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Influenza & H1N1

Influenza comes around every year, usually in the late fall and winter. It’s a virus that is spread by air-borne respiratory droplets and hand contact. It attaches to the cells of the respiratory tract, causing watery eyes, nasal congestion, a scratchy throat, and coughing. People use the word “flu” for stomach viruses, but influenza is a powerful virus that is quite different from many viruses that cause vomiting and diarrhea.

What characterizes influenza is a profound sense of fatigue. Adults will be able to remember exactly what time of day they started to feel “achy” or “tired.” The French term for influenza is “la grippe,” and the German term is “der gripp”–both referring to the feeling of weak muscles. When children have the flu, they act extremely tired and lay around the house like rag dolls. Babies sit limply in their parents’ arms. People describe having achy/tired muscles. This tiredness is a result of the body’s surge of gamma interferon, a naturally produced “anti-virus” substance that’s the main defense against influenza.

For many people, influenza can be simply a runny nose and scratchy throat that goes away in a couple of days. This is what happens to people who are “immune” or who picked up just a few viral particles. For other people, they might have some “laryngitis” and a mild cough. Babies might have croup or bronchiolitis. Asthmatics can experience a flare-up. People who inhale more influenza particles can become sicker than those who only inhale a few. They can run high fevers that last for days. They’re also more likely to get a heavier bronchial cough. In some people, especially the elderly, a bronchopneumonia can develop.

The viruses causes microscopic injury to the brush border of the respiratory lining, making it more susceptible to secondary bacterial infection, especially the bacterial strep pneumonia. Antibiotics have no effect on the influenza virus. Over using antibiotics only allows more virulent bacteria to emerge. However, if a person develops an ear infection or bronchopneumonia, the antibiotic will fight the secondary bacterial infection.

Some people get “hit hard” by influenza, and other people seem completely immune. Every winter, the influenza strain can change slightly because of the way they can “jumble” their DNA. New strains can emerge. If the new strain is similar to one a person is immune to from early in their childhood, they won’t get sick. The different flu viruses are classified according to the glycoproteins on the surface of the virus. One is called H for its ability to cause hemaglutination (clustering of blood cells in test tubes). The other is called N for neuraminidase (an enzyme). There are different subsets of H and N and the combination makes for a variety of different “strains.” People develop immunity to the different strains by either having the illness or being vaccinated against it. Each year the flu vaccine contains the surface coat pattern of three different strains of influenza, such as A/Beijing H1N1 (1995), A/Sydney H3N2 (1997) and B/Harbin (1994). In any given year, more than one “influenza” can circulate through a community.

From one year to the next a person will be exposed to and build up immunity to various viruses. If the person is exposed to a strain that’s similar to the one they had as a child, and to which they have a strong immune response, they won’t get sick. Maybe they’ll have a scratchy throat, mild stuffy nose, or feel “tired.” A person who gets exposed to a large number of influenza virions and inhales them deeply is much more likely to to have a high spiking fever and bronchial infection. If a person is “run down”, sleep deprived, and under stress, they might get sicker.

Children often receive more of a “direct” hit when influenza comes around because they cough into each other’s faces without inhibition. Because they are unable to verbalize how they’re feeling, the diagnosis of influenza is usually not made. Children are more likely to run a high spiking fever with the flu, but at the same time, having a strong constitution, they fight it off well. Young children, however, are more prone to ear infections and secondary pneumonococcal infections.

How to treat influenza

The immune system does most of the work by producing interferon and other immune substances that block the spread of the virus BUT make the person feel tired and sleepy. Antibiotics have no effect. Vitamin C can help thin respiratory secretions, making them less viscous and inviting to bacteria. Echinacea (the American cornflower) has a substance which inhibits bacterial colonization. Giving the echinacea a couple of times a day helps defend the mucosal border while it’s weakened by the virus.

Many berries contain substances called anti-adhesins that diminish the ability of bacteria to cling to the mucous layer. Black elderberry, cranberries, and blueberries are among the berries in this group. Many fruits, lemons, grapefruits, cherries, and grapes also have bioflavinoids that help loosen phlegm.

Rose hip tea, which is rich in flavinoids, is helpful in “loosening” coughs. Cranberry juice is also helpful and can be mixed with lemonade for young children.

A cough is an expected progression of the illness. A nasal decongestant or antihistamine can decrease nasal congestion, but has no effect on how quickly the virus is dismantled.Fighting off influenza takes time. However, if signs of a secondary bacterial infection develop, such as intense ear pain or high spiking fevers with purulent sputum, it’s important to come back to the offices for a reevaluation.

H1N1 – Influenza A

The H1N1 strain of Influenza A is a strain that has not circulated in the world since the early 1900’s. When a strain circulates that has not been around in so long there is no immunity in the community. This means that more people will get the virus.
The symptoms from this form of Influenza A are no different than seasonal flu. The number of people who are sick is just greater.
Call the office if, symptoms start to get better then return. If your child has difficulty breathing. If the signs of dehydration occur, decreased urine output, dry mouth, inability to keep down fluids. Irritability beyond explanation or lethargy beyond explanation are also reasons to call back.

Treatment always starts with offering plenty of fluids and getting lots of rest.
Tamiflu is an antiviral medication that stops replication of the virus. It should be started within the first 48 hours of the fever. It can be used down to age 1 but those under age 5 tend to have more symptoms from the medication(vomiting\nausea) which makes it counter productive. It can be used as a preventative, however in an epidemic this may not be that helpful because you only take it for 7 days. An epidemic lasts for months. For fever control use Acetaminophen for children 6 months and up ( 10 mg/kg/dose every 4 hours). Ibuprofen can be used for fever in children 12 months and up (10mg/Kg/ dose every 6 hours).

Prevention is always the key to fighting viral illnesses. Wash your hands frequently.Get your flu vaccine yearly. Stay out of crowds if lots of people are sick.

Vaccination is the best way to try to protect yourself from the flu. Flu Mist – The nasal vaccine can be given from age 2 years and up in children – it is a live attenuated virus that is cold adopted. It cannot replicate at 98.6 F. So it produces immunity without sickness. Flu shot – The injectable vaccine is a protein vaccine with 2 Influenza A components HxNx and 1 Influenza B component. Children from 6 months on up can get this vaccine. Under 9 children who have never been vaccinated need 2 shots – one month apart.

The Tennessee Department of Health will be deciding how the H1N1 vaccine will be distributed.

We have seasonal flu mist and flu vaccine, although we have not yet received our full shipment. The flu mist schedule for Knox County Schools is on the Tennessee Department of Health Website.

Web sites to visit:

Tennessee Department of Health

Centers for Disease Control