Cold and Flu Season Coming

As we head into fall and winter we see an increase in the number of viral respiratory illnesses in the community. Most of these are simple self-limited infections that healthy individuals can weather after a period of a few days to a week of being uncomfortable from runny noses, sinus congestion, sore throats, coughs, aches and pains and sometimes fever. There are studies out of Scandinavia conducted in extreme cold temperature environments that show that taking an extra gram of Vitamin C per day reduces the number of these infections and the severity and duration in elite athletes and Special Forces military troops. Starting extra vitamin C once you develop symptoms does little to shorten the duration or lessen the intensity of the illness. Vigorous hand washing and avoidance of sick individuals helps as well. Flu shots prevent viral influenza and should be taken by all adults unless they have a specific contraindication to influenza. A cold is not the flu or influenza. Whooping cough or pertussis vaccination with TDap should be taken by all middle aged and senior adults as well to update their pertussis immunity. We often see pictures of individuals wearing cloth surgical masks in crowded areas to prevent being exposed to a viral illness. Those cloth surgical masks keep the wearers secretions and “germs” contained from others but do nothing to prevent infectious agents others are emitting from getting through the pores of the mask and infecting them. If you wish to wear a mask that is effective in keeping infectious agents out then you need to be using an N95 respirator mask.

Once you exhibit viral upper respiratory tract symptoms care is supportive. If you are a running a fever of 101 degrees or higher taking Tylenol or a NSAID will bring the fever down. Staying hydrated with warm fluids, soups and broths helps. Resting when tired helps. Most adults do not “catch” strep throat unless they are exposed to young children usually ages 2-7 that have strep throat. Sore throats feel better with warm fluids, throat lozenges and rest.

You need to see your doctor if you have a chronic illness such as asthma , COPD, heart failure or an immunosuppressive disease which impairs your immune system and you develop a viral illness with a fever of 100.8 or higher. If your fever is 101 or greater for more than 24 hours it is the time to contact your doctor. Breathing difficulty is a red flag for the need to contact your physician immediately.

Most of these viral illnesses will make you feel miserable but will resolve on their own with rest, common sense and plenty of fluids.

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Influenza Vaccine 2015- 2016 Season

The Center for Disease Control and Prevention (CDC) has recommended that all adult s receive the flu shot vaccination this coming fall. Our supply of flu vaccine is expected to arrive by September 1, 2015 and we will begin administering the vaccine shortly thereafter. This season there will be three types of intramuscular injectable flu vaccines available. All will contain a non-live attenuated version of the flu viruses. The Senior High Dose vaccine is recommended for all adults 65 years of age or older. The Trivalent or Quadrivalent vaccine is suggested for younger adults. The vaccine will contain 3 antigens including: an A/California/7/2009 H1N1 pdm09- like virus, an A/Switzerland/9715293/2013 H3N2 like virus and a B/Phuket/3073/2013 like virus. It is called a trivalent vaccine because it contains three virus types. The Quadrivalent Vaccine will contain a fourth antigen B/Brisbane/60/2008 like virus.

Please call the office to set up an appointment for your vaccination. Once you have received the vaccine it takes about ten to fourteen days for your body to develop antibodies against the flu. Influenza begins to appear in the northern United States in late October. The season can run through February into March. In South Florida we see little flu prior to Thanksgiving with the disease peaking in late January early February. Immunity in younger healthier patients will last throughout the flu season. Older and sicker individuals see their immunity decrease over time lasting as short a period as 3-4 months in some. The shortened immunity in seniors is the reason we usually suggest they receive the vaccine between Halloween and Thanksgiving. If you have any questions please call the office.

Flu Vaccine will be available at most commercial pharmacies as well as our office and at many workplaces. Please let us know if and when you obtain the vaccine elsewhere and tell us which of the vaccines you received.

I am often asked about adverse reactions and side effects of the vaccine. It is a dead virus. It cannot give you influenza. A successful vaccine will produce some redness, warmth and swelling at the injection site. That means that your immune system is working and reacting appropriately to the injected material. If this occurs put some ice on it and take two acetaminophen. Feel free to call us or set up an appointment to be seen that day so we can evaluate the injection site.

Cold and Flu Season Coming

SneezeAs we head into fall and winter we see an increase in the number of viral respiratory illnesses in the community. Most of these are simple self-limited infections that healthy individuals can weather after a period of a few days to a week of being uncomfortable from runny noses, sinus congestion, sore throats, coughs, aches and pains and sometimes fever. There are studies out of Scandinavia conducted in extreme cold temperature environments that show that taking an extra gram of Vitamin C per day reduces the number of these infections and the severity and duration in elite athletes and Special Forces military troops. Starting extra vitamin C once you develop symptoms does little to shorten the duration or lessen the intensity of the illness. Vigorous hand washing and avoidance of sick individuals helps as well. Flu shots prevent viral influenza and should be taken by all adults unless they have a specific contraindication to influenza. A cold is not the flu or influenza. Whooping cough or pertussis vaccination with TDap should be taken by all middle aged and senior adults as well to update their pertussis immunity. We often see pictures of individuals wearing cloth surgical masks in crowded areas to prevent being exposed to a viral illness. Those cloth surgical masks keep the wearers secretions and “germs” contained from others but do nothing to prevent infectious agents others are emitting from getting through the pores of the mask and infecting them. If you wish to wear a mask that is effective in keeping infectious agents out then you need to be using an N95 respirator mask.

Once you exhibit viral upper respiratory tract symptoms care is supportive. If you are a running a fever of 101 degrees or higher taking Tylenol or a NSAID will bring the fever down. Staying hydrated with warm fluids, soups and broths helps. Resting when tired helps. Most adults do not “catch” strep throat unless they are exposed to young children usually ages 2-7 that have strep throat. Sore throats feel better with warm fluids, throat lozenges and rest.

You need to see your doctor if you have a chronic illness such as asthma , COPD, heart failure or an immunosuppressive disease which impairs your immune system and you develop a viral illness with a fever of 100.8 or higher. . If your fever is 101 or greater for more than 24 hours it is the time to contact your doctor. Breathing difficulty is a red flag for the need to contact your physician immediately.

Most of these viral illnesses will make you feel miserable but will resolve on their own with rest, common sense and plenty of fluids.

Flu Shots Are Coming

ShotWe recently ordered our influenza prevention vaccine. The official public health kickoff to the influenza 2013 prevention campaign is September 1, but in order to have an adequate supply you have to order it long in advance. Once again the price per dose has increased. Once again we will be competing with Walgreens, and CVS and every country club association for the right to immunize you against a potential lethal but preventable disease. I would prefer that all my adult patients receive the flu shot and I do not care where you get it. Yes I would like to administer enough vaccine to cover my costs but the most important aspect of the flu shot campaign is to vaccinate as many people and protect as many patients as you can.

What’s different about the flu shot campaign this year? Jennie McCarthy, the beautiful and outspoken ex–Playboy playmate and well known almost evangelical opponent of vaccination programs, has now been given a pulpit on the television show “The View.” Her anti-vaccine opinion will certainly be heard loud and clear as the local public health departments get out the word to get your shot. There is a new egg free vaccine for adults 18- 49 years old with a history of severe allergy to eggs. Flublok or RIV3 is not grown in eggs but is made through recombinant DNA technology especially for individuals with egg allergy. I have no information on pricing or availability of the RIV3 vaccine yet but it will be administered to individuals with documented severe egg allergies not just anyone. At the current time any patients in the practice who require RIV3 or Flublok will be referred to a center that stocks it.

The other piece of new but positive news is that a study by Roger Baxter, MD of the Kaiser Permanente Vaccine Study Center in Oakland, California and published in the online version of the Journal of Clinical infectious Disease showed that there is no relationship between the administration of inactivated influenza vaccine and the development of Guillan-Barrre’ Syndrome ( GBS). The study originated after the 1976 vaccination against the Swine Flu virus was found to increase the risk of GBS. Since then in a review of 32.7 million person-years of follow-up there were 415 cases of GBS. Of those 415 incidents ONLY 25 were associated with vaccination in the previous weeks.

We urge our adult patients especially those with chronic health conditions to get flu shot this season. While you are making your plans for a flu shot make sure you are current on tetanus vaccine, shingles vaccine and pneumovax. Keep in mind our peak local flu season occurs in January and February with most adults requiring two weeks after the vaccine is administered to develop complete immunity.

 

 

Pharmacies, Vaccinations and Health Benchmarking

The state legislature in Florida decided it is legal and appropriate for pharmacists and pharmacies to begin administering vaccines against multiple diseases.  Their list of adult vaccines includes seasonal flu shots, pneumovax (pneumonia vaccine) and zostavax (vaccine to prevent shingles).  The rationale of the legislature is that access to doctors to receive these preventive vaccines is limited and difficult.

By refusing to administer vaccines in their office because it is time consuming and not profitable enough, my colleagues in primary care have not made my argument against permitting this any stronger. I thought prevention and administering vaccines was part of the job description in primary care.  I am not asking my colleagues to lose money, but I do believe there is a distinct difference between not making a large profit and losing money.  Isn’t it our professional and ethical responsibility to provide preventive services?

Over the years, the fall season and start of the school year have always provided an opportunity to remind patients that they were due for an annual checkup and to make positive suggestions on what other opportunities were available for them to try and prevent infectious or chronic disease. School-age children have been required to receive immunizations before entering school for obvious public health reasons.  This provides an opportunity to benchmark their growth and age goals and discuss healthy living as well. The visits came towards the end of the calendar year when most individuals had met their annual medical deductible so the out of pocket costs were not great.

As I walk into my local CVS I am confronted by ads for vaccines and same-day clinics. They remind me that physicians have lost this encounter to enhance the doctor/patient relationship and provide sound health advice for the future because administering vaccines isn’t very profitable.  Pharmacies often use vaccinations as a loss-leader to draw you in and get you to purchase other, more profitable, items.

I will continue to provide vaccines in my internal medicine office as I believe it is the professional and responsible thing to do.

Flu Shot Campaign Begins

As school bells ring out announcing a new school year and pigskins fly through the air announcing the arrival of a new football season, the Center for Disease Control and Prevention (“CDC”) begins its annual influenza vaccine campaign.  “Flu” or influenza is a viral illness associated with fever, severe muscle aches, general malaise and respiratory symptoms.  Most healthy children and adults can run a fever for 5 – 7 days and fight off the infection over a 10 day to three week period.  There is clearly a long period of malaise and debilitation in many that lasts for weeks after the acute febrile illness resolves.

The illness is especially severe and often lethal in the elderly, in infants, in patients with asthma and chronic lung disease and in those patients who have a weakened immune system due to disease or cancer treatments. Diabetics and heart patients are particularly vulnerable to the lethal effects of unchecked influenza.

The CDC recommends vaccinating all Americans over six years old against influenza.  Adults can receive an injection, or a nasal application.  The 2012 – 2013 vaccine has been updated from the 2011 – 2012 version based on samplings of current influenza viruses spreading around the world.   It takes about two weeks to develop antibodies and immunity to influenza after you receive the vaccination.  If you received the vaccine last season or had the flu last season you are still advised to receive the 2012 – 2013 vaccine this year because immunity fades with time.  Flu vaccine should have arrived in most physician offices and community health centers and pharmacies by mid- August.  The CDC advises taking the shot as soon as it is available.

The vaccines used are not live viruses so one cannot catch the flu from the vaccine. Side effects usually include warmth and tenderness at the injection site and rarely general malaise and low grade fever a day or so later.  The benefits of receiving the vaccine far outweigh these minor and rare ill effects which can be treated with an ice pack to the injection site and some acetaminophen.  Please call your doctor to set up an appointment for a flu vaccine.

For those individuals who catch the flu we still have several antiviral agents available to treat the illness. These agents should decrease the intensity or severity and duration of the flu. We try to use these medicines as infrequently as possible because the flu can develop resistance to them over time.

Prevention of disease is an ever increasing component of our everyday language. Vaccination against an infectious disease such as flu or influenza is clearly one of the more effective preventive strategies physicians have available to offer patients.  While you are making arrangements to receive your flu shot inquire about several other effective adult vaccines including Pneumovax to prevent bacterial pneumonia, Zostavax to prevent shingles and post herpetic neuralgia and Tdap to prevent whooping cough or pertussis and tetanus.