Ask Us Anything About… the Flu

Description – The video begins inside a clinical visit room at Penn State Medical Group-Elizabethtown. Two people are standing next to each other looking at the camera. From left to right is Scott Gilbert and Dr. Jay Zimmerman.

Scott Gilbert – From Penn State Health, this is Ask Us Anything About the Flu. I’m Scott Gilbert. Every year the flu is responsible for hundreds of thousands of deaths across the world, so it’s not a mere nuisance, it’s something to be taken seriously. Here today to talk with us more about the flu, give us some good information about it, is Dr. Jay Zimmerman, he’s a family medicine physician at Penn State Medical Group, Elizabethtown, which is where we are right now, so thanks for having us here doctor. Let’s talk a little bit about this year’s flu strain. Because, I mean, the flu is not the same every single year, right? The flu is not just simply the flu but rather there are various strains that are prevalent each year.

Dr. Jay Zimmerman  – Right, every year the flu strain that is available around traveling changes, it has different forms, the different viruses you may hear about, the different strains H3N2’s. This year’s one that seems to be going around more right now and from the labs that they’re checking the different types.

Scott Gilbert – And so that’s referred to often as influenza A, but yet like you say, that’s just one of several.

Dr. Jay Zimmerman  – Right. So when you go get your flu shot you get the influenza A vaccine and usually has different strains in there. So whether it’s the H1N1 or the H3N2, and then you also get an influenza B in there, depends on which flu vaccine you get.

Scott Gilbert – And I’ve heard that H3N2, that strain you’re referring to, based on its previous performance in other years can lead to more severe disease, is that a concern among providers this year?

Dr. Jay Zimmerman  – Yeah, it certainly is a concern when we have something like that happen and we have a historic worsening of symptoms like when the H1N1 came out, H1N1 hadn’t been seen for years. So a lot more people who were young and healthy would get it and be really really sick, so.

Scott Gilbert – Yeah, the big swine flu scare several years ago, as it was called.

Dr. Jay Zimmerman  – Correct, yeah.

Scott Gilbert – Alright, you’re watching Ask Us Anything about the flu, from Penn State Heath Dr. Jay Zimmerman is here to answer your questions and mine about the flu. So feel free to add them to the comment field below this Facebook post and we’ll get you answers to those questions whether you ask them live or if you ask them as you’re watching this video on playback, we’ll add those answers as comments here. Let’s talk about the more severe complications that can result from flu. We hear about some of those each year but who’s most at risk, first of all, of developing those complications?

Dr. Jay Zimmerman  – Sure, when you think about that, the people that are most at risk would be the people with preexisting problems like heart problems or lung problems, folks with asthma, emphysema, COPD, or folks with congestive heart failure, those are the people I’d be most worried about. Kids with cystic fibrosis, interestingly enough, pregnant women are also really high risk too, so we always recommend that they get their flu vaccine and them getting flu vaccine can help their babies from getting flu as well.

Scott Gilbert – And I know that you are recommending to your patients that they absolutely get the flu vaccine if they’re able to. We do hear that there are subsets of people who are not able to receive it. Who are they?

Dr. Jay Zimmerman  – So that’s a pretty small minority of people. It used to be that people with egg allergies couldn’t get it and now we find that that is totally safe to do. If you have somebody who’s had some sort of very rare neurologic problem; Guillain-Barre, or GBS, that’d be somebody who shouldn’t get the flu vaccine. But otherwise it’s pretty widespread that you can get it.

Scott Gilbert – And of course the effectiveness of that vaccine varies widely from year to year, why is that?

Dr. Jay Zimmerman  – Yeah. So that’s a great question. And so part of the reason why it varies so widely is that we never know exactly which strain is going to be around so we make the best predictions and so we usually use the southern hemisphere so Australia and other countries in the south to predict. And so this year the H3N2 in Australia was really big and I think it was two years ago, about 90 thousand cases documented and this year jumped up to about 150, 160 thousand cases. So that is a big increase and we’re seeing the H3N2 in the United States here. Will it be as bad? We don’t know because we don’t know how everybody’s going to respond to it, but the flu vaccines made the same so hopefully we’ll get a good response for those folks that get the flu vaccine.

Scott Gilbert – And there are some early indications that this year’s flu vaccine may not be effective in fully preventing the flu, is that right?

Dr. Jay Zimmerman  – Yeah, that’s right. So the data from Australia kind of says that it wasn’t as effective for the Australians and assuming it’s pretty similar here, that’d be the best guess.

Scott Gilbert – So a lot of people thinking then why should I bother to get the vaccine. There’re actually several good answers for that, aren’t there?

Dr. Jay Zimmerman  – Yeah, absolutely. So even if it’s not good, it’s still better than nothing. So most people, they might get soreness at the site of the shot, but otherwise they do really well with the flu vaccine and if it helps prevent you from getting the flu or making it so it’s not nearly so bad, that’s something I certainly would recommend for all my patients.

Scott Gilbert – Why is the misconception out there that the flu shot can actually cause the flu? I’m sure that’s something you hear.

Dr. Jay Zimmerman  – That’s a great question, that’s something we hear all the time. Chances are they probably picked it up at the same time, it just happened to get in and they feel like it’s linked to it. But I’ve certainly seen patients who are utterly convinced and then I can’t convince them to get the flu shot, unfortunately. But you know I think just people kind of feel bad and a little achy afterwards and that can make them feel like they have the flu or they’re worried about it. And if you ever had the flu, you feel like a train wreck, in the worst case you feel like you were run over and that’s not what the flu shot gives you at all. You may feel a little bit sore and achy for a day or two at most from what I’ve seen.

Scott Gilbert – That’s not a bad trade-off for what the flu itself could cause, though.

Dr. Jay Zimmerman  – Correct. And all my patients who’s ever had the flu, they will get the flu shot every year after that, every year. They say I would rather take my chance of only 10% effectiveness if I can prevent that.

Scott Gilbert – Or even lessen the symptoms, right? Because as you mentioned it may not, even if it doesn’t prevent the flu, it may help to mitigate the symptoms.

Dr. Jay Zimmerman  – Right, so your symptoms might be a little more mild, you may not have the high fever or not as many aches, the headache might not be so bad, absolutely.

Scott Gilbert – You’re watching Ask Us Anything About the Flu from Penn State Health. Doctor Jay Zimmerman here welcomes your questions as we come to you live from Penn State Medical Group Elizabethtown. We have a question from Pearl, she asks “once you already have the flu do you need to have the flu shot?” I’m not sure if she means in a given year or if once you’ve had the flu obviously like you just mentioned if you get it one year you still should especially if you get the flu one year you should still get the shot in subsequent years.

Dr. Jay Zimmerman  – Sure. So a lot of my patients come in and say they had the flu already and I asked them what kind of symptoms they’re having and they talk about the stomach flu. And I say well okay that’s very different from the flu vaccine that we’re giving, the flu that we vaccinate for is respiratory, so lungs, breathing, cough, headache, high feverish chills, not the stomach bug, stomach flu. So a lot of people think those are the same things but if you have the flu yes you should still get the flu vaccine because usually flu A goes around first and then a couple months later flu B comes around and so you can still get some protection from flu B then, if that’s the case. And we don’t know if your strain was the same one that we’re vaccinating for or not and every time we get you the vaccination your body is going to develop a response and then the next time the flu comes around it can fight the flu better.

Scott Gilbert – And it goes back to the fact that there are different strains out there and you should protect yourself against all of them. But the stomach flu is not a strain of influenza. It’s a virus but not a–

Dr. Jay Zimmerman  – That’s correct, a lot of times the stomach flu is not influenza per se, there are many viruses in the US that cause that, but yeah.

Scott Gilbert – Well thank you for that question, Pearl. Our next question is from Christina. She says “how long does the flu shot last?” That’s an insightful question because I think some people are afraid of having it too early, is there such a thing?

Dr. Jay Zimmerman  – Yeah, so I mean a lot of people are worried about that so we do see a response in the body to the flu shot, your body starts making a response to the flu and that does kind of increase pretty quickly in the first number of weeks, four to six weeks. But it takes about two weeks for it to kick in. So the problem is if the flu starts going around and then you go get a flu shot and you get the flu the next day, it’s not going to help you. So it takes two weeks for the flu shot to start working a system. Then your body actually creates this types of response that if it sees it again it should then be able to trigger a response anyway, so there’s not such a thing as getting it too early.

Scott Gilbert – I have two small children at home, they really miss the nasal flu mist. Remember, you know, just a couple years ago but it was pretty much deemed to be highly ineffective last year and they haven’t really figured out how to make it effective, right?

Dr. Jay Zimmerman  – Correct. So you know, I loved the flu mist vaccine, I thought it was a very good thing when it first came out. The studies looked pretty good, it’s painless, you might get a little runny nose and that sort of thing. And that’s what I was getting because I thought it was the best and then found out that it doesn’t seems to be as effective as the injection. So because of that, the major body said that we shouldn’t give it to anybody. And so now I think they’re not even making it anymore.

Scott Gilbert – Some people may say well I don’t need to get the flu shot because I’m relatively healthy. If I get the flu it’s probably not going to be that severe of a case. But can you talk about the importance of getting vaccinated to help protect those who are not able to get vaccinated?

Dr. Jay Zimmerman  – Right. So hear a lot of that, oh I’m never sick, I’m always healthy, that’s fine that’s great for you, and may have mild symptoms and go on and go to work and go to the store and that sort of stuff. And all the people around you who don’t have that same immune response, they can’t protect themselves the same way. So with you with your kids, obviously if you don’t get the flu or your flu’s more mild, you’re less likely to pass it on to them or them pass it on to you. So yeah, certainly if you’re caring for somebody who’s elderly or has one of those lung conditions or has young kids or is pregnant, then it’s really a good idea for you to get the flu shot as well.

Scott Gilbert – We welcome your questions for Dr. Jay Zimmerman as we broadcast live from Penn State Medical Group Elizabethtown. For Ask Us Anything About the Flu. Some really good information, very timely too because we’re in December right now and we’re heading into the holidays. But when does flu season typically peak?

Dr. Jay Zimmerman  – So that varies year by year. So with the swine flu it was September once the kids went back to school, but typically we usually see it, last few years it’s been much more almost February and March, although I think we’re starting to see a big uptick now in the States. Four different states I think have already declared that it’s at full activity. And I’m not sure where Pennsylvania is on that right now.

Scott Gilbert – Pearl has a follow-up question asking about how early in the season should you get the flu shot. And she’s also asking when is it too late to get one. So I know you mentioned it takes about two weeks to take effect, is there such thing as too late in the flu season to get vaccinated?

Dr. Jay Zimmerman  – So I think usually when we look at it we kind of see the peak of the flu come through and be gone, that’s usually with the flu A and then flu B can come around up to a month afterwards. So the answer is I don’t know that’s really too late if you’re seeing the flu season’s already come and gone it’s probably a little on the late side. And no there’s not a too early, so I know sometimes the local pharmacies will have a flu in stock in September and getting that then is fine.

Scott Gilbert – We’re talking about vaccination as a great way to prevent the flu, but there are some other methods too like hand hygiene.

Dr. Jay Zimmerman  – Absolutely, washing your hands, using the hand sanitizer, those are the best things. Sneezing into the elbow of course can also be helpful rather than covering with your hand. So those are all good things and of course the hand hygiene is the biggest one.

Scott Gilbert – And so if those measure despite your best attempts don’t work and you get the flu, people may wonder is this something I can treat at home or what are some symptoms that maybe if they surface I should see a provider?

Dr. Jay Zimmerman  – Yeah so there are a lot of people that can treat this at home. So things like the Tylenol, Motrin just for the aches and pains and cough and cold medicines, that certainly is fine. If somebody’s starting to cough up something that looks really bad, if they’re getting really short of breath, they feel like they’re always winded, that’s a good reason to see a medical provider. Of course anybody with those underlying lung conditions or congestive heart failure, who’s pregnant, really young kids, there is medicine. Tamiflu is one of those medicines, that antiviral medicine. It’s not a great drug but it’s the only thing we have out there that actually fights the flu. So it can help reduce the symptoms by some degree. And so that’s something that if in the first two days we start doing it can help.

Scott Gilbert – Very interesting, so there are antiviral medications like that that are available. But like you say, it’s not going to cure it instantly, it’s not going to go away in 24 hours necessarily.

Dr. Jay Zimmerman  – Right. I mean, the flu can last seven to ten days, and like I said a lot of people feel like they’re hit by a Mack truck. Some people will get it much more mild, but there’s people who just look like they’re dragged through the mud.

Scott Gilbert – A lot of things do get referred to as the flu, I know you mentioned the stomach flu earlier. But what we’re talking about here, again, it’s really something that affects the respiratory system more than anything else and that’s not a system you want to mess with.

Dr. Jay Zimmerman  – Right, so I mean certainly shortness of breath, I see people when they have the flu they can to me sound really wheezy when I listen with the stethoscope. They’re going to cough, they’re going to have typically bad headaches, muscle aches, and that sort of stuff, sweating, fevers, absolutely.

Scott Gilbert – Okay. Well this is Ask Us Anything About the Flu from Penn State Health and we’ve been talking with Dr. Jay Zimmerman live here at Penn State Medical Group Elizabethtown. We thank you very much for watching. Anything else to add as we bring things to a close? Anything you want people to know? Other than get that shot.

Dr. Jay Zimmerman  – No, other than we’re still giving the flu vaccine in clinic, that’s it.

Scott Gilbert – Alright so get vaccinated and we hope you stay healthy this winter season and this flu season. Thanks again for watching Ask Us Anything About the Flu from Penn State Health.