Is it a cold or the flu? What you should know

Americans tend to be complacent about the flu, even though it kills an estimated 36,000 people every year. But this season the virus showed up early and many more children than usual are being sickened, some fatally. So the nation is paying more attention.

In past years, health officials have had a difficult time persuading people to get a flu shot, and millions of doses went unused. With the public growing increasingly anxious this year, there hasn’t been enough flu vaccine to meet the demand. Vaccine supplies have run out in some parts of the country, and health officials have had to scramble for additional doses.

Last Tuesday Health and Human Services Secretary Tommy Thompson announced that the federal government would give vaccine manufacturers $50 million to ramp up production and speed research and development to better respond to emerging flu strains.

In California, the virus has struck hardest in the Central Valley, around Fresno and Sacramento. Los Angeles County hasn’t experienced higher rates of flu cases in December compared with particularly bad years, such as 1998. But a confluence of flu, colds and other respiratory illnesses in recent weeks has made it seem like an unusually tough year, filling doctors’ offices with sick patients.

Here are some questions and answers about colds and flu, and some advice on how to prevent and treat them.

Question: Is this really a worse flu season than usual?

Answer: Nationally, this year’s flu season arrived early, with cases reported in many states in November and early December. By last week, outbreaks were widespread, and the federal Centers for Disease Control and Prevention had received reports of at least 42 flu-related deaths among children and teens. (The agency doesn’t officially track flu cases.) Dr. Julie Gerberding, the CDC director, says there is no scientific or epidemiologic evidence to suggest that this year’s flu season will be worse, in terms of the severity of illness or deaths, than other flu seasons in which Type-A flu dominated. Type-A flu generally makes you sicker than Type-B flu. Gerberding also says there is no evidence to suggest that this year’s predominant Type-A Fujian strain is “more virulent than strains that we’ve dealt with before.” In other words, it is too early to say how this season will turn out.

Q: I’m worried by reports of children dying from this flu. Should all children be vaccinated?

A: More children seem to be affected by this year’s flu than is typical, says Dr. Jonathan Fielding, director of public health for Los Angeles County. A few children die from the flu every year, often because of underlying illnesses, but the deaths are seldom publicized. The larger number of children’s deaths early in the flu season has attracted a lot of media attention. The CDC recommends that children between the ages of 23 months and 6 years be vaccinated, but Fielding encourages vaccinating older children too.

Q: I’ve heard about shortages of the vaccine. Is any available and where can I find it?

A: Be persistent. Start by calling your doctor’s office, then checking with your county health department or local hospitals. In some cases, it may be easier to find the FluMist nasal vaccine than the injection. Be advised that FluMist is appropriate only for healthy people ages 5 to 49.

Q: If I can find some vaccine, is it too late to get vaccinated?

A: Although it can take a few weeks to develop immunity after a flu shot or the FluMist nasal vaccine, doctors say it’s not too late. After all, the flu season continues into March or April. One sticking point: Children under the age of 9 who haven’t been vaccinated need two doses, a month apart, so getting the first dose now may still leave a child vulnerable for several weeks.

Q: Are there people who shouldn’t be vaccinated?

A: The only people who should avoid the shot are those who have had severe allergic reactions to eggs or previous flu shots, or have a history of Guillain-Barre syndrome. The FluMist nasal vaccine, which is spritzed into the nose and made from a weakened live virus, shouldn’t be used by those with chronic heart disease, lung disease, diabetes, kidney disease, HIV or by pregnant women. It also shouldn’t be given to health-care workers who could infect patients with viruses shed through their nasal passages.

Q: If I’m pregnant, should I get a flu shot?

A: Yes, if you’re in your second or third trimester, says Dr. Laurene Mascola, chief of L.A. County’s Acute Communicable Disease Control program. Pregnancy suppresses a woman’s immune system and puts a bigger burden on her heart and lungs, increasing the risk of pneumonia.

Q: How effective is this year’s flu shot?

A: No one knows how well the current vaccine formulation will protect against Type-A Fujian, which accounts for virtually all the flu seen in California so far. Flu shots have a range of effectiveness, which drops with age and chronic illness. Health officials say the vaccine should keep the most vulnerable people -- the elderly, the very young and those with chronic illnesses -- from suffering potentially deadly complications.

Q: I’ve heard that some insurance companies weren’t covering FluMist.

A: That was the case, but as supplies of injectable flu vaccine became scarce, several major health insurers, including Aetna and some Blue Cross and Blue Shield plans, announced they would pay for FluMist. However, some of those companies have said they expect to discontinue FluMist coverage next year.

Q: How can I tell if I have a cold or the flu?

A: Both are viral infections that start in the respiratory tract. They have a few overlapping symptoms, including a dry cough, runny or stuffy nose and sore throat. One crucial difference, however, is how quickly symptoms arise, experts say. With flu, you suddenly have body aches, chills, fever, headache and a feeling of fatigue that often is likened to “being hit by a truck.” Children also may have nausea, vomiting and diarrhea.

Q: Why is there no vaccine for the common cold as there is for the flu?

A: That’s because colds are caused by hundreds of viruses that can infect the upper respiratory system. It’s impossible to design a single vaccine to hit so many targets.

Q: If I think I’ve been exposed to the flu, what can I do about it?

A: Ask your doctor about the four prescription drugs designed to shorten the duration and intensity of the infection. Keep in mind, though, that antiviral drugs should be taken within 48 hours of your first symptoms. The drugs are oseltamivir (Tamiflu), zanamivir (Relenza), rimantadine (Flumadine) and amantadine (Symmetrel). Avoid Relenza if you have asthma or chronic respiratory disease. If you have a fever, you can take acetaminophen or ibuprofen, but do not give children aspirin because of the risk of Reye’s syndrome.

Q: Will my medical insurance pay for antiviral medications?

A: That depends on your insurance provider. Typically, if you have a prescription drug benefit, they’re covered.

Q: Can I do anything to halt the spread of the flu or a cold?

A: Wash your hands frequently and avoid touching your hands to your eyes, nose, or mouth. If you’re sick, cover your nose and mouth when coughing or sneezing. Dispose of your tissues. Use alcohol wipes or hand disinfectants. Consider staying home from work or school for the first three days of the illness. Surfaces that a sick person may have touched (telephones, faucets, doorknobs, refrigerator handles) can be washed with a household disinfectant, alcohol-based cleaner or diluted bleach.