How to care for yourself and others with influenza

Influenza happens every year. Scientists say a serious worldwide influenza epidemic – called a “pandemic” – may come at any time. While there is no way to prevent a pandemic, there are ways to lessen its effect.

This booklet gives valuable information on:

• How to prevent influenza.
• How to help yourself and others when influenza happens.
• When to seek medical care.

What is influenza?

Influenza is an infection of the lungs and airways caused by a virus. Various strains of influenza virus circulate throughout the world each year. In North America, influenza usually affects people between November and April.

The influenza virus often changes slightly. Most people who have had influenza will have some protection against the changed virus. However, 3 to 4 times each century the influenza virus changes in a major way. People will not have any protection against it and the virus will spread rapidly around the world. This global epidemic (pandemic) can cause serious illness and death.

How is influenza spread?

The influenza virus passes from person to person by droplets when an infected person coughs, sneezes or talks. Airborne droplets can enter the body through the eyes, nose or mouth. The virus, contained in droplets, can travel 1 to 2 metres in the air. It can live on hard surfaces for 1-2 days; on cloth, tissue and paper for 8-12 hours; and on hands for 5 minutes. People develop symptoms of influenza from 1 to 3 days after becoming infected. They are contagious from the day BEFORE they have the first symptoms until 5 days after the symptoms start.

What are the symptoms?

Symptoms of influenza include:

• sudden fever of 38⁰C (100.4⁰F) or higher.
• dry cough.
• aching body, especially head, lower back and legs.
• extreme weakness and tiredness.

Other symptoms can include:

• chills.
• aching behind the eyes.
• loss of appetite.
• sore throat.

• runny or stuffy nose.

For people older than 75 with influenza, the temperature may be lower, for example 37.2°C (99oF). They may also experience vomiting, diarrhea or stomach pain.

Fever usually goes down and the person starts to feel better in 3 to 5 days. Tiredness and cough can continue for several weeks.

Influenza symptoms are different from those of a cold or gastroenteritis (“stomach flu”).

Is it influenza, a cold or “stomach flu”?

 

Symptoms/ Description	Influenza	Common Cold	Stomach Flu
Fever	Usually high	Sometimes	Rare
Chills, aches, pain	Frequent	Slight	Common
Loss of appetite	Sometimes	Sometimes	Common
Cough	Usual	Sometimes	Rare
Sore throat	Sometimes	Sometimes	Rare
Sniffles or sneezes	Sometimes	Common	Rare
Involves whole body	Often	Never	Stomach/ bowel only
Symptoms appear quickly	Always	More gradual	Fairly quickly
Extreme tiredness	Common	Rare	Sometimes
Complications	Pneumonia; can be life  threatening	Sinus infection Ear infection	Dehydration

How serious is influenza?

Certain groups are at risk to develop serious complications, such as pneumonia, that may even result in death. These groups include:

• children less than 2 years old and seniors, as they have weaker immune systems.
• people with weakened immune systems either by disease or medication/treatment.
• people with certain chronic illnesses, such as heart or lung disease.

Annually, influenza and its complications have a substantial effect on the healthcare system, in addition to their effect on school/work absenteeism and productivity.

How to protect yourself and others against influenza

Choose to immunize

Because the influenza virus is always changing, a new vaccine is created each year containing the 3 virus strains most likely to circulate. This means you need to be immunized yearly. The best time to be immunized is during October and the first half of November – just before the influenza season starts, because it takes 2 weeks for the vaccine to become effective. Even after influenza arrives in the community, it is not too late to get immunized.

The vaccine cannot cause influenza because the virus in the vaccine is killed. The vaccine is 70 - 90% effective in young, healthy people and protection lasts about 6 months. The vaccine is less effective for people with weakened immune systems, but if they are immunized, the illness will be less severe if they do become infected.

Since vaccine strains are selected 6 to 9 months before the start of influenza season, there is a slight chance the circulating strain may change before the season actually starts. The vaccine will NOT protect against other respiratory illnesses.

Who should be immunized?

• People who are at greatest risk of serious complications.
• People such as caregivers, volunteers and health-care workers who might transmit the disease to persons who are at risk.

Alberta Health and Wellness covers the cost for the above at risk people to be immunized. Some employers offer vaccine to their staff. People who are not at risk may be immunized for a fee. Everyone is encouraged to take advantage of these opportunities.

Who should not be immunized?

• People who are severely allergic to eggs, because eggs are used to make vaccine.
• People who have severe allergies to any part of the vaccine.
• People who have had a severe reaction to a previous influenza vaccine.
• Children under 6 months of age.
• People who are ill with fever (They can be immunized after symptoms improve).

Possible vaccine reactions

The most common reaction is some redness and soreness on the arm. Some people may have fever, tiredness and aching after 6 to 12 hours. This may last for 1 to 2 days. Rarely a person has had an allergic reaction within 12 hours to some other ingredient in the vaccine.

What about antiviral medication?

A doctor may prescribe antiviral medication (for example Symmetrel® or Tamiflu®) to prevent influenza for:

• people who are at risk but cannot be immunized.
• at risk people who were immunized after influenza entered the community and need protection until the vaccine takes effect.
• non-immunized people who are in contact with at risk people.
• those at risk in an outbreak when the circulating strain is different from the vaccine.

What about pneumonia vaccine?

One of the major problems that can occur after influenza is pneumonia. There is a vaccine that protects against the bacteria that most often cause pneumonia. Alberta Health and Wellness provides this vaccine free to those who are at risk, including:

• people aged 65 and older.
• residents of long-term care facilities.
• individuals aged 2 years and older with certain chronic conditions.

Most people need the pneumonia vaccine only once in their lifetime. The vaccine can be given at the same time as the influenza vaccine or any time of the year. The pneumonia vaccine is given to infants as part of Alberta’s routine immunization program.

Where to get immunized?

• local public health centres by appointment or at an offsite influenza immunization drop-in clinic (see back page).
• many doctors’ offices (call ahead).
• some work places and pharmacies.

Wash your hands!

Next to immunization, the single most important way
to prevent influenza is frequent hand washing.

Wash your hands

BEFORE:

• handling or eating food or feeding others.
• brushing or flossing teeth.
• inserting or removing contact lenses.
• and after treating wounds or cuts.

AFTER:

• having any contact with a person who has influenza or their immediate environment.
• going to the toilet or changing a diaper.
• blowing your nose or wiping a child’s nose.
• coughing or sneezing.
• handling garbage.

Children should wash their hands after playing with toys shared with other children.

How to wash hands

• Use regular soap. Antibacterial soap is not necessary. Alcohol hand rubs are also effective.
• Rub hands vigorously together for at least 15 seconds covering all surfaces.
• Rinse under running water.
• Dry with a clean or disposable towel.

If using a public restroom, use a disposable towel to turn off the faucet to avoid further contact with the tap.

Respiratory etiquette - “Cover your Cough”

• Throw away tissues after wiping your nose.
• Cover your nose and mouth when sneezing or coughing.
• Wash hands after coughing, sneezing or using tissues.
• Keep your fingers away from your eyes, nose and mouth.

Other ways to prevent the spread of influenza

• Avoid crowds during influenza season.
• Visit those who have influenza only if necessary, and stand more than 3 feet away from them.
• Keep personal items separate if a household member has influenza. Clean surfaces around them often with a detergent cleanser.
• Do not share personal items or drinks.

Stay well

• Drink plenty of water.
• Don’t smoke.
• Exercise regularly.
• Take a multivitamin daily, if you are an older adult.
• Decrease stress, stay optimistic and be socially active.

Be prepared

Everyone should plan ahead in case they become ill with influenza. This is especially important if you live alone, are a single parent or a caregiver.

• Have enough fluids and other supplies, such as tissues, on hand to last 1 to 2 weeks.
• Have medication for fever and a thermometer handy.
• Know what options are available at work when you are ill, for example working from home.
• Have a backup caregiver for loved ones.

How to manage influenza in adults

General self-care measures

• Rest.
• Avoid contact with others while contagious (5 days) if possible.
• Drink extra fluids.
• Gargle with warm salt water.
• Use throat lozenges, saline nose drops, a humidifier.
• Don’t smoke. Avoid second hand smoke.
• Talk to others about concerns and ask for help if needed. Keeping in touch by phone or email can help with feelings of aloneness when sick.
• Treat symptoms with over-the-counter (non-prescription) medication with careful attention to the following guidelines.

Talk to your pharmacist or health-care provider about what product to use, dosage, possible side effects, and conditions when you should not use the remedy.

General guidelines for over-the counter medications (OTCs)

• To prevent adverse reactions or taking extra medication that will have little or no effect, use an OTC remedy that treats only one symptom and/or has only one active ingredient.
• If you are taking more than one medication at a time, check the labels to avoid taking the same ingredient twice.
• Try “regular strength” products before “extra strength”.
• Follow instructions on the label. Note possible side effects or drug/health conditions when the medication should not be used.
• Check the expiry date on medications in your home. Take outdated medications to a pharmacy for disposal.
• Keep all medications out of reach of children.

To treat:

Muscle pain and fever

• Use acetaminophen (the best choice for older adults), for example Tylenol®. If you take acetaminophen for a long time or in high doses, it can affect the liver and kidneys; or
• Ibuprofen, for example Advil® or Motrin®. Ibuprofen can irritate the stomach.

Cough

Try a medication with Dextromethorphan (DM) for a dry cough that prevents you from sleeping or causes chest discomfort. Delsym® and Benylin-Dry Cough®‚ contain DM (without other ingredients).

Stuffy nose

Use a decongestant. Nose drops or sprays act quickly and have fewer side effects than medications you take by mouth but should only be used for 2 – 3 days to avoid rebound congestion. If stuffy nose continues, consider an oral medication such as pseudoephedrine. Decongestants may cause dry mouth, sleep problems, rapid heartbeat or other side effects. People who have long-term health problems or who are on other medications should not take decongestants without talking to a health-care provider.

Sore throat

Try lozenges or throat sprays. Dyclonine (for example, Sucrets®) works best to numb the throat. Products containing honey, herbs or pectin soothe the throat.

Complementary medicines

There is some research that shows the following complementary medicines may help to shorten influenza illness or lessen its severity: Vitamins E and C, COLD-FX®, Echinacea Plus® (an herbal tea), a standardized extract of elderberry (Sambucol®), Quercetin, Bifidobacterium breve, Homeopathic Oscillococcinum, Gingyo-San (a traditional Chinese herbal medicine), and Kan Jang.

Find out all you can about any complementary medications you are thinking of or are taking. For example, echinacea is unsafe for people with autoimmune disease (including type 1 diabetes, rheumatoid arthritis and multiple sclerosis), suppressed immune systems, and certain allergies. Follow the guidelines for OTC medications.

Tell your health-care provider about any OTCs or complementary medicines you are taking.

When to seek medical care

Adults with influenza should seek medical care if they have heart or lung disease or any other chronic condition that requires regular medical attention. They should also seek care if they are frail, or if they have an illness or are on treatments that suppress the immune system.

See a physician immediately if you, or a person in your care, have any one of the following symptoms:

• shortness of breath while resting or doing very little.
• difficult or painful breathing.
• coughing up bloody sputum.
• wheezing.
• chest pain.
• fever for 3 to 4 days without improvement.
• feeling better then suddenly having a high fever or becoming ill again.
• extreme drowsiness and difficulty awakening.
• disorientation or confusion.
• severe earache.
• sudden inability to function in a normally independent elderly person.
• constant vomiting, especially in an elderly person.

Prescription medications

Antibiotics are not normally prescribed for influenza but your doctor may prescribe an antibiotic for complications such as pneumonia.

Antiviral medications can decrease the length and severity of the illness. However, antivirals must be started within 48 hours after the first symptoms appear in order to be effective.

Managing influenza in children

Symptoms to look for in children

Influenza is more severe in children under 5 years, especially between the ages of 6 and 12 months. Children with influenza may have the same symptoms as adults, but there are some differences in babies and toddlers.

For example:

• A fever can be the only symptom of influenza in babies.
• Seizures, or other central nervous system symptoms, may appear in some infants. Children may also have headache, vomiting, irritability and sensitive eyes.
• Young children usually have higher temperatures, often over 39.5⁰C (103.1⁰F).
• About half of children 3 years old or younger have symptoms such as nausea, vomiting, diarrhea and stomach pain.
• Influenza viruses can cause croup, pneumonia or bronchitis in young children.
• Ear infections and red, sore eyes are more frequent in young children. Sore muscles are also common.

Note: Very young children and infants do not know how to tell people they have sore muscles or a headache. They may be irritable and eat poorly. They sometimes have a hoarse cry and barking cough.

Children over 5 years old and adolescents have the same symptoms as adults.

How to care for a child with influenza

• Use acetaminophen (for example Tylenol®) for fever and muscle pain. Take the child’s temperature first. Do not wake a child to give medication. Ibuprofen (for example Motrin®) is another option, but it should not be used for infants less than 4 months old.

Children under 18 should NOT take acetylsalicylic acid (ASA) for example Aspirin® or any products containing ASA. Combined with influenza, ASA can cause Reye’s Syndrome, a very serious condition affecting the nervous system and liver.

• Dress a child in lightweight clothing and keep room temperature at 20^oC.
• Offer water or juice or breast feed often while the child is awake.
• Do not use cool baths or alcohol rubs.
• Encourage the child to rest or involve them in quiet activities for approximately 5 days.
• Try saline nose drops for stuffy nose or cough.
• Use a humidifier, except with asthmatic children.
• Elevate the head of the bed; infants may be more comfortable in a car seat or baby swing.
• Treat other symptoms with OTC medications if appropriate.
  • Use cough suppressant (DM) for a dry cough in children over 2 years old only if it is interrupting your child’s sleep. Do not use DM for asthmatics or to treat a moist cough.
  • Try decongestant sprays in children over 6 months old; oral decongestants with older children if needed.
  • Use throat lozenges or warm salt water gargles for children over 6 years old if needed.

Talk to your pharmacist or health-care provider about what product to use, dosage, possible side effects, and conditions when you should not use the remedy.

Clean your humidifier every day to prevent mold blowing in the air. Use hot water with 1 part bleach to 10 parts water. Scrub the inside with a cloth or bottle brush to get into tight corners. Rinse well with hot water.

When to seek medical care for a child

Almost all children with influenza have fever. So whether or not a child has a fever is not helpful as a sign of how severe their illness is.

Seek medical care if a child has influenza and any one of the following conditions:

• is less than 3 months old.
• has heart or lung disease or any chronic illness requiring regular medical care.
• has a disease or treatments that weaken the immune system.
• takes ASA regularly for a medical condition.
• has a change in breathing (such as breathing fast) or difficulty breathing.
• is very listless and loses interest in playing, watching TV, eating or drinking.
• is very irritable and cries a lot.
• urinates less than usual, for example less often than every 6 hours while awake; or has a dry diaper for more than 3 hours if younger than 6 months, or longer than 6 hours if 6 to 23 months old.
• looks very ill and the caregiver is worried.

When to take a child to the emergency room

Go to a hospital emergency room right away if the child:

• has severe trouble breathing and it is not caused by a stuffy nose.
• has blue lips or hands, suddenly becomes pale, or has cold legs up to their knees.
• is droopy or unable to move.
• is so sleepy they don’t respond when you try to get them up.
• shows signs of pain, such as headache or stiff neck, especially if they also have fever, are listless and their eyes are sensitive to light.
• seems confused.
• has a seizure.

For more information contact:

Health Link Alberta
Edmonton, call 408-LINK (5465)
Calgary, call 943-LINK (5465)
Outside Edmonton and Calgary local calling areas,
call toll-free 1-866-408-LINK (5465)
visit: http://www.healthlinkalberta.ca/

Public Health Centres
(Monday - Friday, daytime hours), or
physicians or pharmacists

Fact Sheets available:

• Pandemic influenza
• Hand washing to prevent influenza
• How to take a temperature – children and adults
• Over-the-counter (non-prescription) medications for influenza
• Influenza antiviral medications
• Dealing with stress or feelings of fear because of influenza

Also available in PDF - CD0092