Feverish Over Flu News?

As I logged on to the Web in the fall to start gathering data on winter ailments, the news of the flu vaccine shortage was breaking, and I realized readers might have some flu concerns. Assume that vaccine allocation allows the most vulnerable to be vaccinated, including most HIV patients, but not caregivers, family, or friends. What are the implications and risks? First, the vaccine is only about 70% to 90% effective, so even if you are vaccinated, you can still get the flu. Second, a low T-cell count can mean that you may not respond to a vaccine, and there is concern that flu shots might not be effective in patients with counts below 100. Therefore, it is important that people around you do not accidentally carry influenza home. In addition, some people might have opted for the nasal spray vaccine. While very effective, it is a live'though weakened'flu virus and can allow shedding of the virus to others around the recipients for about a week. The nasal vaccine should not be given to HIV-positive patients. The most important principle for infection control is hand-washing. While the flu is most commonly transmitted by airborne droplets from coughing and sneezing, these droplets are also infectious if they land on surfaces where hands and fingers can transport them to the mouth. Equally important, there are oral medications that can either prevent influenza or at least reduce the duration of illness. Symmetrel, Flumadine, Relenza, and Tamiflu are all effective against influenza, but they are not all the same. The first two are active against Influenzavirus A only, and they can cause dizziness and other central nervous system side effects. The third is an inhaled powder that does not work to prevent flu and can make lung problems like asthma worse. Most physicians use Tamiflu, which is active against both Influenzavirus A and B. (Also, Tamiflu is excreted through the kidneys and will not interfere with anti-HIV meds.) If started within two days of exposure, it is about 80% effective in preventing the flu. And if you get the flu, symptoms will be shortened by about one day if you start it within 48 hours. Here are few questions I anticipate HIVers might ask: Since people with the flu start shedding the virus about a day before they get sick, how do I know if I have been exposed? The CDC suggests that if an outbreak occurs, people concerned should start preventive treatment for the duration of the outbreak. This recommendation has no clear start or stop point. Obviously, we cannot treat all HIV patients and their immediate circle for the duration of the flu season, so consultation with a doctor is essential. For example, if the local evening news reports that two cases of influenza have been identified in a local hospital, that is not an outbreak. But if a public-health department reports a dramatic increase in the number of new cases reported daily, then that is an outbreak. How long do I stay on the medication? For outbreaks, you may need to stay on medication at least a week or until the outbreak starts to cool down'five days for suspected flu. What are symptoms that would indicate someone near me might have the flu or that I was coming down with it? Typical flu will cause the abrupt onset of significant fever, major headache, and body ache one to four days after exposure. There is also a minor dry cough or slight sore throat or runny nose. Of course, these symptoms are common to most respiratory viruses. So what helps me differentiate suspected influenza from a cold or bronchitis is that the fever and headaches and body aches start quickly and escalate rapidly out of proportion to the cough or runny nose or sore throat. Prevention efforts can start anytime there is reasonable suspicion. But if you show these symptoms, treatment should start within 48 hours. Also, if you have not received Pneumovax, you should be vaccinated'or revaccinated if it has been more than five to seven years since initial vaccination. It prevents the most common type of community-acquired pneumonia, which is often the cause of the serious consequences of influenza. So do not panic. There is a Plan B for influenza this year. Bowers is board-certified in family practice and is a senior partner with Pacific Oaks Medical Group, one of the nation's largest practices devoted to HIV care, located in Beverly Hills, Calif.