Prevention
The ideal way to deal with the flu is prevention. Once the flu is present, treatment works to support the immune system and decrease the severity or duration of symptoms.
Conventional prevention measures include vaccines to decrease the risk of getting the flu. For treatment there are prescription medications (antivirals) that may decrease the severity or duration of symptoms if taken early in the course of infection. Patients also need lots of rest and may need cold compresses or over-the-counter medications to reduce fever if it becomes dangerously high. Also, remember to get plenty of fluids, as fever can wreak havoc on the body's internal homeostasis. There is much “insensible†fluid loss when the body is heated, even if there is no perspiration. Assistance with hydration is especially important in children and the elderly, as these groups usually are more dependent upon others to help them through illness. Influenza outbreaks can happen as early as October and most of the time influenza activity peaks in January or later. For this reason, the Centers for Disease Control and Prevention (CDC) recommends that everyone 6 months of age and older should get vaccinated against the flu as soon as the 2010-2011 seasonal vaccine is available in their respective area and anytime thereafter throughout the influenza season, into December, January, and beyond. It takes about 2 weeks after vaccination before antibodies that provide protection against influenza virus infection develop in the body. Protection lasts for less than one year requiring re-vaccination every year.
For those in one of the high-risk groups for flu, a health care provider will most likely stress the importance of getting vaccinated against the illness in the early fall - usually in September, to decrease their risk of severe flu illness. Vaccination is important for health care workers and other people who live with or care for high risk people to keep from spreading flu to high risk people. Children younger than 6 months are at high risk of serious flu illness, but are too young to be vaccinated. For this reason, people who care for them should be vaccinated.
Unlike the 2009-2010 flu season when two vaccines were needed, for the 2010-2011 flu season you only need the seasonal vaccine. This is because the 2010-2011 influenza vaccine combines the seasonal influenza strains as well as 2009 H1N1 influenza. This preparation of the vaccine will protect against the 2009 H1N1 virus, the influenza A H3N2 virus (prevalent in 2008-2009), and an influenza B virus that also caused illness during the 2009-2010 season. (6) Make sure to work with a doctor to ensure proper protection. If you are 65 and older, or immunocompromised, you may need more shots of the vaccine or a stronger vaccine, which is available.
Many employers, college campuses, and even local pharmacies offer flu shots. Check with the employer's Human Resources department or campus health clinic to see if these programs are available. It may be the easiest and most cost-effective way of protecting against a dreary bout of the flu.
Flu vaccines come in two forms: the commonly known flu shot and a nasal-spray vaccine. Although they protect against the same flu viruses each season, they are not the same. The flu shot is administered as an injection in the arm. This shot contains dead flu virus and protects against the flu because the body becomes familiar with the potential invader and produces antibodies against it, which protects the body at the next exposure. You cannot get the flu from a flu shot vaccine. The nasal spray contains a weakened form of live flu virus and is sometimes referred to as “live attenuated influenza vaccine†or (LAIV). It also provides protection by familiarizing the body with the virus, thereby boosting immunity from the start. Advantages of the nasal spray are easier administration for children and others who are averse to getting a flu “shotâ€. However, the nasal spray is only approved for people ages 2-49, who are in good health, are not pregnant, and who are not working or living with people who have compromised immune function because they could shed enough of the live virus to infect other people.
Different side effects can be associated with the flu shot and the nasal-spray (LAIV) vaccine.
The flu shot: The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot. Some minor side effects that could occur are:
- Soreness, redness, or swelling where the shot was given
- Fever (low grade)
- Aches
If these problems occur, they begin soon after the shot and usually last 1 to 2 days. Almost all people who receive influenza vaccine have no serious problems from it. However, on rare occasions, flu vaccination can cause serious problems, such as severe allergic reactions.
The nasal spray (also called LAIV or FluMist®): The viruses in the nasal-spray vaccine are weakened and do not cause severe symptoms often associated with influenza illness. (In clinical studies, transmission of vaccine viruses to close contacts has occurred only rarely.)
In children, side effects from LAIV (brand name FluMist®) can include:
- runny nose
- wheezing
- headache
- vomiting
- muscle aches
- fever
In adults, side effects from LAIV (brand name FluMist®) can include
- runny nose
- headache
- sore throat
- cough
Medications
In most cases of flu, a doctor will prescribe bed rest and use of over-the-counter or prescription medicines to help alleviate high fevers, cough, or stomach upset. Acetaminophen (Tylenol), aspirin, and ibuprofen are the most commonly recommended remedies to reduce fever and ease flu symptoms. (Do not give aspirin to children or teenagers younger than 18 who have the flu, as this can cause a rare but serious illness called Reye's syndrome.) And remember that fever is the body's mechanism for creating an environment that is less hospitable to infectious invaders. Unless the fever is very high (over103 degrees Fahrenheit), it probably should not be treated.
The neuraminidase inhibitors zanamivir, which is a nasal spray (Relenza®), and oseltamivir (Tamiflu®) may help to shorten the duration of flu by one or two days, as well as to reduce symptoms and prevent serious flu complications. The neuraminidase inhibitors work by blocking the reproduction of the virus in host cells, thus preventing spread of infection. These drugs need to be used early in the course of the condition (within two days of becoming sick) to be helpful. (7, 8) These drugs are Food and Drug Administration (FDA)-approved for the treatment of flu, and in the midst of the 2009 pandemic, the World Health Organization (WHO) recommended physicians administer antivirals early to high-risk patients, rather than waiting for laboratory tests to confirm that patients had the H1N1 influenza as previously recommended. (9)
Elderly patients, high-risk patients or those with a compromised immune system may need more aggressive therapy to prevent flu-related complications that can very easily become serious enough to require hospitalization. For patients who require intravenous therapy, peramivir (also a neuraminidase inhibitor) is an experimental antiviral drug that was approved by the FDA during the pandemic for emergency use in patients with suspected or confirmed 2009 H1N1 influenza A infection— particularly critically ill patients and those who did not respond to oral or inhaled zanamivir or oseltamivir. (10, 11) Intravenous zanamivir also is recommended for patients with oseltamivir-resistant 2009 H1N1 influenza Type A infection. (12)
Some preliminary evidence indicates that the anti-inflammatory effects of statins (drugs taken to lower cholesterol levels and prevent cardiovascular disease) may help to reduce the severity of flu illness, but randomized trials are needed to confirm or refute efficacy. (13, 14)
Tests and Procedures
A doctor will want to review the patient's medical history and evaluate any symptoms that can help differentiate between cold and flu. Often this can be done over the phone in order to allow the patient to rest and to avoid exposure of other patients in the waiting room. Some symptoms of flu that are not usually present in colds include high fever, headache, persistent aches and pains, extreme fatigue, vomiting and diarrhea. Based on the patient's disclosure, the doctor will help the patient construct a treatment plan to address the individual constellation of symptoms and signs.
Patients with severe illness, such as hospitalized patients, or those at high risk for complications may require a rapid test to diagnose flu and rule out other causes of symptoms. These tests are performed by a medical professional by swiping the back of the patient's nose or throat with a swab then sending the swab for laboratory testing. Rapid tests can provide results as quickly as 30 minutes or less. However, these sometimes fail to detect flu viruses, resulting in a false negative test, and they cannot determine the type of virus infecting the patient. According to the CDC, false-negative results are more likely to occur during the height of the influenza season, when disease prevalence (the number of cases in the community) is high within a particular population. And, conversely, false-positive results are more likely to occur at the beginning and end of the influenza season, when prevalence is low. (15) The more sensitive tests must be sent to specialized laboratories for processing; thus results are not immediately available.
Treatment and Prevention
Although extremely debilitating and uncomfortable during illness, most cases of the flu are not dangerous and usually clear up – with or without treatment – within 10 days. A self-care regimen of bed rest, hot fluids and aspirin or acetaminophen helps to ease flu symptoms, and antiviral supplements may help to speed recovery.
Getting a flu shot every fall is the most effective way to prevent that year's flu variation (or at least reduce its severity if contracted). The vaccine is especially recommended for the elderly and anyone else at high risk of developing flu-related complications. Those who are allergic to eggs (the medium for manufacture of flu vaccines) and those with compromised immune systems including eczema and severe allergies, should consult a physician for the most current information regarding vaccine safety before getting a flu shot.
In contrast to many other respiratory viruses that are spread by airborne transmission, influenza virus is most easily spread by contact with contaminated secretions. Repeated hand-washing is one of the most powerful preventive measures available when in close proximity to someone who has the flu.
How Supplements Can Help
Note: none of the supplements or complementary and alternative therapies described below have been specifically tested with 2009 H1N1 influenza A. However, a healthy immune system is the first line of defense, and some of these suggestions may be helpful.
Antioxidants, such as vitamin C and vitamin E, taken at the first sign of a cold or the flu in high doses may help to keep the illness from fully developing and to speed recovery, especially if the diet is deficient in these nutrients. (16-19) In a 1999 prospective, controlled study of 715 students ranging in age from 18 to 32, taking hourly doses of 1,000 mg of vitamin C for the first six hours after flu and cold symptoms arose and then three times daily for the next five to seven days lessened the severity of symptoms by an average of 85% compared to the control group. (13) Studies in mice have shown that vitamin E supplementation improved oxidative stress associated with influenza. (18-19) However, conflicting results exist. Studies have shown that taking vitamin E does not seem to decrease the incidence, duration or severity of upper or lower respiratory infections in elderly people. (20, 21) Studies have also shown that taking vitamin C or vitamin E in advance of getting the illness does not decrease the risk of developing respiratory infection. (22)
Research has shown that some elderberry extracts may help to reduce flu-like symptoms, as well as to reduce the duration of influenza infection (types A and B) when taken within the first two days of symptoms. A 1995 study showed that a specific syrup formulation of elderberry fruit extract (Sambucol, Nature's Way) resulted in significant relief of symptoms including fever within two to four days of treatment, while the placebo group did not show improvement until after six days of symptoms. (23) In a 2004 study of 60 adults with flu, taking 15ml of the elderberry syrup four times daily for five days resulted in a shorter duration of illness (by four days) compared to placebo syrup. (24) On average, the extract seems to reduce the duration of symptoms by about 56%. (24) A 2009 laboratory study showed that flavonoids from the elderberry extract inhibit H1N1 influenza infection in vitro at a rate comparable to that of the conventional treatments oseltamivir and amantadine. (25) More research is needed.
The trace elements selenium and zinc are important in cases of deficiencies, which can exacerbate inflammatory lung damage and infection during influenza. (26) These trace minerals have been shown to rapidly correct deficiencies and to prevent influenza infection, particularly in institutionalized elderly patients. (27-30) In a 1999 two-year randomized, double-blind, placebo-controlled study of 725 institutionalized elderly patients (65 and older), taking low-dose selenium and zinc supplementation daily with or without vitamins (beta carotene, vitamin C and vitamin E) resulted in the correction of deficiencies within six months, higher levels of influenza antibodies after vaccination, and a decrease in the number of patients contracting respiratory tract infections during compared to patients taking vitamins alone or placebo. (28) A 2007 study in mice found that prophylactic use of a novel zinc protein combination (ZnAL42) inhibited the development of H1N1 virus infection. (31) A 2010 study in mice found selenium supplementation improves the immune response to viral infections, including the H1N1 influenza A virus. (32)
Vitamin D has antibiotic properties that may help to fight respiratory infection during influenza. Called the sunlight vitamin, the body produces vitamin D3 when the sun's ultraviolet B (UVB) rays strike the skin. Because the onset of the “flu season†corresponds to the time of year when people have the least sun exposure, nutritional physicians have begun to wonder if vitamin D deficiency predisposes people to getting the flu. British researcher Edgar Hope-Simpson first documented the seasonality of epidemic influenza in the 1960s (after he became famous for discovering the cause of shingles), but he did not identify the specific factor involved. Researchers later hypothesized that vitamin D is the "seasonal factor" responsible for triggering flu epidemics, supported by evidence that vitamin D boosts the immune system, protects against infection and inhibits Inflammation. The main study involved mentally ill patients confined to a hospital ward who were quarantined during an influenza epidemic in 2005. The quarantined patients had been taking 2,000 IU of vitamin D3 daily for several months or longer and did not contract the flu, while staff and patients in the other wards around the quarantined patients who did not receive the supplement were battling the epidemic. (33-35) Experts initially suggested that daily vitamin D supplementation could be effective against the H1N1 influenza virus. However, a 2010 review by the Pennsylvania State University Center for Molecular Immunology and Infectious Disease found insufficient scientific evidence to recommend it at this time, citing a lack of research in cells, mice or humans to evaluate the effect of vitamin D on influenza virus. (36)
Vitamin A has also been shown to fight off infection, maintain healthy lung tissue and reduce inflammation, making it potentially useful in fighting influenza. (37-41) A 2000 study of 61 healthy elderly adults and 27 young adults found no association between plasma vitamin A levels and antibody responses after flu vaccination; however the body typically maintains plasma vitamin A levels in a normal range unless the individual is severely deplete. (42) More research is needed.
Several large randomized, controlled trials indicate that Echinacea taken with goldenseal in early stages of flu may prevent some symptoms from developing and can also reduce the severity of flu symptoms. (43-47) Additionally, laboratory testing in 2009 showed that taking recommended oral dosages of a standardized extract of the herb Echinacea purpurea (Echinaforce, EF) inactivated human H1N1 influenza cells, including Tamiflu®-resistant strains of the virus. (48) Some conflicting evidence exists, however. A recent review of studies indicated that while early use of the aerial parts of the Echinacea purpurea may be beneficial, studies have been inconsistent for other Echinacea species and for prevention. (49) A study with 437 volunteers taking an extract of Echinacea angustifolia demonstrated no efficacy in preventing or treating colds and flu. (50)
Garlic taken at the first sign of flu may prevent flu-related bacterial infections from developing. The antiseptic and antibacterial properties of garlic were recognized centuries ago. Modern research confirms that, at least in the laboratory, the herb fights the germs responsible for causing the common cold, flu, sore throat, sinusitis, and bronchitis. Findings indicate that one of garlic's therapeutic constituents, allicin, blocks key enzymes that aid bacteria and viruses in their effort to invade and damage tissues. (51, 52) More research is needed.
Oil from the borage plant has antibacterial and fever-reducing properties that may help to alleviate flu symptoms. (53)
By thinning mucus and weakening the f