Medical Memo: What To Do About The Flu

content provided by the Faculty of the Harvard Medical School

What to do about the flu

Experts have urged nearly all Americans older than 50 to get a flu shot each year. With the unexpected loss of 48 million doses of vaccine, that's not possible in 2004-05. But it's still possible to prevent the flu.

People at high risk should try to get the vaccine. Among adults, candidates include people over 65 and those with chronic medical conditions such as asthma, emphysema, diabetes, heart disease, kidney disease, and weakened immune systems. Residents of nursing homes and long-term care facilities should be immunized whenever possible. Pregnant women and people who take care of infants younger than six months of age are also candidates for flu shots. Health care workers who have substantial contact with patients round out the list, but many are forgoing their shots to stretch the supply for vulnerable patients. People in good general health should do the same. Individuals with high-grade egg allergies should not get the flu shot. A limited supply of an intranasal vaccine is available, but it's not approved for any high-risk individuals.

Even without the flu shot, you can protect yourself from infection. Here are a few tips:

• Wash your hands. Alcohol-based hand rubs and gels are best. Look for one containing 60% - 95% isopropanol or ethanol. Ordinary soap and water will also help, but you needn't use very hot water or "antibacterial" soaps. Antimicrobial towelettes may be useful when you're on the move. Wash carefully after any contact with folks who have flulike symptoms.

• Keep your distance. The flu is most contagious within three feet of a patient. If your community is hit hard this winter, try to minimize the time you spend in crowded places.

• Wear a mask, particularly if you are in a high-risk group and you can't avoid getting up close and personal with possible flu victims. Be sure your mask fits well. Keep it dry and free of saliva, and change it periodically. N-95 respirator masks are best.

• Protect others. Don't go to work or school if you have the flu. Cover your mouth with a tissue when you sneeze or cough, and dispose of it properly. Wear a mask if you have to go out, especially in health care facilities.

These simple measures will reduce your risk. But if you are in the high-risk group, ask your doctor about prescription drugs that can cut the risk of infection by 60% - 85% even in people who have not been vaccinated. Preventive medications are particularly useful in communities with major flu outbreaks. Three drugs are available:

• Rimantadine (Flumadine) is effective against influenza A, the most common and severe flu bug. Rimantadine is relatively inexpensive and it is quite safe, though some patients experience dry mouth, nausea, dizziness, or nervousness. The usual dose is 100 mg twice a day, but it should be reduced to 100 mg once a day in people over 65 and in those with severe kidney or liver disease.

• Amantadine (Symmetrel) is very similar to rimantadine in its efficacy, cost, and dosage, but it is a bit more likely to cause temporary side effects such as impaired coordination or concentration. Patients with liver disease, congestive heart failure, and epilepsy should not use this medication.

• Oseltamivir (Tamiflu) is a newer, much more expensive drug that works against both influenza A and B. Also a safe medication, it can occasionally cause nausea, vomiting, dizziness, and insomnia. The usual preventive dose is 75 mg once a day (or every other day in patients with severe kidney disease).

If your doctor decides that preventive medication is right for you, start treatment as soon as you are exposed. If you have only a single exposure, you can stop after 10 days, but if you need protection from a outbreak in your community, you can continue the medication for the entire flu season.

Each of these medications can also help if you start them within 48 hours of getting flu symptoms; zanamivir (Relenza), an inhaled medication, is also available but is less desirable because it can cause wheezing. Five days of antiviral medication can shorten the duration of influenza, and fluids, rest, and fever-fighting medications can provide comfort. Still, prevention is best. Because there aren't enough flu vaccinations to go around, many of us will have to rely on simple precautions, and some will benefit from preventive prescription medication.

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Last updated:	August 21, 2006