Some Native Americans reckoned the length of their lives by the number of winters, because winter was the time of the year when the old people died. The winter flu season culls the weak and the elderly. Officially, the flu accounts for 5 percent of deaths among seniors between December and March. Recent research, however, indicates that flu kills many more than statistics suggest.
What do we mean when we say "the flu"
Section titled “What do we mean when we say "the flu"”There are at least three illnesses that go by the name "the flu."
- When you see your doctor for a few days of nausea and diarrhea, she may tell you that you have the "stomach flu," also called gastroenteritis.1
- When you get an upper respiratory tract infection or a cold, with slight fever, sore throat, cough, or mild aching or fatigue, you have what is officially known as "influenza-like illness." These can range from mild to severe, but are most often caused by rhinoviruses, respiratory syncytial virus, adenoviruses, parainfluenza viruses, and other infectious agents. While your doctor may call this "the flu," usually these illnesses are no more than an inconvenience.
- The less common but more dangerous cause of an "influenza-like illness" are the class of viruses called the Orthomyxoviridae. This disease usually has all the subtlety of a baseball bat. The symptoms include runny or stuffy nose, cough, sore throat, and possibly nausea, vomiting, and diarrhea. But the two big things that distinguish this flu are the feeling that you've been hit by a truck and a fever of up to 104 degrees. Plus this one can kill you. This is the influenza we give the shot for, the kind of influenza that killed between 20 and 100 million people in 1918 and 1919. This kind of influenza also includes the newest variety, the 2009 influenza A (H1N1), AKA swine flu. Unfortunately, people can carry the influenza virus without showing symptoms, which means they are out in the community infecting others.
How does influenza affect us?
Section titled “How does influenza affect us?”Influenza usually kills by causing respiratory failure. Deaths by influenza or respiratory diseases in flu season go into the "influenza" death column, yet many elderly die each winter of their chronic illness, pushed over the edge by the flu. These deaths are tabulated as heart failure, or cancer or any of a myriad debilitating illnesses.
The truth is flu can kill not only through respiratory failure but also through secondary inflections of the lungs, ears, or sinuses or by causing dehydration or by worsening chronic medical conditions. Flu can trigger death from heart disease and stroke by increasing whole body inflammation and by increasing the blood's tendency to clot.
Cardiologists in Buenos Aires decided to check out whether the flu actually increases heart disease deaths. They enlisted 300 seriously-affected cardiac patients to influenza vaccine or placebo injection. Then they did what we call "counting the bodies." Within six months, 8 percent of the placebo group had died, compared with 2 percent of the control group.2 The cardiologists continued the study for another six months with the surviving patients. The vaccination group died at a rate just about a third of the unvaccinated group.
To repeat. The Orthomyxoviridae cause inflammatory changes which seriously stress those of us with serious medical conditions. About one in seven people with the flu show no symptoms at all. Some folks with the virus don't know they have flu, but it kills them anyway by worsening their cancer or kidney disease or diabetes.
Now, one study of 300 people in Buenos Aires may not convince you. I did not want to accept it as the last word either, so I looked further.
I found a study from the VA in Minneapolis of over 120,000 senior citizens, showing a 50 percent reduction in the overall death rate in those vaccinated.3 This study was sponsored by vaccine manufacturers, which gave me pause, but I found a later study from the same institution that was not funded by vaccine manufacturers. They looked at 150,000 people and found that influenza vaccination again reduced death from all causes by 50 percent in each of two consecutive years.4 We're not talking about a study published in the Journal of Irreproducible Results, either. This was the New England Journal of Medicine, publishing an even larger study, surveying 700,000 person-years of experience in healthy community-dwelling seniors in Minnesota.5 Again the flu vaccine reduced the overall death rate by about 50 percent! Not just heart disease, not just influenza, but any fatal illness.
Face it, news fans, influenza vaccination rarely hits the front pages. But, cut your risk of death in half? One little shot? It should be in the headlines.
What flus are out there this year?
Section titled “What flus are out there this year?”The viruses that cause flu evolve over time, sometimes slowly, sometimes quickly. This year we're dealing with viruses of both kinds.
Seasonal Flu -- Several viruses that have been circulating for years, slowing changing. Virologists have selected A/Brisbane/59/2007, A/Uruguay/716/2007, and B/Brisbane/60/2008 as especially problematic. This year's seasonal flu vaccine, the kind we offer every year, targets those viruses.
2009 influenza A (H1N1) -- Dr Tom Locke at our Health Department likes to call this new virus the "triple reassortment flu", since it seems to be a meld of human, pig, and bird viruses.6 These viruses usually stick to one species, but they can, with difficulty, exchange genetic material and make a successful jump to a different species. Some virologists think that an avian flu jumped to humans in 1917 or 1918, leading to the 1918 influenza pandemic. The same virus jumped to pigs the following year, taking on the name swine flu. Variations of this H1N1 virus circulated between 1918 and 1957 and reemerged in 1979. The A/Brisbane/59/2007 strain contained in this year's seasonal influenza vaccine is a distant relative of the 1918 pandemic flu. When a new influenza virus appeared in humans in the spring of 2009, virologists initially thought it had spread from pigs to humans and gave it the name "Swine Flu." Now it's clear this virus is spreading among humans, hence the new names.
This latest H1N1 virus is the first "triple reassortment" flu virus to trigger a global pandemic, so we are not certain how it will behave. It produced a low death rate this spring, but so did the 1918 virus when it first appeared in the spring of that year. The avalanche of death came in late summer 1918 in the tropics and fall and winter here in the temperate zone. This year does not appear to be a repeat of that devastation -- the virus has stayed stable as it spread during the Southern Hemisphere's winter season. However, even a new flu virus that is no more severe than season flu can kill tens of thousands of people in the US alone.
Preventing influenza
Section titled “Preventing influenza”Vaccines
Section titled “Vaccines”The seasonal flu shot reduces your chance of catching the slowly evolving influenza viruses A/Brisbane/59/2007, A/Uruguay/716/2007, and B/Brisbane/60/2008. And the new, extra influenza shot reduces your risk of catching 2009 influenza A (H1N1). If you do catch either virus, you should have a much less severe illness. The shot reduces your chance of giving to influenza to those around you. These vaccines do not reduce your chance of catching minor flu or stomach flu.
A new 2009 influenza H1N1 vaccine that's more effective than the current vaccines but still not approved for widespread use provides protection in about two weeks. The current vaccine will act somewhat slower. However waiting until influenza hits the community to become vaccinated leaves you with at least a three week exposure compared to immediate vaccination.7 My recommendation is to get this influenza shot sooner rather than later.
Why do seniors come last for the new vaccine?
Section titled “Why do seniors come last for the new vaccine?”Seasonal flu causes its greatest number of complications in those over age 65, so seniors are first in line for that vaccine. However, seniors appear much less susceptible to the new H1N1 virus than children and young adults. It appears that those who were infected with the H1N1-type flu prior to 1957 have a high degree of immunity to the pandemic H1N1 strain. Globally, 80 percent of confirmed H1N1 infections have been in people under 25 years of age. Only 5 percent have been in those older than 65. For this reason, The Centers for Disease Control has prioritized the new H1N1 influenza vaccine for pregnant women, children and young adults up to age 24, healthcare and emergency medical service workers, and those with chronic illness between 25 to 64 years of age. As more vaccine becomes available, everyone wishing to vaccinated against pandemic H1N1 will have the opportunity.
Other ways to avoid influenza
Section titled “Other ways to avoid influenza”The number one rule is, wash your hands frequently or use a hand sanitizer, whether you feel well or sick.
Rule number two has three parts:
- To protect yourself from other people, avoid touching your eyes, nose and mouth with your hands. Eat healthful food and get enough sleep. Avoid sick people. Wash your hands.
- To protect others when you feel well, cover your nose and mouth completely every time you sneeze or cough. Wash your hands or use sanitizer.
- To protect others when you are ill, leave home only if necessary for medical care. Follow your doctor's instructions. Use a face mask when in public. Did I mention wash your hands?
For more information, go to http://www.cdc.gov/flu/protect/preventing.htm
Influenza vaccination at the Monroe Street Medical Clinic
Section titled “Influenza vaccination at the Monroe Street Medical Clinic”We should have one to two hundred doses of the 2009 influenza H1N1 vaccine within the next two weeks. Please call if you would like to be on the list for the vaccine.
And look forward to springtime!
Next month
Section titled “Next month”We'll talk more about influenza and give you more tips for a healthy winter season.
Footnotes
Section titled “Footnotes”1 http://en.wikipedia.org/wiki/Stomach_flu
2 [Influenza Vaccine Pilot Study in Acute Coronary Syndromes and Planned Percutaneous Coronary Interventions, Circulation. 2002;105:2143-2147. ]
3 [Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens. Nichol KL, Wuorenma J, von Sternberg T. Arch Intern Med. 1998 Sep 14;158(16):1769-76.
4 [Influenza Vaccination and Reduction in Hospitalizations for Cardiac Disease and Stroke among the Elderly n engl j med 348;14 April 3, 2003
5 [Effectiveness of Influenza Vaccine in the Community-Dwelling Elderly N Engl J Med 2007;357:1373-81
6 Flu viruses can also infect horses.
7 (10.1056/NEJMoa0906453) was published on September 10, 2009, at NEJM.org.