(This is Part 2 of Our Flu Series. To read, Part 1, click here).
Preventing Flu Infection in Patients with Pulmonary Fibrosis
If you have Pulmonary Fibrosis or other serious lung disease, an ounce of prevention is worth about 100 pounds of cure. The best way to prevent influenza is to get the Flu vaccine. The more people around you that get vaccinated the better (this is called herd immunity). So get the entire family vaccinated. Even better get the entire block vaccinated. In adults, there are two different types of vaccines—a trivalent (three strain vaccine) and a quadrivalent (four strain vaccine). They are given as an injection in your arm.
It is impossible to get Flu infection from the vaccine.
The vaccines are made from inactivated virus particles that are in no way infectious. In patients 65 years of age and older, there is data supporting a double dose vaccine that leads to higher levels of immunity.
Why bother getting the flu vaccine?
In 2015 the Centers for Disease Control estimated that 40 million Americans were infected with Influenza, 19 million Americans sought medical attention and 1 million were hospitalized with Flu. The number of deaths each year from Flu varies but can reach as high as 49,000. If you have IPF and you get influenza it may be a life-threatening problem. Getting the flu vaccination reduces your risk of getting flu by about 50%. In patients that do still get flu, the infection is less severe. There is also data showing that the best protection is when patients get the flu vaccine every year rather than missing some years.
Some of my favorite reasons that patients have given me over the years are:
- I don’t believe in vaccination.
- I have never had Flu before.
- Last year I got the vaccination and then got sick.
Flu vaccination is a matter of science and fact. Much like the protective effect of wearing a seat belt is a matter of science and fact. No one would ever argue that they are not going to wear a seat belt because they have never been in a car accident. Similarly, just because you wore your seat belt and had a car accident in no way means that the seat belt caused the car accident.
What if I am exposed to Influenza?
Both Tamiflu (Oseltamivir) and Relenza (Zanamivir) are approved for the prevention of influenza. They are not an alternative to the vaccination but used in addition to vaccination. In general, patients at risk for severe disease should consider using a preventative medication after exposure or during influenza outbreaks. Nursing home patients are another group that may benefit. The decision to use preventative medication is complicated and should be discussed with your doctor.
What if I am allergic to eggs?
First, recent data has emerged that the vast majority of patients that have an egg allergy are able to tolerate Flu vaccination without any problems. For patients with very severe egg allergy there are now alternative Flu vaccinations that have no egg proteins in them. The most widely available egg-free Flu vaccine is Flublok.
What are the risks of Flu vaccination?
Approximately 1 in a million patients given a Flu vaccine will have some type of allergic reaction. More common side effects are injection site pain and achiness. Even a low grade fever is not unusual. This does not mean that you are getting sick. This is just your body building an immune response that will protect you.
Treatment of Flu
There are a handful of medications that treat flu. The most commonly used medication is Tamiflu (now available also as the generic Oseltamivir). This medication is most effective if taken within 48 hours of symptom onset. It reduces the duration of the infection and reduces the severity of symptoms. If you are an otherwise healthy person less than 65 years old with mild symptoms, there is not much benefit to treating influenza. On the other hand, if you have chronic heart, lung, or liver disease, neurologic disease, are pregnant or over 65 years of age then I generally offer treatment provided that the patient presents within 48 hours of symptom onset. There is much less benefit to treating mild to moderate influenza after 48 hours. In patients that are hospitalized or are gravely ill, I generally offer treatment regardless of the timeframe.
Choice of Agents to Treat Flu
Tamiflu (Oseltamivir) is the most commonly used medication. It is active against both influenza A and influenza B. It is taken orally at a dose of 75mg twice daily for 5 days. In hospitalized patients with severe influenza pneumonia we may treat for longer. The most common side effect is heartburn or upset stomach. There are reports of strains of Influenza that are resistant to this medication, but the incidence is low. An intravenous form of this medication called Peramivir is available as a single infusion for critically ill patients unable to take oral or inhaled medications.
A second medication called Relenza (Zanamivir) is available to treat influenza A and B infections. It is an inhaled medication. Each inhalation delivers 5mg of medication. The treatment dose is 2 inhalations twice daily for 5 days. The most common side effects are headache, cough and stomach upset. In patients with severe lung disease such as asthma or COPD, this medication should be used with great caution.
The oldest medications are Amantadine and Rimantadine. They are only active against influenza A. These medications are rarely used now due to high levels of resistance.
The take home message is that everyone should get the Flu Vaccine. The risks are very small and the benefits very large. There are few interventions in medicine that are inexpensive, effective and low risk. Protect yourself and your loved ones. Get vaccinated!