The Flu December 2017

1 Ohio Northern University - HealthWise The Flu December 2017 Protect Yourself From The Flu! Flu Health Flu season is upon us! Are you ready? This newsletter will provide information to help protect yourself and others from the flu this season. We have also included information regarding what the flu is, signs/symptoms of the flu, complications that can occur from the flu, as well as treatment and prevention strategies for the flu. It is the mission of ONU HealthWise to provide educational What is the flu? Symptoms & diagnosis options Flu vaccine Page 2 Page 3 Page 4 Page 5 resources to benefit the health of our community. We hope this information gives you a better insight on the flu and how to keep yourself healthy. Noel Aguilera, Erin Froehlich, Olivia Henton, & Jenna Mills, Pharm D Candidates 2018 Table of Contents

What is the flu? Influenza, more commonly known as the flu, is a highly contagious viral illness that can lead to serious health consequences. The flu can occur any time during the year, but peaks during winter months (December through March). Children are most likely to get the flu, however, they are less likely to experience complications from the flu. Populations that are more likely to experience severe complications from the flu include adults over the age of 65, children younger than the age of 2, women who are pregnant, and individuals with heart/lung diseases (such as asthma or heart disease). The best way to prevent seasonal flu, and prevent any subsequent complications from the flu, is to get vaccinated every year. CDC Website How does the flu spread? The flu is spread through person-to-person contact from inhalation of respiratory droplets, which occur when an infected person coughs or sneezes. A person can also get the flu by touching a surface that has the flu virus on it and then touching their own eyes, mouth, or nose. How long can an infected person spread the flu to others? People infected with the flu will shed the virus and can infect others from 1 day prior to about 5 to 7 days after getting sick. Children may be able to infect others for greater than 10 days, and people with weakened immune systems may be able to infect others for weeks to months. Overall, it is important to know that you may be able to pass on the flu to someone else before you know you are sick, in addition to while you are sick. The Flu 2 ONU HealthWise

How do I know if I have the flu? Patients that have the flu may have very general, non-specific symptoms, such as body aches, headache, weakness, tiredness, cough, sore throat, and runny or stuffy nose. The flu is unique in that these symptoms typically come on suddenly, and are most commonly accompanied by a fever. However, not all patients who have the flu will have a fever. Interestingly, not all patients will show the same signs and symptoms of the flu. How the flu presents in each person is different and depends on age, the strength of the immune system, and the presence of other health conditions. Typically, symptoms associated with the flu will resolve about 1-2 weeks after they started. When considering the presence of the flu, a question that often comes up is whether the flu is actually a cold. Both the flu and the cold are respiratory illnesses, but they are caused by different viruses and are treated differently. Thus, it is important to be able to tell the difference between the cold and the flu. Included below is a table that describes the symptoms commonly associated with the flu against symptoms commonly associated with a cold. You might notice that the symptoms look similar symptoms suggestive of the flu (compared to a cold) are usually more severe, accompanied by a fever, and come on suddenly. Something else that is important to know is the flu can cause a variety of complications, especially in patients with heart failure, chronic obstructive pulmonary disease (COPD), or asthma. The flu can cause an exacerbation, or a worsening, in patients with these health conditions. The flu can also lead to a variety of infections, including pneumonia. Symptoms of the Flu versus the Cold Symptom Flu Cold Onset Sudden Slow Fever/Chills Common Rare Body Aches/Muscle Pain Severe Slight Malaise Common Possible Headache Common Rare Cough Severe Mild Sneezing Stuffy, runny nose Sore throat Possible Common How is the flu diagnosed? Even if you got the flu shot, it is still possible that you could get the flu. If suspected, it is advised to seek medical attention, because an early diagnosis may allow for medication to be started. Your doctor may diagnose you with the flu if you have the signs and symptoms commonly associated with the flu and there is flu activity in your community. Your doctor may also order a test to confirm the presence of the flu virus. There are a variety of tests that look for the virus responsible for causing the flu, but the most common are the rapid influenza diagnostic tests. The CDC recommends performing this test in the first 3-4 days of illness in order to get the most accurate result. One of the advantages of this test is how quickly the results come back. If the result of this test is negative and your doctor suspects that you do have the flu based on your symptoms and the prevalence of influenza in the community, additional tests may be done to try to confirm a diagnosis of the flu. If you suspect you have the flu, call your doctor or a local health center to ask if they can perform a flu test! Fever is common with the flu! Adapted from the CDC s Flu vs Cold table Centers for Disease Control and Prevention [Internet]. Atlanta (GA). 2017 [cited 2017 Nov 8]. Available from: https://www.cdc.gov/lyme/index.html Influenza (Flu) Vaccine (Inactivated or Recombinant) [vaccine information statement on the Internet]. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention; [updated 2015 Aug 7; cited 2017 Nov 8]. Available from: https://www.cdc.gov/vaccines/hcp/vis/visstatements/flu.pdf Njoku J. Chapter 109. Influenza. In: In: DiPiro J, Talbert R, Yee G, et al. Pharmacotherapy: a pathophysiologic approach [Internet]. 10 th ed. New York: McGraw-Hill; 2017 [cited 2017 Nov 8]. Available from: http://0- accesspharmacy.mhmedical.com.polar.onu.edu/content.aspx?bookid=1861&sectionid=146071550#1145822512 Picture from: http://clipart-library.com/clipart/1823199.htm The Flu 3 ONU HealthWise

Treating the flu antivirals Because the flu is caused by a virus, antivirals are an appropriate route of pharmacotherapy or using drug agents to treat illness. Medications are not always a good choice for all patients with from the flu. Most patients will not receive medications to treat the flu. According to the Centers for Disease Control and Prevention (CDC), patients should be treated with antivirals if they experience symptoms of the flu and are at high risk of developing complications from the infection. Complications can include pneumonia or respiratory failure. Patients at high risk include children, elderly individuals, those who are pregnant, patients who reside in a nursing home or long-term care facility, patients who are of American Indian or Alaskan native descent, hospitalized patients, as well as patients who suffer from chronic conditions, including asthma, heart disease, liver or kidney dysfunction, diabetes or are immunocompromised. If a patient is a candidate for medication, they should be administered immediately, or within 48 hours of symptom onset, in order to decrease the duration of the flu by one to two days. If started beyond the 48-hour mark, antivirals can still exhibit some benefits for the patient, such as reducing the risk of complications. duration is five days. Most patients who are generally healthy will not receive medication. This decision, however, will be up to the discretion of the provider. Recipients of the flu vaccine should not be excluded from receiving antiviral treatment if they meet the criteria necessary to receive pharmacotherapy. Preventing the flu antivirals Medications can also be used as prevention, to stop the development of infection when an individual has come into contact with flu-ridden patients. Using drugs to prevent illness from the flu should not replace the flu vaccine. The vaccine remains the best way to prevent the flu. The CDC reports that antivirals are 70-90% effective in preventing the flu. Although shown to be effective, prevention with antivirals is not always appropriate. The CDC recommends prevention with antivirals for individuals at high risk of complications of the flu, patients with a compromised immune system, and patients living in a nursing home or long-term care facility during an outbreak of the flu. If appropriate, antiviral therapy for prevention should be initiated within 48 hours of exposure. should continue during exposure and seven days following the last exposure. What medications do we use? Antiviral medications that are indicated for treating both influenza A and B infections belong to a class of drugs called neuraminidase inhibitors. These medications work by blocking the virus from spreading throughout the body. The medications include: oseltamivir (Tamiflu), zanamivir (Relenza), and peramivir (Rapivab). Recommended dosing, contraindications for use, and potential side effects are listed in the table below. The dosage forms of each medication are different and may best serve different patients. Oseltamivir is available as an oral capsule or solution, zanamivir must be inhaled, and peramivir is delivered IV (through a vein). Stay at home! Most patients are not candidates for medications to treat the flu. Those patients should rest at home and stay hydrated by drinking plenty of fluids. Drug Dosage Form Use Dosing oseltamivir (Tamiflu) zanamivir (Relenza) Oral capsule/solution Inhaled powder Prevention Prevention 75mg twice daily for 5 days 75mg once daily for 7 days 2 inhalations twice daily for 5 days 2 inhalations once daily for 7 days Recommended For All ages 3 months and older 7 years and older 5 years and older Common Side Effects Nausea, vomiting Bronchospasm peramivir (Rapivab) Intravenous injection 600mg IV once 18 years and older Diarrhea CDC Website The Flu 4 ONU HealthWise

The Flu Shot Who can get the flu shot? Anyone over the age of 6 months can get the flu shot. Talk to your doctor or pharmacist about what product is right for you and your child. What flu shot is right for me? There are two main types of flu shots. One contains three types of the flu virus and the other contains four types. They are both similar in how well they work. The shot with four types is more common given to children, pregnant women, and those with heart and lung conditions who are at higher risk to get the flu. There is a high-dose flu shot for those over 65. Flu Shot Myths Debunked Myth #1: The flu shot can give me the flu. Truth: The flu shot is made with an inactivated or dead flu virus or it is made so it looks like the flu to the body. The most common side effects are soreness, redness, and tenderness where the shot was given. A mild fever and headache may occur, but this is your body working to fight what it believes is the flu. This normally lasts 1-2 days. Myth #2: Getting two vaccines is better than one. Truth: There is no shown benefit from getting more than one flu shot per season as an adult. However, in some children it is recommended to get two flu shots in a season. Myth #3: I should wait until everyone around me gets the flu before I get the flu shot. Truth: It takes nearly two weeks for your body to develop defenses against the flu. This means that it can take up to two weeks for you to be fully protected. While this is happening, you can become exposed to the flu virus from those around you. It is recommended that you get the flu shot in October or November to be protected during the flu season Resources 1. Centers for Disease Control and Prevention [Internet]. Atlanta (GA). 2017. 2. Grohskopf LA, Sokolow LZ, Broder KR, et at. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2017-18 Influenza Season [Internet]. Atlanta. 3. Clinical Resource. Flu Vaccines for 2017-18. Pharmacist s Letter/Prescriber s Letter. October 2017. The Flu 5 ONU HealthWise