Funny how we are urged to get the vaccine, then find they gave us the wrong strain, as there are huge numbers of strains.
Funny how we are urged to get the vaccine, then find they gave us the wrong strain, as there are huge numbers of strains.
Not really that funny. It is actually like trying to figure out who is going to be in the Final Four BEFORE the season starts. Production lead time is long enough they have to make an educated prediction.
Having had to go to the ER with flu one year (a year I didn’t get the flu vaccine) has convinced me to get the vaccine every fall. Even if it lessens the effect only 10% I will take it. I was pretty damn miserable that bout, and I was only in my mid forties
John
There are a few reasons why Flus are deadly. In older people (80% of fatalities) not taking deep breathes causes pneumonia. In more virulent stains the virus over stimulates the immune system. Inflammatory responses of the flu, body aches, fever is your bodies way of attacking the virus. But, viruses are just packets of RNA that need to infect a cell to replicate. So your body must have a means to attack that cell. Your own body. If the immune system gets over activated in can produce too many cytokines which can cause a septic type illness (mimics blood infection) and cause organs to shut down. Then you’re dead.
Last edited by Mike Cary; 04-08-2018 at 12:28 PM.
Threads like this are why I like reading SMC. I also wonder what the reason was the flu pandemic of early last century killed so many besides the obvious reason of no vaccine. Was it just particularly bad as opposed to most strains? I suppose these strains are ever evolving.
My three favorite things are the Oxford comma, irony and missed opportunities
The problem with humanity is: we have paleolithic emotions; medieval institutions; and God-like technology. Edward O. Wilson
My guess without pulling out the books would be viral load. The body Responds proportionally. In cases of actual sepsis bacteria is throughout the blood steam and the body trying to attack that big of an infection can over stimulate, even in cases of severe trauma like massive injuries in a car accident the body can over produce cytokines and cause multiple organ failure. Virulent flu strains probably produce large amounts of the virus. I’ll check it out.
I hope the advice below both helps and educates
Advice for people with influenza
What advice should I give someone to help manage influenza?
- Advise the person:
- To drink adequate fluids.
- To take paracetamol or ibuprofen( if not contraindicated )for symptomatic relief.
- To rest in bed if they are feeling fatigued.
- To stay off work or school. For most people, about 1 week will be adequate.
- That the worst symptoms of uncomplicated influenza (including fever) usually resolve after about 1 week, although other symptoms (such as cough, headache, insomnia, weakness, and loss of appetite) may take longer than 2 weeks to resolve.
- Advise the person that routine follow up is not necessary, but they should:
- Seek urgent medical attention if they develop shortness of breath or pleuritic chest pain, or if they start to cough up blood (haemoptysis).
- Arrange a follow-up appointment if there is no improvement after 1 week (that is, they are still significantly ill), or they are deteriorating.
- Have a lower threshold for seeking help if they are caring for a young child or baby with influenza, as children cannot accurately communicate their symptoms.
Back to topBasis for recommendation
Self-care advice
- It is universally recommended that adequate fluid intake should be maintained when symptoms of influenza are present, to replace fluid lost by fever, sweating, and nasal discharge. However, a Cochrane systematic review (search date: December 2010) found no controlled trials assessing the effect of increasing fluid intake in people with acute respiratory infections [Guppy et al, 2011]. The authors of the Cochrane systematic review concluded that randomized controlled trials (RCTs) are needed to determine the true effect of this universally recommended medical advice.
- Paracetamol and ibuprofen are recommended for the symptomatic relief of influenza on the basis that they reduce fever and pain (including headache and myalgia).
- The antipyretic and analgesic efficacy of paracetamol and ibuprofen have been confirmed by RCTs in several conditions, including influenza and the common cold [Eccles, 2006].
- Aspirin is not usually recommended as it has a less favourable adverse effect profile than other simple analgesics. It is contraindicated in children younger than 16 years of age because of the risk of Reye's syndrome.
- Many people with influenza feel ill and fatigued to the extent that they voluntarily take to their beds [Jennings and Read, 2005], and this should be encouraged. This level of illness may also differentiate influenza from the common cold.
- There are no formal guidelines as to how long a person should stay off work or school, but prognostic data from the placebo arms of controlled trials indicate that most people should feel sufficiently well to return to normal activities after 1 week at most [Burch et al, 2008].
Advice about when to seek medical attention
- CKS identified no reviews or guidelines on when it is appropriate to follow up a person with influenza. Therefore, these recommendations reflect what CKS considers to be good clinical practice.
- The natural history of influenza indicates that symptoms should be improving after 1 week [Jennings and Read, 2005; Burch et al, 2008]. If symptoms are not improving or are worsening, reassessment of the diagnosis should be considered.
- Shortness of breath, pain on breathing, and haemoptysis may indicate the development of pneumonia secondary to bacterial superinfection, most commonly with Streptococcus pneumoniae, Staphylococcus aureus, or Haemophilus influenzae. This is the most common complication of influenza and is the main cause of death. Therefore, it is prudent to advise the person to seek medical attention if they develop symptoms of lower respiratory tract infection [Jennings and Read, 2005].
Back to topFollow up and admission
When should I follow up or admit a person with influenza?
- Consider follow up (particularly in frail people) after about 1 week, to confirm that symptoms are improving and to exclude the development of secondary complications.
- Consider admission if a complication of influenza occurs, or if there is suspicion that the person has a serious illness other than influenza.
- Pneumonia is a common complication that may be indicated by lower respiratory tract distress (characterized by laboured breathing, shortness of breath, pleuritic chest pain, and haemoptysis).
- It may occur immediately, or up to 2 weeks, after initial symptoms of influenza.
- For more information, see the CKS topics on Chest infections - adult and Cough - acute with chest signs in children.
- People with diabetes (particularly type 1) are at risk of hyperglycaemia, ketoacidosis, and diabetic coma.
- Other illnesses which may present with similar symptoms and signs to influenza include meningitis and malaria. See Differential diagnosis for further information.
- Consider admitting:
- Children younger than 1 year of age if they are in an 'at risk' group.
- Children that have febrile symptoms that may indicate serious illness (see the CKS topic on Feverish children - risk assessment).
Back to topBasis for recommendation
Follow up
- CKS identified no reviews or guidelines on when it is appropriate to follow up a person with influenza. Therefore, these recommendations reflect what CKS considers to be good clinical practice.
- The natural history of influenza indicates that symptoms should be improving after 1 week [Jennings and Read, 2005; Burch et al, 2008]. If symptoms are not improving or are worsening, reassessment of the diagnosis should be considered.
Admission
- CKS identified no reviews or guidelines on when it is appropriate to admit a person with influenza. Therefore, these recommendations reflect what CKS considers to be good clinical practice.
- Pneumonia is the most common serious complication of influenza. It may be caused by the influenza virus itself, or by bacterial superinfection with Streptococcus pneumoniae, Staphylococcus aureus, or Haemophilus influenzae. Pneumonia should be regarded as a serious condition which will usually require specialist assessment and management. Bacterial pneumonia is the main cause of mortality in people who are hospitalized with influenza [Jennings and Read, 2005].
- People with diabetes are known to be at increased risk of bacterial pneumonia and acute complications of diabetes (such as ketoacidosis) after infection with influenza [Joshi et al, 1999]. The incidence of ketoacidosis in people with diabetes has been observed to increase by 50% in influenza epidemic years [Bouter et al, 1991].
- Although less common, other serious illnesses may have signs and symptoms that mimic influenza. People with these symptoms should be seen by a specialist if there is diagnostic doubt.
- Children younger than 5 years of age, especially infants, who have feverish symptoms are at increased risk of serious illness and require a low threshold for admission [NICE, 2013b].
Last edited by Brian Deakin; 04-08-2018 at 6:27 PM.
As to why the 1918 flu was so deadly-- The 1918 flu was a H1N1 strain, and most of the young population had seen only a H3N8 strain that predominated starting in 1889. This left essentially a whole generation unprotected. That coupled with the fact that antibiotics hadn't been discovered yet left a large group of young people susceptible tp pneumonia secondary to the flu infection, which was quite deadly.
I'm in no way trying to stir the pot, and I would never advise against getting the shot, but I'm 22 and haven't had the shot since grade school. I've never gotten the flu in my life. My brother even had it several times growing up, but still never me. Any insight as to why? How could I be so close to someone infected so much but never get it?
Again, I'm in no way trying to advocate not getting it, truthfully I just forget every year.
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First part maybe second part, Plausible but unlikely. Secondary infections leading to pneumonia are rare not common and affects primarily the elderly. The victims of Spanish flu were mostly between the ages of 20-40. Some were described as bleeding from their eyes and nose. This suggests DIC and organ failure from a over active immune response. I like yours better because it would mean it wouldn’t happen today because we have great medicine, but it could and there’s nothing we could do to help. Only us poor vaccinated folks would be left to pick up the pieces.
im just curious if it's possible some people might have a natural immunity to the flu virus. Possible? I have a natural immunity to smallpox that was passed to me via DNA from my Northern European ancestors. As well, there are some instances of folks immune from the AIDS virus.
My three favorite things are the Oxford comma, irony and missed opportunities
The problem with humanity is: we have paleolithic emotions; medieval institutions; and God-like technology. Edward O. Wilson
I wasn't aware you could be immune to the AIDS virus. Seems pretty lucky to naturally be immune to something of that stature
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I never got the shot when I was younger and didn't get the flu until I was in my late-20's. This was despite working retail for many years. Plenty of common colds but no flu. Then, when I did get it, it felt like I got hit by a car. It actually turned into walking pneumonia over a period of months because I was stubborn and figured it would "heal itself" rather than going to the hospital. Ended up losing almost 20 lbs. due to chronic fatigue and lack of appetite. I remember having to call my mom because I couldn't get myself out of bed. When she finally took me to the hospital, my temp was 104F and I remember all the oncoming car headlights looking like different colors of the spectrum. I took me MONTHS to get back to a normal state, all because of my IDGAF attitude. Point being, if I could go back in time and give myself advice, "Get the shot". Just my 2-cents.
Erik