You might think having a couple of days off from work or school could be a welcome break; however, when the reason you take time off is because you are in bed with fever, headache, body/muscle aches, extreme exhaustion, and other influenza-related symptoms, that is certainly no fun at all.  According to research done by the Stanford School of Medicine, influenza (or the flu as it is commonly called) affects 10 percent to 20 percent of the U.S. population each year, with an average of 2.8 work days lost per ill individual.

We know that there are many steps we can take to prevent catching the flu, such as frequently washing your hands and avoiding contact with infected people; however, The Centers for Disease Control and Prevention report that the best way to prevent the flu is to get the vaccine (or shot). We are now into the beginning of the flu season, and I would like to urge all of you to join me in fighting the flu and especially to consider seriously getting your flu vaccination early. 

For a schedule of flu shots, click here

In this Healthy College Newsletter, you will find very valuable information regarding Flu prevention and other very important health related topics.

Thank you.

Kathie

What is the Flu?

Flu vs Cold

Myths and Misconceptions
about the Flu and Flu Shot

Signs ans Symptoms of the Flu

Flu Prevention and Treatment

Who should get the Vaccine?

Flu Vaccination and the Flu During Pregnancy and Lactation

Complications of the Flu

Conjunctivitis

Useful Resources

Information for this newsletter came from the following sources

The fall season is that time of year when temperatures begin to cool, families gather and holiday shopping begins. Unfortunately, this season also causes many Americans to experience fever, headache, coughing, sneezing, sore throat, runny or stuffy nose, and muscle aches. For this reason, the “Fall” season is better known in the medical community as the “Flu” season.

Editors
Carla Clark
Marie Etienne

Committee
Patricia Baker
Maxinee Black-Arias
Helen Brown
Carla Clark
Cindy Cork
Marie Etienne (Chair)
Donna Fishkin
Pete Gutierrez
Iris F. López (Technical Assistance)
Fredy Ruiz
Dalia Sanchez-Suarez

Cold vs Flu
Amarilys Diaz , RN, BSN, MSN-c

Myths and Misconceptions about the Flu and Flu Shot
Maxinee Black-Arias, RNC, MSN, GNP

Myths and misconceptions about the flu and flu shot remain a barrier for many members of our community. Each year about 200,000 people in the U.S. are hospitalized and about 36,000 people die because of the flu.  This is the result of the myths and misconceptions people have about the flu and flu shot.

Here are some common myths and misconceptions about the flu and flu shots:

MYTH: “The flu isn’t a serious disease.”
FACTS: “Influenza (Flu) is a serious disease of the nose, throat, and lungs, and it can lead to pneumonia.

MYTH:  “The flu shot can cause the flu.”
FACTS:  “The flu shot cannot cause the flu.”  Some people get a little soreness or redness where they get the shot. It goes away in a day or two. Serious problems from the flu shot are very rare.

MYTH:  “The flu shot does not work.”
FACTS:  Most of the time, the flu shot will prevent the flu. In scientific studies, the effectiveness of the flu shot has ranged from 70% to 90% when there is a good match between circulating viruses and those in the vaccine. Getting the vaccine is your best protection against this disease.

MYTH:  “The side effects are worse than the flu.”
FACTS:  The worst side effect you’re likely to get from the shot is a sore arm. The nasal mist flu vaccine might cause nasal congestion, runny nose, sore throat and cough. The risk of a severe allergic reaction is less than 1 in 4 million.

MYTH:  “Only older people need a flu vaccine.”
FACTS:  Adults and children with conditions like asthma, diabetes, heart disease, and kidney disease need to get a flu shot. Doctors also recommend children 6 months and older get a flu shot every year until their 5th birthday.

MYTH:  “You must get the flu vaccine before December.”
FACTS:  Flu vaccine can be given before or during the flu season. The best time to get vaccinated is October or November. But you can get vaccinated in December or later.     

Summary

• Getting a flu shot every year is the best protection against influenza;
• Flu shots cannot give you the flu;
• People aged 65 and older are at increased risk of flu-related complications and should make getting a flu shot a priority;
• Your flu shot not only protects you – it helps protect your whole family;

Signs and Symptoms of the Flu  
Marie Etienne, RN, MSN, ARNP, FNP, PNP

It is important for your to recognize the common signs and symptoms of the flu and take action by reporting them to our healthcare provider immediately. Common signs and symptoms of the flu include:

• Fever over 101 F in adults, and often as high as 103 to 105 F in children
• Chills and sweats
• Headache
• Dry cough
• Muscular aches and pains, especially in your back, arms and legs
• Fatigue and weakness
• Nasal congestion
• Loss of appetite
• Diarrhea and vomiting in children
  

Flu Prevention and Treatment
Fredy Ruiz, MD, Family Practice Medicine

PREVENTION

Flu Vaccine
The best tool for preventing the flu is the flu vaccine, and the best time to get a flu vaccine is from early October to mid-November. The vaccine can also be given at any point during the flu season, even if the virus has already begun to spread in your community. You need a flu vaccine every year because the virus is constantly changing, and new vaccines are developed annually to protect against new strains. However, because the particular flu strains that the vaccine protects against may not be the same ones that are going around your area, the vaccine is not always 100% effective.

There are two types of flu vaccines:

• The “flu shot” — which is given with a needle, usually in the arm, is an inactivated (or killed) vaccine.
• The nasal flu spray vaccine (sometimes referred to as LAIV for “Live Attenuated Influenza Vaccine”) — which is a spray taken in the nose — is an attenuated (or weakened) vaccine.

Side Effects and Adverse Reactions to Flu Shots

• The flu vaccine is made from a virus that is no longer active. Therefore, no one can catch the flu from a flu shot.
• Less than 1 out of 3 people will develop soreness around the injection site for 1 or 2 days.
• Fever, aches and pains are not common, and more severe reactions are rare.
• A recent American Lung Association study has proven that the flu shot does not increase asthma attacks.

TREATMENT

There are four main types of flu treatments or medications that people usually rely on to fight the flu — vaccines, antivirals, over-the-counter treatments, and non-medical alternatives.

If You Get the Flu, Antivirals Can Help

Should you or a family member come down with the flu, antivirals may be your best bet. Antivirals can shorten the duration of the flu but only if they're taken within 12-48 hours of the onset of symptoms. So if you think you feel symptoms coming on, act fast and speak to your healthcare provider immediately. Antiviral medications are not a substitute for vaccination; although, physicians may prescribe them for people who cannot or have not received the flu shot.

What Can Be Done if You Get the Flu?
There are effective treatments that can reduce the duration of the suffering caused by the flu and improve your quality of life. See your healthcare providerwithin 2 days of when flu symptoms appear to find out if these and other treatments are right for you.

The following four antiviral medications are available to treat the influenza virus:

• Oseltamivir (brand name: Tamiflu®)
• Zanamivir (brand name: Relenza®)
• Amantadine (brand name: Symmetrel®)
• Rimantadine (brand name: Flumadine®)

The first two medications, oseltamivir (Tamiflu®) and zanamivir (Relenza®), are members of a new class of drugs that act against both influenza types A and B, while amantadine (Symmetrel ®) and rimantadine (Flumadine®) are older medications that may be used to treat influenza type A only.

Time is of the essence! Starting treatment with these medications within 2 days after flu symptoms appear will reduce the length of the illness and the severity of symptoms by at least 1 day. Early treatment can lead to faster results, enabling you to resume daily activities in a shorter amount of time.

NOTE: Be sure to tell your doctor if you have a chronic lung disease such as asthma because some precautions may be necessary if zanamivir (Relenza®) is prescribed.

NOTE: Some of the antiviral medications can be prescribed for children over one year of age. Consult your doctor as soon as possible after flu symptoms appear or whenever a child has a fever.

Symptom Relief
Over-the-counter medications can minimize discomfort associated with flu symptoms, but these medications do not treat the virus infection.

Aspirin should not be used in children under eighteen years old because it may play a role in causing Reye Syndrome, a rare but severe liver and central nervous system condition. Acetaminophen will be an option.

Congestion, cough and nasal discharge are best treated with a decongestant, antihistamine, or in combination. There are many over-the-counter flu remedies that contain both of these ingredients. Check with your doctor if you have chronic medical conditions such as thyroid disease or high blood pressure.

Who should Get the Flu Vaccine?
Pete Gutierrez MD, MMS, PA-C

The following are the recommendations from the Centers for Disease Control and Prevention:

• All children from the age of 6 months to 5 years of age.
• All persons over the age of 50.
• Children over the age of 6 months to 18 years on long term aspirin treatment, since they can develop Reye Syndrome if they were to get ill with the influenza virus.
• Women who will be pregnant during the flu season.
• HIV/AIDS or other immune disease patients treated with steroids.
• Patients with long term health care problems such as:
  • Lung Disease
  • Asthma
  • Chronic Health Problems
  • Seizure disorders
• The vaccine is highly recommended for anyone who lives or is a caregiver for persons at high risk of contracting the disease, such as:
  • Health care providers
  • Caregivers
  • Persons in close quarters, such as dormitories

Risks from the Inactivated Influenza vaccine are:

• Swelling at site of injection
• Fever
• Aches

The most severe problem is life threatening allergies (low incidence).

Flu Vaccination and the Flu During Pregnancy and Lactation
Diann Gregory, ARNP, CNM, MS

Should pregnant women and nursing moms receive the flu vaccine?  Generally the answer is yes. The killed virus flu vaccine is considered completely safe during pregnancy. Some doctors avoid first trimester vaccination; however, there are no known complications associated with the vaccine during any trimester. Because of concern about possible effects on the developing fetus, women have been warned to avoid vaccines that contain the preservative thimerosal. Thimerosal is a derivative of ethyl mercury. However, recently the Food and Drug Administration (FDA) announced the release of afluria® which is thimerosal, mercury and latex-free and is recommended for pregnant women   

Pregnant women are more vulnerable to complications (such as pneumonia) from the flu than their non-pregnant counterparts. During pregnancy, the woman’s body has reduced immune response to keep the expecting mother from rejecting her fetus (a foreign body). Although this does not usually increase her risk for acquiring the flu, it does increase her risk of severe complications from the flu. 

Although dying from the flu is rare, it occurs three times more often in pregnant women than in non pregnant individuals. When the mother gets the flu, it is unlikely that the fetus will be affected unless she develops serious complications from the flu. In those cases, she may be at higher risk for miscarriage (early pregnancy) or preterm birth (later pregnancy).

Side effects from the vaccine are usually related to allergies. Due to decreased immune response in pregnancy, the pregnant woman is less likely to have an allergic reaction.

Breastfeeding women may take the flu vaccine. If a lactating woman does get the flu, it is better that she continue to breastfeed to protect the infant from complications associated with the flu.  According to the FDA, the flu virus cannot be transmitted through breast milk. However the breast milk can afford the infant protection from further bacterial infections associated with complications of the flu. The mother may need to increase her fluid intake to keep an adequate milk production due to fluid loss associated with the flu.

Complications of the Flu
Helen Brown, A.A, A.S. and Donna Fishkin, MS., LMT

We all know that taking care of ourselves is important.  Getting enough rest, eating properly and keeping fit will help to keep your immune system strong.  However, even if we have a strong immune system, we can still catch the flu bug.  Since the flu is a virus and is spread through droplets released into the air when someone sneezes or coughs, you can catch the virus by breathing in these droplets or by having contact with surfaces where they have settled.  Most flu bugs last about a week, but it is not uncommon to continue to feel weak and tired for several weeks as you regain your strength.   

Anyone can get the flu, but people who are not well to begin with can be more prone to serious complications that can follow a bout of the flu.   Those aged 65 and older and persons of any age with chronic medical conditions are at highest risk for serious complications of the flu.  Some of the complications include:

• Bacterial Pneumonia
• Bronchitis
• Dehydration
• Worsening of chronic medical conditions such as congestive heart failure, asthma or diabetes
• For children, sinus and ear infections

Please take care of yourself, and, if you do get caught, follow doctors’ orders to prevent complications!

Conjunctivitis
Cindy Cork, O.D.

Viral conjunctivitis, also known as “pink eye”, is an infection of the eye most commonly caused by one of the adenoviruses, a family of viruses that is also responsible for upper respiratory illnesses (colds).   These viruses can spread from person to person on hands and in airborne respiratory droplets (coughs and sneezes).  Most cases of conjunctivitis are mild and self-limiting, but some have the potential to severely affect your sight.

Signs and symptoms of viral conjunctivitis include:

• Red, watery eyes
• Foreign body sensation
• Serous discharge (thick tears) that may form crusts around the eyelashes.  Most patients with viral conjunctivitis report the eyes matted shut upon awakening in the morning.
• Lid edema (swollen lids)
• Photophobia (sensitivity to light) and decreased vision in severe cases

Viral conjunctivitis is contagious for 12-14 days so it is recommended that you stay at home from work or school until there is absolutely no discharge from the eyes.  Expect the symptoms to get worse for about 7-10 days before getting better.  As with most viral conditions, it is self-limiting but may not completely go away for three to six weeks.  The most effective treatment is hygiene.  Wash your hands frequently and avoid touching your eyes.  Do not share towels, linens, wash cloths or facial cosmetics, especially eye makeup, with others.

If you wear contact lenses, discontinue wearing your lenses immediately until the condition resolves.  Continued use of contact lenses while infected puts you at increased risk to develop severe complications that can damage the eye. 

Medical management ranges from cold compresses (for eyelid swelling) and artificial tears to topical vasoconstrictors like Visine.  Antibiotics are not recommended:  use of these can lead to bacterial resistance.   Topical steroids may be prescribed by your eye doctor in severe cases if the cornea becomes involved.

Not all conjunctivitis ("pink eye") are caused by viruses, so it is important to consult your eyecare provider if you experience any symptoms.

Useful Resources
Carla M. Clark, MEd., MLIS

Miami Dade College’s Libraries have a number of resources on the flu. In addition to the resources recommended below, MDC’s Libraries maintain subscriptions to several online health databases that provide full text Medical Dictionaries, Medical Encyclopedias, and articles from reputable medical journals. These databases can be accessed by connecting to the Libraries’ Homepage at http://www.mdc.edu/libraries/, clicking on “Find Articles” and entering your Borrower ID and PIN # from your MDCard.

Colds, Flu, & Other Common Ailments Chad T. Kimball

Influenza: The Next Pandemic? Connie Goldsmith

Recommended Websites
Centers for Disease Control & Prevention: Seasonal Flu - provides comprehensive information on how to prevent the flu as well as what to do if you get sick.

Information for this newsletter came from the following sources:

ABO Pharmaceuticals. (2007). Retrieved November 10, 2007, from http://www.abopharmaceuticals.com/

American Academy of Family Physicians. (2007). Preventing the flu. Retrieved November 5, 2007, from http://familydoctor.org/online/famdocen/home/healthy/vaccines/477.html

American Lung Association. (2007). Retrieved November 7, 2007, from http://www.lungusa.org

Centers for Disease Control and Prevention. (2007). Key facts about seasonal influenza (flu). Retrieved       November 5, 2007from http://www.cdc.gov/flu/keyfacts.htm

Centers for Disease Control and Prevention. (2007). Severe methicillin-resistant staphylococcus aureus community-acquired pneumonia associated with influenza-Louisiana and Georgia, December 2006–January 2007. The Journal of the American  Medical Association 297(19),2070-2072.

DeNoon, D. (2003). Pregnancy raises flu death risk. Retrieved November 10, 2007, from http://www.webmd.com/content/Article/78/ 95743.htm?pagenumber=1

Friedman, N. J., Pineda, R., and Kaiser, P. K. (1998). The Massachusetts eye and ear infirmary illustrated manual of ophthalmology. Philadelphia: W. B. Saunders.

Help the Aged. (2007). Retrieved November 6, 2007, from http://www.helptheaged.org.uk

MayoClinic. (2007). Influenza (flu). Retrieved November 15, 2007, from http://www.mayoclinic.com

Roche Laboratories, Inc. (2006-2007). fluFacts.com. Retrieved November 7, 2007, from http://www.flufacts.com/

South-Paul, J. E., Matheny, S. C., and Lewis, E. L. (2004). Current diagnosis and treatment in family medicine. New York, NY: McGraw Hill.

Sowka, J. W., Gurwood, A. S., and Kabat, A. G. (2000-2001). Handbook of ocular disease management. Retrieved November 12, 2007, from http://www.revoptom.com/HANDBOOK/hbhome.htm