infection with influenza makes a person more susceptible to bacterial pneumonia.

Certain people are especially vulnerable to complications. These include:

• Older people
• Infants
• People with certain chronic diseases
• People with suppressed immune systems.

Diagnosis

Your doctor will evaluate your symptoms. Flu is likely to cause fever, coughing, chills and muscle aches. Flu tends to occur during winter months.

Doctors usually assume the diagnosis is flu when you have symptoms of influenza in the winter. If your symptoms or physical examination suggest something other than the flu, your doctor may order a blood test. He or she will swab your nose and throat for influenza testing.

Your doctor may order a chest X-ray. This is likely if he or she suspects that the influenza virus has caused pneumonia or may lead to a bacterial superinfection.

Expected duration

Influenza symptoms can last for as few as 24 hours or for a week or more. A typical case lasts four or five days. As long as you have symptoms, you are contagious.

Prevention

Options for heading off an attack of influenza have increased in recent years.

• Vaccination — Vaccination can reduce your chances of getting the flu and transmitting it to others. Vaccination each year is recommended for everyone aged 6 months and older. Vaccination is particularly recommended for
  • All children and adolescents aged 6 months to 18 years of age. This is especially true for those receiving long-term aspirin therapy. That is because children taking aspirin are at increased risk for experiencing a serious illness called Reye's syndrome if they get influenza infection.
  • All people older than 50 years
  • Women who are pregnant or will be pregnant during the influenza season
  • Adults and children who have disorders that affect their
    • Lungs, including chronic lung disorders such as asthma
    • Heart
    • Kidney
    • Liver
    • Blood
    • Metabolism (including diabetes)
  • Adults and children whose immune systems are suppressed
  • Adults and children who have any condition that can
    • Compromise lung function
    • Compromise the handling of respiratory secretions
    • Increase the risk for aspiration such as mental impairment, spinal cord injuries, seizure disorders, or other neuromuscular disorders
  • Residents of nursing homes and other chronic-care facilities
  • Health-care personnel
  • Adults or children who are in close contact with
    • Children younger than 5 years (especially children younger than 6 months)
    • Adults older than 50 years
  • Adults or children who are in close contact with people who have medical conditions that put them at higher risk for severe complications from influenza.

For maximum effectiveness, doctors advise getting vaccinated at the start of flu season. This generally means October or November. There are a number of different types of vaccinations available to prevent influenza. They vary by how they are given (for example, by injection or inhaled through the nose), by the type and number of virus strains covered and by the method of vaccination production (for example, using an altered live virus or an inactivated virus).

Recommendations vary for different people and from year-to-year so ask your doctor which specific vaccination is best for you.

Other ways to protect yourself from getting the flu include:

• Good hygiene — The virus usually is passed through the air, by coughing. It also is passed by direct contact, such as shaking hands or kissing.

Practicing good hygiene can help you to avoid getting the flu or spreading it to others. Good hygiene includes covering your mouth when you cough and washing your hands frequently.

• Antiviral drugs — Zanamivir (Relenza) and oseltamivir (Tamiflu) can substantially reduce your chance of getting the flu if they are taken just before an expected outbreak. Your doctor may recommend one of these medications if you are at high risk for severe influenza or complications of the infection.

Treatment

To ease symptoms, your doctor will recommend that you rest and drink plenty of fluids.

For fever and body aches, you can take over-the-counter pain relievers. The antiviral drugs baloxavir (Xofluza), oseltamivir (Tamiflu), peramivir (Rapivab) or zanamivir (Relenza) are also options, depending on how long you've been sick (since treatment may speed recovery only if started soon after the onset of symptoms), severity of symptoms and risk factors for complications. In general, starting one of these medications three or more days after the onset of flu symptoms is unlikely to be effective.

Because flu is a viral infection, antibiotics are not effective.

Children who are suspected of having flu, and who have high fevers should be given acetaminophen (Tylenol). They should never be given aspirin to treat the fever. This can cause a serious illness called Reye's syndrome.

When to call a professional

If you have a chronic disease and suddenly get flu symptoms, call your doctor's office. You may benefit from starting an antiviral medication within 48 hours.

You also should notify your doctor if you have flulike symptoms along with

• Chest pain
• Ear pain
• Shortness of breath
• Fever that does not go away
• A cough that produces blood or thick, foul-smelling mucus.

Prognosis

Most people recover fully from the flu. But some develop serious complications. Complications can include life-threatening conditions such as pneumonia.

Additional info

Centers for Disease Control and Prevention (CDC)
https://www.cdc.gov/