December 19, 2014
The influenza epidemic of the winter of 2014-2015 continues to evolve, here is what we know as of today.
No one needs a doctor to know that respiratory viruses are infecting many, many people right now.
In the Greater Cleveland area, it seems almost everyone is sick with a cold or flu, or knows someone who is. The numbers are so great that absences have forced at least 3 area schools to close for one or more days in December.
Here are some key facts about this year's epidemic:
1. Many of these cases are caused by one species of virus, the famous influenza virus, but not all.
For an entire winter, about 1/3 of all colds and respiratory flus (that is not stomach flus) are caused by the influenza virus.
2. We are in a period of lots and lots of influenza virus activity. The CDC tracks this carefully. We are on track to have this virus cause most of its havoc in its typical time period, namely, appear in December, peak in middle to the end of December (now), and fade slowly through February, vanishing by spring.
3. As many know, the flu vaccine is always a prediction. Typically about 3-4 subtypes of influenza virus circulate every winter, but the subtypes vary year to year, and so in making a vaccine in the spring for use in the winter, a prediction has to be made. We always hope the subtypes that are in the community turn out to match those in the flu vaccines.
4. This year, one strain, called A-H3N2, is different in our community than in the vaccine. That means the vaccine will not protect so well, or in some cases, at all, if the A-H3N2 that is circulating infects you. The influenza vaccine given this year does protect against the other 2-3 strains.
5. Putting all this together, we are seeing a big burst of influenza virus activity, much of which is not protected against by this year's influenza vaccine. These two facts combine to explain why so many of us are sick.
The course of this infection
Influenza viral colds and respiratory flus are very much like all viral colds and flus- you feel awful, fever, lots of mucus, sneezing, prolonged coughing, sore throat, and a variety of other experiences like headache, stomach ache, neck ache, achiness.
This year the fever is especially high, more in the 103-105 range than the more usual 99-102 range.
Like all such viruses, the illness itself typically lasts about 8 days, but if the cough is intense, it can go only without complications for 2-3 weeks.
When to Worry
Fever itself is a harmless, if miserable and agonizing, experience. That is, once fever ends, there is never any sign of ongoing harm caused by it. The normal range of fever in humans is 100.4-105.8. Now high fevers of 103-105.8 are miserable to experience, but even these high fevers are harmless.
So when to worry? If one of these four symptoms occur:
- Stiff neck (not sore neck or achy neck). A stiff neck means you can't bend your neck. If you can touch your chin to your chest, your neck is not stiff.
- Trouble breathing when not coughing. Simply look at your child and if he or she is breathing comfortably in and out of their mouth when not coughing then they are not having trouble breathing.
- Severe pain anywhere.
- Fever, 106 and beyond. Temperatures below 106 are harmless.
Medical science has very limited options to treat viruses, including influenza. So most treatments that are safe and helpful are comfort measures, like using ibuprofen, comfort foods, back rubs, ice cream, soup, tea, etc.
A word on three medications:
Tylenol or acetaminophen
Acetaminophen has been associated with increasing the risk of a child developing asthma, so we do not recommend its use. People should also know that if you give your child ibuprofen, adding tylenol does not tend to control the fever any better.
This has been a very good year for those who sell Tamiflu. A run on the drug has been ignited by the widespread use of rapid influenza testing and recommendations to use this drug.
There are two issues with the use of Tamiflu in children.
1. Particularly in children, the risk of Tamiflu causing a child to have a seizure is increased. This risk is strong enough that TV ads for Tamiflu actually feature this risk as one to be especially concerned about. Tamiflu is also known to cause delirium and behavioral disturbances, and propel those who take it to commit acts of self-injury that at times can be quite serious. This pattern of side effect- seizure, delirium, and serious behavioral disturbance all point to Tamiflu having some effect on brain function.
2. Tamiflu sometimes works well giving people relief, we all know those who have had this experience. But many people, including most people in careful studies of the drug, don't really have much relief from Tamiflu, especially children.
Given that nearly all influenza infections in healthy children cause no lasting harm, exposing children to a drug that can cause significant impact to the brain seems to be causing more harm than good.
If Tamiflu is not used, there is no benefit to testing for the influenza virus, since if the test is positive, no change in treatment will be made.
Over the counter cough and cold remedies.
With the exception of ibuprofen, the hundreds of cold and cough remedies, including decongestants, expectorants, and cough syrups, don't work. This is based on many, many studies, and reflects consensus statements from many professional societies. The FDA is currently investigating 500 of these medications for fraud!
- Every winter influenza virus comes to make us ill, usually in December.
- True to form it is here in December
- This year, a dominant subtype sadly does not match its subtype in this year's flu vaccine, so a lot more people than usual are ill.
- Influenza, like all respiratory viruses, causes much misery, but in healthy children, not much harm.
- Tylenol may increase the chance of developing asthma and is not recommended.
- Tamiflu causes more harm to children, particularly to their brains, than adults, and often has little benefit, so it is not recommended in routine cases of flu in otherwise healthy children.
- This year's flu is a high fever flu, but fever is harmless at 105.8 and below.
- It is important to call if fever reaches 106 or above, if significant pain is present, if there is trouble breathing, or if there is a stiff neck.
Here is to a happy and healthy holiday season,
Dr. Arthur Lavin
*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.