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A (flu) shot of prevention: a study questions the value of anti-influenza drugs, making the flu vaccine and personal prevention even more important.

Flu season is fast approaching, and if you've managed to avoid the flu in years past, don't push your luck.

Each year, more than 200,000 Americans (many of them seniors) are hospitalized with flu-related complications, according to the U.S. Centers for Disease Control and Prevention (CDC). And, a recent study suggests that the antiviral medications used to treat the flu may do little to help you avoid flu complications or hasten an end to flu symptoms.

The findings point to the importance of being vaccinated against influenza and doing everything you can to prevent infection by the flu virus, a Cleveland Clinic expert says.

"Especially if you're older, there's a greater chance of being hospitalized or dying from the flu," says Raul Seballos, MD, vice chairman of Cleveland Clinic's Department of Preventive Medicine. "Obviously, the antivirals are not a substitute for the flu shot. Flu prevention is still the way to go."


In the study, published April 10 in the Cochrane Database of Systematic Reviews, investigators analyzed data from 20 trials involving oseltamivir (Tamiflu[R]) and 26 trials involving zanamivir (Relenza[R]), encompassing a total of more than 24,000 people. They found that oseltamivir and zanamivir, when used as preventive treatment, were somewhat effective at reducing the risk of developing symptomatic influenza.

The antiviral drugs shortened the duration of flu symptoms only by an average of about half a day, although the use of symptom-relief medications, such as pain and fever reducers, might have been partly responsible for this effect, according to the study.

If the antivirals are to confer any benefits, Dr. Seballos notes, they must be used within 48 hours of symptom onset. "If you think you have the flu, you have to call your doctor immediately," he says. "I've had cases where people have called me a week later, and by then it's too late."

The study investigators reported finding no good evidence that the antivirals reduce hospital admissions, halt the spread of influenza, or prevent serious complications from influenza infection, such as pneumonia, bronchitis, or ear or sinus infections.

Although zanamivir tended to be well tolerated, oseltamivir was associated with an increased risk of nausea and vomiting, as well as a greater risk of psychiatric events when used as preventive therapy, the study found. The researchers also found evidence that oseltamivir might prevent some people from generating sufficient numbers of their own antibodies to fight influenza infection.

"The balance between benefits and harms should be considered when making decisions about use of both [drugs] for either the prophylaxis or treatment of influenza," the study authors concluded.


Instead of relying on antiviral medications, take personal steps to guard against the flu (see "Facts About the Flu" chart).

And, most importantly, get the influenza vaccine, one of the most effective ways of preventing the flu and reducing its severity, Dr. Seballos says.

The CDC recommends getting vaccinated for influenza by October each year, although you can still gain protection even if you're vaccinated later. Most people build up immunity to the flu about two weeks after they're vaccinated.

Although the CDC encourages anyone age 6 months or older to get a flu shot, the vaccine is especially important for higher-risk people: those age 65 and older, people with chronic illnesses (such as heart, lung, liver or kidney disease, diabetes, cancer), patients who have medical conditions or take medications that decrease immune function, nursing home residents, the morbidly obese, and health-care employees or others caring for high-risk patients.

The vaccine is given as an injection containing an inactivated (dead) virus, or as a nasal spray containing a weakened live virus--the nasal spray vaccine is indicated only for healthy people ages 2 to 49. A trivalent vaccine guards against three strains of influenza, while a newer quadrivalent form protects against an additional strain.

"Don't worry about which type," Dr. Seballos emphasizes. "Just get the flu shot."

The flu shot is available at your doctor's office, pharmacy, and many other health-care outlets. For people allergic to the egg proteins found in traditional flu vaccines, a new egg-free type is available. And, for anyone over age 65, a newer vaccine contains four times the standard vaccine dose, to bolster older immune systems that don't respond as well to standard flu shots.

"We've really removed the barriers to influenza immunization," Dr. Seballos says. "I see no reason why anyone shouldn't get the flu shot."



* Each year, about 5 to 20 percent of the U.S. population develops the flu.

* Flu activity in the United States usually peaks in January or February, but may begin as early as October and continue through May.

* Symptoms: Fever, headache, body aches, chills, fatigue, cough/ chest discomfort, sore throat, stuffy nose and sneezing. Vomiting and diarrhea also are possible.

The flu vaccine

* The vaccine targets the three or four viruses expected to cause the most illness during a given flu season.

* Ideally, you should receive the flu shot by October, although getting it later will still afford some protection.

* Although some people report mild fatigue and other symptoms after receiving the flu shot, the vaccine does not cause the flu.

Personal prevention

* Wash your hands frequently with soap and water or an alcohol-based sanitizer, and dry your hands with paper towels.

* Try not to touch your eyes, nose, and mouth.

* Cover your nose and mouth with a tissue when you cough or sneeze; throw the tissue in the trash afterward.

* Clean germ hotspots--such as doorknobs, telephones, and countertops--with a virus-killing disinfectant, and don't share dishes or towels.

* Avoid contact with flu sufferers, and if you're sick, limit contact with others as much as possible.

* If you have the flu, stay home for at least 24 hours after your fever subsides without the use of fever-reducing medicine.
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Title Annotation:General health
Publication:Men's Health Advisor
Date:Oct 1, 2014
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