Influencing Influenza

Influencing Influenza

Author: Mark Parkinson RPh:  President  AFC-CE

Credit Hours 1- Approximate time required: 60 min.

Educational Goal:

Explain what the flu is and why it is important to get a flu vaccination.

Educational Objectives:

Define what influenza is.

Explain about the different types of the flu virus.

List the risk factors and complication of the flu.

Explain why it is important to get a yearly flu shot.

Tell how the flu is managed.

 

Procedure:

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Disclaimer

   The information presented in this activity is not meant to serve as a guideline for patient management. All procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this article should not be used by care providers without evaluation of their patients’ Doctor. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication. Nutritional products discussed are not intended for the diagnosis, treatment, cure, or prevention of any disease.

 

 

 

 

Influencing Influenza

 

I recently was driving around town and noticed all the signs plastered around pharmacies about getting a flu shot. It started to make me think. Who should get a flu shot? Why should you get a flu shot? Is the flu that big of deal to warrant a special trip out? I recalled memories from my pre-pharmacy days thinking that the flu was just a cold that just got more annoying? If I being a pharmacist had these thoughts I told myself that it was time to research and write a Continuing Education article on the flu. I intend to provide the answers to the caregivers who might be thinking the same kind of questions.

In quick summary- Yes, it’s worth paying attention to and No it’s just not a more annoying cold. Influenza, commonly shortened to just the “flu”, is a highly contagious illness that disproportionately affects children and the elderly. It can cause mild to severe cases including the deaths of tens of millions of people in the past. Without vaccination it continues to pose a significant health threat to the public in general and to the infirm and children specifically.

 

What is Influenza?

Influenza is a viral infection of the upper respiratory tract. In healthy adults the illness lasts between 1 to 2 weeks. Its initial symptoms appear like the common cold, mainly sneezing, coughing and a running nose. As the infection progresses, more advanced symptoms begin to appear. The advanced signs and symptoms of the flu are; fever over 100.4 F (38 C), aching muscles, chills and sweats, headache, a dry persistent cough, fatigue, weakness, and a sore throat. In those with compromised or under developed immune systems, influenza can lead to the death of the patient. Other infections have similar signs and symptoms. The common cold, pneumonia, bacterial infections and GI tract infection (stomach flu) have all been mistakenly called influenza.

Officially, influenza is only caused by the Orthomyxoviridae RNA virus, of which there are four types- A B C and D. Types A and B cause most of the seasonal epidemic outbreaks. Type C occurs occasionally, and Type D occurs mostly in animals. Type A generally produces the most virulent symptoms. Type B is milder and is seen a lot in in children.

Virus surfaces are covered with glycoproteins that interact with the body. Functionally we call them antigens. Each virus type has variations in these antigens that greatly affect how the virus infects its victims. The two most important ones are the hemagglutinin (H) and neuraminidase (N). The H type enables the virus to enter a cell and the N type promotes the virus spreading to other cells. These antigens stick out of the virus like pins in a pincushion. The body produces antibodies that recognize the antigens so that the immune system can find the virus and fight it off.

 

Unfortunately, the antigens are highly variable. So far, we have identified 18 (H) and 11 (N) types. You might recognize the name H1N1 virus that causes the swine flu. Each year the influenza virus mutates into a new variant and starts to spread. The body needs to produce a new set of antibodies to recognize the new variant before the immune system can be triggered. If the body cannot adapt quickly enough the infection starts to spread uncontrollably. The most dramatic example of this was the Spanish Flu at the end of WWI which caused more than 50 million deaths worldwide.

Because influenza has caused so much death and disease in the past, medical science and governments keeps a close watch on developing variations. They strive to develop vaccinations that stimulate the body to produce the necessary antibodies that recognizes the new mutation variant. When vaccinated patients come in contact with the new strain of the virus the body can recognize it and fight it off more quickly. This explains why it is wise to get a new flu shot each year.

 

Influenza is Highly Contagious

The influenza virus spreads through the community very quickly. It is possible to catch the flu and start spreading the virus to others even before you know you are sick. The virus travels through the air in vapor droplets produced when those who are infected cough or sneeze. New victims catch the disease when they inhale the virus or come in contact with the droplets on common surfaces like telephones, light switches, door knobs or even hands. Once the virus containing droplet is passed to the nose, eye or mouth of the next victim, the virus invades the surface and starts to multiply and spread. Those who start to show the signs of infection remain contagious 5 to 10 days after symptoms appear. Those with weakened immune systems like the elderly and children remain contagious slightly longer.

There are those who are more susceptible to catching the flu than others. You will notice that many risk factors on the following list are commonly found in adult foster care residents.

Risk factors for the flu-

• Seasonal influenza tends to target young children and older adults.
• Living or working conditions. People who live or work in facilities along with many other residents, such as nursing homes or military barracks, are more likely to develop influenza.
• Weakened immune system. Cancer treatments, anti-rejection drugs, corticosteroids and HIV/AIDS can weaken your immune system. This can make it easier for you to catch influenza and may also increase your risk of developing complications.
• Chronic illnesses. Chronic conditions, such as asthma, diabetes or heart problems, may increase your risk of influenza complications.
• Pregnant women are more likely to develop influenza complications, particularly in the second and third trimesters. Women who are two weeks postpartum are also more likely to develop influenza-related complications.
• People with a BMI of 40 or more have an increased risk of complications from the flu.

Source: https://www.mayoclinic.org/diseases-conditions/flu/symptoms-causes/syc-20351719

 

Complications

A healthy individual can fight off the flu infection in 1-2 weeks. For those who are vaccinated that time will be even less. Those who are not healthy or are under a lot of stress will feel the symptoms of the flu to a greater degree and may experience the following complications.

• Pneumonia
• Bronchitis
• Asthma flare-ups
• Heart problems
• Ear infections
• Stomach Problems and Diarrhea

 

Pneumonia is the most serious complication. In Pneumonia the lungs can become inflamed and possibly fill up with mucus, making it hard to breath. If conditions worsen, death can occur. Walking Pneumonia is also of concern. In walking pneumonia, the outward symptoms of the flu are felt less. The victim is unaware that their ability to breath is becoming compromised. In either case, caregivers should be very concerned if breathing starts to be impaired, even if the infection just appears to be a mild cold.

It is very rare for an adult to experience stomach problems or diarrhea with the flu, but it can occur in children. Those who claim to have a “stomach flu” are actually experiencing another kind of aliment. Ear aches are also uncommon in adults but may occur in children. Ear aches can be quite painful and stomach ailments can cause a lot of worry. Many concerned caregivers demand an antibiotic to “cure” the problem. Since most ear aches and “stomach flus” are caused by viruses the antibiotic will do nothing except cost money and created bacterial resistance. They’re are bacterial infections that can mimic the symptoms of the flu. It is very hard for caregivers to tell the difference between viral and bacterial caused infections. Fortunately, there are several tests the doctor can run that can diagnose between the two. I suggest that caregivers concentrate symptom relief and let the doctor worry about the cure.

 

Treating Influenza

The best treatment for the flu is to put effort into not catching it in the first place. Caregivers should practice “universal precautions”. It has been proven to halt the spread of disease. This is particularly important in the fall and winter months which is the height of cold and flu season. It is worth the effort because influenza free residents are easy to take care of residents.

If the flu does enter the home, try to stop its spread by isolating the infection as much as possible. The use of gloves and masks can help. Caregivers should pay attention to potential reservoirs of the virus like toothbrushes, razors, combs and denture cups. Take extra precautions in the cold and flu season. Monitor incoming friends and visitors for signs of infection. There are several cleaners that are labeled “sanitizers” that can kill the flu virus on infected surfaces including Pine Sol, Clorox and Lysol.

 

 

A mixture of 1/4 cup chlorine bleach to 1-gallon hot water will also disinfect. Caregiver could take advantage of the extra hot water of dishwashers and washing machines to clean infected items like dentures and toothbrushes.

 

For healthier adults, treating the flu mainly falls to symptoms relief and making the patient as comfortable as possible. There are several multi-symptom relieving “over the counter” medications that can work quite well. Though, dispensed with skill, single symptom relievers are generally more effective.

As a pharmacist I saw the general notion that if the patient felt better the OTC med “cured” the flu. As you already know that is not the case. This myth can be taken advantage of by caregivers to give comfort to a suffering resident. If the patient thinks they are getting a cure they may become more cooperative. The body will mostly cure itself in 1-2 weeks regardless of what the patient thinks. It really doesn’t matter either way as long as the caregiver is monitoring the resident for the signs of more serious complications that may occur.

For those who are unhealthy or stressed, which are the categories that most adult foster care residents fall under, a yearly flu vaccination is highly recommended. Even the most carefully administered home still exists in a flu ridden world. Caregivers can’t control all the ways that the influenza virus can enter their home. Flu shots are relatively pain free and easily obtained at a clinic, doctor’s office or pharmacy. It’s a good excuse for an outing away from the home for the entire house or individually with family members. Generally, flu shots are free through insurance or very inexpensive. Prescriptions are easily obtained. If family members take the resident to get a shot without a prescription be sure to notify the doctor’s office. I have even heard of instances of home health nurses or clinical pharmacists who review med lists providing vaccinations in your home. It never hurts to ask if such the service is available. If flu shots are impractical there is a more expensive version called Flumist which is inhaled. Flumist is not recommended for persons with egg allergies. As with all medical treatments there is a chance of unwanted sided effects occurring. Pain, itching or inflammation may occur at the injection site.

Allergic reactions are also possible, especially to those with egg allergies. If egg allergies are present, alternative vaccinations can be obtained. Tell those who are giving the shot in advance of the egg allergies or any other previous reactions to flu shots. As with all vaccinations you are trying to fool the immune system into fighting off a supposed infection. The vaccination may produce mild flulike symptoms that should go away by themselves. If they don’t or the symptoms get worse contact the doctor. There are rare reports of suicide ideation in teenagers who are clinically depressed after flu inoculations. Mental health homes should be alert to the possibility.

 

There are antiviral medications that can be used to shorten the course of the infection and decrease the severity of the illness. They are most effect within 48 hours after the start of symptoms, the sooner the better is the rule of thumb.

Over the Counter medications are;

• Echinacea that can boost the immune system
• Zinc lozenges like Cold Eeze prevent the viruses from multiplying
• Homeopathic remedies have been reported to be effect in flu cases, like Oscillium and Zicam.

Prescription Antiviral medications are;

• oseltamivir (Tamiflu) capsule or suspension. Monitor for unusual mental behaviors (self-injury and delirium)
• zanamivir (Relenza) which is inhaled. Watch for milk allergies
• peramivir (Rapivab) injection. Monitor for unusual mental behaviors

 

Other Important Notes

• Prescription Antivirals are not approved for preventing (prophylaxis) viral outbreaks but they may be used in that roll if the risk for serious infection is high enough.
• Despite internet claims there is no evidence that immunization causes autism in children.

 

Conclusion

Influenza is a highly contagious virus cause illness that happens to tens of millions of people each year. Normal it is a self-limiting illness that goes away in about a week. To those who are immunocompromised the flu can cause serious illness, other disease complications and even respiratory failure caused death. Caregivers should ensure those who are at risk get a yearly flu vaccine. They should also be particularly vigilant during flu season in universal precautions and sanitizing cleaning procedures. Care providers play a significant role in protecting their residents from the ravages of influenza.

 

As always Good luck in your caregiving efforts.      Mark Parkinson BSPharm

 

References:

Influenza (flu) Mayoclinic.org. 2018. https://www.mayoclinic.org/diseases-conditions/flu/symptoms-causes/syc-20351719

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season. Centers for Disease Control and Prevention. Recommendations and Reports / August 24, 2018 / 67(3);1–20

https://www.cdc.gov/mmwr/volumes/67/rr/rr6703a1.htm?s_cid=rr6703a1_w

Jeannette Wick, RPh, MBA, FASCP. Questions, Questions, Question: Influenza Takes the Nation by Storm. PowerPak.com. February 27, 2018. UAN: 0430-0000-18-012-H01-P

https://www.powerpak.com/course/preamble/116233

 

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