Seasonal Influenza (Flu)

What's the Problem?

Influenza is a viral infection that is most common from October to February. Symptoms include fever, cough, sore throat, runny or stuffy nose, headache, muscle aches and extreme fatigue. Most people who get an influenza infection recover fully within 1-2 weeks. However, some people develop serious, life-threatening complications such as pneumonia. Many people use the word "flu" to describe any illness that features a cold and fever, even if it isn't the flu.

Who's at Risk?

Everyone can get the flu, but influenza poses a serious health hazard to the elderly. Each winter, in the United States alone, influenza typically takes the lives of 36,000 Americans, most of whom are older than 65. Pneumonia that results from influenza is the sixth leading cause of death in the United States.

Can It Be Prevented?

Yes. An influenza vaccine (flu shot) is available, as well as a pneumococcal vaccine, which prevents serious infections, including some forms of pneumonia. Both are covered by Medicare.

However, in 1995 only 58% of those eligible received the vaccine. More older Americans are receiving the shots now, but only 40% of older African Americans and only half of older Hispanics were vaccinated last year. Influenza vaccinations must be given annually because the virus changes from year to year, and new vaccines are manufactured annually. The Centers for Disease Control and Prevention works with partners in Asia to monitor annual strains of the influenza virus that appear first in Asia. A vaccine is developed for worldwide use, to prevent or minimize illness from the strain that is considered most likely to spread throughout the world. Vaccine development is based on the best scientific evidence available to predict which strain will become the most likely to spread.

Many older adults avoid being vaccinated because they mistakenly believe they can't afford it. Some fear influenza vaccine can cause the flu, a fear that should be put to rest. Someone who develops a flu-like illness shortly after vaccination could have one of many other infections, including the common cold virus or a flu virus they were exposed to before receiving the vaccine. The vaccine takes about 10 to 14 days to begin its full protection. It does not protect against other illnesses that may be referred to as "flu."

The Bottom Line

• People should receive influenza vaccinations between October and mid-November each year to prevent influenza and life-threatening complications such as pneumonia.
• The elderly are at increased risk for influenza and its complications.
• Flu shots do not cause the flu and they are affordable. Medicare covers flu shots for the elderly and free flu shots are available at many hospitals and public health clinics.

It is recommended that other high risk groups get the flu shot annually. These groups include:

• People with underlying chronic medical conditions, especially chronic lung diseases (including asthma) or heart ailments;
• People with compromised immune systems (from AIDS, HIV or chemotheraphy);
• Children six months to eighteen years old with a long history of aspirin use (catching influenza could result in Reye's Syndrome); and
• Women who expect to be more than three months pregnant during flu season.

Case Examples

1. A 70-year-old grandmother flies across the country to visit her family. After landing, she has a scratchy throat, coughs a little, and is tired and maybe even a little feverish, but she chalks it up to the long flight. At her daughter's house, she lies down. The daughter checks on her a bit later, and finds her burning with fever, with an intense headache and body aches. She is coughing and congested. The daughter calls a doctor who says the symptoms sound like influenza infection. Has the mother had a flu shot? No. The mother and daughter immediately go to the hospital emergency room where the diagnosis is acute bronchitis infection and pneumonia. The mother is hospitalized, antibiotics are administered, but her condition declines. She dies three days later.
2. Ed, a semi-retired smoker, has chronic bronchitis His secretary comes in with some flu-type symptoms that are only beginning to show—she is highly contagious, but doesn't know it. She ultimately infects several people in the office by sneezing, coughing, etc. Ed did not have a flu shot, and within a couple of days becomes seriously ill with pneumonia. He is hospitalized, and his condition declines. However, after several days of antibiotics to treat secondary infections, and plenty of rest, he eventually recovers. Although well enough to return home, it is a while before he has enough energy to return to work.
3. A nurse at the local assisted living facility posts a notice on the hallway bulletin board alerting residents that flu shots and pneumonia shots will be given the following Monday. The nurse reminds residents who are walking past the sign that they need an annual flu shot, but that they don't need an annual pneumonia shot if they had one before. She answers questions and signs them up for the vaccines.