At the Forefront Live: Flu Season

[MUSIC PLAYING] Hello, and welcome to the University of Chicago Medicine at The Forefront live. And we're heading into fall, and that means flu season is right around the corner. The flu is a miserable illness that can mean days away from work or school, and for some people it can even be deadly. Millions of Americans get the flu each year, and thousands will die. 

Now flu is, for the most part, preventable. Dr. Allison Bartlett and Dr. Emily Landon join me today to discuss flu, how you get it, how you prevent it. And we'll also be taking your questions, so start typing. As always, we want to remind our viewers though that our program today is not designed to take the place of a medical consultation with your physician. Now, let's start right off with our physicians, and if you guys could introduce yourselves and tell us about your areas of expertise. 

Sure. My name is Dr. Allison Bartlett. I am a pediatric infectious disease specialist here at the University of Chicago and Comer Children's Hospital. I also work with Dr. Landon in the infection prevention department. 

I'm Dr. Emily Landon, and I'm an adult infectious diseases doctor. And I'm the medical director of our infection control program here at the University of Chicago. 

All right, let's get right to our questions. It's mid-October. How is the 2018 flu season going so far? Is this one look like it might be better than last year? Or worse? Or what are the thoughts so far? 

I think the flu season's pre-contemplative. It hasn't decided to show up yet, which is great. Every day that we don't have flu is a good day. 

Yeah, I think we've had occasional sporadic cases. But unfortunately, no trends yet, which could be good. We're going to go with it's going to be good. 

Let's talk about trends for a minute because it always kind of fascinates me when we talk about the flu vaccine each year and the trends that are spotted by physicians and scientists. How do you do that? What do you look for in the flu season to determine how to treat it? 

Influenza treatment is pretty much the same for most different kinds of influenza. But how we prevent it is really where it matters most about what strain is going to be circulating. The people that develop the flu vaccines go ahead and look at what's happening in the southern hemisphere that had winter just over when we were having our summer. And they figure out what's been spreading through the southern hemisphere and use that to make the vaccine that we're going to use and that many people are already getting for this year's flu season. 

So last year's flu season, I remember, was a pretty bad one. How bad was it, and why was it so bad last year? 

So last year was one of the worst flu seasons lately. So 2011, when we had a pandemic, was bad, but last year over 80,000 deaths from the flu. Several different types of flu circulating-- so people were able to get the flu more than once. And unfortunately, the main kind of flu that was circulating is one that we just haven't quite figured out how to make the vaccine work quite as well for. 

It's interesting, I think when we kind of discussed the topic of flu, people just think of being laid up for a few days. But you mentioned 80,000 fatalities due to the flu. So it's very serious, and it is important for people to get the flu vaccine no matter your fears of it. You should go do it. 

Yes. And the recommendation here in the United States is for everyone who's six months of age and older to get the flu vaccine. There are certain groups that are at more increased risk from getting extra sick from the flu, but really everyone is at risk. And so everyone should be vaccinated. 

And we want to remind our viewers we are taking questions for the physicians, so please start typing. We'll try to get to as many as possible over the next half hour or so. So are the types of flu-- the strains different year to year? And how do they differ? 

Yeah, they do. They switch up a little bit. They're sort of these main types of influenza. Like you sometimes hear about H3 influenza and H1 influenza. And sometimes you hear about the avian influenza, which happens to be an H5 influenza. These are all sort of different major types of influenza A, and each one has to require a different kind of vaccine. Although the vaccine that we use here has four different strains-- two of influenza A and two of influenza B in it. 

But it's whether or not the septic subtype of H3 matches up exactly or H1. The years that we have H1 disease predominating are usually not as bad. The years that we have H3 predominating are usually the tougher ones. That's what Dr. Bartlett was mentioning about the vaccine isn't quite as effective for those. Last year was an H3 year. If we're all really lucky, this will be an H1 year. 

OK, you're getting into an area that I really find fascinating when it comes to the influenza virus and how we try to prevent against it. So there are actually four vaccines in one-- is that how it works? 

Yeah, there's protection against for different kinds of influenza in one vaccine. 

OK. And so do you have to hit it right on the money? Or you get pretty close and you're good? 

Both. 

Well-- yeah. I think we can all agree that there's sort of like a scale of how well influenza vaccines work. And sometimes they work better. Sometimes they don't work as well. Certainly, we know that people who get a flu vaccine, even if it doesn't match exactly, tend to get less sick with influenza than people who didn't get the flu vaccine and got influenza. 

So the vaccine provides protection even if it doesn't keep you from getting the flu all the way. And that can be really, really important for decrease-- if you're not as sick, then you're not transmitting as much to those immunocompromised, and young people, and old people around you. And if they don't get sick, it can make the overall epidemiology of the flu season-- or how many people get sick, how many people die, how many people have complications-- can be a lot improved even with a much less effective vaccine. 

So why does the influenza virus take on different forms from one year to the next? And what influences the mutation? 

I think that's a great question that a lot of scientists are working hard to figure out, and we don't have all the answers. Certainly, this sort of changing between major groups and switching in between minor groups happens all the time. The flu virus is one that's not just affecting humans. 

It affects animals as well, so we hear about avian influenza. It turns out that flu likes to infect birds. It likes to infect pigs, and a lot of recombining of the genetic material happens. And so in areas where there are people, and pigs, and birds together, more mixing happens. And that's when we get some of the new strains that can happen. 

OK. Talk to us a little bit about the biomechanics of the flu shot. What's a good time to get a shot? Can you get one too early? That's another question and a concern that I've heard from several people because I think we're starting to lineup to get our flu shots. I haven't had mine yet. I will get that very soon. But can you get it too early in the season and then not be protected at the back end of the season? 

I don't think so. I think as long as you get the flu shot. It doesn't come out until like the beginning of September each year, so maybe if you got it in July or August. But no one's able to do that because there is no flu vaccine available for that season yet. So I think if you get it when it comes out, that's a good time to get it. 

Whenever you're seeing your doctor, whenever you're walking by a Walgreens, or a CVS, or wherever it is that you are and you think, huh, flu shot-- they used to have a sign outside-- get it then. Whenever you have a few minutes to spare, just get it in. Even if it's later in the season, it can still protect you from some of the influenza that's around. 

It takes about two weeks for the flu shot to become completely effective. And so the right time is two weeks before flu gets really bad. But-- 

Who knows when that's going to be? 

Exactly. So you getting yourself into a routine of going back to school in the fall, time to start thinking about getting your flu shot for the year. 

Well, you mentioned two weeks before the season gets-- but we've already seen flu cases haven't we. 

Yeah. 

Yeah, we've seen some sporadic flu cases, and that's not atypical for this time of year. But it hopefully will be several weeks or months before we start seeing a rapid increase in the number of cases. 

So you mention two weeks is what it takes to really get going within you. How does the flu shot actually work inside your body? What does it do? 

Well, the flu shot works the same way any vaccine does. It takes particles of influenza that have been killed. Mainly it uses the outside of the influenza virus-- the capsule, which is the part that your immune system recognizes. And it puts some of those into your body in advance of the flu so that your immune system can be like, ooh, hey, flu. And then it like has this system where your b-cells start to make extra antibodies for the flu because it's now seen some influenza. 

It's basically like an early notification system. It says, immune system, watch out for this kind of flu. It's coming and be ready for it. And that's sort of the cartoon version of what happens when you get a flu shot. There's nothing unnatural about the flu vaccine or about any vaccine. In fact, it's really just a lot like what people say is homeopathy. 

You're giving people just a little bit of the infection in order for their immune systems to respond to it. In the case of influenza, the shot doesn't have any live virus in it that can replicate. It's actually just pieces of the killed virus. So you definitely can't get the flu from the flu shot-- not unless you believe in things coming to life on their own, which we don't. 

When I talk to my kids about it who are complaining that they have a sore arm after they get their shot or feeling a little bit achy and tired and sore the next day-- that is exactly what's supposed to happen. That means your immune system is recognizing that. It's getting ready so that if and when you're exposed to the virus, itself, you're ready to go, and you can fight it off, and you don't get sick at that time. 

And you've answered this question, but I want to hammer this home a little bit more. You can't get sick from the flu shot. And the people who say, oh, I get the shot, it's always made me sick-- you're not getting sick because of the shot. They're getting sick because they were getting sick. 

Yeah, this is also kind of the time of year when colds start to come back into play. You have this nice summer where you're outside all the time and in the water, and you're playing around. And then you go back to school, and everybody's stuffed into their little offices and start closing their windows. And they're into to their classrooms, and all the kids are sharing germs. And then they bring home colds, and then we share them at work. 

And so it's the time of year when people get a lot of colds again, and that doesn't really have anything to do with the flu shot. But because we get the flu shot at the same time of year, people tend to put them together in their head. There have been a lot of studies done about the flu shot where they give the flu shot to a bunch of people. And to a bunch of other people they give them a saline shot. And it turns out that people with the flu shot are more likely to have a sore arm than the saline people. But other than that, they're not any more likely to get a cold than everybody else. 

So Ashley has a question for us. We have our first question at the Forefront live on Facebook. Does vitamin D help protect you from the influenza virus? And should I talk about him in the supplement to help stay safe? 

So vitamin D is something that I mostly associate with bone health and a good thing to do for your bone health when you're not getting some natural sun exposure in the winter in this lovely tropical environment that we live in. There's-- 

Sub, sub, subtropical. 

Some folks like to think about getting more vitamin C in an attempt to help ward off infection and boost your immune system. I think the verdict is not in yet. But also drinking some extra orange juice is not a harmful thing too. 

Yeah, one of the things to remember about vitamin D is that some vitamins you can take as much of them as you want. You can take as much vitamin C as you want and not much is going to happen to you. Vitamin D is one of those ones where you can take too much of it, so you might want to get a doctor's advice if you're going to take vitamin D. But some people in this part of the world do need more vitamin D in order to support their immune system health in addition to their bone health. But most people don't. And so it's sort of an individual question for you to raise with your doctor. 

OK, we have a follow-up question also from Ashley concerning herd immunity. Heard a lot about herd immunity when it comes to immunizations for things like measles. Does the same thing apply to flu, and does it really even work? 

That's a great question. And my new favorite term that I learned last week at the national conference for herd community is "community protection." It makes us sound less like cattle. 

So community protection is very important for diseases like measles but as well as for influenza. So measles in particular is very contagious. And so it takes a very high level of immunity in the community to help prevent the spread. Influenza is less so but especially with the incomplete effects of the vaccination itself. The more people that are more protected and less contagious at any given time really does help protect those of us who, because of their immune system or other reasons, are unable to get the vaccine. 

Another Facebook question-- why do some people get a nasal spray vaccine rather than the shot? What does that do? And did we even do the nasal spray last year? 

So last year we did not. There's a big controversy. So there was initial evidence that giving this nasal spray, which as Dr. Landon mentions, is a little bit different than the shot. This is actually what we call a live attenuated-- so a weakened form of the virus-- that we were hoping that that was a more biologically similar way to deliver a vaccine. 

Turns out that some of the strains that were in the vaccine the past few years did not add any benefits at all. There was no immunity conferred. And so last year the decision was made in the United States to not offer that product. It was different in Europe, and it's back on the market this year. And I think all we can say is that the jury is out. 

We are hopeful, right? It's a much easier sell to get the intranasal vaccine than to convince-- 

Especially kids. 

--kids to get a shot. I got a second call from my husband with my kids. Are you sure we have to? Yes, I'm sure. 

My son said the same thing. 

You have to get the shot. I'm hopeful though with sort of the scientific improvements and continued follow-up it will be a reliable product again. But unfortunately this year we just don't know how well the nasal one is going to work. 

Just remember there are some people because it includes live-- what we call "attenuated influenza," in other words influenza that's not supposed to make because it doesn't make normal people sick. It doesn't mean that everyone can get it. So really young kids, people with asthma, very old people, and people that have a lower immune system for whatever reason-- some of you take medication that make your immune system lower, some of you have other conditions that make your immune system lower-- you shouldn't get the intranasal vaccine for that reason. But it's OK if someone else in your house gets it because they're not likely to spread it around. And we know that for sure from some good studies. 

Absolutely. 

Interesting. So Mike has a question. Can you be a carrier of the flu and not feel sick? And could you pass the flue on to someone who is not immunized? 

Turns out yeah, you can. In fact, some people do get the flu and don't get very sick. And we don't know very much about why that happens. We think some of it maybe because people get vaccinated, and they don't really realize that they have full-on influenza. But other people just get the flu and don't ever feel bad, and they can pass it on to other people. 

We're really worried about what happens when that happens in the healthcare system. So we screen people and watch really closely in the hospital. But it's something to think about at home. If you've been exposed to influenza, you could get flu and not really have many symptoms, which is good for you but bad for the people living with you. 

Courtney has a question for us. Is the high dose flu vaccine really more effective in seniors? 

I would say that-- I'll take this since I take care of adults. Allison gets a pass. I think that there is some evidence that older adults get a little bit better immune response from getting that senior or double dose, high dose flu shot. That doesn't necessarily mean that they have less cases of influenza, and it's not clear whether they have fewer symptoms of flu if they do get sick than people who got a regular dose flu vaccine. 

So honestly, the best flu vaccine is the one you get, not the one you didn't. So if your doctor has the high dose flu vaccine and you qualify for it, then by all means get the high dose flu vaccine. But if you walk in to get a flu vaccine and all they have is the regular dose flu vaccine, then get the regular dose flu vaccine. We just want to get some vaccine into everyone. 

And I think building on that as the child advocate here, right? From a community protection standpoint, many elderly adults are going to be exposed to influenza through their grandchildren or other kids around. So the more that we can vaccinate everyone around the more vulnerable elderly, the better. 

So the next question-- how long does the immunization last? Are we talking six months? Four months? Eight months? It's probably hard to put an exact date on it. 

It really is because the flu season is time limited, and so we don't really have a lot of experience with someone who gets the flu in June having been vaccinated the previous August. But certainly the fact that we have to get repeat vaccinations every year-- we do that because we know that the immunity is not as durable as we would like it to be. 

And that flu changes. So the flu you've got vaccinated to before may not be around so much after a year or so. So there's a lot of reasons why flu vaccines are pretty challenging. 

Now, let's talk a little bit about folks who might actually have the flu. First of all, we're sorry. Secondly, so what do you do? What's the best course of action if you or your child has the flu? Let's talk with [INAUDIBLE] Let's talk about these first. 

Sure. So when someone comes down with influenza, it's first you have to figure out is this the flu? Is this just a cold? So things that make us think more strongly about influenza certainly if it's flu season. But having the sudden onset of a high fever-- kids may not be able to describe as much that they are achy all over, a lot of times if there's some vomiting and diarrhea symptoms associated with it. Cough is another common symptom that happens with influenza. 

So a couple of things-- there is medication that you can take early on in the course of flu that we think shortens the duration of illness. So it's worth reaching out to your healthcare provider if that's the case. Much of the other things that we do are really what we call supportive-- making sure that you are well hydrated, making sure that you're comfortable from a fever standpoint. In kids, we keep an eye-- in adults as well-- for secondary infections. So once you've had an infection with a virus, we know you're at risk of getting a bacterial infection as a follow-up. For kids, it turns out it's mostly ear infections, but it can be pneumonia as well. 

In adults, it's mostly pneumonia. 

And it's very important to stay hydrated as well. 

Yeah, fever really takes it out of you. You lose a lot. It's like running a marathon. Your body's sort of working just as hard as you would if you were exercising vigorously. And you need to stay hydrated. You need to rest. You need to take care of yourself, and that's a lot for some people. 

Yeah. And that needs to be done at home. Not at work, not at school. 

Not at the grocery store or the library. No. 

It's hard, and no one likes missing school or missing work. But really for the safety of all of your colleagues and the health of your classmates, it's the right thing to do. 

So back to the high dose flu vaccine. Kathy wrote a question to us or wrote to us with a question and asked do the higher dose of flu shots cover more strains or the higher dose vaccines? 

No. The higher dose, the double dose, this senior flu shot, the high dose-- we have a lot of names in the media-- it really just covers the same strains. But it gives you more, a larger dose of flu particles in each injection. It doesn't have additional protection for additional virus subtypes. 

Another question from a viewer. Skip asks, I got a flu shot last year, then ended up getting the flu in mid-April. The ED physician who diagnosed me said it was likely a mutation that occurred late in the season. Does that make sense? 

Well, last year's flu was not as responsive to the vaccine as we wanted it to be. So it could have been, but it also could have just been the flu virus. But yeah, flu shifts enough over the course of a season even that we see slightly different viruses at the end than from the beginning. 

OK. Now, you've piqued my interest because I've never heard that one before. So we actually see a shifting? 

Well, we don't see a change in the strain, but it's like sort of very subtle changes. Influenza's always doing this really subtle changing thing. It's really tricky. 

I figured once you had the strain nailed down, that was it for the season. 

No. 

Wow. OK. 

I wish. 

That makes it a little more challenging then, doesn't it? 

It is. And of course the time when you're trying to nail down the strain from a vaccine perspective, it's six months in advance of when the virus actually appears. 

Now, you should have protection against these subtle changes in influenza just from having the right kind of strain in your flu vaccine because it's not that different. But over time those differences build up to create a majorly different flu virus. 

Next question. Aside from a vaccine, what are some of the ways people can minimize their exposure to the flu virus? And are there over-the-counter remedies that will maybe stop? Or-- we already talked about lessening the impact of it. 

This is where I wish we had some cool fancy technology to share with everyone. But really, minimizing exposure is taking care of yourself from washing your hands, covering your mouth when you cough, disposing of tissues when you use them, staying home from work when you're sick, when there are sick people at your work encouraging them to go away. Nothing rocket science. 

A lot of these things rely on other people to do those things when they're sick. But what you can do is clean your hands. Clean your hands, clean your hands, clean your hands. That's how stuff gets from surfaces and from around you into your mouth, nose, and eyes, which is how you pick up the flu virus. 

And so the rules at my house are you clean your hands when you come inside from outside or when you switch buildings. And you clean your hands before you eat, and you clean your hands if you been doing something dirty because you're supposed to do that-- like if your hands are dirty. Like paint for example. That's for the furniture. 

But the other thing I think people can do is when you see other people that are sick around you, especially those that are coughing, keeping some distance between you and then makes a difference. Coughs and sneezes only travel so far-- about six feet. Sneezes travel further than coughs. 

But if you step back even from someone a few feet, you can reduce your exposure significantly. And so I'm not suggesting that imposed social isolation is a great thing for society. But the person that's coughing on the train-- don't sit by them. Move down. Go to another car. Step away. Even just leaning back is better than nothing. 

So entry points on your body where you have mucous membranes-- your eyes like you mentioned, mouth, nose. So if you touch your face, you're going to have a much higher likelihood of getting this or if you have somebody coughing. 

It is, right? And it's one of those behaviors that you don't know that you're doing. And I think to Dr. Landon's point about it's being around someone who coughs. You think about it-- they have coughed also germs onto all their potentially shared surfaces. And so you touch them, you can pick up the germs. 

And so your first line of defense to protect yourself, again, is washing or sanitizing your hands as frequently as you can. Because you don't know whether what you're touching is contagious or not. And then you're just instinctively touching your face more than you think about. 

And when it gets colder, think about your gloves. We put those gloves on, and we wear them everywhere. And we're touching our face, and your nose runs when it's cold. And you rub your nose. And then you're just taking them off and throwing them. 

Your hands are not clean when you take those gloves off. You need to clean your hands. And you can throw them in the wash in many cases. Although, I don't know that many people who do that. I strongly recommend it. 

That's an excellent point. I never thought about-- I wear gloves all the time during the winter. And I have never thought about that. 

Aha, see? 

It makes perfect sense. Another question from a viewer-- can you get the flu shot if you're allergic to eggs? 

So that used to be a big concern, and we've had a lot of experience over the past 5 or 10 years that are incredibly reassuring. So now we don't even need to be asking about whether someone has an egg allergy or not. Even the vaccines that are made in eggs do not cause problems even with people who have had anaphylaxis or very bad allergic reactions to the eggs. 

We do recommend that they're given by a healthcare provider. But short of that, that's all we do. 

And if you're really still very concerned, you can get the flu vaccine that's not made in eggs. They now make one that doesn't have any egg in it at all. But we know it's safe to get either one. 

So is it as effective-- the version without eggs? 

Mhm. 

Interesting. 

We understand it to be. The best evidence is that it's just as effective. 

OK. And you touched on this a little bit earlier, but I want to kind of reinforce this. Some people just think they have a bad cold and not realize maybe they're quite as sick as they are-- stay home. But how do you know if it's actually the flu? 

Well, you know if you go to the doctor and they do a test to see whether or not you have flu viral particles in your nasopharynx, or the space between your nose and your mouth. That's the best way to tell for sure. 

But without that-- again, the typical flu case is, as Dr. Bartlett said, quick onset of fever, really bad chills, and this aching that just feels like you've been running a marathon and you didn't even get out of your bed with this kind of hacking cough that comes in that just feels like your chest is just absolutely sore. Yeah, that's what people describe, and that's what we see when we see people with the flu. 

But there are plenty of people that have influenza that don't have all those symptoms-- only have one or two, or have different symptoms, or really bring up a really productive cough. Any of those things can be true. So you can't ever be sure you don't have the flu. 

I think that's where sort of the respiratory etiquette and just protecting those around you when you have any respiratory virus is really important. I think we worry about the flu and the potential severity. But the good news is if you are one of the people who gets one of these much more mild cases of flu and don't have the high fever and don't have the bad cough-- I think your risk of progressing to anything more serious is much lower. 

Yes. 

Let's talk about hand sanitizers for just a minute. We've got a question that came in concerning that. And I've got the bottle of hand sanitizer on my desk, which I probably use a little bit too much. But-- 

No, you don't. 

You don't? OK. 

It's impossible. 

Promise. 

That's the question then. Some people have said that that will actually cause mutations of the-- 

No. So there used to be hand sanitizers made that had an antibiotic in them called triclosan. That's no longer allowed in the United States. That's not recommended in soap or anything. Antibiotics and anti-viral medications should only be used in patients that have confirmed influenza or infection as the case may be. And they should be used by a doctor that can use the right one to treat the right thing. 

So these hand sanitizers are mostly just alcohol and some emollients to help keep your hands soft. And alcohol works differently than medications because it doesn't have to disrupt the way the virus lives or the bacteria lives. It actually just dries it out to the degree that it can't survive anymore. 

And it's very difficult for them to become resistant to drying, and so that's why we can still after many, many years use alcohol to clean your skin before you have your blood drawn in the hospital. And we don't worry about that causing any sort of mutation over time. And the same thing's true of those alcohol-based hand sanitizers that you buy at the grocery store. 

Well, the Purell company's going to be happy to hear that, because I go through bottles of that stuff pretty quickly, and others. One final question from a viewer-- we're about out of time. Kathy is asking, again, should I wear a mask and gloves? And she works in a salon, so she has a lot of contact with the public and is obviously worried about the flu. Good idea? Bad idea? What do you think? 

I don't know of there's any benefit to gloves. I think that good hand washing or hand sanitizer will be sufficient. I think if you can't trust those who you are encountering wearing a mask in the height of flu season is not unreasonable. 

Yeah, especially if you have a low immune system. Wearing a mask is probably better protection. The problem with gloves-- they might keep your hands clean, but they don't keep you from touching your face. And certainly we see people touch their face all the time with their gloves on. 

And so unless it's going to stop you somehow-- maybe you need one of those like collars they put on dogs so you can't touch your face anymore-- that might work. I don't know. You might not be able to see what you're doing. 

As someone who works in the salon, it may not be ideal. 

Well, you know. 

Or when you're driving to and from work. 

Correct. I recommend a clear path of vision. 

Probably shouldn't do that. But yeah, it's interesting. Mask-- not a bad idea then potentially. All right, you guys did a fantastic job. That was very informative. 

Good. I'm, glad. 

I learned several new things today, so that's good. That's all the time we have today. We want to thank Dr. Bartlett and Dr. Landon for their help with this program and all of the wonderful information that they gave us. If you want to learn more, please visit our website site at uchicagomedicine.org or call 888-824-0200. Thanks, again, for watching at The Forefront live. Hope you have a great week.