Influenza

Flu season is around the corner and we should take a look at the virus for preparation purposes.

Influenza

Every few years, I revisit this virus in my writing, not only to keep it on your radar in preparation, but also because of the significant illness and death it continues to cause. It’s never wise to dismiss its potential impact. Influenza reliably returns each year, difficult to escape even with strict isolation.

The flu is different from the common cold in many ways as the flu has:

1) Rapid onset with high spiking fevers

2) Muscle and headaches 

3) Little to not sneezing and sore throat

4) Rapid and robust cough onset

Influenza season is beginning in the United States this fall. Who gets sick? In short, people of all ages. Seasonal influenza has a reproductive rate of just over one, meaning that each infected person typically spreads the virus to one or two others through coughing or sneezing in close proximity. The virus also survives on surfaces for up to 24 hours, creating another common route of transmission, especially in children. Young kids frequently touch surfaces and each other, then touch their faces, providing the perfect pathway for infection. Because of this, schools remain a major hub for flu transmission across the country.

Preventing the virus from taking root in your body is the key to avoiding a bad outcome. 

Things that I think of as critical to avoiding or preventing this infection:

1) Keeping your vitamin D level greater than 50 ng/ml is an important way to prevent influenza infections. Get tested and supplement accordingly. As always the sun is your natural route to normal D levels

2) Get adequate sleep based on your age to keep your immune system in great shape. Sleep is very important for immune health

3) Eat lots of fiber based foods that are natural and minimally or not processed

4) Wash your hands throughly for 20 seconds with soap and water multiple times a day. Especially in high risk areas like schools

5) Eat lots of fresh citrus and colorful yellow, red and orange foods for adequate vitamin C

6) Maintain adequate zinc levels in your body for a healthy immune system. Zinc is commonly found in beef, lamb, wheat germ, spinach, seeds, mushrooms, nuts, beans, pork and cocoa

7) Avoid touching your eyes, nose and mouth. This helps you avoid viral transmission

8) Stay well hydrated and keep your system stout by drinking 1 ounce of water per kilogram of body weight a day

9) Stay positive mentally and be happy - immune enhancing



Does the vaccine make a huge difference? For some, yes.

"During 2010-2016, the incidence of symptomatic influenza among vaccinated and unvaccinated US residents, including both medically attended and nonattended infections, was approximately 8% and varied from 3% to 11% among seasons." (Tokars et. al. 2018) Last year's flu season was particularly rough in North Carolina. According to the CDC there were 275 pediatric deaths last year primarily among young children and children with chronic health conditions of which the majority were not vaccinated. (CDC stats) This was the highest death rate in some time. We also know that Influenza claims 10's of thousands of lives a year in this country, especially among the elderly.

Consider getting the flu shot as it can significantly reduce your risk of mortality (if you are at risk) even if it does not entirely prevent everyone from getting sick. 

All high risk groups should definitely get a flu vaccine and avoid the risk. Who is high risk?: pregnant women, children less than 2 years old, people with lung diseases, neurodegenerative disorders, immune defects, heart disease ...

If you contract the virus, then what should you do???

Medicines that are antiviral for the influenza virus seem to be of limited value in the average healthy adult or child over age 5 years according to the published research. High risk groups can still benefit from these medicines to control a potential bad outcome.

Continuing on this theme: Does the flu or the medicine used to treat the flu lead to the neurological symptoms that are seen after treatment with oseltamivir? Accorinding to Dr. Antoon and colleagues, it is the virus and not the medicine that is the culprit. From the paper: "Among 692,975 eligible children, a total of 692,295 children experienced 1230 serious neuropsychiatric events (898 neurologic and 332 psychiatric) during 19,688,320 person-weeks of follow-up. Among the 151,401 influenza episodes, 66.7% were dispensed oseltamivir (60.1% among those at high risk for influenza complications). The most common events overall were mood disorders (36.3%) and suicidal or self-harm behaviors (34.2%). Compared with untreated influenza, event rates were lower during oseltamivir-treated influenza periods and post treatment periods. Subanalyses suggest that this finding is driven more by a reduction in neurologic events than psychiatric events. Sensitivity analyses suggest misclassification or unmeasured confounding would not explain these findings." (Antoon et. al. 2025)

This is not surprising to me as it is well known that viral illnesses and bacterial disease can trigger neurological changes and symptoms. Reducing the inflammation related to the infection would likely reduce disease risk.

Be flu aware,

Dr. M

Tokars Clin Inf Dis

Antoon JAMA Neurology