It’s a bad year for flu, get your vaccine, if offered

IN the run-up to Christmas, there are several things that need to be checked off the list — Christmas shop; order in the turkey; put the tree up and get a flu jab.

That last one is potentially the most important of all. Unless you have had your head buried in wrapping paper and tinsel, you will probably have noticed the headlines surrounding the rise in flu cases and the impact it is having on hospitals.

Without wanting to put a dampener on things, it’s worth talking about. Because it’s Christmas, I thought I’d start with a quiz. Pens at the ready.

1) Roughly how many global cases of flu are there annually?

A) 5 million

B) 100 million

C) 1 billion

2) Which of the following are the signs that suggest you should speak to a doctor?

A) My phlegm has turned green so I think I need antibiotics.

B) I feel generally rubbish, I’m still coughing, I’ve lost my appetite and it’s been four days without improvement.

C) I am starting to struggle with my breathing.

D) After two weeks, I felt a bit better but now I’m coughing again, my temperatures have returned and I’m shaking.

3) Influenza got its name…

A)…from the Latin word for “influence” due to the belief that outbreaks were influenced by the stars.

B)…from an Italian maiden called Influenza, believed to be the first documented case.

C)…from the small Belgian village of Fluenz in which scientists first isolated the virus.

4) The influenza virus has four types, A, B, C and D. Which type generally causes the big outbreaks?

A) A

B) B

C) C

D) D

5) What should I do if I get the flu?

A) Rest, stay away from other people where possible, drink plenty of fluid, take over-the-counter paracetamol and/or ibuprofen to help with the symptoms and wait for it to pass.

B) Immediately panic, jump up, head straight to A&E and plead with the doctors to admit you.

C) Call your GP to ask for antibiotics so you are ok for Christmas.

D) Get on with your life, dose yourself up, drag yourself into work and stop complaining.

1) The answer is 1 billion. Three to five million of these are cases of severe illness and flu is thought to cause up to 650,000 deaths globally each year. Unfortunately it looks as if this year is shaping up to be a bad one. Already the numbers are 50 per cent higher than last year. These are frequently conflated with flu but there is a significant difference between even a bad cold and flu.

2) The answers here are C and D. Before I explain, let’s start with looking at what you can expect from a bout of flu. After infection, which is spread either by touch or by airborne droplets from coughing and sneezing, the incubation period is between one and four days. Typically it starts with a fever and is associated with fatigue, all over body aches and a loss of appetite. It primarily affects the airways so causes a cough, sore throat and runny nose. Alongside all of that it is common to feel headachey and, if you’re unlucky, you might feel nauseous or have an upset tummy too.

The symptoms occur because your body is fighting the infection. That means all the inflammatory mediators in your blood are heading to the airways to fight the infection. The waste products of this are what create all the mucus and catarrh. This can be green but it is a myth that green phlegm means it is a bacterial infection and thus requires antibiotics.

Influenza is a virus and, as such, will not respond in the slightest to antibiotics. That said, the vast majority of patients just need to ride things out as the body will get on top of things eventually. In a minority of cases, mostly in those who are vulnerable, it can take hold and cause secondary bacterial infections or even a viral pneumonia. This is likely to present with significant and worsening shortness of breath, a resurgence of fever after a partial recovery and gradual worsening over one to two weeks. This is the point at which a doctor should be consulted.

3) The answer is A. In the middle ages, during flu-like disease outbreaks, it was believed that the bad humours causing illness flowed into sufferers from the stars. Hence the adoption of influenza, meaning to flow into or influence. Influenza would not be an acceptable name, as far as I am concerned, for any child, and Fluenz is a place I made up.

For a time, bacteria were thought to be the cause of influenza, which explains why some bacteria have the word in their Latin titles. There have been several pandemics over the last 150 years thought to be down to flu, the most severe being the Spanish flu pandemic of 1918.

Spanish flu was devastating at a time when no one knew what caused it or how to treat it. Estimates at the time put the death toll at 25 million but this has subsequently been revised upwards to as much as 100 million.

It wasn’t until 1933 that it was discovered that influenza was caused by a virus, which leads us neatly on to the next question.

4) The answer is A. While types B and C cause flu, they tend to be milder illnesses (particularly C), while influenza D only affects cattle. Influenza A is the big one and is commonly subtyped according to the proteins that sit on the outside of the virus. H for haemagglutinin and N for Neuraminidase. The H1N1 strain is thought to have been responsible for the Spanish flu pandemic whereas the H3N2 strain is the one currently tearing through our population. At the time of writing, around two per cent of hospital beds in England are taken up with flu patients. In 2022 and 2023 there were around 16,000 flu-related deaths in the UK, and last winter it was more like 8,000.

What can you do though if you think you’ve come down with it? See question 5.

5) Hopefully everyone answered A on this one. There are antiviral medications that can be used to reduce severity of the most serious cases but otherwise it is a case of allowing your body to get on with it. Rest and hydration are key.

Vaccination is so important. Those over 65 and between six months and five years, healthcare workers, carers and immunocompromised patients are eligible. The UKHSA estimates the vaccine reduces the risk of hospital attendance by 30 to 40 per cent in adults. At the very least, it will reduce the severity of flu.

The adult vaccine is either inactivated flu or contains only the proteins on the outside of the virus. It is impossible for it to infect someone. It can take between one and 14 days for the vaccine to work, there’s every chance that one can still catch flu in that period. Don’t blame the vaccine!

Please do what you can to reduce the spread this year. Wear a mask in crowded spaces, ensure you wash your hands, especially after coughing and sneezing, and take up the invitations for free flu jabs.