Influenza: Drug Warning!

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What is Influenza?

Commonly known as "Flu," "Grippe" or "Grip," influenza is a specific acute viral respiratory disease characterized by fever, coryza (cold or "sipon"), cough, malaise, headache, and inflamed respiratory mucous membranes. During this flu season people usually take drug remedies for cold, cough, sneezing and congestion. The FDA in the United State, on November 6 this year, has warned the public that some these over-the-counter and even prescription cold and flu medications (and diet pills too!) contain an ingredient in them that could cause fatal cerebral hemorrhage (bleeding in the brain), which issue we shall discuss in more details below.

What causes Influenza?

The viruses that cause Flu are called orthomyxoviruses, tiny "germs" who sizes vary from 80-120 nm. They are classified into types A, B and C. Type A is the most common single cause of Flu. Type B causes epidemics about every five years. Type C is not a very prevalent virus. The Influenza pandemic of 1918 left more than 20 million people dead.

How does it spread?

Flu is a very contagious illness. It spreads by person-to-person contact. Airborne droplet spray (from sneezing or coughing) into the atmosphere infects people and contaminates objects that can transmit the infection. This is why persons who have the Flu are advised to cover their nose and mouth. Washing hands frequently is highly recommended to limit the transmission of the virus.

Who have the greatest risk?

Persons of all ages are afflicted, but school children are most prone to catch the Flu. People at highest risk of developing severe disease are those with chronic lung disease and valvular heart disease, and those with lung congestion. The elderly, the very young, the bedridden and women in their third trimester of pregnancy are also at great risk. Deaths have been reported following a bout of Flu in this group, especially those who are old and bedridden.

Which type kills more people?

Type A Influenza is associated with significant morbidity and deaths during epidemics, higher than type B, which could also cause severe disease but not as bad. Type C is the most benign of the three. This admonishes us not to take Flu lightly.

How long does it take for the symptoms to show?

From exposure, the incubation period is about 48 hours. During this period, asymptomatic viremia (virus flooding the blood stream) occurs with replication of the virus in the respiratory tract. The, "suddenly" chills and fever up to 39 to 39.5 C (102-103 F) develop over 24 hours. Body aches and pains (back and legs) and malaise follow. Headache and sensitivity to light (pains in the back of the eyes) are most common. There is accompanying watery eyes, scratchy throat, dry cough and a lot of nasal mucus discharge. The face is warm and flushed. The throat and tonsils might be sore and reddened. Nausea and vomiting may be present. After 48 to72 hours, the acute symptoms rapidly subside and fever disappears, but weakness and fatigue may linger another few days.

Are there severe cases?

Yes. In severe cases, complications could set in, like hemorrhagic bronchitis and pneumonia could set in within a few hours. Fulminant and fatal viral penumonia can occur, with severe shortness of breath and spitting up blood, and death following in 48 hours. This usually happens among patients with pulmonary, heart or neurologic problem. Indeed, Influenza is nothing to sneeze at!

How is Influenza diagnosed?

A specific diagnosis may be made by isolating the virus by immunoflourescense technique or serologic tests, but the condition is so common just about any lay person can make the diagnosis. The important thing is to make sure it is "only the Flu" and nothing more serious, especially when the symptoms persist for more than a week. In this case, a physician should be consulted.

Is there a pill for preventing the Flu?

Yes. Amantadine 100 mgm orally (for adults) has been used for prophylaxis against Influenza Type A. It is not effective against Type B. This is recommended for those who are at high risk of developing complications. During the Amantadine treatment, those persons who have not been vaccinated should receive the Flu vaccine, and Amantadine may be discontinued after 2 to 3 weeks. If, for any reason, vaccine cannot be given, then the pill should be continued for 6 or 8 weeks.

Does Amantadine have adverse side effects?

Yes, among them are nervousness and insomnia in about 7% of patients. These side-effects are more prevalent among elderly persons and those with impaired kidney functions and brain dysfunction. A newer drug, with lesser side-effects, is Rimantidine.

Is chicken soup, lugao or arroz caldo good for the Flu?

There is no curative value of these foods but they do make persons with the Flu or Cold feel better. They are light and warm, and warm liquids (tea, kalamansi juice, etc) in general are soothing to the person with the Flu. Taking liberal amount of oral liquids also prevents dehydration and helps bring the fever down. Regular or heavy meals make most patients feel bloated and nauseated.

Why is aspirin unsafe for children?

Aspirin was once used among children like water. However, since about 1963, a fatal condition known as Reye's syndrome was discovered and was linked to the use of aspirin, which increases the risk of having the syndrome by as much as 35-fold. The cause is still unknown but viral agents (Influenza A or B and Chicken Pox virus) have been implicated, and so with aspirin ingestion among children under 18 years of age. Children develop acute encephalitis and go into coma and die. Today, Pediatricians no longer prescribe aspirin and prefer acetominophen (Tylenol) for fever and aches and pains in children.

What is the treatment for the Flu?

Generally, the treatment is symptomatic: Bed rest to conserve energy and minimize malaise. To reduce fever and body aches, antipyretic-analgesic (anti-fever-anti-pain) pills (Tylenol) is given. To feed and hydrate the patient, lugao, arroz caldo, chicken soup, juices, water, other oral fluids, etc. Sponge bath or cold compress over the forehead, if fever goes above 39 C (102 F). The physician might prescribe an antibiotic if he/she suspects a superimposed bacterial infection, and antiviral drugs for those who are at high risk of developing complications. As always, prevention is most essential.

How does one prevent the Flu?

Having a healthy life-style helps a lot in warding off many forms of illnesses. This includes high fiber, low-fat diet, no smoking, daily exercises, taking multivitamins daily, including Vitamins B, C and E, and the mineral Zinc. Most one-a-day multivitamins already include these. Flu vaccines are now available, and are recommended to be taken by adults October 15th-November 15th each year. This annual Flu shot has been found to be 75% effective in preventing Flu. It also reduces the severity of the disease and can even be lifesaving for some people. Both the person with the Flu and those around him/her should be careful to prevent airborne droplet transmission of the virus and infection by contaminated items. Kissing, handshaking or any form of physical contact can transmit the virus. Again, simple, old fashioned hand washing that we learned in kindergarten can prevent infection.

What is the FDA drug warning about?

The Yale University Hemorrhagic Stroke Project researchers found in May this year that a common ingredient in many cold, flu and diet medications called Phenylpropanolamine Hydrochloride (PPA) increases the risk of hemorrhagic stroke (caused by bleeding in the brain). Many of these drugs are sold over the counter and some of them are prescription drugs, which physicians have prescribed over the years, until the recent FDA warning about the dangers of PPA.

What are these medications in the U.S.?

Any medication containing Phenylpropanolamine Hydrocholoride, or diet aid ephedra (ma-huang, which is converted to PPA when ingested), can potentially cause brain hemorrhage and death, according to the Yale study. Some products with PPA include Dimetapp, Vicks DayQuill Sinus caplets, Robitussin CF, Comtrex, Tavist-D, some Triaminic products, Contac 12-hour, some Alka Seltzer Plus cold medications, appetite suppressants like Acutrim and Dexatrim.

How about those in the Philippines?

According to the PIMS (medical prescription reference booklet) among the medications sold in the Philippines that contain PPA are: Alledec, Altussan, Altussin, Bitussin, Coderex Forte, Coldenal, Coldex, Coldflu, Colinol, Colvan, Congestril, Coperyl, Corex-DM, Cori Tussal, Cosyr, Cynosal, Decolgen, Decolsin, Dextricyl DAC, Dimetapp, Diphenyl D, Disudin, Drinus, Nafarin, Nalgestan, Neosep, Rhinopront, Travegyl-D, Triaminic, Tuseran. This is NOT a complete list. The best is to consult your physician and also read the label. If the medication contains Phenylpropanolamine, beware! Both the US FDA and the BFDA in the Philippines have already warned the public about this danger. It is best to heed the this medical alert and be on the safe side.

©2003Raoul R. Diez, M.A.O.D.