Medicine For People!

February 2015

Influenza

Type A Influenza - An Underestimated Threat

  • Flu, an Ambiguous Term
    • Everyday flu
    • Stomach flu
    • Influenza A
  • Putting Viral Illnesses in Perspective
  • Ebola vs Influenza
  • Why We Underestimate the Toll of Type A Influenza
  • Executive Summary

Preservative-Free Influenza Vaccination

Flu, an Ambiguous Term

Flu is one of those ambiguous words, like liver (do you mean the lively party animal or the organ he's abusing with that glass of beer?). Most of the time, by 'flu' we intend to mean non-life-threatening respiratory infections that last for a few days. More narrowly we mean influenza type A, the illness you get the "flu shot" for, the illness that kills about 40,000 people every year in the United States.

These are quite different illnesses, and each worthy of a short description.

Everyday flu: usually comes on gradually, making you ill enough, perhaps, to question going to work, but most often the you can do what you really need to. Symptoms include runny or stuffy nose, sore throat, stuffed up sinuses, mild headache, cough. Many people in the United States will have this perhaps once each winter, others more, others less.

Stomach flu: we humans are also prone to viral infections of the gastrointestinal tract, commonly referred to as the stomach flu. These are absolutely not related to type A influenza.

Influenza A: comes on like a runaway truck. Within an hour or so most people get in bed and spend no time worrying about whether to go to work or not. They have a fever and they want to go to sleep if their aching body will allow them. They may or may not have the symptoms of an everyday flu. The difference is that they usually are in no condition to decide what they are going to do for the next couple of days. The agenda is clear: lay in bed and suffer.

This is the kind of influenza that can kill. We identify types like H1N1 or H3N2, the latter being more common this flu season.

Putting Viral illnesses in Perspective

A few months ago the Ebola virus got the headlines. This is a horrible virus for those who succumb to it, but let it not distract us from type A influenza, a much greater killer in the United States.

In an average season as much as 20 percent of the U.S. population contracts type A influenza, with 200,000 people requiring hospital care. The annual death toll varies but the 40,000 per year mentioned above is rarely too far off.

Many deaths due to influenza do not show up on death certificates. Someone may have severe emphysema or heart disease, and die because of the added stress of fighting type A influenza. Most of the time they won't show a clear enough symptom picture to allow doctors to recognize it as a death due to influenza. They had been on the edge for some time, and suddenly they went over it.

While influenza hits the very old and very young the hardest, about six out of 10 people hospitalized for influenza are between 18 and 61 years old.

Ebola vs Influenza

Let's compare Ebola to type A influenza. Some 8300 Africans have died from Ebola compared to one here in the US. If Jefferson County, with 30,000 souls, were in Liberia, with the same infrastructure and the same poverty, 75 people in our county would have caught Ebola, and 30 would have died.

Let's compare that with the 1918 influenza, which killed some 600,000 here in the United States. Jefferson County's share today would be 175 dead. So the news you don't read in the headlines is that type A influenza is a far greater killer in the United States than Ebola is in Africa. A major difficulty in our efforts to prevent type A influenza is that the deaths are hard to see.

Why We Underestimate the Toll of Type A Influenza

On any particular winter day, some 800,000 Americans are in the hospital, many with heart or lung disease, cancer or some other very serious illness. In today's world, one has to be pretty ill to land in the hospital. Only in the past few years have we recognized the danger type A influenza poses for these seriously ill individuals. Only when some hospitals began requiring influenza vaccination for all of their healthcare workers did the hidden influenza toll become clear. In those hospitals where most healthcare workers were vaccinated against the flu, the wintertime increase in death from all causes was significantly less than it was in hospitals where healthcare workers were not so immunized.

Suppose your loved one dies of heart disease in the wintertime. Their precarious hold on life may have been upset by exposure to a hospital worker or a family member with pre-symptomatic type A influenza. No one would be aware that type A influenza pushed them over the edge, and it would not appear on the death certificate. These days the words "silent killer" are a cliché--that doesn't lessen the danger of the situation.

Executive Summary

Influenza type A threatens us today. New strains can come out of the poultry/pig/human incubator in over-populated nations at any time.

If you think you have type A influenza, you have about 48 hours to seek medical treatment, after which time anti-viral medication will do you little good. We'll tell you more at a later date.

Future letters in this series will tell you why I recommend a flu shot for just about everyone.

Preservative-Free Influenza Vaccination at the Rienstra Clinic

If the only vaccine available were a flu vaccine with preservative, I'd take it. The benefit outweighs the risk.

Since preservative free vaccine is available, though, I think it best to avoid the minuscule amount of mercury in the standard vaccine. We have to order our supply every spring. We will reserve a dose for you for a $40 deposit made by March 1. While the standard vaccine is available throughout flu season, companies make the preservative free version available only by advance order.

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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.