Hey MilDoc - Flu question

[crokett]

My youngest was running a +103 fever since yesterday. It was over 104 this AM so my wife took her to the dr who diagnosed viral flu. The doc wrote a prescription (not sure for what med).

Some questions: I thought you couldn't treat viruses with meds, just have to wait till they run their course? This is an interference drug. Only way I can see it working is it interferes with the virus reproducing. So if they can do that, why not prescribe for other viruses, or is it too specific and/or breeds superbugs?

[MilDoc]

Probably prescribed Tamiflu (oseltamivir) which, if given early enough will save you 1-2 days of suffering. Problem is the flu strain circulating this year is sometimes resistant to it.

Antiviral drugs can be virus specific. For example. acyclovir often works for Herpes infections (cold sores, chickenpox, shingles), while valganciclovir fights CMV virus. And viruses can develop resistance to them, or change their genetics rapidly to "avoid" them (like HIV does).

All antibiotics, including the antivirals, could be called "interference drugs." They are designed to disable specific proteins, or to replace a needed nutrient, or other methods.

Antibiotics for bacteria work the same way, but bacteria and viruses don't share the same chemistry, so antibiotics do not work for viruses and should never be prescribed for colds, the flu, etc. Far too much resistance to antibiotics already, due to overprescribing.

[crokett]

It is Tamiflu. My wife just got over what my daughter has and I seem to be coming down with it so we will see if my flu vaccine was worth it. My onset does not seem to be as fast as my wife's was, so far.

I know bacterial infections are different from viruses. I was just asking because I thought there was nothing you could prescribe for a virus.

[TB Roye]

Was at my Doctor for a check up this morning. She advised that the flu shot I got does not have protection for 2 strains of the flue running around this year. One of the strains is a bad one and they have no vaccine for it at the moment. Mildoc might have a better explanation.

Tom

[MilDoc]

She advised that the flu shot I got does not have protection for 2 strains of the flue running around this year.

Exactly right. Flu vaccines are developed early in the year based on the "best guess" of what strains will occur in the winter. Usually they get it right. Not always. There are numerous different strains of the flu virus and they constantly change, sometimes even changing ("drifting") in the same season.

This year a strain typed H3N2 A/Brisbane has been circulating. H3N2 strains typically cause more severe disease, and although this year's vaccine contains an H3N2 strain it is not an exact match. There is also a "B" strain circulating, and the vaccine's strain again is "close but no cigar."

BUT - the flu vaccine, though not as effective, it will still protect many people, often resulting in a less severe illness and fewer complications (it's usually the complications that kill you) due to cross-protection. The antibodies you build in response to the vaccine will have some effectiveness. So, it's not quite true that this year's vaccine offers no protection.

Regarding Tamiflu, there has been no detected resistance to the drug in the H3N2 and B strains, so if you get one of those and had a flu shot, you should do well. And it is the H3 strain that is circulating most right now (the H1 strain was more common early this season).

[MilDoc]

.. I was just asking because I thought there was nothing you could prescribe for a virus.

I should have mentioned that for the general, run-of-the-mill cough & cold viruses, there are no really effective antiviral drugs. 2 reasons:

1) many viruses cause colds, at least 6 types, and there are over 100 strains of one of them.

2) antivirals do have potential side effects. Not worth it to give you 1-2 days relief of your 4-7 day cold.

A drug called pleconaril was under development for years to treat the most common viral cause of colds, but just didn't hold up in clinical testing. Maybe someday there will be effective treatment --- but don't hold your breath!

Now, excuse my soapbox. Far too many people want and get an antibiotic for their colds. Because it "must" be a "sinus infection." This is just plain wrong. Sinusitis is a clinical diagnosis in most cases, and even then does not demand treatment! And overuse of antibiotics has led to so much resistance (MRSA anyone?) that I fear for the future. In most cases you do not need an antibiotic sooner than 9-10 days of a cold that is not getting better at all. There are exceptions, but an antibiotic on day #3 is rarely indicated.

Sorry. Just had to rant a bit!

[gsmittle]

Sorry. Just had to rant a bit!

A well said and very needed rant, at that!

Paul, here's a waaaaaaay off topic question for you--how do you remember all this stuff?????

g.

[TB Roye]

Back in 1964 I was at Ft. Ord for basic training in the army. Supposedly some of us were given some kind of cold/flu prevention shot as a test. They never told us what was going on, sound familiar? Shortly there after I developed a cold and ended up in the hospital. Don't know to this day if I got one of those shots or not but I was a sick puppy. Meningitis was also going through the base like crazy. We lost 3 people in our training company during the last week of training. One thing I have learned is quiting smoking was the best thing I could have done as far as getting Colds, Bronchitis and Pneumonia. I still get colds but nowhere as severe as before I quit. I haven't had the flu sence I started getting the flu shots, but being retired helps as I am not out in the working environment anymore were the exposure is greater. I get my Pneumonia shot every 5 years. I have a good doctor and she watches over me and makes sure everything is upto date. Besides that she is pretty.

Tom

[MilDoc]

Paul, here's a waaaaaaay off topic question for you--how do you remember all this stuff????? g.

Lots and lots and lots of continued study and reading, conferences, etc. Plus I'm often called upon to give lectures and conferences on various topics, not just those within my own field. My experience teaching medicine for years made the desire to keep up ingrained. If you don't keep up as a teacher the interns and residents will make you look / feel like an idiot.

If I spent half as much time on woodworking I'd have custom orders coming in from all over the world!

[MilDoc]

Back in 1964 I was at Ft. Ord for basic training in the army. Supposedly some of us were given some kind of cold/flu prevention shot as a test. They never told us what was going on, sound familiar? Shortly there after I developed a cold and ended up in the hospital. Don't know to this day if I got one of those shots or not but I was a sick puppy. Meningitis was also going through the base like crazy. We lost 3 people in our training company during the last week of training.Tom

There was a study of a rhinovirus vaccine going on around that time which didn't show much effectiveness. This is the virus with over 100 strains. not surprising it didn't work well.

RE: meningitis. Highest incidence is young kids, college students, and military recruits. There is a new vaccine (Menactra) that should be much better than the one we used to use, and is recommended from age 11 up. I especially recommend it for any kids planning college. Military recruits get it as part of their vaccinations.

[crokett]

Ok 'nother question, can 2 people with the same virus strain present differently? My wife is just getting over what my daughter has - all in the chest. Jury is still out on what I have but for now it

a) does not appear to be as rapid onset as my wife and
b) is in my head. So either I have something different or it hasn't gotten to my chest yet. Having a head cold for me is infinitely preferable to something in my chest.

[MilDoc]

Ok 'nother question, can 2 people with the same virus strain present differently?

Absolutely. Far too many factors enter into immunity and the body's ability to prevent / fight off any infection to expect any 2 people to respond exactly the same. Add to that environmental factors (amount of exposure, general health, diet, age, prior exposures, smoking or exposure to it, vaccines received, etc) and there can be big differences in response. These factors also effect complication rates, and those complications are in general the cause of death.

OTOH, your wife and child may have the "true flu," and you may just be getting a cold. Not everyone exposed to the flu (or just about any infection) will get it. That's called the "attack rate," and it is rarely 100%.