F... Flu

September 06, 2018

F... Flu

It’s been a good winter for the Cape, we have had some rain, snow and a proper cold season. It feels like winters I remember from my UCT days, wet, wild and windy.

They were not fun days pre a car and long walks from distant parking to various hospitals around the peninsula and the inevitable snotty nose and thick phlegmy coughs.

I will admit up front I have been a poor supporter and USER of the annual Flu (influenza) vaccine, though unlike the multi anecdotal tails spread around of “I had the worst flu ever, the year I had the vaccine”.

I have no excuse for my own lack of uptake, nor my pushing the vaccine harder in my patient group/practice, it is a weird one. For sure I believe it is safe and effective and relatively cheap (compared to some other vaccines), but maybe I was blurred by the effects of Respiratory Syncytial virus in my younger patients, or I am just tired of pushing the regular routine (are they?) vaccines in an ever skeptical society.

So why am I confessing, as usual it is rather reactionary , well its because I have spent the last few weeks/months dealing with a much heavier burden of influenza disease. The telephone conversation; whats app chats and admissions to hospital of varying ages of children with brutal temperatures; muscle and body pains so debilitating that walking is not possible and secondary pneumonia/sinusitis/otitis, all now much more easily proven to be Influenza with rapid fire PCR (and expensive) testing.

The question of why testing is often raised, particularly by medical aids, as the tests do run into 1000 + rands, and again I will defend my actions. The test allows reassurance and hopefully more rational antibiotic use; it helps to give parents and families answers and also can guide protection through anti-viral prophylaxis to protect, as yet, unvaccinated, family members. I believe that the Influenza epidemic, though a routine annual process is exacerbated by the weather; the cold keeps us indoors with our windows shut, gathered around the fire or heater and at creches and schools, kids are kept indoor in groups where a sneeze or cough can infect 10’s of people within seconds.

Within 48 hours the Influenza B has people doubled over with abdominal pain and vomiting, so severe referrals to surgeons and radiology to exclude appendicitis explode, followed by severe fevers and nasal congestion and days of lethargy and weeks of recovery. The H1N1 swine flu strain is even more debilitating from a muscle pain and respiratory tract inflammation, again with terrible fevers.

Big Pharma!! scores as cough syrups, anti inflammatories and “cold” remedies fly off the shelves to try and make our aching bodies and snotty noses and painful coughs marginally better, followed by a course of antibiotics when the phlegm becomes the “bacterial” green. And all this is safely and easily prevented with a vaccine costing well under 100 rand, and sure it wont stop the Rhino virus (common cold) nor the croupy para influenza virus, but these have a far less severe effect on the individual , for a far shorter period of time and cause far few days off school or work. I always say it is the season to be snotty, sung with the christmasy vibe of “jolly”, but why are we globally but tragically locally so poor at making it less so with a simple safe effective vaccine.

A study in 2015 by Lalloo (https://tandfonline.com/doi/figure/10.1080/23120053.2018.1504532?scroll=top&needAccess=true) showed in patients with medical aid the overall uptake of Flu vaccine in season was 5%, varying according to age form < 2% in undr 5 year olds to 16% in >66 year olds; indicating GPs and old age homes are the more effective purveyors of prevention, than me and my fellow paediatricians.

The herd protection of 2 vaccinated individuals in an office of 10 people is 20 fold, schools, work places, creches and hospitals would be safer; more productive and if employers, heads of schools and hospitals and even hotels demanded, or even better, provided vaccines for their cohorts. 2018 may have filled our dams, but it has also filled our wards; our noses/sinuses and lungs.

I vaccinated myself……a little later than is recommended, but will be pushing and injecting with a lot more vigor in the future. Back Home

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