The Flu Syndrome manifests itself by an abrupt onset of malaise, myalgia or muscle ache, headache, fever, sore throat.  The illness is severe for 3 to 14 days, and the convalescence lasts from 1 to 4 weeks.


            Influenza is transmitted by virus-containing small particle aerosols that is spread by sneezing, coughing and talking.  The incubation period  last from 18 to 72 hours.  Viral shedding persists for 5 to 10 days.  In a community, person-to-person transmission is rapid,  spreading initially among children and then to adults.


            Epidemic spread of the Influenza virus is due to the appearance of new antigen  variations of the virus in non-immune populations.  Antigen variations occur almost annually in Influenza serotype A, whereas variation occurs much less frequently in Influenza B.  Major variation is called antigenic shift and results in pandemic spread of a new strain, almost always type A, throughout regions of the world where there is little natural immunity.  In recent years, epidemic Influenza has occurred regularly and has influenced death rates.  Although it is often not possible clinically to separate infections due to type A or B, Influenza A is responsible for greater morbidity and mortality than type B.


            Type A or B Influenza, when uncomplicated makes you feel uncomfortable for a few days.  It comes with fever, chills, headaches, severe body ache and backache.  The fever may be as high as 106F in some cases, typically lasting 3 days, and may persist for 5 to 7 days.  Respiratory symptoms such as cough, nasal discharge, hoarseness and sore throat appear as systemic symptoms wane - cough and weakness usually subside after two weeks, but may persist for a longer time.


            Though the Flu and cold may have similar symptoms, there are some very clear differences between the two illnesses.


Typical Symptoms of a Cold


Onset begins slowly;

Scratchy and sore throat;

Sneezing, runny nose and mild cough; and

Normal or slightly elevated temperatures.


The above symptoms last from a few days to a week.


Typical Symptoms of the Flu


Sudden onset, headache, dry cough, and chest discomfort;

Chills, muscle aches, including back and legs;

Fever and extreme exhaustion; and

Fatigue that lasts from 1 to 4 weeks.


Treatment of the Flu Syndrome


            Supportive measures are important for symptomatic relief.  Bed rest and adequate Fluid intake are advised.   Aspirin, 600 to 900 mg. Every 4 hours, or acetaminophen, if aspirin is contraindicated reduces headache, fever and body ache.  Sponging with water is effective in lowering high fever.  Relief of nasal discharge may be obtained by agents such as topical decongestants.  Relief from cough with cold suppressants, such as Dextrometorphan is helpful.  Antibiotics will not help cure a cold or Flu, except in cases of secondary bacterial infections, since antibiotics do not kill viruses.


            The oral decongestants phenylpropanolamine and pseudoephenedrine are somewhat helpful.  When prescribed in the recommended doses, these drugs will not cause blood pressure increase in treated hypertensive patients.


            Your physician may prescribe certain medicines if you see him or her within 24 to 48 hours of onset of the Flu syndrome.  Those medicines are:  Amantadine or rimantadine and a new medicine called Tami Flu.  Treating with these medicines should be seriously considered for patients at high risk of morbidity and mortality who develop Influenza.


High Risk Group Include:


1.  Unvaccinated children and adults with chronic diseases, including pulmunonary, cardiovascular, metabolic, neuromuscular or immuno-deficiency diseases;


2.  Adults whose activities are vital to community function in which absenteeism may be highly detrimental, such as selected hospital personnel, firemen and policemen; and


3.   Patients with life-threatening primary Influenza pneumonia.           


Most Feared Complications of Influenza:


            Patients should be advised that dyspnea  hemoptysis or spitting up blood, wheezing, purulent sputum, fever persisting more than 7 days, severe muscle pain, herald complications that demand prompt medical attention and usually hospitalization.  The worse complications are Influenza pneumonia, secondary bacterial pneumonia and bronchitis.


Prevention of Influenza or Flu:


            According to the Center for Disease control and Prevention, the following group of people should take extra precautions and should receive the Flu Vaccine starting in October of each year:


            People over the age of 65;

            Adults and children with Diabetes;

            People with chronic heart and lung diseases;

            People with kidney disease, severe anemia or asthma;

            Residents of  Nursing Homes and other long-term facilities;

Children receiving long-term aspirin therapy who may be at risk of developing Reye's

Syndrome following the Flu;

            Health care workers, especially those with extensive patients contacts;  and

Caregivers who provide assistance to high-risk patients.

It may also be given to anyone who asks for the Flu Vaccine.


It is important to know that trivial intercurrent illness, such as mild upper respiratory tract infection, should not be viewed as contraindications to timely Influenza immunization of individuals in high-risk groups.


Annual immunization with the contemporary vaccine begins in October, before the Influenza season and may continue until December or January.  The vaccine recommended each year is polyvalent, containing antigens from type A and B strains that are expected to prevail during that season.


The vaccination consists in a single intramuscular injection of 0.5 ml of Influenza Vaccine usually inside the deltoid muscle localized in the upper arm.


Contraindication to the vaccine is anaphylactic hypersensitivity to eggs.  Your doctor or caregiver will always ask you about eggs allergy before injecting the vaccine.


  Common adverse reactions of the vaccine are mild fever and local tenderness.  Otherwise, it is usually well tolerated.


                                                                         Joseph J. Nicolas, M.D.

104-105 Springfield Blvd.

Queens Village, NY  11429

Tel.  (718) 776-6050

Fax  (718) 776-6051


Sources:  1) Harrison Principles of Internal Medicine and 2) Ambulatory Medicine.


The above is provided solely for  informational purposes.  It is in no way to be construed as a substitute for professional medical care.


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