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Introduction
Pathogenesis
Perception v. Fact
Prevention & Control
Symptoms & Progression
Diagnosis
Treatment
Economic Impact
Management Program
Bibliography

Perception: "It's Just the Flu"
Facts:
  • Influenza infects over 30 million people in the U.S. each year - that's 10-20% of the U.S. population.
  • Over 150,000 people are hospitalized annually in the U.S. with complications from flu.
  • Influenza and its complications are the sixth leading cause of death in the U.S., killing 20,000-40,000 people a year.
  • 60% of those with influenza are misdiagnosed and begun on antibiotics.
  • During the "flu season," emergency room wait-time commonly exceeds four hours and "true" emergencies have to be sent to other ER's.
  • Business productivity drastically drops due to flu sick time.
  • Total costs exceed $10,000,000,000 in the U.S. All this occurs in the 4 month "influenza season." That's "Just the Flu!"
 Perception: It's only the high-risk patient that you have to worry about.
Fact:
Infants and the very young have more severe influenza symptoms and complications, as do those over age 65 with "forgetful" immune systems. Certainly those with compromised immune systems (e.g., AIDS, asthma, chronic obstructive pulmonary disease [COPD], oncology, and cardiovascular patients) are high risk. Those considered "at-risk," but not high-risk, are people who care for high-risk patients - you, your staff and family members. Risk varies from year to year, but a new strain, such as the 1997-98 type "A/Sidney" brings increased risk for all ages.

Perception: Most physicians think they can accurately diagnose influenza.
Fact:
In one study, doubly board-certified ER/infectious disease specialists correctly diagnosed influenza only 30% of the time. Influenza was over-diagnosed at the peak of the flu season and under-diagnosed at other times of the year. Another study showed that misdiagnosis of influenza as a bacterial infection (e.g., sinusitis, bronchitis, pneumonia, etc.) occurred 60% of the time. Treatment with antibiotics usually follows these misdiagnoses. The influenza syndrome is less specific than most think, and a diagnostic tool is necessary to make a definitive diagnosis.

Perception: There is no way to diagnose influenza for certain.
Fact:
ZstatFlu™ is a rapid (20 min) throat swab test with 99% specificity for influenza that can be done in your office.

Perception: Treatment with antivirals has poor results, a high prevalence of side effects and is expensive.
Fact:
Treatment with amantadine or rimantadine is effective in treating influenza A if begun within the first 48 hours after symptom onset. Side effects are exhibited in fewer than 2% of patients and severe reactions are rare. The drugs wholesale for less than 20 cents per tablet and a normal treatment course calls for one tablet twice daily - approximately 12 hours apart - for 5 days. Thus amantadine and rimantadine are cheaper than any antibiotic.

Recently, a new class of antivirals has become available for treatment of influenza A and B - neuraminidase inhibitors. The first of these, zanamivir (Relenza®, a trademark of GlaxoWellcome), was approved by the FDA in 1999. This drug, which is administered by use of a special inhaler, has been shown to reduce the duration of flu symptoms when given within two days of symptom onset. Zanamivir is approved for use in patients 12 years of age and older. Side effects are comparable to placebo, although the safety of the drug has not been established in patients with high-risk underlying medical conditions, such as COPD or asthma.

Another neuraminidase inhibitor, oseltamivir (Tamiflu®, a trademark of Roche), was approved by the FDA in fall of 1999. This drug is administered orally and has also been shown to reduce the duration of flu symptoms if administered within 48 hours of symptom onset.


Perception: We've got to be certain there is no bacterial illness first.
Fact:
According to many infectious disease experts, bacterial illness during the first 3 days of influenza in the immunocompetent patient doesn't occur. In fact, most of the time, complications follow by 7-10 days. Flu virus in a community is many times more common than any bacterial illness. It's the horse, not the zebra during flu season.

Perception: My managed care plan doesn't want me to see the flu. I'm capped, so seeing patients with flu costs me money.
Fact:
By seeing every patient with influenza-like illness, you may be able to diagnose early, possibly preventing a complication that could lead to hospitalization. Your costs are absorbed, and better quality medicine is delivered.

Perception: Some physicians believe a "wait and see" attitude or phoning in an antibiotic to prevent any complications is the best way.
Fact:
The "wait and see" approach assumes nothing can be done, which is incorrect and counterproductive. During the first 48 hours of symptoms, a definitive diagnosis can be made and effective treatment can be started to shorten the disease's course and to prevent complications and spread. Several clinical studies have shown that antibiotics given to prevent bacterial complications do, in fact, increase the rate of complications. Broad spectrum antibiotics eliminate protective flora, encouraging the presence of more dangerous organisms.
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