Preparing for the flu, by Dr. Melanie Hallman

Melanie Gibbons Hallman, DNP, CRNP, CEN, FNP-BC, ACNP-BC, ENP-C, TCRN, FAEN

As a nurse, I have received an annual flu vaccine for as long as I can remember. It is a way to protect myself, the patients I care for, their families and the public from this nasty bug, and in the 35 years that I have provided direct care to emergency room patients diagnosed with the flu, I have only had the flu once. I think this speaks volumes about the effectiveness of the vaccine.

Occasionally, the anticipated strains in the vaccine are not completely accurate, and those who are vaccinated can still contract the virus. Those instances, however, should not deter vaccination.

Several years ago, I was busily preparing for the afternoon appointment rush at a fast-paced health care clinic. The morning had passed briskly with an average load of follow-up patients and a few new injuries. Most of the clinic staff were out for lunch, and I was my usual energetic, fast-moving self, speedily walking up the hall to discuss the afternoon schedule with my colleague.

Suddenly — BOOM, I felt like I was in slow motion. My extremities felt heavy, my head hurt, and I was freezing. I felt as though I could not take another step. I swayed into an exam room, flopped onto an exam table and weakly called out to my colleague. She ran to the room and exclaimed, “Your face is flushed, you look terrible. Do I need to call for help?”

I explained my symptoms and described feeling as if I had been run over by a truck. Like a switch, I went from moving quickly and feeling strong to experiencing extreme fatigue, chills and aches. My coworker immediately backed away from me and said, “You have the flu!”

I told her that couldn’t be the case. I get my flu shot every year, and I just had one a few weeks prior. Despite my protest, I was down for the count. My coworker called my husband to come get me and he took me to my health care provider’s office. After a nasal swab, it was confirmed — I had the flu. My provider explained that the influenza vaccine used that year may not have covered the strain of flu that I had. I quarantined myself at home, stayed hydrated, took medication to reduce fever and aching, and laid around for about six days before I began to feel better.

Those six days confirmed what we warn patients about — having the flu is no joke. It can rob you of work, time with family and friends, and even your life. It also has potential to infect others.

National Influenza Vaccination Week has been recognized each December since 2005. The focus of the week is to bring awareness to the importance of sustaining flu vaccination efforts throughout the holiday season, when more people attend large gatherings, stay in close quarters and are around those who are most vulnerable to the flu. The flu virus exists year-round, but flu season is recognized from October to May, typically peaking between December and February.

What is the flu?

A 3D graphical representation of the biology and structure of a generic influenza virus. Courtesy of Centers for Disease Control and Prevention.

Influenza is a viral illness that affects the respiratory system. Transmission is thought to be caused by droplets containing influenza virus spreading through the air when an infected person coughs, sneezes or even while talking. Once the virus is airborne, it can attach to the surfaces of another person’s nose or mouth, invade the entire respiratory tract and then enter cells. Adults may be contagious for nearly 24 hours before showing signs of illness, and children may be contagious for even longer.

Sometimes, individuals mistake their flu for an average cold. Colds and flu are both respiratory illnesses, however, they are caused by different viruses. Flu symptoms usually develop rapidly and are much worse than the typically mild, more gradual onset of cold symptoms which possess less likelihood for complications.

Common flu symptoms include fever, cough, sore throat, congested or runny nose, aching muscles, headache and fatigue. Vomiting and diarrhea may occur but are more common in children than adults. Infection of the sinuses and ears and bronchitis may develop following flu infection.

Serious complications may accompany influenza infection including pneumonia and inflammation of the heart, brain and muscles, as well as life-threatening sepsis and organ failure. These post-flu complications are more likely in people who have pre-existing health conditions such as asthma, other lung diseases, diabetes, heart disease and weakened immune systems. Complications are also more likely in adults 65 or older, and in children younger than 5. Children under 2 years of age are at significant risk, as are pregnant women or women who have recently delivered babies.

Stopping the spread

If you suspect you have the flu, stay home and avoid others until you have been fever-free for at least 24 hours without taking fever reducing medications. If you have a condition that places you at higher risk for complications, notify your health care provider as soon as you suspect that you have the flu.

If it is caught early enough — within two days of the onset of illness – you may be prescribed antiviral drugs. These drugs may shorten the length of symptoms and decrease the likelihood of worsening in people at high-risk for complications.

If your symptoms are mild and you are not in a high-risk category, — do not go to the emergency department for treatment. It is best to stay at home, ingest plenty of fluids and get rest to not put others at risk. You can also decrease the spread of the flu by wearing a mask over your nose and mouth, washing your hands frequently and using a tissue to cover coughs and sneezes.

However, if you are significantly ill — have a high fever and cough, difficulty breathing, chest pain, abdominal pain, abrupt dizziness, severe vomiting, inability to take in enough fluids, or confusion, you should go to the emergency department for evaluation.

Significant symptoms in children can include difficulty breathing, bluish skin color, a rash, high fever, excessive irritability, confusion or difficulty waking; in infants, these symptoms include not making tears or wetting through diapers, inability to eat or rapid breathing. Again, these symptoms require going to the emergency department for evaluation.

Vaccinate for prevention

The best measure to prevent the flu is to get a flu vaccine every year. The Centers for Disease Control and Prevention (CDC) recommends that all persons 6 months and older be immunized for flu with a licensed vaccine specific for their age. Women who are pregnant may also take the vaccine at any stage of their pregnancy.

And, there is a common misconception to clear up about the flu vaccine. The vaccine is made from a deactivated virus that helps the body build up protections against strains of the virus but, despite what you may have heard, it cannot “give” a person the flu. If a person is already sick with a virus or another infection when they receive the flu vaccine their symptoms may be more pronounced as the immune system responses to the vaccine. Some people mistake this for getting the flu from the vaccine, but that is simply not the case.

Further information about influenza and the flu vaccine can be found at:

Melanie Gibbons Hallman, DNP, CRNP, CEN, FNP-BC, ACNP-BC, ENP-C, TCRN, FAEN, has more than 38 years of prehospital and emergency care experience, and has practiced as an emergency nurse practitioner for the past 24 years. She is an Assistant Professor of Nursing, and coordinator of the Emergency Nurse Practitioner subspecialty. Dr. Hallman is certified as a Family Nurse Practitioner, Acute Care Nurse Practitioner and Emergency Nurse Practitioner, and is a four-time alumna of UAB School of Nursing.

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