JJ Levenstein


JJ Levenstein

It’s almost December, the kids are back in school after Turkey Day, and it’s time to test your Flu IQ….and then get yourself to your doctor’s office for a flu vaccine before it’s too late!


What is the flu?


Influenza is a very contagious virus that causes fever, chills, muscle aches, headache, cough and congestion – all appearing rather abruptly and lasting 5-10 days.  I counsel patients that, unlike the common cold or other viruses, the flu feels like a truck hit you.  In North America, it typically appears in the Fall, extends through Winter, and may linger until May.  It’s a serious virus, causing millions of lost work days and school days each year. 


Is there more than one type of flu?


There are 2 kinds of flu – A and B – and many strains of the virus have been identified for both type A and B.  Influenza A tends to have more severe symptoms, but type B can come in a close second. And some unfortunate folks can suffer from both strains at the same time!


Even though I got the vaccine last year, I still got the flu.  Why did that happen?


The challenge each year is that some strains of the flu may mutate and change and the current years’ vaccine may not cover each and every strain.  Mutations occur every 3-4 years, and sometimes more often.  Vaccine manufacturers make flu vaccine in advance of each season (it’s a very time consuming process), and use worldwide data on existing strains from the prior years to hopefully predict the combination that will be most successful for public health.


Why is it so important to be protected against the flu?


It’s estimated that between 170,000 and 700,000 people in the US are hospitalized because of the flu or its complications EVERY YEAR. That amounts to 2% of the population – a staggering number.  And tragically between 12,000 and 60,000 people die from complications of the flu yearly – the majority are typically very young or elderly, but many healthy adults fall prey to the flu virus.   Already this year we have had loss of lives due to the flu in all age groups.


Who should receive flu vaccine?


All people eligible to receive the vaccine should be inoculated in the early Fall – ideally by the end of October. But it’s not too late to vaccinate now!

Everyone 6 months of age and older should be covered.  When children under the age of 8 years receive flu vaccine for the first time, it’s administered in  2 doses given 4 weeks apart.  In subsequent years, only one vaccine yearly is needed.  If a child under 8 received only one dose the first time and didn’t receive the second, then the next year 2 vaccines will be necessary.


It’s especially important that children and elderly receive the vaccine, as well as all pregnant women, people with diabetes, heart disease, malignancies, immune deficiencies, blood diseases, HIV and other chronic illnesses.  Family members and caregivers of babies under the age of 6 months should receive the flu vaccine to protect these most vulnerable wee ones.


How is influenza spread?


Flu virus can travel about 6 feet with a sneeze or a cough.  The virus can live on hands for several minutes, and on hard surfaces for about 24 hours.  So imagine picking up a phone, typing on a keyboard, or standing in a crowded subway train during flu season.  If you are infected, you are contagious a day BEFORE you have obvious symptoms, and for 5-10 days after getting sick.  The term “going viral” is a great way to conceptualize just how quickly flu becomes epidemic.


How long is the incubation period for the flu?


It’s about 1-5 days; on average, most folks will get sick within 2-3 days of exposure.

When’s the best time to get the vaccine?


Ideally between September and October – what we see reproducibly in the US is that the first cases usually occur on the East Coast and move West…typically around Thanksgiving, and that is NOW.  Turkey is not the only thing we share at Thanksgiving, and flying to see family during the holidays places all passengers at risk – face it, when you want to get home, you want to go, even if you are feeling under the weather.  And this is precisely how flu gains momentum. It’s never too late to get the vaccine any time during flu season, but advisable to do so early so if exposed, you are covered.


How long does it take the vaccine to protect me?


About 2 weeks after it is given – the exception is children receiving the vaccine for the first time.  The first of 2 doses gives the immune system a heads up, and the second vaccine amps up immunity.



Won’t I get the flu from the vaccine?


In a word, NO.  Many individuals get a vaccine after the season has started, and may have been exposed to the flu in the days before receiving it.  And because it takes a couple of weeks for the flu vaccine to work, a person already exposed may get a case.


I’m allergic to eggs*.  Can I safely get the flu vaccine?


Yes.  If you have mild symptoms when eating eggs, your doctor can give you the flu vaccine and you don’t have to be observed after.  However, if you have had severe egg allergy in the form of airway swelling, facial swelling or anaphylaxis, the vaccine should be given under medical supervision in a setting where response to a reaction can be rapid.

*Part of the process of making flu vaccines involves incubating in a culture media derived from eggs.


I hate shots – are there other forms of flu protection?


The most common way to give flu vaccine is as an injection.  Most people do just fine with that. 

And if the sting makes you fearful, you can ask your healthcare provider to use a numbing spray or cream to make the process more comfortable.


However, in response to those who struggle with needles, there are two other forms of flu vaccine.  The first is a nasal spray form – called LAIV (live, attenuated influenza vaccine) – it is back this year, covers 4 strains, and those 2  years – 49 years of age are eligible to receive it.

There is a new form of flu vaccine that is given via a pressurized jet injection – those 18 – 64 years of age are eligible to receive this form.  People 65 and above should receive vaccine developed especially for that age group – because complications are more common in the elderly, this shot is designed to boost even more immunity.

*A note of caution – make sure your insurance company covers the newer forms.


How can my healthcare provider diagnose the flu?


Typically, your symptoms and history will prompt your doctor to test you for the flu.  Most in-office tests are very easy to perform – just a sample or swab of nasal mucus is all that’s necessary to give.  The majority of in-office tests take just about 15 minutes to determine if you have influenza A, B, both (and that does happen) or another virus.  The tests are pretty sensitive  - that said, if you have a negative test but a convincing history (as a small percentage of tests fail to give the real answer), your doctor may opt to treat you for the flu anyway.  Viral cultures (which take 3-10 days to get an answer) are no longer necessary in the majority of cases.  And because a rapid flu test can give an answer same-day, treatment can thoughtfully be initiated same-day too.


What else can I do to prevent the flu?


Besides vaccinating, washing hands with soap and water after coming in from outside, before eating, and after coughing and/or sneezing can kill all viruses on your hands (even more effectively than hand sanitizer).  Stay away from sick people.   Cover your coughs and sneezes. Clean your phones and computer keyboards, especially if you’ve been sick.  Don’t share food with others.  Open your windows if weather permits to encourage germs to leave.  Don’t use public transportation if you are under the weather or have a fever.  And if you’ve gotten the flu, don’t return to work or school unless you are fever free for a couple of days AND feel better.  Relapses can occur if you return to activity too soon.



If I do get the flu, is there an antibiotic for the flu?


There are specific anti-viral medications available to treat the flu.  One of the most well known anti-flu medications is called Tamiflu.  Tamiflu can reduce flu symptoms and contagion, but the medication itself can cause side effects that may be as challenging as those from the flu.


There are more medications in the pipeline that will likely come to market in the next few years.  Tamiflu is typically given twice daily for 5 days to treat the flu (must be given within 48 hours of onset of fever to work best), or once daily for 10 days in the event of known exposure.  These are prescription medications, so they must be written by your healthcare provider. 


What should I do if I get the flu?


The best thing to do is rest, hydrate, nourish yourself to the best of your ability, and manage symptoms with humidification, fever relief, and time.  Flu symptoms typically peak on the second through fourth day, and then improvement should occur.  If you find your symptoms are worsening, are short of breath, have a painful cough, or other really uncomfortable symptoms, you should see your doctor immediately.  Severe complications can happen to anyone, but may be more likely to happen to people who have certain chronic medical conditions, are very young, or in elderly persons.