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Flu (in៯�uenza, conventional, H1N1, H3N2, and bird ៯�u [H5N1])

facts

In៯�uenza, commonly called "the ៯�u," is caused by viruses  that infect the
respiratory tract.

Flu symptoms include

fever,

chills,

cough,

sore throat,

headache,

muscle aches, and

fatigue.

The incubation period for ៯�u is about one to four days.

Flu is contagious  , and symptoms may last up to seven to 14 days.

Flu is diagnosed by the patient's history, physical exam, and laboratory tests.

Flu is spread directly and indirectly; directly from person to person by airborne
droplets produced during sneezing or coughing, for example, and indirectly when
contaminated droplets land on surfaces that are subsequently touched by uninfected
individuals.

In៯�uenza viruses are divided into three types, designated A, B, and C, with in៯�uenza
A types usually causing the most problems in humans.

 In៯�uenza (Flu) / What

 are ៯�u (in៯�uenza) 
 Most people who get the conventional or seasonal ៯�u recover completely in one to
two weeks, but some people develop serious and potentially life-threatening medical
complications, such as pneumonia.

The ៯�u can make chronic health problems worse

Much of the illness and death caused by conventional or seasonal in៯�uenza can be
prevented by annual in៯�uenza vaccination.

In៯�uenza A undergoes frequent antigenic changes that require new vaccines to be

developed and people to obtain a new vaccination every year. New vaccine technology is
being developed.

In April 2009, a new ៯�u virus termed novel H1N1 swine ៯�u developed in Mexico,
rapidly spread worldwide, and caused the WHO to declare a ៯�u pandemic. Eventually, the
WHO declared the pandemic over in 2010. In 2012, a new type of ៯�u strain developed,
H3N2v, but has not developed into any epidemic situations currently.

Effectiveness of the ៯�u vaccine varies year to year because strains causing ៯�u also
vary yearly.

Some home remedies may reduce ៯�u symptoms.

Suggestions for foods are listed to help individuals recover from the ៯�u.

Prescribed medicine for ៯�u virus and over-the-counter treatments for the ៯�u are
listed.

Like the in៯�uenza virus, drug treatments are constantly changing and improving, but
currently, timely vaccination is still considered to be the best defense against the ៯�u.
However, the U.S. Centers for Disease Control and Prevention (CDC) considers antiviral
drugs an important adjunct to the ៯�u vaccine in the control of the disease process.

CDC recommendations for use in treatment of the ៯�u for the 2017-2018 ៯�u season
are listed.

People should be aware that ៯�u pandemics can cause severe ៯�u symptoms and
sometimes cause death in many individuals who may be more susceptible to the
pandemic ៯�u than the conventional ៯�u; however, the previous pandemic ៯�u virus (H1N1)
has been available in vaccines and is considered part of the conventional circulating ៯�u
viruses.
 In៯�uenza (Flu) / What
 are ៯�u (in៯�uenza) 
 Bird ៯�u (H5N1) mainly infects birds, but it also infects humans who have close
contacts with birds.

Individuals should check with their doctors to determine if they are considered to be
at higher risk of getting severe ៯�u symptoms than the normally healthy population.

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Flu Shot Side Effects

Many people worry about side effects from the u shot, but serious complications are rare. Some
people believe that they can actually get the u from receiving the shot, but this is not the case. For the
majority of people, the risks of developing the u are far greater than any risks associated with the vaccine.

Most side effects and reactions to the u shot are mild. Most commonly, people experience a soreness, redness, or
mild swelling at the site where the shot was given. These effects generally do not last for more than 2 days. In rare
cases, people may develop other mild reactions to the u vaccine like fever and aches, which may mistakenly lead
them to believe that they developed the u as a result of the vaccine. These symptoms also go away after about 1 to 2
days. Because the u shot contains inactivated, or killed, virus particles, there is no possibility of contracting the
infection from the u shot.

Allergic reactions to the u shot are very rare.

Read about ៯�u shot side effects »

What is ៯�u (in៯�uenza)?

In៯�uenza, commonly called "the ៯�u," is an illness caused by RNA viruses that infect the respiratory
tract of many animals, birds, and humans. In most people, the infection results in the person
getting a fever, cough, headache  , and malaise (tired, no energy); some people also may
develop a sore throat  , nausea, vomiting, and diarrhea. The majority of individuals has ៯�u
symptoms for about one to two weeks and then recovers with no problems. However, compared

 In៯�uenza (Flu) / What

 are ៯�u (in៯�uenza) 
 with most other viral respiratory infections, such as the common cold, in៯�uenza (៯�u) infection can
cause a more severe illness with a mortality rate (death rate) of about 0.1% of people who are
infected with the virus.

The above is the usual situation for the yearly occurring "conventional" or "seasonal" ៯�u strains.
However, there are situations in which some ៯�u outbreaks are severe. These severe outbreaks
occur when a portion of the human population is exposed to a ៯�u strain against which the
population has little or no immunity because the virus has become altered in a signiퟪ�cant way.
These outbreaks are usually termed epidemics. Unusually severe worldwide outbreaks
(pandemics) have occurred several times in the last hundred years since in៯�uenza virus was
identiퟪ�ed in 1933. By an examination of preserved tissue, the worst in៯�uenza pandemic (also
termed the Spanish ៯�u or Spanish in៯�uenza) occurred in 1918 when the virus caused between 40-
100 million deaths worldwide, with a mortality rate estimated to range from 2%-20%.

In April 2009, a new in៯�uenza strain against which the world population has little or no immunity
was isolated from humans in Mexico. It quickly spread throughout the world so fast that the WHO
declared this new ៯�u strain (ퟪ�rst termed novel H1N1 in៯�uenza  A swine ៯�u, often later
shortened to H1N1 or swine ៯�u) as the cause of a pandemic on June 11, 2009. This was the ퟪ�rst
declared ៯�u pandemic in 41 years. Fortunately, there was a worldwide response that included
vaccine production, good hygiene practices (especially hand washing) were emphasized, and the
virus (H1N1) caused far less morbidity and mortality than was expected and predicted. The WHO
declared the pandemic's end on Aug. 10, 2010, because it no longer ퟪ�t into the WHO's criteria for
a pandemic.

A new in៯�uenza strain, H3N2, was identiퟪ�ed in 2011, but this strain has caused only about 330
infections with one death in the U.S. Another strain, H5N1, a bird ៯�u virus, has been identiퟪ�ed
since 2003 and has caused about 650 human infections; this virus has not been detected in the
U.S. and currently is not known to be easily spread among people in contrast to other ៯�u strains.
Unfortunately, people infected with H5N1 have a high death rate (about 60% of infected people
die); currently, H5N1 is not readily transferred from person to person like other ៯�u viruses.

The most recent data for the mortality (death rates) from in៯�uenza rate (death rate) for the United
States in 2016 indicates that mortality from in៯�uenza varies from year to year. Death rates
estimated by the CDC range from about 12,000 during 2011-2012 to 56,000 during 2012-2013.

Haemophilus in៯�uenzae is a bacterium that was incorrectly considered to cause the ៯�u until the
virus was demonstrated to be the correct cause in 1933. This bacterium can cause lung
infections in infants and children, and it occasionally causes ear, eye, sinus, joint, and a few other

 In៯�uenza
infections, but it does not /cause
(Flu) What
theare ៯�u (in៯�uenza)
៯�u. 
Another confusing term is stomach ៯�u. This term refers to a gastrointestinal tract infection, not a
respiratory infection like in៯�uenza (៯�u); stomach ៯�u (gastroenteritis) is not caused by in៯�uenza
viruses.

Although initially symptoms of in៯�uenza may mimic those of a cold, in៯�uenza is more debilitating
with symptoms of fatigue  , fever, and respiratory congestion. Colds can be caused by over 100
different virus types, but only in៯�uenza viruses (and subtypes) A, B, and C cause the ៯�u. In
addition, colds do not lead to life-threatening illnesses like pneumonia  , but severe infections
with in៯�uenza viruses can lead to pneumonia or even death.

Flu vs. cold

Compared with most other viral respiratory infections, such as the common cold  , in៯�uenza
(៯�u) infection usually causes a more severe illness with a mortality rate (death rate) of about 0.1%
of people who are infected with the virus. Cold symptoms (for example, sore throat, runny nose,
cough (with possible phlegm production), congestion, and slight fever) are similar to ៯�u
symptoms, but the ៯�u symptoms are more severe, last longer, and may include vomiting, diarrhea
 , and cough that is often a dry cough.

The following table is provided by the CDC to help distinguish between a cold and in៯�uenza:

Signs and Symptoms In៯�uenza Cold

Symptom onset Abrupt Gradual

Fever Usual; lasts 3-4 days Rare

Aches Usual; often severe Slight

Chills Fairly common Uncommon

Fatigue, weakness Usual Sometimes

Sneezing Sometimes Common

Stuffy nose Sometimes Common

Sore throat Sometimes Common

Chest discomfort, cough Common; can be severe Mild to moderate; hacking cough

Headache Common Rare

Flu vs. food poisoning

 In៯�uenza (Flu) / What

 are ៯�u (in៯�uenza) 
Although some of the symptoms of in៯�uenza may mimic those of food poisoning, others do not.
Most symptoms of food poisoning  include nausea, vomiting, watery diarrhea, abdominal pain,
cramps, and fever. Note that the majority of food poisoning symptoms are related to the
gastrointestinal tract, except for fever. The common ៯�u signs and symptoms include fever but
also include symptoms that are not typical for food poisoning, because the ៯�u is a respiratory
disease. Consequently, respiratory symptoms of nasal congestion, dry cough, and some breathing
problems help distinguish the ៯�u from food poisoning.

What are the causes of the ៯�u (in៯�uenza)?

In៯�uenza virus information

In៯�uenza viruses cause the ៯�u and are divided into three types, designated A, B, and C. In៯�uenza
A and in៯�uenza B are responsible for epidemics of respiratory illness that occur almost every
winter and are often associated with increased rates of hospitalization and death. In៯�uenza type
C differs from types A and B in some important ways. Type C infection usually causes either a
very mild respiratory illness or no symptoms at all; it does not cause epidemics and does not have
the severe public-health impact of in៯�uenza types A and B. Efforts to control the impact of
in៯�uenza are aimed at types A and B, and the remainder of this discussion will be devoted only to
these two types.

In៯�uenza viruses continually change over time, usually by mutation (change in the viral RNA). This
constant changing often enables the virus to evade the immune system of the host (humans,
birds, and other animals) so that the host is susceptible to changing in៯�uenza virus infections
throughout life. This process works as follows: A host infected with in៯�uenza virus develops
antibodies against that virus; as the virus changes, the "ퟪ�rst" antibody no longer recognizes the
"newer" virus and infection can occur because the host does not recognize the new ៯�u virus as a
problem until the infection is well under way. The ퟪ�rst antibody developed may, in some instances,
provide partial protection against infection with a new in៯�uenza virus. In 2009, almost all
individuals had no antibodies that could recognize the novel H1N1 virus immediately.

Type A viruses are divided into subtypes or strains based on differences in two viral surface
proteins called the hemagglutinin (H) and the neuraminidase (N). There are at least 16 known H
subtypes and nine known N subtypes. These surface proteins can occur in many combinations.
When spread by droplets or direct contact, the virus, if not killed by the host's immune system,
replicates in the respiratory tract and damages host cells. In people who are immune
compromised (for example, pregnant women, infants, cancer patients, asthma patients, people
with pulmonary disease, and many others), the virus can cause viral pneumonia or stress the
 In៯�uenza (Flu) / What
 are ៯�u (in៯�uenza) 
individual's system to make them more susceptible to bacterial infections  , especially bacterial
pneumonia. Both pneumonia types, viral and bacterial, can cause severe disease and sometimes
death.

Antigenic shift and drift

In៯�uenza type A viruses undergo two major kinds of changes. One is a series of mutations that
occurs over time and causes a gradual evolution of the virus. This is called antigenic "drift." The
other kind of change is an abrupt change in the hemagglutinin and/or the neuraminidase proteins.
This is called antigenic "shift." In this case, a new subtype of the virus suddenly emerges. Type A
viruses undergo both kinds of changes; in៯�uenza type B viruses change only by the more gradual
process of antigenic drift and therefore do not cause pandemics.

The 2009 pandemic-causing H1N1 virus was a classic example of antigenic shift. Research
showed that novel H1N1 swine ៯�u has an RNA genome that contains ퟪ�ve RNA strands derived
from various swine ៯�u strains, two RNA strands from bird ៯�u (also termed avian ៯�u) strains, and
only one RNA strand from human ៯�u strains. According to the CDC, mainly antigenic shifts over
about 20 years led to the development of novel H1N1 ៯�u virus. A diagram that illustrates both
antigenic shift and drift can be found below (see Figure 2) and features in៯�uenza A types H1N1
and bird ៯�u (H5N1), but almost every in៯�uenza A viral strain can go through these processes that
changes the viral RNA. A recent ៯�u epidemic in India was partially blamed on antigenic drift/shift.

When does ៯�u season begin and end?

Flu season oៈ�cially begins in October of each year and extends to May of the following year.
According to the CDC, people can follow the development of ៯�u across the United States by
following CDC's weekly update of the locations where ៯�u is developing in the U.S. (see the ៯�u
map).

What are ៯�u (in៯�uenza) symptoms in adults and in children?

Typical clinical features of in៯�uenza may include

fever (usually 100 F-103 F in adults and often even higher in children, sometimes
with facial ៯�ushing and/or sweating  ),

chills,

respiratory symptoms such as

cough (more often in

 In៯�uenza (Flu)  areadults),
/ What ៯�u (in៯�uenza) 
 sore throat (more often in adults),

runny or stuffy nose (congestion, especially in children),

sneezing,

headache  ,

muscle aches (body aches), and

fatigue, sometimes extreme.

Although appetite loss, nausea, vomiting, and diarrhea can sometimes accompany in៯�uenza
infection, especially in children, gastrointestinal symptoms are rarely prominent. The term
"stomach ៯�u" is a misnomer that is sometimes used to describe gastrointestinal illnesses caused
by other microorganisms. H1N1 infections, however, caused more nausea, vomiting, and diarrhea
than the conventional (seasonal) ៯�u viruses. Depending upon the severity of the infection, some
patients can develop swollen lymph nodes, muscle pain, shortness of breath, severe headaches,
chest pain or chest discomfort, dehydration, and even death.

Most individuals who contract in៯�uenza recover in a week or two, however, others develop
potentially life-threatening complications like pneumonia. In an average year, in៯�uenza is
associated with about 36,000 deaths nationwide and many more hospitalizations. Flu-related
complications can occur at any age; however, the elderly and people with chronic health problems
are much more likely to develop serious complications after the conventional in៯�uenza infections
than are younger, healthier people.

In៯�uenza A information
As mentioned previously, has hemagglutinin on the viral surface. The viral hemagglutinins have at
least 18 types, but these types are broken into two main in៯�uenza A categories. For example, one
of the two main categories includes human H1, H2, and avian H5 viruses while the other major
category includes human H3 and avian H7 viruses. Researchers in 2016 at UCLA and the
University of Arizona discovered that if you were exposed to one of these groups as a child, you
had a much better chance of being protected against other viruses in that same group or
category later in life. For example, if you are exposed to H2 as a child and then later in life to H2 or
H5 viruses, you may have as high as a 75% chance of protection against those H2 and/or H5
strains, but if you are exposed to the other major category that included H3 or H7, you would be
much more susceptible to these viral types. The reverse situation would be true if you were

exposed as a child(Flu)
In៯�uenza / H7
to H3 or viruses.
What
 The
are ៯�u researchers concluded that the immunological
(in៯�uenza) 
 imprinting early in life helps determine the response (immune response) to these viral types or
categories. Consequently, the ퟪ�rst strain of ៯�u that a person is exposed to in childhood likely
determines that person's risk in the future for severity of the ៯�u depending upon the exact
category of the ퟪ�rst viral strain that infects the child. The researchers hope to exploit these new
ퟪ�ndings in the development of new and more effective ៯�u vaccines.

What is the incubation period for the ៯�u?

Incubation period for the ៯�u, which means the time from exposure to the ៯�u virus until initial
symptoms develop, typically is one to four days with an average incubation period of two days.

How long is the ៯�u contagious, and how long does the ៯�u last?
The ៯�u is typically contagious about 24-48 hours before symptoms appear (from about the last
day of the incubation period) and in normal healthy adults is contagious for another ퟪ�ve to seven
days. Children are usually contagious for a little while longer (about seven to 10 days). Individuals
with severe infections may be contagious as long as symptoms last (about seven to 14 days). In
adults, ៯�u symptoms usually last about ퟪ�ve to seven days, but in children, the symptoms may last
longer (about seven to 10 days). However, some symptoms such as weakness and fatigue may
gradually wane over several weeks.

How do health care professionals diagnose the ៯�u (in៯�uenza)?

The ៯�u is presumptively diagnosed clinically by the patient's history of association with people
known to have the disease and their symptoms listed above. Usually, a quick test (for example,
nasopharyngeal swab sample) is done to see if the patient is infected with in៯�uenza A or B virus.
Most of the tests can distinguish between A and B types. The test can be negative (no ៯�u
infection) or positive for types A or B. If it is positive for type A, the person could have a
conventional ៯�u strain or a potentially more aggressive strain such as H1N1. Most of the rapid
tests are based on PCR technology that identiퟪ�es the genetic material of the virus. Some rapid
in៯�uenza diagnostic tests (RIDTs) can screen for in៯�uenza in about 10-30 minutes.

Swine ៯�u (H1N1) and other in៯�uenza strains like bird ៯�u or H3N2 are deퟪ�nitively diagnosed by
identifying the particular surface proteins or genetic material associated with the virus strain. In
general, this testing is done in a specialized laboratory. However, doctors' oៈ�ces are able to send
specimens to specialized laboratories if necessary.

How does ៯�u spread?

How can you get

In៯�uenza / What
in៯�uenza?
(Flu)  are ៯�u (in៯�uenza) 
 Flu is easily spread from person to person both directly and indirectly. The in៯�uenza virus can
spread to other people in droplets contaminated with the virus. Produced by coughing, sneezing,
or even talking, these droplets land near or in the mouth or the nose of uninfected people, and the
disease may spread to them. The disease can spread indirectly to others if contaminated droplets
land on utensils, dishes, clothing, or almost any surface and then are touched by uninfected
people. If the infected person touches their nose or mouth, for example, they transfer or spread
the disease to themselves or others.

What is the key to ៯�u (in៯�uenza) prevention?

Flu vaccine

Most of the illness and death caused by in៯�uenza can be prevented by annual in៯�uenza
vaccination. The CDC's current Advisory Committee on Immunization Practices (ACIP) issued
recommendations for everyone 6 months of age and older, who do not have any contraindications
to vaccination, to receive a ៯�u vaccine each year.

Flu vaccine (in៯�uenza vaccine made from inactivated and sometimes attenuated [noninfective]
virus or virus components) is speciퟪ�cally recommended for those who are at high risk for
developing serious complications as a result of in៯�uenza infection.

A new vaccine type, Fluzone Intradermal, was approved by the FDA in 2011 (for adults 18-64
years of age). This injection goes only into the intradermal area of the skin, not into the muscle
(IM) like most conventional ៯�u shots, and uses a much smaller needle than the conventional
shots. This killed viral preparation is supposed to be about as effective as the IM shot but claims
to produce less pain and fewer side effects (see section below).

Other simple hygiene methods can reduce or prevent some individuals from getting the ៯�u. For
example, avoiding kissing, handshakes, and sharing drinks  or food with infected people and
avoiding touching surfaces like sinks and other items handled by individuals with the ៯�u are good
preventive measures. Individuals with the ៯�u should avoid coughing or sneezing on uninfected
people; quick hugs are probably okay as long as there is no contact with mucosal surfaces and/or
droplets that may contain the virus.

Are there any nasal spray vaccine or ៯�u shot side effects in
adults or in children?
Although annual in៯�uenza (injectable) vaccination has long been recommended for people in the
high-risk groups, many still do not receive the vaccine, often because of their concern about side
effects.In៯�uenza
They mistakenly / What
(Flu) perceive are ៯�u (in៯�uenza)
 in៯�uenza as merely a nuisance and believe that the vaccine 
causes unpleasant side effects or that it may even cause the ៯�u. The truth is that in៯�uenza
vaccine causes no side effects in most people. The most serious side effect that can occur after
in៯�uenza vaccination is an allergic reaction  in people who have a severe allergy to eggs, since
the viruses used in the vaccine are grown in hens' eggs. However, a newer form of the vaccine is
available that is not grown in chicken eggs. For this reason, people who have an allergy  to
eggs should not receive the conventional in៯�uenza vaccine, but the newer forms may be
appropriate for them. Also, the vaccine is not recommended while individuals have active
infections or active diseases of the nervous system. Less than one-third of those who receive the
vaccine have some soreness at the vaccination site, and about 5%-10% experience mild side
effects, such as headache, low-grade fever, or muscle cramps, for about a day after vaccination;
some may develop swollen lymph nodes. These side effects are most likely to occur in children
who have not been exposed to the in៯�uenza virus in the past. The intradermal shots reportedly
have similar side effects as the IM shot but are less intense and may not last as long as the IM
shot.

Nevertheless, some older people remember earlier in៯�uenza vaccines that did, in fact, produce
more unpleasant side effects. Vaccines produced from the 1940s to the mid-1960s were not as
highly puriퟪ�ed as modern in៯�uenza vaccines, and it was these impurities that caused most of the
side effects. Since the side effects associated with these early vaccines, such as fever, headache,
muscle aches, and/or fatigue and malaise, were similar to some of the symptoms of in៯�uenza,
people believed that the vaccine had caused them to get the ៯�u. However, injectable in៯�uenza
vaccine produced in the United States has never been capable of causing in៯�uenza because it
consists of killed virus.

Another type of in៯�uenza vaccine (nasal spray) is made with live attenuated (altered) in៯�uenza
viruses (LAIV) but is not currently recommended by the CDC. This vaccine is made with live
viruses that can stimulate the immune response enough to confer immunity but do not cause
classic in៯�uenza symptoms (in most instances). The nasal spray vaccine (FluMist) was only
approved for healthy individuals ages 2-49 years of age and was recommended preferentially for
healthy children aged 2 through 8 who did not have contraindications to receiving the vaccine, if it
is readily available. This nasal spray vaccine contains live attenuated virus (less able to cause ៯�u
symptoms due to a designed inability to replicate at normal body temperatures). This live vaccine
could possibly cause the disease in infants and immunocompromised people and does not
produce a strong immune response in many older people. Side effects of the nasal spray vaccine
include nasal congestion, sore throat, and fever. Headaches  , muscle aches, irritability, and
malaise have also been noted. In most instances, if side effects occur, they only last a day or two.
This nasal spray has been produced for conventional ៯�u viruses and should not be given to
 In៯�uenza (Flu) / What
 are ៯�u (in៯�uenza) 
 pregnant women or anyone who has a medical condition that may compromise the immune
system because in some instances the ៯�u may be a side effect. Please note that the CDC
recommended that the nasal spray (LAIV) vaccine should not be used during the 2017-2018 ៯�u
season because of relatively lower effectiveness seen from 2013-2016 (see the entire
recommendation at http://www.cdc.gov/media/releases/2016/s0622-laiv-៯�u.html).

Some people do not receive in៯�uenza vaccine because they believe it is not very effective. There
are several different reasons for this belief. People who have received in៯�uenza vaccine may
subsequently have an illness that is mistaken for in៯�uenza, and they believe that the vaccine
failed to protect them. In other cases, people who have received the vaccine may indeed have an
in៯�uenza infection. Overall vaccine effectiveness varies from year to year, depending upon the
degree of similarity between the in៯�uenza virus strains included in the vaccine and the strain or
strains that circulate during the in៯�uenza season. Because the vaccine strains must be chosen
nine to 10 months before the in៯�uenza season, and because in៯�uenza viruses mutate over time,
sometimes mutations occur in the circulating virus strains between the time the vaccine strains
are chosen and the next in៯�uenza season ends. These mutations sometimes reduce the ability of
the vaccine-induced antibody to inhibit the newly mutated virus, thereby reducing vaccine
effectiveness. This commonly occurs with the conventional ៯�u vaccines as the speciퟪ�c virus
types chosen for vaccine inclusion are based on reasoned projections for the upcoming ៯�u
season. Occasionally, the vaccine does not match the actual predominating virus strain and is not
very effective in generating a speciퟪ�c immune response to the predominant infecting ៯�u strain.

How effective is the ៯�u vaccine?

Vaccine eៈ�cacy also varies from one person to another. Past studies of healthy young adults
have shown in៯�uenza vaccine to be 70%-90% effective in preventing illness. In the elderly and
those with certain chronic medical conditions such as HIV, the vaccine is often less effective in
preventing illness. Studies show the vaccine reduces hospitalization by about 70% and death by
about 85% among the elderly who are not in nursing homes. Among nursing-home residents,
vaccine can reduce the risk of hospitalization by about 50%, the risk of pneumonia by about 60%,
and the risk of death by 75%-80%. However, these ퟪ�gures did not apply to the 2014-2015 ៯�u
vaccine because the quadrivalent (four antigenic types) vaccine did not match well with 2014-
2015 circulating strains of the ៯�u (vaccine effectiveness was estimated to be 23%). This occurs
because the vaccine needs to be produced months before the ៯�u season begins, so the vaccine is
designed by projecting and choosing the most likely viral strains to include in the vaccine. If drift
results in changing the circulating virus from the strains used in the vaccine, eៈ�cacy may be
reduced. However, the vaccine is still likely to lessen the severity of the illness and to prevent

 In៯�uenza
complications death, /according
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What the(in៯�uenza)
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Why should the ៯�u (in៯�uenza) vaccine be taken every year?
 Why should the ៯�u (in៯�uenza) vaccine be taken every year?
Although only a few different in៯�uenza virus strains circulate at any given time, people may
continue to become ill with the ៯�u throughout their lives. The reason for this continuing
susceptibility is that in៯�uenza viruses are continually mutating, through the mechanisms of
antigenic shift and drift described above. Each year, the vaccine is updated to include the most
current in៯�uenza virus strains that are infecting people worldwide. The fact that in៯�uenza viral
genes continually change is one of the reasons vaccine must be taken every year. Another reason
is that antibody produced by the host in response to the vaccine declines over time, and antibody
levels are often low one year after vaccination so even if the same vaccine is used, it can act as a
booster shot to raise immunity.

Many people still refuse to get ៯�u shots because of misunderstandings, fear, "because I never get
any shots," or simply a belief that if they get the ៯�u, they will do well. These are only some of the
reasons -- there are many more. The U.S. and other countries' populations need to be better
educated about vaccines; at least they should realize that safe vaccines have been around for
many years (measles, mumps, chickenpox, and even a vaccine for cholera), and as adults they
often have to get a vaccine-like shot to test for tuberculosis exposure or to protect themselves
from tetanus. The ៯�u vaccines are as safe as these vaccines and shots that are widely accepted
by the public. Consequently, better efforts need to be made to make yearly ៯�u vaccines as widely
acceptable as other vaccines. Susceptible people need to understand that the vaccines afford
them a signiퟪ�cant chance to reduce or prevent this potentially debilitating disease, hospitalization
and, in a few, a lethal ៯�u-caused disease.

What are some ៯�u treatments an individual can do at home

(home remedies)?
First, individuals should be sure they are not members of a high-risk group that is more
susceptible to getting severe ៯�u symptoms. Check with a physician if you are unsure if you are a
higher-risk person. Home care is recommended by the CDC if a person is healthy with no
underlying diseases or conditions (for example, asthma  , lung disease, pregnant, or
immunosuppressed).

Increasing liquid intake, warm showers, and warm compresses, especially in the nasal area, can
reduce the body aches and reduce nasal congestion or head congestion. Nasal strips and
humidiퟪ�ers may help reduce congestion, especially while trying to sleep. Some physicians
recommend nasal irrigation  with saline to further reduce congestion; some recommend
nonprescription decongestants like pseudoephedrine (Sudafed). Fever can be treated with over-

 In៯�uenza
the-counter (Flu) / What
acetaminophen  areor
(Tylenol) ៯�uibuprofen
(in៯�uenza)
(Advil, Motrin and others); read labels for safe 
dosage. Cough can be suppressed by cough drops, over-the-counter cough syrup, or cough
medicine that may contain dextromethorphan (Delsym) and/or guaifenesin (Mucinex). Notify a
doctor if an individual's symptoms at home get worse.

What types of doctors treat the ៯�u?

Individuals with mild ៯�u symptoms may not require the care of a physician unless they are a
member of a high-risk group as described above. For many individuals, treatment is provided by
their primary care physician or provider (including internists or family medicine specialists and
physician assistants and other primary caregivers) or pediatrician. Complicated or severe ៯�u
infections may require consultation with an emergency-medicine physician, critical care
specialist, infectious-disease specialist, and/or a lung specialist (pulmonologist).

What medications treat the ៯�u?

The CDC published the following guidance concerning antiviral drugs:

Antiviral medications with activity against in៯�uenza viruses are an important adjunct to in៯�uenza
vaccine in the control of in៯�uenza.

In៯�uenza antiviral prescription drugs can be used to treat in៯�uenza or to prevent

in៯�uenza.

Oseltamivir, zanamivir, and peramivir are chemically related antiviral medications

known as neuraminidase inhibitors that have activity against both in៯�uenza A and B
viruses.

The following are the CDC recommended antiviral medications for the treatment of in៯�uenza (៯�u)
for the 2016-2017 season are as follows: oral oseltamivir (Tami៯�u), inhaled zanamivir (Relenza),
and intravenous peramivir (Rapivab). See Table 1 below for details about utilizing these drugs in
adults and children.

Over-the-counter medications that may help reduce symptoms of congestion (decongestants),

coughing (cough medicine), and dehydration  include diphenhydramine (Benadryl),
acetaminophen (Tylenol), NSAIDs (Advil, Motrin, Aleve), guaifenesin (Mucinex), dextromethorphan
(Delsym), pseudoephedrine (Sudafed), and oral ៯�uids. Aspirin may be used in adults but not in
children.

Antibiotics treat bacterial infections, not viral illnesses like the ៯�u.

 In៯�uenza (Flu) / What

 are ៯�u (in៯�uenza) 
Individuals with the ៯�u may also beneퟪ�t from some additional bed rest, throat lozenges, and
possibly nasal irrigation; drinking ៯�uids may help prevent symptoms of dehydration (for example,
dry mucus membranes and decreased urination).

What can people eat when they have the ៯�u?

While a person has the ៯�u, good nutrition can help the recovery process. Anyone with the ៯�u
needs to avoid dehydration, soothe sore throat and/or upset stomach, and have a good protein
intake. Dehydration can be avoided by adequate ៯�uid intake such as juices (orange, cranberry,
grapefruit, tomato, grape, and others). Sore throat and upset stomach may be relieved by broths
or warm soups (chicken, vegetable, or beef) and plain crackers, toast, and ginger tea or
noncarbonated ginger ale. Scrambled eggs, yogurt, and/or protein drinks are good protein
sources. In addition, bananas, rice, and applesauce are food that are often recommended for
those with an upset stomach. This list is not exhaustive but should provide a balanced approach
to help speed recovery from the ៯�u.

When should a person go to the emergency department for the

៯�u?
The CDC urges people to seek emergency medical care for a sick child with any of these ៯�u
effects (symptoms or signs):

1. Fast breathing or trouble breathing (shortness of breath)

2. Bluish or gray skin color

3. Not drinking enough ៯�uids

4. Severe or persistent vomiting

5. Not waking up or not interacting

6. Being so irritable that the child does not want to be held

7. Flu-like symptoms improve but then return with fever and cough

The following is the CDC's list of symptoms that should trigger emergency medical care for
adults:

1. Diៈ�culty breathing or shortness of breath

2. Pain  or pressure in the chest or abdomen

 In៯�uenza (Flu) / What
 are ៯�u (in៯�uenza) 
 3. Sudden dizziness

4. Confusion

5. Severe or persistent vomiting

6. Flu-like symptoms improve but then return with fever and worse cough

7. Having a high fever for more than three days is another danger sign, according to the
WHO, so the CDC has also included this as another serious symptom.

Who should receive the ៯�u vaccine, and who has the highest
risk factors? When should someone get the ៯�u shot?
In the United States, the ៯�u season usually occurs from about November until April. Oៈ�cials have
decided each new ៯�u season will start each year on Oct. 4. Typically, activity is very low until
December, and peak activity most often occurs between January and March. Ideally, the
conventional ៯�u vaccine should be administered between September and mid-November. Flu
season typically occurs between October and May. It takes about one to two weeks after
vaccination for antibodies against in៯�uenza to develop and provide protection. The CDC has
published a summary list of their current recommendations of who should get the current
vaccine:

Summary of CDC in៯�uenza vaccination recommendations for 2017-2018

Routine annual in៯�uenza vaccination of all people aged ≥ 6 months without contraindications
continues to be recommended. No preferential recommendation is made for one in៯�uenza
vaccine product over another for people for whom more than one licensed, recommended
product is otherwise appropriate. Updated information and guidance in this document includes
the following:

In light of low effectiveness against in៯�uenza A(H1N1)pdm09 in the United States

during the 2013-14 and 2015-16 seasons, for the 2017-18 season, ACIP makes the
interim recommendation that LAIV4 (nasal spray) should not be used. Because LAIV4 is
still a licensed vaccine that might be available and that some providers might elect to
use, for informational purposes, reference is made to previous recommendations for its
use.

The 2017-2018 U.S. trivalent in៯�uenza vaccines will contain an

 In៯�uenza (Flu) / (H1N1)pdm09-like

A/Michigan/45/2015 What virus, an A/Hong Kong/4801/2014 (H3N2)-like
 are ៯�u (in៯�uenza) 
 virus, and a B/Brisbane/60/2008-like virus (Victoria lineage). Quadrivalent vaccines will
include an additional vaccine virus strain, a B/Phuket/3073/2013-like virus (Yamagata
lineage).

Recent new vaccine licensures are discussed:

An MF59-adjuvanted trivalent inactivated in៯�uenza vaccine (aIIV3), Fluad

(Seqirus, Holly Springs, North Carolina), was licensed by FDA in November 2015 for
people aged ≥ 65 years. Regulatory information is available at
http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/ucm473989.htm.
aIIV3 is an acceptable alternative to other vaccines licensed for people in this age
group. ACIP and CDC do not express a preference for any particular vaccine
product.

A quadrivalent formulation of Flucelvax (cell culture-based inactivated

in៯�uenza vaccine [ccIIV4], Seqirus, Holly Springs, North Carolina) was licensed by
the FDA in May 2016 for people aged ≥ 4 years. Regulatory information is available
at:
http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm502844.htm.
ccIIV4 is an acceptable alternative to other vaccines licensed for people in this age
group. No preference is expressed for any particular vaccine product.

Recommendations for in៯�uenza vaccination of people with egg allergy  have

been modiퟪ�ed, including the following:

Removal of the recommendation that egg-allergic recipients should be

observed for 30 minutes postvaccination for signs and symptoms of an allergic
reaction. Providers should consider observing all patients for 15 minutes after
vaccination to decrease the risk for injury should they experience syncope, per the
ACIP General Recommendations on Immunization (8).

A recommendation that people with a history of severe allergic reaction to

egg (for example, any symptom other than hives) should be vaccinated in an
inpatient or outpatient medical setting (including but not necessarily limited to
hospitals, clinics, health departments, and physician oៈ�ces), under the supervision
of a health care provider who is able to recognize and manage severe allergic
conditions.

For more information and details too extensive to include here, the following site is
 In៯�uenza
recommended: (Flu) / What
 are ៯�u (in៯�uenza)
http://www.cdc.gov/៯�u/professionals/acip/index.htm. 
What is the prognosis for patients who get the ៯�u? What are
 What is the prognosis for patients who get the ៯�u? What are
possible complications of the ៯�u?
In general, the majority (about 90%-95%) of people who get the disease feel terrible (see
symptoms) but recover with no problems. People with suppressed immune systems historically
have worse outcomes than uncompromised individuals; current data suggest that pregnant
individuals, children under 2 years of age, young adults, and individuals with any immune
compromise or debilitation are likely to have a worse prognosis. Complications from the ៯�u may
worsen medical conditions such as asthma  , congestive heart failure, and diabetes. Other
complications may include ear infections, sinus infections, dehydration, pneumonia, and even
death. In most outbreaks, epidemics, and pandemics, the mortality rates are highest in the older
population (usually above 50 years old). Complications of any ៯�u virus infection, although
relatively rare, may resemble severe viral pneumonia or the SARS (severe acute respiratory
syndrome caused by a coronavirus strain) outbreak in 2002-2003, in which the disease spread to
about 10 countries with over 7,000 cases, over 700 deaths, and had a 10% mortality rate. Guillain-
Barré syndrome (GBS), a rare immune disorder that can result in weakness or paralysis, may
occur after having the ៯�u or very rarely, after vaccination against the ៯�u (estimated by the CDC to
be about one person per every million people vaccinated).

Can the ៯�u be deadly?

Yes. However, associated deaths per year depend upon the virulence of the particular strain of
virus that is circulating. That means for any given year, the likelihood of dying from the ៯�u varies
according to the speciퟪ�c infecting viruses. For example, from 1976-2007 (the most reliable
available data according to the CDC), deaths associated with the ៯�u range from a low of about
3,000 per year to a high of about 49,000 per year. The CDC estimates about 36,000 deaths/year in
the U.S. in recent years. The 1918 ៯�u pandemic (1918-1919) was estimated to cause 20-50
million deaths worldwide.

What is the bird (avian) ៯�u?

The bird ៯�u, also known as avian in៯�uenza and H5N1, is an infection caused by avian in៯�uenza A.
Bird ៯�u can infect many bird species, including domesticated birds such as chickens. In most
cases, the disease is mild; however, some subtypes can be pathogenic and rapidly kill birds within
48 hours. Rarely, humans can be infected by these bird viruses. People who get infected with bird
៯�u usually have direct contact with the infected birds or their waste products. Depending on the
viral type, the infections can range from mild in៯�uenza to severe respiratory problems or death.
Human infection with bird ៯�u is rare but frequently fatal. More than half of those people infected

 In៯�uenza
(over 650 people)/ have
infected (Flu) What are(current
died ៯�u (in៯�uenza) 
estimates of the mortality [death] rates in humans is
about 60%). Fortunately, this virus does not seem to be easily passed from person to person. The
major concern among scientists and physicians about bird ៯�u is that it will change (mutate) its
viral RNA enough to be easily transferred among people and produce a pandemic similar to the
one of 1918. There have been several isolated instances where a person had been reported to get
avian ៯�u in 2010; the virus was detected in South Korea (three human cases), resulting in a
quarantine of two farms, and in 2012, over 10,000 turkeys died in a H5N1 outbreak with no human
infections recorded. Recent research suggests that some people may have had exposure to H5N1
in their past but had either mild or no symptoms.

In addition, researchers, in an effort to understand what makes an animal or bird ៯�u become
easily transmissible to humans, developed a bird ៯�u strain that is likely easily transmitted from
person to person. Although it exists only in research labs, there is controversy about both the
synthesis and the scientiퟪ�c publication of how this potentially highly pathogenic strain was
created.

Do antiviral agents protect people from the ៯�u?

Vaccination is the primary method for control of in៯�uenza; however, antiviral agents have a role in
the prevention and treatment of mainly in៯�uenza type A infection. Regardless, antiviral agents
should not be considered as a substitute or alternative for vaccination. Most effectiveness of
these drugs are reported to occur if the antivirals are given within the ퟪ�rst 48 hours after infection;
some researchers maintain there is little or no solid evidence these drugs can protect people
from getting the ៯�u so some controversies exist regarding these agents.

Is it safe to get a ៯�u shot that contains thimerosal?

Thimerosal is a preservative that contains mercury and is used in multidose vials of conventional
៯�u vaccines to prevent contamination when the vial is repeatedly used to extract the vaccine.
Although thimerosal is being phased out as a vaccine preservative, it is still used in ៯�u vaccines in
low levels. There is no data that indicates thimerosal in these vaccines has caused autism or
other problems in individuals. However, ៯�u vaccine that is produced for single use (not a
multidose vial) contains no thimerosal; however, these vials are not as readily available to doctors
and likely cost more to produce. Consequently, the FDA has published these two questions with
clear answers that are quoted below:

 In៯�uenza (Flu) / What

 are ៯�u (in៯�uenza) 
 "Is it safe for children to receive an in៯�uenza vaccine that contains thimerosal?"
"Yes. There is no convincing evidence of harm caused by the small doses of
thimerosal preservative in in៯�uenza vaccines, except for minor effects like swelling
and redness at the injection site."

"Is it safe for pregnant women to receive an in៯�uenza vaccine?"

"Yes. A study of in៯�uenza vaccination examining over 2,000 pregnant women
demonstrated no adverse fetal effects associated with in៯�uenza vaccine. Case reports
and limited studies indicate that pregnancy can increase the risk for serious medical
complications of in៯�uenza. One study found that out of every 10,000 women in their
third trimester  of pregnancy during an average ៯�u season, 25 will be hospitalized
for ៯�u-related complications."

However, as stated above, the FDA goes on to say that single-dose vial of conventional and other
៯�u vaccines will not contain the preservative thimerosal, so that if a person wants to avoid the
thimerosal, they can ask for vaccine that comes in a single-dose vial. The nasal spray vaccine
contains no thimerosal, but it is not recommended for use in pregnant women. The CDC further
states, that after numerous studies, there is no established link between ៯�u shots with or without
thimerosal and autism  .

Where can people ퟪ�nd additional information about the ៯�u?

During a ៯�u pandemic, guidelines and situations can change rapidly. People are advised to be
aware that several sources are available to them to keep current with developments. The web
sites below are frequently updated, especially when a pandemic is declared. The ퟪ�rst web site
contains an update written for the public and caregivers; the government and WHO sites provide
detailed information that are updated as guidelines and developments occur.

http://www.who.int/topics/in៯�uenza/en/

http://www.cdc.gov/៯�u/weekly/

http://www.fda.gov/

REFERENCES:

Grohskopf, L.A., L.Z. Sokolow, K.R. Broder, et al. " Prevention and Control of Seasonal In uenza with Vaccines:
Recommendations of the Advisory Committee on Immunization Practices -- United States, 2017-18 In uenza Season."
MMWR Recomm Rep 66(No. RR-2) 2017: 1-20. DOI: http://dx.doi.org/10.15585/mmwr.rr6602a1.

Lambert, L., and Fauci, A. "In uenza Vaccines for the Future." New Eng. J. Med. 361.21 (2010): 2036-2044.

Monto, A.S., Ohmit, S.E., Petrie, J.G., Johnson, E., Truscon, R., Teich, E., Rotthoff, J., Boulton, M., Victor, J.C. "Comparative
E cacy of Inactivated and Live Attenuated In uenza Vaccines." N Engl J Med 361 Sept. 24, 2009: 1260.

Nguyen, H. "In uenza." Medscape.com. Aug. 22, 2016. <http://emedicine.medscape.com/article/219557-overview>.

Perez-Padilla, R., de la Rosa-Zamboni, D., Ponce de Leon, S.P., Hernandez, M., Quinones-Falconi, F., Bautista, E., Ramirez-
Venegas, A., Rojas-Serrano, J., Ormsby, C.E., Corrales, A., Higuera, A., Mondragon, E., Cordova-Villalobos, J.A. "Pneumonia
and Respiratory Failure from Swine-Origin In uenza A (H1N1) in Mexico." N Engl J Med 361 Aug. 13, 2009: 680.

Switzerland. World Health

In៯�uenza (Flu) / What
Organization.
"Cumulative number of con rmed human cases for avian in uenza A(H5N1)
are ៯�u (in៯�uenza)
reported to WHO, 2003-2014." Jan. 24, 2014. <http://www.who.int/in uenza/human_animal_interface/ 
EN_GIP_20140124CumulativeNumberH5N1cases.pdf?ua=1>.
EN_GIP_20140124CumulativeNumberH5N1cases.pdf?ua=1>.

United States. Centers for Disease Control and Prevention. "Estimating Seasonal In uenza-Associated Deaths in the U.S."
Dec. 9, 2016. <https://www.cdc.gov/ u/about/disease/us_ u-related_deaths.htm>.

United States. Centers for Disease Control and Prevention. "FluView Interactive." Apr. 21, 2017.
<https://www.cdc.gov/ u/weekly/ uviewinteractive.htm>.

United States. Centers for Disease Control and Prevention. "In uenza (Flu)." Nov. 10, 2016. <https://www.cdc.gov/ u/>.

United States. Centers for Disease Control and Prevention. "Seasonal In uenza (Flu): In uenza Antiviral Medications:
Summary for Clinicians." Sept. 4, 2014. <http://www.cdc.gov/ u/professionals/antivirals/summary-clinicians.htm>.

United States. Centers for Disease Control and Prevention. "Seasonal In uenza (Flu): Use of Antivirals." Sept. 1, 2011.
<http://www.cdc.gov/ u/professionals/antivirals/antiviral-use-in uenza.htm>.

United States. Centers for Disease Control and Prevention. "2011-2012 Trivalent In uenza Vaccine Data From the U.S.
Vaccine Adverse Event Reporting System (VAERS)." <http://vaers.hhs.gov/resources/SeasonalFluSummary_2011-
2012.pdf>.

United States. Centers for Disease Control and Prevention. "2009 H1N1 Flu (Swine Flu)." Oct. 12, 2009.
<http://www.cdc.gov/H1N1FLU/>.

United States. Flu.gov. "H5N1 Avian Flu (H5N1 Bird Flu)." <http://www. u.gov/about_the_ u/h5n1/>.

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INFLUENZA (FLU) CENTER

Reviewed on 9/29/2017 References 

 In៯�uenza (Flu) / What

 are ៯�u (in៯�uenza) 
 In៯�uenza (Flu) / What
 are ៯�u (in៯�uenza) 