Posted tagged ‘flu’

Control your mucus

August 24, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

Germs love warm, sticky mucus. If you want to spread them around, spray your coughs and sneezes like a cropduster. Alternatively, you could sneeze or cough on your own hands, then smear the ick on doorknobs. Either way, the germs win.

At the height of last year’s novel-H1N1 epidemic, researchers in New Zealand wanted to see if people in public places were taking public health advice seriously. Dozens of medical students surreptitiously watched people in a hospital, shopping mall, and a train station to see how they sneezed and coughed, observing and taking notes on 384 mucus-producing events. The results, as reported here:

  • 65% covered their mouths and nose with their own hands, ensuring their ability to wipe their infectious germs on the next unsuspecting doorknob or stranger.
  • 27% didn’t cover anything at all—they just let ‘er rip!
  • 3% sneezed into tissues or handkerchiefs.
  • 1% sneezed or coughed into their own elbows, Dracula-style. This is what my kids were taught to do in kindergarten. It looks weird, but it prevents snot from spraying without getting a child’s hands covered with infectious goo.

So: the vast majority of people observed in this study did nothing to prevent the spread of disease. Somehow, I’m not surprised.

We could all do a better job at keeping our germs to ourselves. Some simple, effective steps:

  • Stay home if you’re sick, and keep your kids home if they’re sick.
  • Get your family vaccinated against influenza, and encourage your friends and neighbors to do this too. The more of us who are vaccinated, the better protection we all have.
  • Wash hands frequently, and use an alcohol-based hand gel between washings.
  • Finally: Be in control of your mucus! Teach children to sneeze into their elbows, and use a tissue to prevent your germs from spreading. And throw away those tissues afterwards—don’t just wad them up somewhere.

We’re all in this together, folks. Let’s do what we can to stay a bit healthier and less sticky this winter.

H1N1 update: Can we relax now?

December 22, 2009

The Pediatric Insider

© 2009 Roy Benaroch, MD

While no one is ready to call it over, H1N1 season seems to winding down in most parts of The United States. In my practice, we’ve seen only a handful of cases in the last few weeks. We’re also getting far fewer panicked phone calls for Tamiflu (the wonder-drug, as in “I wonder why so many people think this stuff works so well?”) The vast majority of children and adults who had H1N1 (or “Swine”) flu recovered after four or so days of fever and misery.


There are definitely some sobering statistics. About 1 in 6 Americans probably came down with this flu by mid-November, an astonishing number that reflects just how rapidly and thoroughly a new virus can spread. There have been far too many deaths among children: about 212 at last count, a number that is certain to rise as further reports are processed. Obese adults and pregnant women also turned out to be particularly vulnerable.

The vaccine turned out to be both safe and effective, but probably didn’t reach a “critical mass” of widespread availability until a little too late for most people. Cases of H1N1 are waning just as the vaccine is becoming easy-to-find, and it’s difficult to know for certain just how big an impact the vaccine has had on the epidemic. The Swine Flu of 2009 illustrated some important lessons for dealing with an epidemic: it takes too long to make influenza vaccines using current technology, and it’s difficult to distribute millions of doses of vaccines through 50 states and thousands of health departments. Hopefully lessons from this pandemic can spur development of improved vaccine technologies and public health infrastructure to support a massive delivery of vaccines, medicines, and  other stuff needed to keep a country healthy.

Some dosing issues for the H1N1 vaccine were confusing. Early studies showed that a single dose was effective in adults, but that two doses were needed in children. Because of poor availability and quirks in the FDA licensing, getting two doses into children proved quite challenging, and I’m doubtful that even now most families have gotten both doses for their kids. A more recent study from Australia trumpeted in the headlines just this week announced that a single dose is effective for most children—but that formulation used twice as much influenza antigen in each dose, so the results really don’t apply to the H1N1 vaccines available in the United States.

At this point, I still recommend that children who haven’t yet reached their ninth birthday get two doses of the H1N1 flu vaccine. Though the epidemic is winding down, in some years flu comes back when the coldest part of winter hits, after children return to school in January. Also, H1N1 is not going to disappear after this year—you can bet it will be part of next year’s flu season. Getting two doses this year means that your child is primed for good immunity next year (when presumably H1N1 will be included in the ordinary seasonal flu vaccine.)

There was also a recent recall of some lots of children’s H1N1 vaccine, about 800,000 doses in total. These lots were found to be a little less potent than they were supposed to be, by about 10-12%. The affected lots were only designed for children less than three, who all are supposed to get a second dose. Even if your child got one of these sub-par doses, as long as you get that second dose of vaccine your child will be well-protected.

So: yes, H1N1 was pretty bad—many people got sick, and some died. But it wasn’t a huge catastrophe. Hopefully, the worst is behind us. Keep washing your hands and using that hand sanitizer, and if you haven’t been immunized yet, it’s still a good idea. Children less than 9 still ought to get two doses of H1N1 vaccine, which has been remarkably free of serious side effects.

Not that anyone wants to hear about this, but there’s the “regular” flu season, still to come! Just because H1N1 has overshadowed other causes of flu so far, don’t expect that we’ll get to skip the ordinary flu season. That’ll be here, probably in January. Did I mention you ought to keep washing your hands?

I know the kids are delighted to have to get two kinds of flu vaccines this year, for both H1N1 and for ordinary seasonal flu—so plan to stop by QuikTrip for a tasty chocolate-mint milkshake on the way home. Or pick up a box (or three*) of Trader Joe’s Candy Cane Joe-Joes. Either one will put a smile back on a child who had to get a shot. Heck, they’re probably more effective than Tamiflu for a child who ends up getting the flu.

*One for child, one for you, one to mail to me!

A Pandemic Primer for Parents

August 29, 2009

The Pediatric Insider

© 2009 Roy Benaroch, MD

It’s here.

The “new flu”, officially known as “Novel-H1N1 influenza,” and often referred to as “swine flu,” is now widespread throughout the United States and the rest of the world. We’ve seen dozens of cases in my office, and will probably see hundreds more in the next few months. The World Health Organization has officially declared it an epidemic, and I’m officially declaring it a great big pain in the arse. For parents, kids, and pediatricians, it’s going to be a long, long winter.

The new flu first appeared in Mexico in the spring of 2009, and cases very started appearing in the United States soon after. Although early media reports focused on a very high mortality rate, hundreds of those early cases were later re-classified  by United Nations health officials as unrelated to, or at least not-definitely-caused-by, the new flu strain. Still, media reports have seemed to give the impression ever since then that this new flu was far deadlier than influenza infections we have seen before. While there is some fear that the new flu could become more virulent, right now the strain circulating here is not worse than any other flu. It’s more common, and it’s spreading faster, but in terms of how sick your child is likely to get the new flu is no worse than ordinary winter flu. Which is still pretty bad, don’t get me wrong, but the media is really pushing an unwarranted “killer flu” story that’s causing a lot of unnecessary anxiety.

Let’s set the record straight.

Why is the new flu special? Why are they making such a big deal about it?

This influenza strain, called “Novel H1N1,” truly is a new flu virus. No one has ever been exposed to it before, so almost none of us have any protective antibodies (about a third of elderly people have some antibody protection, presumably from flu strains that circulated long ago, but it’s unclear if that will help prevent them from getting sick.) It has quickly spread throughout the globe, and we’re seeing many cases of flu right now caused by this new strain well before the start of the usual winter flu season.

It is worse than regular flu?

Because no one is immune, the new flu will probably infect far more people this year than typically get the winter flu. Some health authorities estimate that ten percent of the American population will get it. With so many sick people, there could be a major impact on businesses and the economy, and on the ability of hospitals and clinics to help take care of sick people.

But at least so far, individuals who catch this new flu are no sicker than individuals who catch the ordinary winter flu. It makes people sick, sure, but the vast majority of us will recover fully with no medication needed.

Why is it called the swine flu, anyway?

The new H1N1 flu is genetically similar to an influenza virus that occurs in pigs, and may it is probably a mutated version. But you can’t catch swine flu from being around pigs or eating pork.

Good, I like bacon. If I can’t get it from pigs, where can I catch it?

People, especially sick people, and especially sick people who don’t wash their hands.

How can my family avoid it?

There are many strategies that can help. As a community, we need to encourage sick people to stay home from work, and sick children to stay home from school. People with flu need to avoid crowds for about a week, or at least 1 day past the time all symptoms improve. This creates difficulties with people feeling they need to get back to work—but we’re all in this together. Employers need to encourage people to stay home, and schools need to STOP penalizing children for missing days when they’re sick.

One of the most important strategies for avoiding the flu is to keep your hands clean. Flu virus must get into your body through the lining of your nose, or your mouth, or your eyes. It can’t get through your skin. Even if you just shook hands with The Captain of the Influenza Snot team, you won’t catch the flu until you touch your own face. Wash your hands frequently, or use hand sanitizer. Use a tissue if you’ve got an itchy nose rather than your bare hand, and throw that tissue away afterwards. And stop fiddling with your contact lenses, will ya?

Isn’t there a vaccine for the swine flu?

Yes, there is a vaccine in development—but the CDC is now saying they think it will be available in mid-October, and that’s probably optimistic. It’s not clear how it will be distributed, how many doses will be necessary, how many doses will be available, or for whom the vaccine will be recommended. You can follow the latest news about the vaccine and availability at the CDC’s novel H1N1 flu site.

Will the ordinary winter flu vaccine help?

You should definitely get the ordinary winter flu vaccine, which is available now. While it won’t specifically protect you against the new flu, soon the regular winter flu will also be circulating, and getting them both will be a miserable double-whammy. If fewer people catch the ordinary winter flu, may help prevent the new flu from becoming more virulent.

What are the symptoms of the flu?

Fever, body aches, headaches, runny or congested nose, and cough are the most frequent symptoms. Some people also have nausea, vomiting, or diarrhea. The symptoms last about five days. While some people use the word flu to describe any sort of bad cold, the symptoms really are quite different from and more severe than an ordinary upper respiratory infection.

If I think I have the flu, or my child has the flu, should I go to the doctor?

People are having severe symptoms should certainly see their doctor. This includes difficulty breathing or pain that isn’t relieved by over-the-counter medicine. People whose illness lasts longer than five days without improvement, or people who are at high risk for complications of the flu (babies, elderly people, or those with chronic health problems) should also strongly consider a doctor visit.

On the other hand, most people with influenza have relatively mild symptoms that are at least temporarily relieved by rest and over-the-counter medicine. These people really ought to stay home so they don’t unnecessarily expose more people to illness, and so they don’t overwhelm clinics and emergency rooms that will be needed for sicker patients.

What are the warning signs of severe flu—the signs that we need to see the doctor right away, or go to the emergency room?

  • Fast breathing or trouble breathing
  • Bluish or gray skin color
  • Not drinking enough fluids
  • Severe or persistent vomiting
  • Not waking up or not interacting
  • Being so irritable that a child does not want to be held
  • Flu-like symptoms improve but then return with fever and worse cough


What can relieve symptoms of the flu?

Rest and fluids are very important. Over the counter medicines like ibuprofen (Motrin or Advil) and acetaminophen (Tylenol) will help relieve the aches and fevers. Honey helps cough, nasal saline spray helps congestion, and a nice pot of chicken soup helps everything. I like ice cream and popsicles, too (I am a pediatrician, after all.) There are shelves full of “cold and flu” medications available at the local CV-Rite-greens, but by and large they don’t actually work.

There are a few medications that can be prescribed to fight the flu virus, but they’re not especially effective and shouldn’t commonly be used. The one that’s most widely known is Tamiflu. Ordinary winter flu has already become nearly 100% resistant to this drug, and the new flu is quickly becoming more resistant as well. To work, Tamiflu and other flu medications need to be started as soon as possible after infections; even then, they don’t confer a tremendous benefit. Currently, anti-flu medicines are recommended only for cases of severe flu and for people at high risk for complications from flu.

What’s the incubation period for flu? How long is a patient contagious?

The incubation period for ordinary flu is 1-4 days, usually 2. A person becomes contagious 1 day prior to the fever, and can continue to spread the virus at least until the fever is gone (5 more days), and probably for one further day. Although these characteristics aren’t as well studied for the new flu virus, they’re probably about the same.

What’s with the masks, anyway?

Media reports on the new flu from Mexico, and the Bird Flu of East Asia, invariably showed people wearing masks. Though flu virus can spread in coughs and sneezes, the main way that masks probably help is by preventing healthy people from reaching up to scratch their noses, or reaching into their own mouths. Likewise, eye protection will not only keep sneezed flu-laden mucus from reaching you, it’ll also keep your hands away from your own eyes. That’s a very good habit for this winter.

Wow, thanks unpaid physician author, I’ll sleep much better tonight! But what if I have more questions?

Stay away from the “It bleeds, it leads” local news, and instead check out these reliable resources:

Flu, a cold, or something else

March 11, 2009

Mindy wants to know what the difference is between a cold and the flu: “Someone told me he knows he has the flu when he’s sick in the winter if he has a fever.  No fever, it’s just a cold.  So, if my son has a cold in the winter and his fever is 101 or so, does that mean he has the flu?  (or is more likely to have the flu)?  We’ve all had our shots so symptoms will be light this year anyway if it is flu so it’s hard to tell from symptoms.”

The symptoms of influenza really are quite different from a common cold.

The flu starts suddenly, with severe symptoms arising all at once, or within a few hours. A typical fever is 103 or higher (highest I’ve seen is 106.1), and it’s accompanied by chills and shaking. There are body aches, head aches, and belly aches, and sometimes some nausea and vomiting. There may be a cough or sore throat, but these usually aren’t severe. An episode of flu lasts about five days. People who are vaccinated are much less likely to get the flu, and if they do the illness is usually more mild, with lower fevers and a shorter illness.

A cold usually creeps up on you, rather than starting all at once. It begins with a day or so of a vague feeling of unwell, just a feeling that you’re coming down with something. Then a sore throat will begin, and last a few days. During this first few days there may be a fever, though usually not over 102 (children tend to run higher fevers than teens or adults.) After a few days of sore throat the throat gets better while the nose gets more congested, and after the nose is stuffy a cough often begins that can linger for a few weeks.

Just to throw in another common wintertime ailment: strep throat is another sudden-onset illness. The main symptoms are sore throat, which can be very uncomfortable, plus a fever, headache, and belly ache. Runny nose and cough are absent, and flu-like body aches don’t occur.

So: cold symptoms + a fever of 101 is almost certainly just a cold—which can still be unpleasant, but isn’t the flu. Another way of looking at this: people who’ve had the flu, the real flu, will tell you that it’s nothing like a cold. If you’re not sure if it’s the flu or a cold, you’ve probably got a cold. The best advice: wash your hands, get some sleep, and have some nice chicken soup.