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ScientIST: The Flu!

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Now that it’s November and the fall is officially here LA-style (the rain this past weekend totally counts), we feel that it’s our ScientIST duty to gently put aside the upcoming holiday season to focus on YOU. To that end, we hope you’ll join us each Monday this month to discover ways to keep you healthy and sane through butter-laden pecan pies, overbearing relatives, and the seasonal flu.

Well, Angelenos, it’s that time again. Sneaking up on us ever so quietly until it’s too late, the seasonal flu is back and better than ever at a doorknob near you. Sure, you were fine last year, but remember how bad it sucker-punched your boyfriend/girlfriend/gym partner/8 year old who wasn’t so lucky? All we’re saying is that if you have time to unearth your umbrella from the back of the hall closet or hit up J. Crew at The Grove for a couple of cashmere v-necks, you’ve got the time to drag yourself and your loved ones to get the flu vaccine. With some help from our friends at the Center For Disease Control(CDC) and the Mayo Clinic, we break down the What? Where? and Will it Hurt? for you here, so read up and then get moving. You can thank us in February.

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What is the "Seasonal Flu"?
The "flu" is short for influenza, a respiratory illness caused by a virus. Unlike bacterial infections, antibiotics cannot cure viral infections. Symptoms can range from mild to severe, with approximately 200,000 yearly hospitalizations and 36,000 deaths in the US alone. Generally, one can expect a high fever, headache, exhaustion, dry cough, sore throat, runny nose, and muscle aches. While stomach distress can occur (nausea, vomiting, diarrhea), these symptoms are more common in children than adults. Once the flu has weakened the immune system, the body is left open for opportunistic bacteria to wreak more havoc, and ear and sinus infections are not uncommon. Additionally, the flu can worsen already present chronic conditions, such as asthma or diabetes.

Jeez! That sounds bad. How do I get it?
The flu is highly contagious, and is spread through viral-laden airborne respiratory droplets created by infected people coughing or sneezing. This can either infect you directly over short distances, or by touching something infected with the flu (such as shaking hands or doorknobs) and then touching your own eyes, nose, or mouth. Adults can infect others just one day before symptoms first arise and up to one week after, and children can be contagious even longer. This means you could be infecting people before you even know you have the flu.

Gross. How do I NOT get it?
Although only 5%-20% of the population will actually get the flu, the best way to decrease your chances of being one of them is to get vaccinated. The vaccine comes in two flavors: the shot or the nasal spray. The shot is an inactivated vaccine (containing killed viruses) and generally administered in the upper arm with a needle. It is recommended for the majority of the population. Alternatively, the nasal spray, containing live, attenuated (weakened) virus (FluMist®) is OK for healthy people 2-49 years old who are not pregnant. Some side effects may occur from both the shot and the spray. Since the shot is inactivated virus, the worse you might expect is some soreness or swelling at the site of injection, low-grade fever, or muscle aches, all lasting 1-2 days. For the nasal spray, runny nose, headache, sore throat, cough, muscle aches, and fever might appear.

Besides the vaccination, basic "good health habits" can help decrease your chance of getting the flu or spreading it once you're infected. Avoiding close contact with people who or sick, or staying home from work/school if you find yourself ill can help contain the virus. If you must head to the store for Theraflu, then cover your mouth and nose with a tissue when coughing or sneezing, or cough and sneeze into your elbow. Since the virus is killed with common detergents and disinfectants, WASH YOUR HANDS often and correctly (see here for directions!) or be liberal with your use of alcohol-based hand sanitizer. Wipe down commonly touched surfaces in your home and work area. Avoid touching your eyes, nose, and mouth. Don't forget to eat well, get plenty of rest and exercise, and keep your stress low to keep your immune system running at peak performance.

If I got vaccinated last year, aren't I all set this year?
Sorry, but NO.

The influenza virus comes in three types; A, B, and C. A and B cause the seasonal winter epidemics in the US and are the types that the vaccination targets. The A type is divided into two subtypes, H and N (named after special surface proteins each subtype contains - hemagglutinin and neuraminidase), and then further divided again into different strains. The B types are not differentiated by subtypes, but broken down into different strains like A. Each year, scientists at the FDA sit down and determine which strains and subtypes to include in the vaccine for the following flu season (the World Health Organization does this, too), then pass this along to a variety of pharmaceutical companies who manufacture the shot and the nasal spray. You can play "Which Pharma Made My Vaccine?" with your friends afterwards. Drink one shot of Nyquil if it's Novartis, drink two shots for GlaxoSmithKline, etc. (We kid! DO NOT do shots of Nyquil. It's bad for you.)

The CDC postulates that the match between the strains reflected in the vaccine and those circulating each winter are pretty damn close, so that the flu shot ends up being about 70-90% effective in keeping you healthy (slightly less for those with chronic medical conditions or those living in nursing homes). The flu is a lot like high school - the popular ones can change from year to year - so what you were vaccinated against last year might not do squat this time around. Like most viruses, as they replicate, their genetic material can change such that our immune system may not recognize the new strain or subtype. Thus, the recommendation is to be vaccinated anew each flu season.

But I'm healthy. I thought only old people need the flu shot?
The CDC recommends that the following groups get vaccinated, but if you are someone that might come in contact with any of these groups, including children under the age of 6 months who are too young to be vaccinated, you should be vaccinated as well. And if you just don't want to run the risk of feeling like crap this year on your Bahamas Christmas vacation you've been planning for 6 months, just get vaccinated and sleep better at night.

• Children aged 6 months - 18 years old (to 19th birthday)
• Pregnant women
• Those 50 years or older
• People with chronic medical conditions or a weakened immune system
• People living in nursing homes or long-term facilities

The CDC also recommends that some people DO NOT get vaccinated. Check to see if you fall into any of these categories:

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• People who have severe chicken egg allergy
• People who have had an allergic reaction to a flu vaccine in the past
• People who developed Guillain-Barré syndrome within 6 weeks of getting a flu
vaccine in the past
• Children less than 6 months of age
• People who have a moderate to severe acute illness with a fever (wait until symptoms subside before getting the flu vaccine)

OK. You've convinced me. Where do I go and how much will it cost?
You can always schedule an appointment with your primary care provider or pediatrician. But if you're going to be out running errands, then check out this handy locator for a participating drugstore near you (the cost is around $30). Alternatively, try the LA County Public Health Flu Clinic Finder, as well as the Public Health Centers Influenza Vaccination Clinic Schedule (download the PDF) for free vaccinations. If you're a college or graduate student, check with your Student Health department. Most universities in the area (UCLA, USC, Loyola, Pepperdine) are offering free or low-cost flu shots for students.

UGH. I totally read this post when it first came out, ignored your advice, and now I have the flu. IT SUCKS. What do I do?
There are some antiviral drugs available for the 2008-09 flu season: oseltamivir (Tamiflu®) and zanamivir (Relenza®), effective against both A and B viruses. See your health care professional to determine if you are a candidate for treatment.

If it's too late for the antivirals, then do like the rest of us: Stay home, get plenty of rest, drink lots of liquids, avoid alcohol and tobacco (no time to quit smoking like pneumonia!), and take over-the-counter (OTC) meds (check with your pediatrician before giving ANYTHING to children and teens).

Keep an eye out for emergency warning signs that require a trip to the doctor or emergency room, STAT: Fast or troubled breathing or shortness of breath, bluish skin color, dehydration, not waking up or interacting, fever with rash, pain or pressure in chest or abdomen, sudden dizziness, confusion, severe or persistent vomiting.

The CDC has designated National Influenza Vaccination Week as December 8th - December 14th, 2008. Children's Vaccination Day is Tuesday, December 9th; Seniors' Vaccination Day is Thursday, December 11th, Health Care Worker's Vaccination day is Friday, December 12th.