the Winter Bugs:
How to hold your own against colds and flu
The winter months present plenty of
opportunities for viruses to spread. Chilly weather
keeps more of us indoors at the same time, and the
holiday season brings together family members of
all ages. Colds and flu (influenza) can occur anytime,
but appear mostly in the fall and winter.
For most people, viral respiratory
illnesses are usually self-limited and last only
a few days. But along with making millions of us
feel lousy every year, colds and flu can cause serious
problems and can even be deadly. Each year flu complications
cause an average of 114,000 hospitalizations and
36,000 deaths, according to the Centers for Disease
Control and Prevention (CDC). Death rates are highest
for people ages 65 and up and for those with medical
conditions that put them at increased risk for flu
Here are tips to ward off colds and
flu and to ease the misery if they strike:
Get the flu vaccine.
A vaccine against colds hasn't been
developed because colds can be caused by many types
of viruses. But the flu vaccine remains the best
way to prevent and control the flu.
Influenza viruses are classified as
types A, B, or C. Type A and B viruses are the most
serious because they are the ones most often responsible
for cases of the flu and all of its complications.
Type C viruses are mostly associated with cold symptoms.
Flu season in the United States runs
from November to April. October to November is the
usual vaccination time for most people. "But
you can also get good results when the vaccine is
used in December and January, even if influenza
is already starting to spread through a community,"
says Roland A. Levandowski, M.D., a medical officer
and virologist in the Food and Drug Administration's
Center for Biologics Evaluation and Research. We
need a new flu shot every year because the predominant
flu viruses change every year.
The protective effect of the vaccine
starts working rapidly in people who have been previously
infected with flu viruses or have received a flu
shot in the past. Infection-fighting antibodies
in the blood reach a peak about three weeks after
these people get the shot. But for some, such as
children younger than 9 who haven't been previously
vaccinated, two doses of the influenza vaccine about
a month apart are recommended for the first vaccination.
In older people and in those with chronic illnesses,
the shot may not necessarily prevent the flu, but
can reduce the symptoms and risk of complications
if they do get sick.
The flu vaccine is made of killed
virus and can't cause the flu. The most common side
effect is soreness at the injection site. The flu
shot is not recommended for certain people, including
those allergic to eggs. The viruses for flu vaccines
are grown in eggs.
In June 2003, the FDA approved FluMist,
the first nasally administered flu vaccine to be
marketed in the United States. The needle-free vaccine
is for healthy children and adolescents ages 5 to
17 and in healthy adults ages 18 to 49. The nasal
spray is manufactured by MedImmune Vaccines Inc.
of Gaithersburg, Md., and is marketed by MedImmune
and Wyeth Vaccines of Philadelphia.
FluMist is also the first live virus
influenza vaccine to be approved in the United States.
The most common side effects are nasal congestion,
runny nose, sore throat, and cough. As with other
live virus vaccines, FluMist should not be given
to people with suppressed immunity, such as people
with AIDS or cancer. The vaccine also shouldn't
be given to pregnant women, people with a history
of asthma or other reactive airway diseases, people
age 50 and over, or to children under 5.
Wash your hands.
Both colds and flu can be passed through
coughing, sneezing, and touching surfaces such as
doorknobs and telephones. So it's wise to make a
habit of washing your hands and to teach children
to do the same. This helps you prevent spreading
respiratory infections and picking them up from
According to the American Society
for Microbiology, a national survey found that Americans
were most likely to say they wash their hands after
changing a diaper and before handling food. Most,
however, said they don't wash their hands after
coughing and sneezing.
The CDC recommends regular scrubbing
of your hands with warm, soapy water for about 15
seconds. Touching your nose, mouth, and eyes with
contaminated hands makes it easy for cold and flu
viruses to enter the body. Others can become ill
by just coming in contact with someone who has become
infected with a cold or flu virus or who has come
in contact with a contaminated area.
Limit exposure to infected people.
Sometimes people are infected with
a virus and they don't know it because they haven't
experienced symptoms yet. If possible, avoid people
who you know have colds and flu. Keep infants away
from crowds for the first few months of life. "This
is especially important for premature babies who
may have underlying abnormalities like lung disease
and heart disease," says Larry Pickering, M.D.,
a fellow of the American Academy of Pediatrics and
a pediatrician in Atlanta.
If keeping your distance is too difficult--say
in the case of parents who can't help but hold and
kiss their sick kids--then, in addition to washing
your hands frequently, you can keep surfaces clean
with a virus-killing disinfectant available at the
grocery store. A solution of 1 part bleach mixed
with 10 parts water also is effective in killing
Practice healthy habits.
Eating a balanced diet, getting enough
sleep, and exercising can help the immune system
better fight off the germs that cause illness. Because
smoking interferes with the mechanisms that keep
bacteria and debris out of the lungs, those who
use tobacco or who are exposed to secondhand smoke
are more prone to respiratory illnesses and more
severe complications than nonsmokers.
If you've been feeling run down, some
stress management might not be a bad idea. David
Skoner, M.D., chief of allergy and immunology at
Children's Hospital in Pittsburgh, has studied the
effects of chronic stress on susceptibility to cold
and flu infections. "We've found that people
who experience more stress are more likely to get
sick and experience worse symptoms," he says.
Examples of chronic stress are personal crises such
as going through a divorce or feeling stuck in a
"Research has also shown that
the more social you are, the less likely you are
to get sick," Skoner says. It could be because
having more social contacts and support is less
stressful than keeping to yourself, he says.
If you do come down with a cold or
flu, here's advice on safe relief from symptoms:
Drink up and rest.
Fluids such as water, juice, soup,
and non-caffeinated beverages can help loosen mucus,
keep you hydrated, and make you feel better, especially
if you have a fever. Alcohol and drinks containing
caffeine may have a dehydrating effect. To help
others stay healthy, limit your exposure to them
and promptly throw out tissues rather than letting
them pile up on your nightstand.
Gargling with salt water can help
relieve a sore throat. A cool-mist humidifier, which
breaks water into droplets and releases them into
the air, may help relieve stuffy noses. Keep the
humidifier clean to avoid a buildup of mold, which
could be harmful if inhaled. Saline nasal drops
and suctioning with a bulb syringe can help infants
and small children breathe better. But be gentle
because aggravating the nasal passages could make
swelling worse. Also, dress sick children comfortably--like
you would dress yourself, Pickering says. "Some
parents bundle them up if they have a fever, but
that can make it worse."
Choose over-the-counter (OTC) medicines
that are appropriate for your symptoms.
With all the choices on the shelves,
it can be hard to know what medicine to pick. It
may seem easier to grab a multi-symptom medicine
that promises to take care of everything, but it's
better to take a product specific to your symptoms,
says Jeffrey Delafuente, a professor and director
of geriatric programs at Virginia Commonwealth University's
School of Pharmacy.
"If your only problem is a runny
nose, why take a cough suppressant?" he says.
Taking medicine for symptoms you don't have may
not be harmful, he adds, but it unnecessarily exposes
you to medicine and the accompanying side effects.
"Multi-symptom medicines can be useful if you
truly have many symptoms."
If you want to unclog a stuffy nose,
then nasal decongestants may help. Cough suppressants
quiet coughs; expectorants loosen mucus so you can
cough it up; antihistamines help stop a runny nose
and sneezing; and pain relievers such as acetaminophen
can ease fever, headaches, and minor aches. Check
with a pediatrician or your family physician first
before treating children suffering from cold and
flu symptoms with medicine.
Don't give aspirin or aspirin-containing
medicines to children and teen-agers.
Children and teen-agers suffering
from flu-like symptoms, chickenpox and other viral
illnesses shouldn't take aspirin because of the
possibility of Reye syndrome. Some medicine labels
may refer to aspirin as salicylate or salicylic
acid. Be sure to educate teen-agers, who may take
OTC medicines without their parents' knowledge.
Children with Reye syndrome start
vomiting and become drowsy within a few days of
becoming sick. The disorder, which is now rare,
can affect all body organs and lead to brain damage
and death. Reye syndrome occurs almost exclusively
in children 4 to 12 years of age and is rare in
adults, Pickering says.
Read OTC medicine labels carefully
and follow directions.
Use the dosing device that comes with
the medicine and don't exceed recommended dosages
or length of use. Taking a nasal spray for too long
during a cold could result in an even stuffier nose,
for example. Always check with a doctor first if
the correct dose for a child isn't listed on a label
and before giving a child more than one medicine
at a time.
Delafuente says he tells older people,
who often take multiple medications, to check with
a doctor or pharmacist before taking a new OTC cough
and cold medicine because some can worsen underlying
health problems, such as high blood pressure or
heart disease. Decongestants can speed up heart
rate, for example, and antihistamines can cause
urinary retention in men with prostate problems.
For both young and old, antihistamines can make
you drowsy, which could affect driving.
Be sure to check expiration dates
and get rid of old medicine. The FDA has warned
consumers against using OTC and prescription drug
products containing phenylpropanolamine because
the ingredient has been associated with an increased
risk of hemorrhagic stroke (bleeding in the brain).
This ingredient was commonly used as a decongestant
in OTC and prescription cough and cold medicines
before the warning.
Be careful not to double up on ingredients.
If you take more than one medication
at a time, be careful not to duplicate ingredients,
says Marina Chang, a pharmacist with the FDA's Center
for Drug Evaluation and Research. "Look at
the active ingredients of every medicine you take,"
For example, you don't want to accidentally
take two different medicines that both contain acetaminophen.
The same goes for taking acetaminophen tablets to
relieve pain while also taking a cough medicine
containing acetaminophen. Too much of this drug
can result in liver damage.
Jon Temte, M.D., Ph.D., associate
professor of family medicine at the University of
Wisconsin Medical School, recalls a young woman
who came in complaining of a racing heartbeat and
anxiousness. He discovered her symptoms occurred
because she had taken two different products, both
containing a decongestant.
Facts About Flu Drugs.
Relenza (zanamivir) and Tamiflu (oseltamivir),
both approved for use in 1999, are to treat uncomplicated
cases of influenza caused by types A and B flu virus.
Tamiflu also is approved for preventive use, while
Relenza is approved only for treatment. Two older
drugs, amantadine and rimantadine, which are sold
under the trade names Symmetrel and Flumadine respectively,
are approved for the treatment and prevention of
Type A influenza.
Talk with your health care provider
about any use of these drugs in children. The doses
and approved ages are different for each. Because
some of the drugs' side effects can be serious and
because viruses may become resistant when antiviral
drugs are used indiscriminately, the FDA recommends
that decisions to use these drugs be based on individual
evaluations of risk and benefit.
Relenza, which is orally inhaled as
a dry powder with a device known as a Diskhaler,
can cause wheezing or serious breathing problems,
and is generally not recommended for patients with
asthma, chronic obstructive pulmonary diseases and
other airway diseases.
Common side effects of Tamiflu, which
comes in pill and liquid form, include nausea and
vomiting. Both amantadine and rimantadine can cause
gastrointestinal side effects and central nervous
system changes such as nervousness and difficulty
concentrating. Other side effects that can occur
are mentioned in the drugs' package inserts.
Other important flu drug facts:
- Antiviral drugs are not meant to take
the place of a flu shot. The flu shot remains
the best way to protect yourself. The drugs
are sometimes used as a backup to the vaccine
in special situations, such as to control a
- The treatment effect of these drugs is
modest. They won't make you instantly better,
but can help shorten the time the flu lasts
by about a day. And use of flu drugs does not
eliminate the risk of flu complications.
- The drugs are meant to be taken within
the first two days you experience flu symptoms.
That means if you arrive at the doctor's
office on Day 5 asking for a flu drug, you'll
be too late. By that time, uncomplicated flu
usually starts to get better on its own, and
people who develop complications are likely
to need other treatment.
- Flu drugs don't influence bacterial infections
or other illnesses that may look like the flu.
It's important to talk with your health care
provider if you are being treated with an antiviral
drug but aren't getting better or if you experience
Michelle Meadows is a staff writer
for FDA Consumer.
Cold and Flu Symptoms
People who get the flu usually know
the exact day that it hit, whereas a cold tends
to come on gradually. Both colds and flu cause inflammation
of the mucous membranes (found in the nose, throat
and mouth). Symptoms for colds and flu can be similar;
both can cause a stuffy nose, sore throat, cough,
and fever. Symptoms generally last about a week
Colds are usually distinguished by
a runny nose and sneezing. Along with coming on
suddenly, the flu is more serious than a cold, lasts
longer, and often leaves you with a wiped-out feeling,
a headache, chills, dry cough, and body aches.
Young children may also experience
nausea and vomiting with flu, but what many people
call "stomach flu" is something different--probably
gastroenteritis, which is usually caused by other
viruses, bacteria, and toxins.
When You Need a Doctor
Jerry Rogers, M.D., a family physician
in Moorhead, Minn., says some patients have asked
him about taking an antibiotic early on, before
their cold or flu symptoms get bad. But antibiotics
don't help viral illnesses. Using antibiotics inappropriately
only spreads antibiotic-resistant bacteria, making
fewer drugs effective for treating disease.
Most of the time, colds and flu simply
have to run their course. "We don't typically
treat colds and flu unless they become complicated,"
Rogers says. You usually don't need to call the
doctor at the first signs of cold and flu, but there
are times when you should.
Doctors will look for and treat cold
and flu complications such as bronchitis, sinusitis,
ear infections, and pneumonia--bacterial infections
that may require antibiotics. For some people, colds
and flu can aggravate underlying medical conditions
like heart disease and asthma.
If you aren't getting any better after
about a week or your symptoms worsen, you should
see a doctor. Your viral infection may have caused
enough mucus buildup to allow for a bacterial infection
to occur. Signs of trouble might be a cough that
gets so bad it disrupts sleep, a fever that won't
go down, increased shortness of breath, and pain
in the face because of a sinus infection (sinusitis).
Another warning signal is if after
feeling better for a short time you start to feel
worse and experience a high fever, chest pain, or
notice a difference in the mucus you're producing,
such as a change from clear to thick, yellow-green
With children, be alert for high fevers
and abnormal behavior--acting unusually drowsy,
refusing to eat, crying a lot, holding the ears
or stomach, and wheezing.
Some people rely on vitamin C supplements,
zinc lozenges, and echinacea to prevent and treat
cold and flu symptoms. These remedies may make some
people feel better. However, their health effects
are unknown, says Linda Lambert, a program officer
with the National Institute of Allergy and Infectious
No conclusive data has shown that
large doses of vitamin C prevent colds; they may
reduce the severity or duration of symptoms, but
there is no definitive evidence. And the jury is
still out on zinc. "There are about an equal
number of studies that say zinc helps as there are
studies that say it doesn't," Lambert says.
As for echinacea, "studies have
been done of echinacea for preventing or treating
colds and flu, but these studies were not rigorous
or definitive and the products tested were diverse,"
according to a written statement from Stephen Straus,
M.D., director of the National Center for Complementary
and Alternative Medicine, part of the National Institutes
of Health. "These studies at best suggest that
echinacea may be beneficial in the early treatment
of colds and flu, but does not help prevent them."
Always tell your doctor about any
supplements or herbal remedies you use, and don't
overdo it. For example, taking too much vitamin
C can cause diarrhea.
Groups for Flu Vaccination
The best time to get a flu vaccination
is from October through November, and people who
have a high risk of complications from flu should
be vaccinated starting in September, according to
the Centers for Disease Control and Prevention.
The CDC strongly recommends annual
flu vaccination for these primary target groups:
Unvaccinated high-risk persons, health-care
workers, those living with high-risk people, and
all people ages 50 and older should try to be vaccinated
by November, and should continue to seek influenza
vaccine in December or later if necessary.
Here are the primary target groups
for annual flu vaccination:
People at increased risk for complications
from the flu, including
- people 65 and older
- residents of nursing homes and other facilities
that house people who have chronic medical conditions
such as diabetes, asthma, and heart disease
- adults and children who have chronic pulmonary
or cardiovascular disorders, including asthma
- adults and children who have required regular
medical follow-up or hospitalization during
the preceding year because of chronic metabolic
diseases (including diabetes), kidney dysfunction,
disorders caused by hemoglobin abnormalities,
or a weakened immune system, including immunosuppression
caused by medications or the virus that causes
- children and teen-agers (ages 6 months to
18 years) who are receiving long-term aspirin
therapy, and therefore might be at risk for
developing Reye syndrome
- women who will be in the second or third
trimester of pregnancy during the flu season.
People who can transmit influenza
to those at high risk
- physicians, nurses, and other personnel in
hospital and outpatient care settings, including
emergency response workers
- employees of nursing homes and chronic-care
facilities who have contact with patients or
- employees of assisted living and other residences
for persons in high-risk groups
- persons who provide home care to persons
in groups at high risk
- household members (including children) of
people in groups at high risk.
People ages 50-64 because this group
has increased prevalence of high-risk conditions.