Is it Ebola? Or "just" the FLU?

You have a fever, chills, sore throat muscle aches, headache, nausea and vomiting…is it Ebola Virus? Or perhaps that new respiratory virus (Enterovirus 68)? While technically speaking, it is possible for your illness to be caused by one of these dreaded agents, the odds are very much against it. However, you very well may have the FLU.

NOW is the time to get your flu vaccine- please! The flu vaccine is recommended for EVERYONE aged 6 months and older (who does not have a contraindication for the immunization.) We are already seeing cases of flu here in Austin, as others are across the United States. Instead of fretting about the two cases of Ebola virus here in Texas, recognize that last year in Texas alone, twenty children died from the flu. Twenty. Children. Gone. And, according to the CDC,  across the United States we have over 23,000 deaths and over 200,000 hospitalizations from influenza.

"But Dr. Grimes, the flu shot always gives me the flu!"
No, it does not. The flu shot does NOT contain live virus- it is not capable of causing influenza. In randomized, blinded studies the only difference between people who got a placebo (salt water) vs those who receive the actual flu vaccine is that the real vaccine makes your arm more sore for a few days.

There are no absolutes in medicine, but I will share that in my 20 years of practice, 99% of my patients who have actually HAD a real case of influenza make it a priority to get a flu shot each year so they don't have to experience the flu again. This is not a perfect vaccine, but annual flu vaccines greatly reduce your chance of getting the flu, and definitely decrease the severity of the infection if you end up with influenza.

BOTTOM LINE: The CDC recommends ANNUAL FLU VACCINE for everyone* over the age of 6 months. I got mine- did you get yours yet?

(*Flu vaccine is not indicated for the minority of people with "severe, life-threatening allergies to flu vaccine or any ingredient in the vaccine. This might include gelatin, antibiotics, or other ingredients. ")

I Got Mine! Did You Get Yours?

As we zip into the holiday season, give yourself 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?
This 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.

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:  FLU SEASON has begun again- get vaccinated!

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.)

The Flu: When to Treat?

Yesterday, I had a discussion with some friends about whether or not to treat the flu with antiviral medications (Tamiflu or Relenza). Conveniently, today the CDC posted expert commentary on the latest guidelines, so I thought I'd share them with you.
Basically it boils down to this:

People at risk of more severe illness should definitely be treated: pregnant women, the very old or very young, people with underlying medical issues that suppress their immune system (cancer, HIV)
People with severe or rapidly progressive flu symptoms should be treated.
Anyone hospitalized should be treated.

For the rest of the public- the otherwise healthy, non-pregnant population- the CDC has wisely left it up to the DOCTOR's discretion, as long as treatment is started within 48 hours of the onset of symptoms.

The antiviral medications have been shown to shorten the course of the flu by one day, and can limit the severity of the flu. However, side effects often include significant nausea or vomiting, as well as headache. It really depends on how sensitive you are to side effects as to whether or not it is "worth it" to treat for the flu.

Don't forget, though, that prevention with the flu vaccine and consistent hand-washing are your best first lines of defense!

BOTTOM LINE: If you develop flu symptoms (fever, chills, cough, sore throat, runny nose, muscle aches and headaches), see your doctor quickly so if you ARE a candidate for antiviral therapy, you can start it with 48 hours of your symptoms.