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Random Thoughts on Influenza

These past few weeks have been quite interesting…. Never before in 30 + years of medical practice have I seen Influenza cases in June.

The original cases in Mexico were very alarming - a new, very contagious strain appeared that seemed extremely virulent and often fatal. Fortunately, the illness that ultimately emerged and spread to the North Shore and the rest of the world was, in comparison, a far weaker version.

Most of our patients had only modest fevers accompanied by chills, aches and sweats. Malaise (lack of energy) was another common symptom. But complications such as pneumonia, sinusitis and ear infections were uncommon and, fortunately, we had only one hospitalization. The duration of the flu was also shorter (3-5 days) than is usually seen (7-10 days). And many patients were well long before the "official" 7 day isolation period was over.

Several conclusions seem to be obvious from our experience:

• Influenza is a common, yearly (or more!) illness and is very contagious.
• The severity of Influenza should not be underestimated. Normally there are 30,000 - 60,000 deaths per winter per year in the USA every year. Basically, we got lucky this year. We could have gotten a more severe strain. For some very scary reading look at the influenza pandemic of 1918-19 that killed over 20-50 million people worldwide and affected young, healthy adults. http://www.pbs.org/wgbh/amex/influenza/
• Flu shots are important. For Everyone! Every year! Let's hope next year's flu shot will have the right strain combination. Remember, prevention is easier than therapy once you get sick. Shots should be available next fall.
• Therapy. There is no definitive treatment for Influenza. Two new antivirals are now available (tamiflu and relenza). But these medicines only modify (shorten) the illness and should, optimally, be given only for established cases and at-risk contacts only. Over prescribing can cause resistance patterns to occur. Finally, remember that aspirin should not be given to influenza patients.
• Public Health Policy. We need better, more timely guidance from health authorities (CDC, State of Illinois Health Dept, etc). We do not need non medical personal or the media making medical decisions for treatment, isolation or public closings.

We urge all of our patients to talk to us so that we can make rational medical decisions for you on an individual and community basis.

R Ruderman, MD

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