Prevention and Treatment

Treatment Goals

1. Prevent illness from occurring
2. Reduce the risk of serious complications

Vaccines

How does a person avoid getting influenza?

Aside from good hygiene including frequent hand washing and avoiding people with influenza (flu) type symptoms the primary method for preventing illness is vaccination. Antiviral agents can prevent illness in people who have been exposed or will be exposed to the influenza virus if it is taken within 36 to 48 hours of exposure. However, due to the risk of developing viral resistance, these medications are reserved for special circumstances, such as people who are at high risk for complications.

How does a person prevent spreading influenza?

When you have influenza (flu) like symptoms, the best way to prevent spreading it includes:

• frequent hand washing
• covering your mouth with a tissue or your elbow when you sneeze or cough
• avoid close contact with people
• try to avoid contact with children less than two years of age, people with chronic illness, or conditions that can compromise their ability to clear their respiratory tracts
• stay away from work, school, church, shopping centers and other public areas
• remain in your bedroom as much as possible until symptoms have disappeared

What are the benefits of the vaccine?

Influenza vaccine is recommended for:

• possible prevention of hospitalization and death among persons at high risk
• a reduction of influenza-related respiratory illnesses
• a reduction in physician visits
• a reduction of ear infections
• a reduction in work related absenteeism
• a reduction in health care costs

How effective is the vaccine?

The effectiveness of the vaccination depends on:

• how well researchers were able to predict the type of virus that would cause an outbreak
• and the individual?s ability to produce antibodies

Every year in February researchers try to predict the type of viruses that will lead to influenza outbreaks the following year and use this prediction to develop a new vaccine. When viruses that had not been anticipated are involved in an outbreak the vaccine will be less than 100 % effective in preventing influenza. However, even when a vaccine fails to prevent influenza it can still decrease the severity of the symptoms and the complications associated with it.

How often does someone need to get vaccinated?

Because influenza viruses mutate (change) rapidly it is important to get a vaccination yearly.

What types of vaccines are available?

There are two types of vaccines available:

• trivalent inactivated vaccine (TIV), which is administered as an injection
• live attenuated influenza vaccine (LAIV), which is available as a nasal spray.

Trivalent Inactivated Vaccine (TIV)

Examples:

Fluzone - for children and adults 6 months and older

Fluvirin -for children and adults 4 years and older

Fluarix - for adults ?18 years

FluLaval - for adults?18 years

• contains killed viruses
• cannot produce signs or symptoms of infection
• administered by injection
• required yearly
• approved for adults and children >6 months
• approved for healthy individuals, individuals with chronic illnesses and immunocompromised patients
• avoid in individuals with severe allergies to eggs
• side effects: soreness, redness, swelling, limited movement at injection site

Live Attenuated Influenza Vaccine (LAIV) Example: FluMist

• contains live, attenuated viruses
• can produce mild signs and symptoms of infection
• administered by nasal spray
• required yearly
• approved for use among healthy persons aged 2-49 years of age
• approved for healthy individuals only
• avoid in individuals with severe allergies to eggs
• avoid in individuals who have had Guillain-Barre Syndrome and children or adolescents receiving aspirin
• side effects: mild flu like symptoms, runny nose, congestion, headache, fever, muscle aches and vomiting, primarily in children

When should a person get the influenza (flu) vaccine?

The best time to get the influenza vaccine is in October or November. However, because the demand sometimes exceeds the supply, healthcare providers are not always able to get the number of vaccines they need. For this reason people who are at greater risk for complications from influenza are encouraged to get their vaccination as early as September to make sure they get it before supplies run out.

Can I receive the vaccine if I have a cold?

People who have mild illness can get the vaccine. However if you have a runny nose or nasal congestion, the nasal spray could be less effective, so you should either get the injection or wait until your symptoms have cleared. People who have moderate or severe symptoms should wait until they are well.

How many doses of vaccine are required?

Injection: Children 9 years of age and under who are receiving influenza vaccine for the first time should receive 2 doses administered at least one month apart. Adults and children 9 years and older receive one dose of vaccine by injection. Vaccination is recommended yearly.

Nasal Spray: Children 2 to 8 years of age who are receiving influenza vaccine for the first time should receive 2 doses administered 6-10 weeks apart. All others receive one dose. Vaccination is recommended yearly.

How soon is the vaccine effective?

It generally takes the body about two weeks to develop immunity against the influenza virus after receiving the vaccine.

How do I decide which type of vaccination I should choose, the injection or the nasal spray?

Only healthy individuals between the ages of 2 and 49 should use the nasal spray. Two groups of people should receive the injection, 1) individuals at risk for complications because of age or illness and 2) those in frequent contact with individuals who are at high risk for complications (i.e. cancer patients, organ transplant recipients).

1. Those who need to avoid getting influenza

• children aged 6-59 months;
• adults ? 50
• children and adolescents (aged 6 months--18 years) who are receiving long-term aspirin therapy and, therefore, might be at risk for experiencing Reye syndrome after influenza virus infection;
• women who will be pregnant during the influenza season;
• adults and children who have chronic lung disease such as asthma, emphysema, chronic bronchitis, bronchiectasis, tuberculosis, or cystic fibrosis
• adults and children with cardiovascular (heart) disease (hypertension is not considered a high-risk condition);
• adults and children who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies (anemias)
• adults and children with immunodeficiency caused by immunosuppressive treatments
• adults and children with immunodeficiency diseases such as those caused by the human immunodeficiency virus (HIV);
• adults and children who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration;

2. People who need to avoid transmitting influenza

• breast feeding mothers
• family and close contacts of immunocompromised patients (i.e.cancer, organ transplant)
• caregivers of children 0-59 months
• caregivers for individuals at risk for influenza complications
• all health care workers
• employees in group homes