By Dr. A. Scott Lea

Is it too late to get the flu vaccine?
No, it’s not too late and can be obtained from your health care provider, hospital or local pharmacy, in most cases.

How long does it take before the influenza shots are effective?
Influenza vaccine is effective 7 to 14 days after the administration. Those who regularly take the vaccine may react more quickly than individuals who are taking the vaccine for the first time.

Is there anything else I can do to avoid catching the flu during an outbreak?
Be meticulous about your personal hygiene and wash your hands. Set an example and cover your mouth with a tissue when you cough. During an outbreak, avoid large gatherings of people, if possible.

Will the flu shot really fight this year’s strain of the flu? Doesn’t it change every year?
The flu vaccine is formulated each year to cover the most likely strains of the virus that will occur in the United States. One can presume the vaccine administered is this year’s vaccine. The year and viral strains should be clearly visible on the vaccine label. We know that the flu strains in Texas are covered by the 2012-2013 vaccine.

Are there different types of flu vaccine?
Yes, most folks take the regular “flu shot.” There are two concentrations for adults. The higher concentration is given to the elderly. If it is not available, older Americans should take the regular strength vaccine. The vaccine also may be given twice, particularly to children. Double-dosing can improve the initial response to the vaccine in children who have never had the flu or flu vaccine. This is done with the direction of a pediatrician or family physician. There is a nasal vaccine (Flumist) for individuals between the ages of 2 and 49. It is effective but much more expensive. Finally, there is a new intradermal shot. The needle is shorter and the vaccine is injected into the dermal layer of the skin. It is a bit more expensive than the regular flu shot. Some patients think it’s great and others think it stings more.

Can I get the flu even if I’ve had the flu vaccine?
Yes, optimally the vaccine is about 75 to 90 percent effective in reducing the number of influenza cases in an exposed population. This year, the CDC reports the vaccine is about 60 percent effective, which isn’t as good, but is protective for most individuals who have taken the vaccine. Most individuals who are sick with respiratory illness and who have taken the flu vaccine most likely have something besides the flu. Right now that something else could be respiratory syncytial virus, or RSV. Currently, about one quarter of the cases of respiratory infection in Texas are due to Influenza A and another one quarter are due to RSV. There are a variety of other respiratory viruses that are not flu.

How can I tell if I have cold or the flu?
Flu symptoms include muscular aches and pains, malaise, fever, cough with sputum production, shortness of breath and chest discomfort. Many individuals will have a short course of diarrhea at the onset of symptoms. The disease usually has an abrupt onset and runs its course in 7 to 10 days. The common cold is caused by a different virus called a Rhinovirus. Colds usually are much less severe and are associated with runny nose, sore throat, sneezing, nasal congestion and even sinus and bronchial symptoms (cough). What’s absent is the debilitating malaise and fever. Basically, the common cold is much less severe and generally affects the upper respiratory tract. Patients with influenza are frequently debilitated to the point that they cannot work or function in society.

Should I get a flu shot if I’ve already had the flu (or think I’ve had it)?
Yes, even if you had Influenza A diagnosed by a physician, you only had an infection with one of the three influenza viruses that are present in the community this year and you can still contract the other two. The vaccine will still prevent the other two.

If I get the flu, is there anything to help minimize symptoms?
Yes, there are a few things to note:
• The two viral drugs oseltamavir (Tamiflu) and zanamivir (Relenza) can be quite dramatic in relieving symptoms related to flu. They are most effective when given within 48 hours of the onset of symptoms.
• Conventional antibiotics won’t help unless you develop a secondary bacterial complication, such as pneumonia or sinusitis.
• Most people find relief with aspirin, acetaminophen or ibuprofen/naproxen. Aspirin should be avoided in children. These agents also help with the muscular aches and pains.
• You should remain well hydrated. Many people have various drinks, “totties,” teas and “potions” they swear by.
• Most people with flu are not particularly hungry. Chicken soup hydrates and nourishes at the same time. It is bland and tastes good to most folks.
• Coughs can be treated with guaifenesin (e.g., Robitussin, Mucinex, Guiatuss), which are expectorants and allow patients to easily cough up secretions. Dextromethorphan (DM) or codeine can be added to suppress the cough.
• Antihistamines need to be taken carefully because they dry up secretions, making eliminating the sputum difficult. This can be particularly problematic in patients with preexisting lung disease. If necessary, the decongestant pseudoephedrine is preferred since it is less likely to dry up secretions.
• Be careful with nose drops. Oxymetazoline (e.g., Afrin) can cause a rebound syndrome and “nose drop dependence” if used for more than five days. Start with normal saline drops and see if they will work before using medicated drops.

Dr. A. Scott Lea is Associate Professor of Internal Medicine in the Division of Infectious Diseases at The University of Texas Medical Branch.