2015 Flu Vaccine "Cattle Call"

BEVO says, "Healthy Horns get Flu Shots!"

Attention Longhorns, Aggies, and everyone else, flu season is upon us, so it's time for your annual flu vaccine.  UT students- we have completed our large flu vaccine clinics, but now you may schedule an appointment at UHS to receive your shot. 

Who should get the flu vaccine?
The Center for Disease Control and Prevention (the CDC) continues to recommend annual flu vaccines for everyone over the age of six months.

What is different this year?
Last year, the vaccine was not a great match for the strain that ended up dominating the scene (H3N2). This year's vaccine includes two type A strains, both last year's H3N2 and the H1N1 that was so intense from 2009, as well as two less well- known type B strains.

But I hate needles...no problem, ask for the vaccine that is delivered via a nasal spray! The only caveat here is that this is a live vaccine, so there are some restrictions: you must be age 2-49 years, not pregnant, have no major problems with immunity (such as having AIDS or cancer), not take aspirin daily, and not have asthma.

New this year: "Jet-Injectors" which use a "high-pressure, narrow stream of fluid" to directly penetrate the skin- no needle involved at all! The only vaccine to be delivered this way for 2015-2016 will include three (rather than four) strains of flu, the type A strains H3N3 and H1N1, along with one B strain, and recipients must be ages 18-64 years old.

What is FLU? Influenza is not a simple cold, nor is it a twenty four hour stomach virus. The flu causes fever, chills, cough, runny/stuffy nose, muscle aches, headaches, fatigue, and sometimes involves vomiting and diarrhea (more often in kids). Colds and allergies tend to bother you from the neck up- stuffy, sore throat, headache- but don't knock you down for the count, and coughs are generally less bothersome.

How is the FLU spread? This virus is spread from infected people when the cough, sneeze or talk, via tiny respiratory droplets, and the scary part is that you are contagious a full day BEFORE you develop symptoms (as well as for about a week after you feel sick.)

How can you prevent the FLU? Wash hands FREQUENTLY and get vaccinated. Get vaccinated. Get vaccinated! 

Who should NOT get vaccinated? Those with bad reactions to vaccine in the past; infants younger than 6 months; and those people with a history of an uncommon disease called Guillain-Barre. If you are sick with a fever, wait till this illness is over before getting the vaccine.

BOTTOM LINE:  Grab a friend, family member or co-worker and make time to get your FLU VACCINE!

Flu Without Fever?

Can it be? Should you even wonder if you have the flu if you don't have a fever? Unfortunately, YES. While it is true that the classic presentation of seasonal flu includes an often HIGH fever, body aches, fatigue, sore throat, cough and abdominal symptoms like nausea, pain or diarrhea, no single symptom is absolutely necessary for a diagnosis.  Children under the age of 6 years frequently do not have fever and cough with their flu symptoms. This year in particular, I have seen more cases of flu with purely fatigue and stomach symptoms...including one in our family this week.

The incubation period for influenza averages about two days, so that means that you are exposed to flu 1-4 days before you have symptoms. Unfortunately, you are contagious (spreading germs yourself) the day BEFORE you have intense symptoms, and then continue to be contagious for roughly 5 - 7 days. Whether or not you have FEVER.

What's my point? We all have to be responsible about not spreading the flu. It's hard for anyone to miss work/school/sports, but when we go back too soon, we are just increasing the chance of passing on this illness to our peers. When SHOULD we return to work/school? If you HAVE fever, it's a clear recommendation to wait to go back until you have been completely fever-FREE for 24 hours, without the benefit of tylenol or ibuprofen (which obviously can lower temperatures, and therefore, mask a fever). If you do NOT have fever, but have a positive flu test, then it is less obvious when you should go back, but on average most otherwise healthy people will need to be at home for at least three days. If you are vomiting and having diarrhea, a good rule of thumb is to wait for 24 hours after these symptoms subside to return to work/school. As a parent, I cringe every time I here someone talking about sending their kid to school after that same kid was up "all evening last night vomiting" or they comment nonchalantly, "I know she's wiped out, but she hasn't thrown up since lunch yesterday... and they have a huge test this week."

The flu is spread via respiratory secretions, and this can be transmitted directly by coughing or sneezing (or simply by talking) or indirectly by transfer as the infected person touches their mouth or nose, then touches surface (leaving the virus there) and then the next person touches that surface before touching their own mouth/nose. Remember all of this is microscopic, not visible.

When we DO go back, perhaps we should at least take some antibacterial hand sanitizer with us. And tell your friends and family to get the flu vaccine. True, this year's vaccine is not a great match, but at least it lessens the severity of the flu if you still get it.

BOTTOM LINE: Please, if you get the flu, do your part to stop spreading this disease and STAY HOME from work, school, sports, (and restaurants, grocery stores, Starbucks, whatever!) until you feel significantly better AND are FEVER-FREE (and puke-free) for at least 24 hours without taking medicines to stop/blunt those symptoms.

'Tis the FLU SEASON

It's that special time of year again...so please give yourself (and your family) the GIFT of a flu vaccine NOW so you are not struck down with this illness at the busiest time of year! Flu shots have been available for a few weeks and seem to be available everywhere.  Clinics, schools, grocery stores, pharmacies and many employers are all offering flu shots these days. Add a flu shot to your grocery list- I'll bet the pharmacy there is stocked and you won't even have to add an extra stop on your weekly errands.

Who should get the flu vaccine?
The Center for Disease Control and Prevention (the CDC) recommends annual flu vaccines for everyone over the age of six months.

What is different this year?
As with last year, we have quadrivalent vaccines (that include protection against four strains- 2 influenza type  A strains, and 2 influenza type B strains) in addition to the usual trivalent vaccines. Pick one or the other, you don't need both. If you have egg allergies, make sure to ask for the trivalent vaccine that is egg-free.

Didn't I hear that the flu vaccine this year doesn't match the strain that is going around? 
Well...unfortunately, yes. We are early in the season, and the CDC is seeing that most of the diagnosed cases are a result of the H3N2 strain (as opposed to the H1N1 that was so devastating several years ago), and although that strain is included in the vaccine this year, there has been a mutation in roughly half of the circulating virus that makes it resistant to the vaccine. The take-home message, however, is that even if the vaccine is LESS effective, it is still the best protection that we have AND it should still reduce the severity of the infection if you happen to contract one of those mutated strains.

But I hate needles...no problem, just ask for the vaccine that is delivered via a nasal spray! The only caveat here is that this is a live vaccine, so there are some restrictions: you must be age 2-49 years, not pregnant, have no major problems with immunity (such as having AIDS or cancer), not take aspirin daily, and not have asthma.

Hate needles and have asthma? There is also a trivalent shot that has a tiny needle which is injected just below your skin, rather than into the muscle.


What is FLU? Influenza is not a simple cold, nor is it a twenty four hour stomach virus. The flu causes fever, chills, cough, runny/stuffy nose, muscle aches, headaches, fatigue, and sometimes involves vomiting and diarrhea (more often in kids). Colds and allergies tend to bother you from the neck up- stuffy, sore throat, headache- but don't knock you down for the count, and coughs are generally less bothersome.

How is the FLU spread? This virus is spread from infected people when the cough, sneeze or talk, via tiny respiratory droplets, and the scary part is that you are contagious a full day BEFORE you develop symptoms (as well as for about a week after you feel sick.)

How can you prevent the FLU? Get vaccinated. Get vaccinated. Get vaccinated! 

Who should NOT get vaccinated? Those with bad reactions to vaccine in the past; infants younger than 6 months; and those people with a history of an uncommon disease called Guillain-Barre. If you are sick with a fever, wait till this illness is over before getting the vaccine.

BOTTOM LINE:  Your best gift for good health this season is the FLU VACCINE!

What about Tamiflu? Should you take it?

So if you GET the flu, should you take Tamiflu? Or less known, Relenza?

Ah, that's the million dollar question...literally, since Tamiflu and Relenza are the only drugs FDA approved and indicated for this year's flu. These drugs are flying off the shelves as the flu season kicks into full gear, and we are desperate to get over the flu as fast as possible. Much is being debated these days about the efficacy of these anti-viral drugs. What do we know?

We know that antiviral treatment typically shortens the symptoms of the flu by at least twenty-four hours. We know treatment is recommended for those with weakened immune systems or those with severe enough symptoms to be hospitalized. We know starting these medications when you have already had symptoms for more than two days is NOT helpful. We know that taking Tamiflu can help prevent getting the flu if you are definitely exposed to someone with the flu.

What else do we know? We know that there are no independent studies of the drug (meaning that the manufacturer of the drug has at least partially funded all the studies). That does not mean the studies are invalid, but certainly it calls bias into question.

Tamiflu and Relenza are not without side effects. In my own clinical experience, I have had patients who took one of these drugs because their family member was diagnosed with the flu, and the side effects of the drug were "as bad as the flu"- particularly nausea. That being said, I have also had patients who had zero side effects and happily did not get the flu despite obvious exposure.

What do I do clinically? If I diagnose you with the flu, and you've had symptoms for more than two days, I will not prescribe an antiviral. If you have a very sensitive stomach, I am unlikely to prescribe an antiviral. If you are a college student living in a dorm (translation, exposing a zillion other kids to your flu), I am likely going to encourage you to take an antiviral. So, it depends...on YOU and your symptoms and your risk factors.

BOTTOM LINE: If you have true flu symptoms, get in to see your doctor ASAP...and then have a DISCUSSION about whether or not an antiviral medicine is likely to help you (or your roommates.)

Flu Vaccine- It's Not Too Late!

Okay, it's January, and now EVERYONE you know is getting the flu! Is it too late for you to get vaccinated? ABSOLUTELY NOT! The truth is that now that we're all scared, it's tough to find somewhere that has the flu vaccine in stock! Call your doctor or your pharmacy and find out how many they have left, then jump in your car and head over.

This year is another one of those "really bad" flu years. Yes, if you are vaccinated today, you have to wait a couple weeks for your shot to protect you. BUT...the flu season is just catching its stride, so all you have to lose is a temporarily sore shoulder.

This year's flu seems to be bringing with it the added bonus of nausea and vomiting, as if muscles that feel like a Mack truck hit you were not enough. The flu is NOT just a stuffy or runny nose and cough- that's a cold. The flu is OMG, I can NOT get out of bed and function, because my head is splitting, my muscles are screaming, and yes, this year's bonus is the vomiting and diarrhea. Believe me, a sore arm for a few days is a happy trade for the flu.

Who should be vaccinated? Hello, it's EVERYONE. The CDC (Center for Disease Control and Prevention) recommends that everyone over the age of 6 MONTHS get a flu vaccine each year.

Wash hands, wash hands, and oh yes, wash your hands...for 20 full seconds! When you dash them under the water or take 5 seconds to apply hand sanitizer, you are nicely moving your germs around, so spend the extra 15 seconds and scrub a bit to be more effective.

BOTTOM LINE: FLU SEASON is in FULL SWING- Strike back by getting your FLU VACCINE and WASHING YOUR HANDS...for a full 20 seconds!

For more info, check out the current stats on this year's flu at the CDC at: 
http://www.cdc.gov/flu/about/season/flu-season-2012-2013.htm

Can't Get Rid of that COUGH?

This time of year especially, coughs seem to stick around forever. Here in Austin, the culprit may be seasonal allergies, but overall the major cause of persistent coughs is viral upper respiratory infections- from both simple "colds" and the big, bad flu. With these infections, after you get past the headaches, and stuffy nose part, you find yourself coughing- often up to SIX WEEKS after the initial illness. Sometimes it's a minor "clear your throat" type of cough, while other times, it's the crazy fits of coughing that keep you from sleeping.

Is there anything that can be done for a cough that wont go away? Yes, but a cough does NOT mean you definitely need an antibiotic- in fact, typically, you do NOT. However, a cough that is not managed with over the counter medicines should be addressed by your physician. Coughing all day long at school or work (or keeping up your spouse with coughing all night) is NOT a good plan!

What can your doctor do? First of all, she does need to rule out any secondary infection such as a pneumonia. If you are a week into your symptoms, and suddenly you feel a ton worse and develop a fever, this might be a bacterial infection setting up shop AFTER the virus cleared the way past your body's defenses. For this scenario, yes, you need an antibiotic. More commonly, though, you may have developed some over-reactive airways and may benefit from some inhalers or other asthma-style of medicines. A prescription cough syrup used at night may help with the nighttime exacerbations, and your doctor can remind you of some traditional home remedies such as cool mist humidifiers that may help. Finally, sometimes a cough comes from other sources, such as acid reflux or sinus drainage, which require different treatments.

BOTTOM LINE: See your doctor to evaluate coughs that get worse after a respiratory illness, or that wont go away- don't expect antibiotics, but know there are other treatment options!!

FLU News: 2011 Season

Flu season can be a scary, challenging time for all of us, especially the last two years, thanks to H1N1 (formerly known as the Swine Flu). The BAD news this year is that we're already seeing some cases of the flu, but the GOOD news is that we already have this year's flu vaccine available, and it will provide immunity to several strains of the flu, including the 2009 H1N1. In fact, each year the flu vaccine has three parts, including an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus.

There are two types of vaccines offered- a live vaccine, which is a weakened version of the virus (this is the nasal spray vaccine) and a "killed" vaccine, the traditional injection. I often hear patients say they "got the flu" from the vaccine, but that is impossible from the injection because those viral particles are NOT ALIVE- they can NOT cause disease. It takes about two weeks for your body's immunity to kick in after the shot, so plan ahead, especially if you are traveling.

In the 2010-2011 flu season, which peaked in early February 2011, was less severe than the pandemic flu season the year before, but still had very significant impact on our population. While most people infected have a miserable several days to a week of symptoms, there were over 300 deaths confirmed to be from influenza, including over 100 pediatric deaths (average age around 6 years.) This is not a disease to be ignored.

WHO should get the flu vaccine this year? The CDC recommends that "EVERYONE 6 months of age and older should get a flu vaccine as soon as the 2011-2012 vaccines are available." And that is NOW! Don't worry about the effects wearing off before the end of flu season, by the way, because the effects last throughout the whole season.

When is flu season? Though typically we say October to January, it really starts with September and most likely extend beyond February this year. Let's be proactive and line up early to receive a vaccination, and then follow up with consistent hand-washing and STAYING HOME if we get sick! I LOVE that all our grocery stores, and many other public places now have the anti-bacterial cleansers positioned right as you enter their store- USE IT!

BOTTOM LINE: Don't wait- head to your doctor's office or your pharmacy for a FLU VACCINE now!

Flu Vaccine- It's Time AGAIN!

Last year's flu season was a scary, challenging time for all of us, thanks to H1N1 (formerly known as the Swine Flu). The BAD news this year is that we're already seeing some cases of the flu, but the GOOD news is that we already have this year's flu vaccine available, and it will provide immunity to several strains of the flu, including the 2009 H1N1.

When is flu season? Though typically we say October to January, we'll need to start with September and most likely extend beyond February this year. Let's be proactive and line up early to receive a vaccination, and then follow up with consistent hand-washing and STAYING HOME if we get sick! I LOVE that all our grocery stores, and many other public places now have the anti-bacterial cleansers positioned right as you enter their store- USE IT!

WHO should get the flu vaccine this year? The CDC (Center for Disease Control) has recommended that EVERYONE over the age of 6 months receive it this year, so we can avoid the near pandemic we faced last year. It is especially important for people at high risk of serious complications: pregnant women, kids <5 years old, adults > 50 years old, anyone with chronic illness (asthma, diabetes, cancers, etc.) and health care workers. I would add TEACHERS to that list, as well.

BOTTOM LINE: Don't wait- head to your doctor's office or your pharmacy for a FLU VACCINE now!
(PS If you are a West Lake Family Practice patient, we are expecting our vaccine shipment to arrive next week.)