Influenza Update: A Summary of the Latest Recommendations from the CDC

REDUCE THE RISKS OF CATCHING OR SPREADING THE FLU

You can reduce your risks of getting the flu by doing the following:

  • Get the flu vaccine— The United States Centers for Disease Control and Prevention (CDC) recommends that all people six months of age or older get a flu vaccine every flu season, especially people at high risk. (See sidebars for on adjacent page for more information).
  • Keep your hands clean—Wash your hands before, during, and after food preparation; after eating, going to the bathroom, or blowing your nose, sneezing, or coughing; afterhandling/petting an animal; after caring for someone who is sick; after touching garbage; and after cleaning a wound.

• Cover your nose and mouth when you sneeze or cough. Make sure to wash your hands after sneezing or coughing into them.

• Avoid touching your eyes, nose, or mouth. A person might get the flu by touching a surface or object that has flu virus on it and then touching his or her own mouth, nose, or eyes.

• Practice good hygiene and health habits. Clean and disinfect frequently touched surfaces at home, work, or school, especially when someone is ill. Keep your hands clean. Make sure you get plenty of sleep, are physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

• Stay home. People with the flu should stay home or keep their sick children home until the fever has been gone for 24 hours.

WHERE CAN YOU GET YOUR FLU VACCINE?

Your doctor’s office will offer flu shots. Several national chain drug and grocery stores offer flu vaccinations to the public, such as CVS Pharmacy, Wegmans, Rite Aid, and Giant Food Stores. However, the CDC has a nifty widget on their website that will provide a list of stores and pharmacies in your area that offer flu shots. You just enter your zip code and click “go.” Here’s the link: https://www. cdc.gov/flu/freeresources/flu-finder- widget.html.

TREATMENT RECOMMENDATIONS

Most people who get the flu won’t require medical intervention. They will be ok just letting the illness run its course, provided they stay hydrated and get plenty of bed rest. Aches and pains, fever, nausea, and other physical symptoms can be reduced with over-the-counter medications (e.g., acetaminophen, ibuprofen, anti-nausea medications), which will make you feel more comfortable. Children and teens recovering from flu-like symptoms should never take aspirin because of the risk of Reye’s syndrome, a rare but potentially fatal condition.

In cases of very severe infection or for those individuals who are at higher risk to develop complications from the flu, medical intervention, such as prescription medication and/or hospitalization, may be required. (See sidebar on adjacent page for high risk factors).

Because the flu is caused by a virus, not a bacteria, antibiotics are ineffective against the flu. However, there are prescription antiviral drugs available for flu treatment. Ideally, antiviral drugs should be started within two days of first developing flu symptoms. If started early enough, these medications can reduce fever and flu symptoms and shorten the amount of time you are sick. Antiviral drugs can also reduce the risk of the following:

  • Respiratory complications requiring antibiotics
  • Hospitalization for the flu or other flu-related complications in adults Risk of death in adults who have been hospitalize for the flu or associated complications
  • Ear infections in children.

The CDC recommends the following antiviral medications, which are only available by prescription: oseltamivir phosphate (available as a generic version or under the trade name Tamiflu®), zanamivir (Relenza®), peramivir (Rapivab®), and baloxavir marboxil (Xofluza®).

Health facts about the Flu Vaccine

  • All people aged six months or older get an annual flu vaccination, with rare exception.
  • Children younger than six months of age are too young to get a flu shot
  • People with severe, life-threatening allergies to flu vaccine or any ingredient in the vaccine should not get the vaccine (e.g., gelatin, antibiotics, or other ingredients).
  • The vaccine can be administered as a shot or as a nasal spray.
  • There are different flu shots approved for people of different ages (i.e., some shots can be used in people as young as 6 months old, and others are only approved for use in adults).
  • Flu shots are recommended for pregnant women and people with chronic health conditions.
  • The nasal spray is an option for healthy, non-pregnant people aged 2 to 49 years of age.
  • People who are immunocompromised, who are younger than two years of age, who are 2 to 4 years of age and have asthma, or who are pregnant should not get the nasal spray vaccine.

Health Factors that Increase the Risk of Developing Complications from the Flu

  • Asthma
  • Neurologic and neurodevelopment conditions
  • Blood disorders (e.g., sickle cell disease)
  • Chronic lung disease (e.g., chronic obstructive pulmonary disease [COPD], cystic fibrosis)
  • Endocrine disorders (e.g., diabetes mellitus)
  • Heart disease(e.g. Congenital heart disease, congestive heart failure and coronary artery disease)
  • Kidney disorders
  • Liver disorders
  • Metabolic disorders (e.g., inherited metabolic, mitochondrial)
  • Body mass index[BMI]of 40 or higher
  • Aged 18 or younger on long-term aspirin- or salicylate-containing medications
  • Weakened immune system due to disease (e.g., HIV, AIDS, leukemia) or medications (e.g., chemotherapy or radiation treatment for cancer, chronic corticosteroids, other drugs that suppress the immune system)
  • Aged65yearsorolder
  • Aged younger than 2 years old—Although all children younger than 5 years old are considered at high risk for serious flu complications, the highest risk is for those younger than
    2 years old, with the highest hospitalization and death rates among infants younger than 6 months old.
  • Pregnancy and 2weeksafterthe end of pregnancy
  • American Indian or Alaska Native descent
  • Living in a nursing home or other long-term care facility

Flu Warning Signs to Seek Medical Care Right Away

IN CHILDREN

  • Fast breathing or trouble breathing
  • Bluish lips or face
  • Ribs pulling in with each breath
  • Chest pain
  • Severe muscle pain (child refuses to walk)
  • Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
  • Not alert or interacting when awake
  • Seizures
  • Fever above 104°F

IN CHILDREN LESS THAN 12 WEEKS OF AGE

  • Any fever
  • Fever or cough that improve but then return or worsen
  • Worsening of chronic medical conditions

IN ADULTS

• Difficulty breathing or shortness of breath

• Persistent pain or pressure in the chest or abdomen

  • Persistent dizziness, confusion, inability to arouse
  • Seizures
  • Not urinating
  • Severe muscle pain
  • Severe weakness or unsteadiness
  • Fever or cough that improve but then return or worsen
  • Worsening of chronic medical conditions

Disrupting the Gut Microbiome May Affect Some Immune Responses to Flu Vaccination

The normal human gut microbiome is a flourishing community of microorganisms, some of which can affect the human immune system. In a new paper published this past September (2019) in the journal Cell, researchers found that oral antibiotics, which can kill gut microorganisms, can alter the human immune response to seasonal influenza vaccination. The work was led by scientists at Stanford University and funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. The research team examined 33 healthy adult participants in their study. One group of 22 volunteers was studied during the 2014-2015 flu season, and the second group with 11 volunteers was studied during the 2015-2016 flu season. The group of 22 volunteers had high pre-existing immunity to the influenza virus strains contained in the 2014 to 2015 seasonal influenza vaccine. The group of 11 volunteers had low immunity to the 2015 to 2016 seasonal influenza vaccine’s virus strains.

All study participants received a seasonal influenza vaccine. Half the participants in each group also received a five-day course of a broad-spectrum antibiotic regimen (consisting of neomycin, vancomycin, and metronidazole) by mouth before receiving the vaccine. By analyzing stool and blood serum samples taken at various times up to one year after vaccination, the researchers tracked the participants’ immune response to the influenza vaccines, as well as the diversity and abundance of the organisms in their gut microbiomes.
As expected, most participants who received antibiotics experienced reduced levels of gut bacteria. In addition, among the 2015 to 2016 participants who had little prior immunity to the seasonal influenza virus vaccine strains, a course of antibiotics hindered their immune responses to one of the three influenza virus strains in the vaccine, an H1N1 A/California-specific virus. This likely indicates that should they be exposed to this

H1N1 virus after vaccination, these participants would be less protected against infection with that strain than people who had not received antibiotics, according to the authors. This finding supports earlier research results in mice.

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