Flu (Influenza)

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Flu Slideshow: 10 Foods to Eat When You Have the Flu

Flu (influenza, conventional, H1N1, H3N2, and bird flu [H5N1]) facts

  • Influenza, commonly called "the flu," is caused by viruses that infect the respiratory tract.
  • Flu symptoms include
  • The incubation period for flu is about one to four days.
  • Flu is contagious, and symptoms may last up to seven to 14 days.
  • Flu is diagnosed by the patient's history, physical exam, and laboratory tests.
  • Flu is spread directly and indirectly; directly from person to person by airborne droplets produced during sneezing or coughing, for example, and indirectly when contaminated droplets land on surfaces that are subsequently touched by uninfected individuals.
  • Influenza viruses are divided into three types, designated A, B, and C, with influenza A types usually causing the most problems in humans.
  • Most people who get the conventional or seasonal flu recover completely in one to two weeks, but some people develop serious and potentially life-threatening medical complications, such as pneumonia.
  • The flu can make chronic health problems worse
  • Much of the illness and death caused by conventional or seasonal influenza can be prevented by annual influenza vaccination.
  • Influenza A undergoes frequent antigenic changes that require new vaccines to be developed and people to obtain a new vaccination every year. New vaccine technology is being developed.
  • In April 2009, a new flu virus termed novel H1N1 swine flu developed in Mexico, rapidly spread worldwide, and caused the WHO to declare a flu pandemic. Eventually, the WHO declared the pandemic over in 2010. In 2012, a new type of flu strain developed, H3N2v, but has not developed into any epidemic situations currently.
  • Effectiveness of the flu vaccine varies year to year because strains causing flu also vary yearly.
  • Some home remedies may reduce flu.
  • Suggestions for foods are listed to help individuals recover from the flu.
  • Prescribed medications and over-the-counter treatments for the flu are listed.
  • Like the influenza virus, drug treatments are constantly changing and improving, but currently, timely vaccination is still considered to be the best defense against the flu. However, the CDC considers antivirals an important adjunct to the flu vaccine in the control of the disease process.
  • CDC recommendations for use in treatment of the flu for the 2016-2017 flu season are listed.
  • People should be aware that flu pandemics can cause severe flu symptoms and sometimes cause death in many individuals who may be more susceptible to the pandemic flu than the conventional flu; however, the previous pandemic flu virus (H1N1) has been available in vaccines and is considered part of the conventional circulating flu viruses.
  • Bird flu (H5N1) mainly infects birds, but it also infects humans who have close contacts with birds.
  • Individuals should check with their doctors to determine if they are considered to be at higher risk of getting severe flu symptoms than the normally healthy population.
Picture of the influenza virus
Picture of the influenza virus

Quick Guide10 Foods to Eat When You Have the Flu in Pictures

10 Foods to Eat When You Have the Flu in Pictures
Learn about influenza treatment.

Flu Shot Side Effects

Many people worry about side effects from the flu shot, but serious complications are rare. Some people believe that they can actually get the flu from receiving the shot, but this is not the case. For the majority of people, the risks of developing the flu are far greater than any risks associated with the vaccine.

Most side effects and reactions to the flu shot are mild. Most commonly, people experience a soreness, redness, or mild swelling at the site where the shot was given. These effects generally do not last for more than 2 days. In rare cases, people may develop other mild reactions to the flu vaccine like fever and aches, which may mistakenly lead them to believe that they developed the flu as a result of the vaccine. These symptoms also go away after about 1 to 2 days. Because the flu shot contains inactivated, or killed, virus particles, there is no possibility of contracting the infection from the flu shot.

  • Allergic reactions to the flu shot are very rare.

What is flu (influenza)?

Influenza, commonly called "the flu," is an illness caused by RNA viruses that infect the respiratory tract of many animals, birds, and humans. In most people, the infection results in the person getting a fever, cough, headache, and malaise (tired, no energy); some people also may develop a sore throat, nausea, vomiting, and diarrhea. The majority of individuals has flu symptoms for about one to two weeks and then recovers with no problems. However, compared with most other viral respiratory infections, such as the common cold, influenza (flu) infection can cause a more severe illness with a mortality rate (death rate) of about 0.1% of people who are infected with the virus.

The above is the usual situation for the yearly occurring "conventional" or "seasonal" flu strains. However, there are situations in which some flu outbreaks are severe. These severe outbreaks occur when a portion of the human population is exposed to a flu strain against which the population has little or no immunity because the virus has become altered in a significant way. These outbreaks are usually termed epidemics. Unusually severe worldwide outbreaks (pandemics) have occurred several times in the last hundred years since influenza virus was identified in 1933. By an examination of preserved tissue, the worst influenza pandemic (also termed the Spanish flu or Spanish influenza) occurred in 1918 when the virus caused between 40-100 million deaths worldwide, with a mortality rate estimated to range from 2%-20%.

In April 2009, a new influenza strain against which the world population has little or no immunity was isolated from humans in Mexico. It quickly spread throughout the world so fast that the WHO declared this new flu strain (first termed novel H1N1 influenza A swine flu, often later shortened to H1N1 or swine flu) as the cause of a pandemic on June 11, 2009. This was the first declared flu pandemic in 41 years. Fortunately, there was a worldwide response that included vaccine production, good hygiene practices (especially hand washing) were emphasized, and the virus (H1N1) caused far less morbidity and mortality than was expected and predicted. The WHO declared the pandemic's end on Aug. 10, 2010, because it no longer fit into the WHO's criteria for a pandemic.

A new influenza strain, H3N2, was identified in 2011, but this strain has caused only about 330 infections with one death in the U.S. Another strain, H5N1, a bird flu virus, has been identified since 2003 and has caused about 650 human infections; this virus has not been detected in the U.S. and currently is not known to be easily spread among people in contrast to other flu strains. Unfortunately, people infected with H5N1 have a high death rate (about 60% of infected people die); currently, H5N1 is not readily transferred from person to person like other flu viruses.

The most recent data for the mortality rate (death rate) for the United States in 2014 shows 823.7 deaths per 100,000 people with the flu, and the infant mortality rate is 5.82 deaths per 1,000 live births according to the National Vital Statistics system in the U.S.

Haemophilus influenzae is a bacterium that was incorrectly considered to cause the flu until the virus was demonstrated to be the correct cause in 1933. This bacterium can cause lung infections in infants and children, and it occasionally causes ear, eye, sinus, joint, and a few other infections, but it does not cause the flu.

Another confusing term is stomach flu. This term refers to a gastrointestinal tract infection, not a respiratory infection like influenza (flu); stomach flu (gastroenteritis) is not caused by influenza viruses.

Although initially symptoms of influenza may mimic those of a cold, influenza is more debilitating with symptoms of fatigue, fever, and respiratory congestion. Colds can be caused by over 100 different virus types, but only influenza viruses (and subtypes) A, B, and C cause the flu. In addition, colds do not lead to life-threatening illnesses like pneumonia, but severe infections with influenza viruses can lead to pneumonia or even death.

Flu vs. cold

Compared with most other viral respiratory infections, such as the common cold, influenza (flu) infection usually causes a more severe illness with a mortality rate (death rate) of about 0.1% of people who are infected with the virus. Cold symptoms (for example, sore throat, runny nose, cough (with possible phlegm production), congestion, and slight fever) are similar to flu symptoms, but the flu symptoms are more severe, last longer, and may include vomiting, diarrhea, and cough that is often a dry cough.

The following table is provided by the CDC to help distinguish between a cold and influenza:

Signs and SymptomsInfluenzaCold
Symptom onsetAbruptGradual
FeverUsual; lasts 3-4 daysRare
AchesUsual; often severeSlight
ChillsFairly commonUncommon
Fatigue, weaknessUsualSometimes
Stuffy noseSometimesCommon
Sore throatSometimesCommon
Chest discomfort, coughCommon; can be severeMild to moderate; hacking cough

Flu vs. food poisoning

Although some of the symptoms of influenza may mimic those of food poisoning, others do not. Most symptoms of food poisoning include nausea, vomiting, watery diarrhea, abdominal pain, cramps, and fever. Note that the majority of food poisoning symptoms are related to the gastrointestinal tract, except for fever. The common signs and symptoms of the flu include fever but also include symptoms that are not typical for food poisoning, because the flu is a respiratory disease. Consequently, respiratory symptoms of nasal congestion, dry cough, and some breathing problems help distinguish the flu from food poisoning.

What are the causes of the flu (influenza)?

The flu (influenza) viruses

Influenza viruses cause the flu and are divided into three types, designated A, B, and C. Influenza types A and B are responsible for epidemics of respiratory illness that occur almost every winter and are often associated with increased rates of hospitalization and death. Influenza type C differs from types A and B in some important ways. Type C infection usually causes either a very mild respiratory illness or no symptoms at all; it does not cause epidemics and does not have the severe public-health impact of influenza types A and B. Efforts to control the impact of influenza are aimed at types A and B, and the remainder of this discussion will be devoted only to these two types.

Influenza viruses continually change over time, usually by mutation (change in the viral RNA). This constant changing often enables the virus to evade the immune system of the host (humans, birds, and other animals) so that the host is susceptible to changing influenza virus infections throughout life. This process works as follows: A host infected with influenza virus develops antibodies against that virus; as the virus changes, the "first" antibody no longer recognizes the "newer" virus and infection can occur because the host does not recognize the new flu virus as a problem until the infection is well under way. The first antibody developed may, in some instances, provide partial protection against infection with a new influenza virus. In 2009, almost all individuals had no antibodies that could recognize the novel H1N1 virus immediately.

Type A viruses are divided into subtypes or strains based on differences in two viral surface proteins called the hemagglutinin (H) and the neuraminidase (N). There are at least 16 known H subtypes and nine known N subtypes. These surface proteins can occur in many combinations. When spread by droplets or direct contact, the virus, if not killed by the host's immune system, replicates in the respiratory tract and damages host cells. In people who are immune compromised (for example, pregnant women, infants, cancer patients, asthma patients, people with pulmonary disease, and many others), the virus can cause viral pneumonia or stress the individual's system to make them more susceptible to bacterial infections, especially bacterial pneumonia. Both pneumonia types, viral and bacterial, can cause severe disease and sometimes death.

Antigenic shift and drift

Influenza type A viruses undergo two major kinds of changes. One is a series of mutations that occurs over time and causes a gradual evolution of the virus. This is called antigenic "drift." The other kind of change is an abrupt change in the hemagglutinin and/or the neuraminidase proteins. This is called antigenic "shift." In this case, a new subtype of the virus suddenly emerges. Type A viruses undergo both kinds of changes; influenza type B viruses change only by the more gradual process of antigenic drift and therefore do not cause pandemics.

The 2009 pandemic-causing H1N1 virus was a classic example of antigenic shift. Research showed that novel H1N1 swine flu has an RNA genome that contains five RNA strands derived from various swine flu strains, two RNA strands from bird flu (also termed avian flu) strains, and only one RNA strand from human flu strains. According to the CDC, mainly antigenic shifts over about 20 years led to the development of novel H1N1 flu virus. A diagram that illustrates both antigenic shift and drift can be found below (see Figure 2) and features influenza A types H1N1 and bird flu (H5N1), but almost every influenza A viral strain can go through these processes that changes the viral RNA. A recent flu epidemic in India was partially blamed on antigenic drift/shift.

Picture of influenza antigenic shift and drift
Figure 2. An example of influenza antigenic shift and drift

When does flu season begin and end?

Flu season officially begins in October of each year and extends to May of the following year. According to the U.S. Centers for Disease Control and Prevention (CDC), people can follow the development of flu across the United States by following CDC's weekly update of the locations where flu is developing in the U.S. (see the flu map).

What are flu (influenza) symptoms in adults and in children?

Typical clinical features of influenza may include

  • fever (usually 100 F-103 F in adults and often even higher in children, sometimes with facial flushing and/or sweating),
  • chills,
  • respiratory symptoms such as
    • cough (more often in adults),
    • sore throat (more often in adults),
    • runny or stuffy nose (congestion, especially in children),
    • sneezing,
  • headache,
  • muscle aches (body aches), and
  • fatigue, sometimes extreme.

Although appetite loss, nausea, vomiting, and diarrhea can sometimes accompany influenza infection, especially in children, gastrointestinal symptoms are rarely prominent. The term "stomach flu" is a misnomer that is sometimes used to describe gastrointestinal illnesses caused by other microorganisms. H1N1 infections, however, caused more nausea, vomiting, and diarrhea than the conventional (seasonal) flu viruses. Depending upon the severity of the infection, some patients can develop swollen lymph nodes, muscle pain, shortness of breath, severe headaches, chest pain or chest discomfort, dehydration, and even death.

Most individuals who contract influenza recover in a week or two, however, others develop potentially life-threatening complications like pneumonia. In an average year, influenza is associated with about 36,000 deaths nationwide and many more hospitalizations. Flu-related complications can occur at any age; however, the elderly and people with chronic health problems are much more likely to develop serious complications after the conventional influenza infections than are younger, healthier people.

Does a child's first flu infection help to determine the patient's lifelong risk to other viruses?

Influenza A, as mentioned previously, has hemagglutinin on the viral surface. The viral hemagglutinins have at least 18 types, but these types are broken into two main influenza A categories. For example, one of the two main categories includes human H1, H2, and avian H5 viruses while the other major category includes human H3 and avian H7 viruses. Researchers in 2016 at UCLA and the University of. Arizona discovered that if you were exposed to one of these groups as a child, you had a much better chance of being protected against other viruses in that same group or category later in life. For example, if you are exposed to H2 as a child and then later in life to H2 or H5 viruses, you may have as high as a 75% chance of protection against those H2 and/or H5 strains, but if you are exposed to the other major category that included H3 or H7, you would be much more susceptible to these viral types. The reverse situation would be true if you were exposed as a child to H3 or H7 viruses. The researchers concluded that the immunological imprinting early in life helps determine the response (immune response) to these viral types or categories. Consequently, the first strain of flu that a person is exposed to in childhood likely determines that person's risk in the future for severity of the flu depending upon the exact category of the first viral strain that infects the child. The researchers hope to exploit these new findings in the development of new and more effective flu vaccines.

What is the incubation period for the flu?

Incubation period for the flu, which means the time from exposure to the flu virus until initial symptoms develop, typically is one to four days with an average incubation period of two days.

How long is the flu contagious, and how long does the flu last?

The flu is typically contagious about 24-48 hours before symptoms appear (from about the last day of the incubation period) and in normal healthy adults is contagious for another five to seven days. Children are usually contagious for a little while longer (about seven to 10 days). Individuals with severe infections may be contagious as long as symptoms last (about seven to 14 days). In adults, flu symptoms usually last about five to seven days, but in children, the symptoms may last longer (about seven to 10 days). However, some symptoms such as weakness and fatigue may gradually wane over several weeks.

How do health-care professionals diagnose the flu (influenza)?

The flu is presumptively diagnosed clinically by the patient's history of association with people known to have the disease and their symptoms listed above. Usually, a quick test (for example, nasopharyngeal swab sample) is done to see if the patient is infected with influenza A or B virus. Most of the tests can distinguish between A and B types. The test can be negative (no flu infection) or positive for types A or B. If it is positive for type A, the person could have a conventional flu strain or a potentially more aggressive strain such as H1N1. Most of the rapid tests are based on PCR technology that identifies the genetic material of the virus. Some rapid influenza diagnostic tests (RIDTs) can screen for influenza in about 10-30 minutes.

Swine flu (H1N1) and other influenza strains like bird flu or H3N2 are definitively diagnosed by identifying the particular surface proteins or genetic material associated with the virus strain. In general, this testing is done in a specialized laboratory. However, doctors' offices are able to send specimens to specialized laboratories if necessary.

How does flu spread?

Flu is easily spread from person to person both directly and indirectly. The influenza virus can spread to other people in droplets contaminated with the virus. Produced by coughing, sneezing, or even talking, these droplets land near or in the mouth or the nose of uninfected people, and the disease may spread to them. The disease can spread indirectly to others if contaminated droplets land on utensils, dishes, clothing, or almost any surface and then are touched by uninfected people. If the infected person touches their nose or mouth, for example, they transfer or spread the disease to themselves or others.

What is the key to flu (influenza) prevention?

Flu vaccine

Most of the illness and death caused by influenza can be prevented by annual influenza vaccination. The CDC's current Advisory Committee on Immunization Practices (ACIP) issued recommendations for everyone 6 months of age and older, who do not have any contraindications to vaccination, to receive a flu vaccine each year.

Flu vaccine (influenza vaccine made from inactivated and sometimes attenuated [noninfective] virus or virus components) is specifically recommended for those who are at high risk for developing serious complications as a result of influenza infection.

A new vaccine type, Fluzone Intradermal, was approved by the FDA in 2011 (for adults 18-64 years of age). This injection goes only into the intradermal area of the skin, not into the muscle (IM) like most conventional flu shots, and uses a much smaller needle than the conventional shots. This killed viral preparation is supposed to be about as effective as the IM shot but claims to produce less pain and fewer side effects (see section below).

Other simple hygiene methods can reduce or prevent some individuals from getting the flu. For example, avoiding kissing, handshakes, and sharing drinks or food with infected people and avoiding touching surfaces like sinks and other items handled by individuals with the flu are good preventive measures. Individuals with the flu should avoid coughing or sneezing on uninfected people; quick hugs are probably okay as long as there is no contact with mucosal surfaces and/or droplets that may contain the virus.

Are there any flu shot or nasal spray vaccine side effects in adults or in children?

Although annual influenza (injectable) vaccination has long been recommended for people in the high-risk groups, many still do not receive the vaccine, often because of their concern about side effects. They mistakenly perceive influenza as merely a nuisance and believe that the vaccine causes unpleasant side effects or that it may even cause the flu. The truth is that influenza vaccine causes no side effects in most people. The most serious side effect that can occur after influenza vaccination is an allergic reaction in people who have a severe allergy to eggs, since the viruses used in the vaccine are grown in hens' eggs. However, a newer form of the vaccine is available that is not grown in chicken eggs. For this reason, people who have an allergy to eggs should not receive the conventional influenza vaccine, but the newer forms may be appropriate for them. Also, the vaccine is not recommended while individuals have active infections or active diseases of the nervous system. Less than one-third of those who receive the vaccine have some soreness at the vaccination site, and about 5%-10% experience mild side effects, such as headache, low-grade fever, or muscle cramps, for about a day after vaccination; some may develop swollen lymph nodes. These side effects are most likely to occur in children who have not been exposed to the influenza virus in the past. The intradermal shots reportedly have similar side effects as the IM shot but are less intense and may not last as long as the IM shot.

Nevertheless, some older people remember earlier influenza vaccines that did, in fact, produce more unpleasant side effects. Vaccines produced from the 1940s to the mid-1960s were not as highly purified as modern influenza vaccines, and it was these impurities that caused most of the side effects. Since the side effects associated with these early vaccines, such as fever, headache, muscle aches, and/or fatigue and malaise, were similar to some of the symptoms of influenza, people believed that the vaccine had caused them to get the flu. However, injectable influenza vaccine produced in the United States has never been capable of causing influenza because it consists of killed virus.

Another type of influenza vaccine (nasal spray) is made with live attenuated (altered) influenza viruses (LAIV). This vaccine is made with live viruses that can stimulate the immune response enough to confer immunity but do not cause classic influenza symptoms (in most instances). The nasal spray vaccine (FluMist) was only approved for healthy individuals ages 2-49 years of age and was recommended preferentially for healthy children aged 2 through 8 who do not have contraindications to receiving the vaccine, if it is readily available. This nasal spray vaccine contains live attenuated virus (less able to cause flu symptoms due to a designed inability to replicate at normal body temperatures). This live vaccine could possibly cause the disease in infants and immunocompromised people and does not produce a strong immune response in many older people. Side effects of the nasal spray vaccine include nasal congestion, sore throat, and fever. Headaches, muscle aches, irritability, and malaise have also been noted. In most instances, if side effects occur, they only last a day or two. This nasal spray has been produced for conventional flu viruses and should not be given to pregnant women or anyone who has a medical condition that may compromise the immune system because in some instances the flu may be a side effect. Please note that the CDC recommended that the nasal spray (LAIV) vaccine should not be used during the 2016-2017 flu season because of relatively lower effectiveness seen from 2013-2016 (see the entire recommendation at http://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html).

Some people do not receive influenza vaccine because they believe it is not very effective. There are several different reasons for this belief. People who have received influenza vaccine may subsequently have an illness that is mistaken for influenza, and they believe that the vaccine failed to protect them. In other cases, people who have received the vaccine may indeed have an influenza infection. Overall vaccine effectiveness varies from year to year, depending upon the degree of similarity between the influenza virus strains included in the vaccine and the strain or strains that circulate during the influenza season. Because the vaccine strains must be chosen nine to 10 months before the influenza season, and because influenza viruses mutate over time, sometimes mutations occur in the circulating virus strains between the time the vaccine strains are chosen and the next influenza season ends. These mutations sometimes reduce the ability of the vaccine-induced antibody to inhibit the newly mutated virus, thereby reducing vaccine effectiveness. This commonly occurs with the conventional flu vaccines as the specific virus types chosen for vaccine inclusion are based on reasoned projections for the upcoming flu season. Occasionally, the vaccine does not match the actual predominating virus strain and is not very effective in generating a specific immune response to the predominant infecting flu strain.

How effective is the flu vaccine?

Vaccine efficacy also varies from one person to another. Past studies of healthy young adults have shown influenza vaccine to be 70%-90% effective in preventing illness. In the elderly and those with certain chronic medical conditions such as HIV, the vaccine is often less effective in preventing illness. Studies show the vaccine reduces hospitalization by about 70% and death by about 85% among the elderly who are not in nursing homes. Among nursing-home residents, vaccine can reduce the risk of hospitalization by about 50%, the risk of pneumonia by about 60%, and the risk of death by 75%-80%. However, these figures did not apply to the 2014-2015 flu vaccine because the quadrivalent (four antigenic types) vaccine did not match well with 2014-2015 circulating strains of the flu (vaccine effectiveness was estimated to be 23%). This occurs because the vaccine needs to be produced months before the flu season begins, so the vaccine is designed by projecting and choosing the most likely viral strains to include in the vaccine. If drift results in changing the circulating virus from the strains used in the vaccine, efficacy may be reduced. However, the vaccine is still likely to lessen the severity of the illness and to prevent complications and death, according to the CDC.

Recent studies suggest that in younger children (ages 2-8) the nasal spray flu vaccine may prevent about 50% more cases of flu than the vaccine administered by the flu shot. Therefore, children in this age group who have no contraindications should receive this form of the vaccine if it is available. However, the CDC recommends that vaccination not be delayed if this form is not available; the flu shot should be given in this case.

Why should the flu (influenza) vaccine be taken every year?

Although only a few different influenza virus strains circulate at any given time, people may continue to become ill with the flu throughout their lives. The reason for this continuing susceptibility is that influenza viruses are continually mutating, through the mechanisms of antigenic shift and drift described above. Each year, the vaccine is updated to include the most current influenza virus strains that are infecting people worldwide. The fact that influenza viral genes continually change is one of the reasons vaccine must be taken every year. Another reason is that antibody produced by the host in response to the vaccine declines over time, and antibody levels are often low one year after vaccination so even if the same vaccine is used, it can act as a booster shot to raise immunity.

Many people still refuse to get flu shots because of misunderstandings, fear, "because I never get any shots," or simply a belief that if they get the flu, they will do well. These are only some of the reasons -- there are many more. The U.S. and other countries' populations need to be better educated about vaccines; at least they should realize that safe vaccines have been around for many years (measles, mumps, chickenpox, and even a vaccine for cholera), and as adults they often have to get a vaccine-like shot to test for tuberculosis exposure or to protect themselves from tetanus. The flu vaccines are as safe as these vaccines and shots that are widely accepted by the public. Consequently, better efforts need to be made to make yearly flu vaccines as widely acceptable as other vaccines. Susceptible people need to understand that the vaccines afford them a significant chance to reduce or prevent this potentially debilitating disease, hospitalization and, in a few, a lethal flu-caused disease.

What are some flu treatments an individual can do at home (home remedies)?

First, individuals should be sure they are not members of a high-risk group that is more susceptible to getting severe flu symptoms. Check with a physician if you are unsure if you are a higher-risk person. Home care is recommended by the CDC if a person is healthy with no underlying diseases or conditions (for example, asthma, lung disease, pregnant, or immunosuppressed).

Increasing liquid intake, warm showers, and warm compresses, especially in the nasal area, can reduce the body aches and reduce nasal congestion or head congestion. Nasal strips and humidifiers may help reduce congestion, especially while trying to sleep. Some physicians recommend nasal irrigation with saline to further reduce congestion; some recommend nonprescription decongestants like pseudoephedrine (Sudafed). Fever can be treated with over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil, Motrin and others); read labels for safe dosage. Cough can be suppressed by cough drops, over-the-counter cough syrup, or cough medicine that may contain dextromethorphan (Delsym) and/or guaifenesin (Mucinex). Notify a doctor if an individual's symptoms at home get worse.

What types of doctors treat the flu?

Individuals with mild flu symptoms may not require the care of a physician unless they are a member of a high-risk group as described above. For many individuals, treatment is provided by their primary-care physician or provider (including internists or family medicine specialists and physician assistants and other primary caregivers) or pediatrician. Complicated or severe flu infections may require consultation with an emergency-medicine physician, critical-care specialist, infectious-disease specialist, and/or a lung specialist (pulmonologist).

What medications treat the flu?

The CDC published the following guidance concerning antiviral medications:

Antiviral medications with activity against influenza viruses are an important adjunct to influenza vaccine in the control of influenza.

  • Influenza antiviral prescription drugs can be used to treat influenza or to prevent influenza.
  • Oseltamivir, zanamivir, and peramivir are chemically related antiviral medications known as neuraminidase inhibitors that have activity against both influenza A and B viruses.

The following are the CDC recommended antiviral medications for the treatment of influenza (flu) for the 2016-2017 season are as follows: oral oseltamivir (Tamiflu), inhaled zanamivir (Relenza), and intravenous peramivir (Rapivab). See Table 1 below for details about utilizing these drugs in adults and children.

Over-the-counter medications that may help reduce symptoms of congestion (decongestants), coughing (cough medicine), and dehydration include diphenhydramine (Benadryl), acetaminophen (Tylenol), NSAIDs (Advil, Motrin, Aleve), guaifenesin (Mucinex), dextromethorphan (Delsym), pseudoephedrine (Sudafed), and oral fluids. Aspirin may be used in adults but not in children.

Individuals with the flu may also benefit from some additional bed rest, throat lozenges, and possibly nasal irrigation; drinking fluids may help prevent symptoms of dehydration (for example, dry mucus membranes and decreased urination).

Picture of antiviral medications recommended for treatment and chemoprophylaxis of influenza

What can people eat when they have the flu?

While a person has the flu, good nutrition can help the recovery process. Anyone with the flu needs to avoid dehydration, soothe sore throat and/or upset stomach, and have a good protein intake. Dehydration can be avoided by adequate fluid intake such as juices (orange, cranberry, grapefruit, tomato, grape, and others). Sore throat and upset stomach may be relieved by broths or warm soups (chicken, vegetable, or beef) and plain crackers, toast, and ginger tea or noncarbonated ginger ale. Scrambled eggs, yogurt, and/or protein drinks are good protein sources. In addition, bananas, rice, and applesauce are food that are often recommended for those with an upset stomach. This list is not exhaustive but should provide a balanced approach to help speed recovery from the flu.

When should a person go to the emergency department for the flu?

The CDC urges people to seek emergency medical care for a sick child with any of these symptoms or signs:

  1. Fast breathing or trouble breathing (shortness of breath)
  2. Bluish or gray skin color
  3. Not drinking enough fluids
  4. Severe or persistent vomiting
  5. Not waking up or not interacting
  6. Being so irritable that the child does not want to be held
  7. Flu-like symptoms improve but then return with fever and cough

The following is the CDC's list of symptoms that should trigger emergency medical care for adults:

  1. Difficulty breathing or shortness of breath
  2. Pain or pressure in the chest or abdomen
  3. Sudden dizziness
  4. Confusion
  5. Severe or persistent vomiting
  6. Flu-like symptoms improve but then return with fever and worse cough
  7. Having a high fever for more than three days is another danger sign, according to the WHO, so the CDC has also included this as another serious symptom.

Who should receive the flu vaccine, and who has the highest risk factors? When should someone get the flu shot?

In the United States, the flu season usually occurs from about November until April. Officials have decided each new flu season will start each year on Oct. 4. Typically, activity is very low until December, and peak activity most often occurs between January and March. Ideally, the conventional flu vaccine should be administered between September and mid-November. Flu season typically occurs between October and May. It takes about one to two weeks after vaccination for antibodies against influenza to develop and provide protection. The CDC has published a summary list of their current recommendations of who should get the current vaccine:

Summary of CDC influenza vaccination recommendations for 2016-2017

Routine annual influenza vaccination of all people aged ≥ 6 months without contraindications continues to be recommended. No preferential recommendation is made for one influenza vaccine product over another for people for whom more than one licensed, recommended product is otherwise appropriate. Updated information and guidance in this document includes the following:

  • In light of low effectiveness against influenza A(H1N1)pdm09 in the United States during the 2013-14 and 2015-16 seasons, for the 2016-17 season, ACIP makes the interim recommendation that LAIV4 (nasal spray) should not be used. Because LAIV4 is still a licensed vaccine that might be available and that some providers might elect to use, for informational purposes, reference is made to previous recommendations for its use.
  • The 2016-2017 U.S. trivalent influenza vaccines will contain an A/California/7/2009 (H1N1)-like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008-like virus (Victoria lineage). Quadrivalent vaccines will include an additional vaccine virus strain, a B/Phuket/3073/2013-like virus (Yamagata lineage).
  • Recent new vaccine licensures are discussed:
    • An MF59-adjuvanted trivalent inactivated influenza vaccine (aIIV3), Fluad (Seqirus, Holly Springs, North Carolina), was licensed by FDA in November 2015 for people aged ≥ 65 years. Regulatory information is available at http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/ucm473989.htm. aIIV3 is an acceptable alternative to other vaccines licensed for people in this age group. ACIP and CDC do not express a preference for any particular vaccine product.
    • A quadrivalent formulation of Flucelvax (cell culture-based inactivated influenza vaccine [ccIIV4], Seqirus, Holly Springs, North Carolina) was licensed by the FDA in May 2016 for people aged ≥ 4 years. Regulatory information is available at: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm502844.htm. ccIIV4 is an acceptable alternative to other vaccines licensed for people in this age group. No preference is expressed for any particular vaccine product.
  • Recommendations for influenza vaccination of people with egg allergy have been modified, including the following:
    • Removal of the recommendation that egg-allergic recipients should be observed for 30 minutes postvaccination for signs and symptoms of an allergic reaction. Providers should consider observing all patients for 15 minutes after vaccination to decrease the risk for injury should they experience syncope, per the ACIP General Recommendations on Immunization (8).
    • A recommendation that people with a history of severe allergic reaction to egg (for example, any symptom other than hives) should be vaccinated in an inpatient or outpatient medical setting (including but not necessarily limited to hospitals, clinics, health departments, and physician offices), under the supervision of a health-care provider who is able to recognize and manage severe allergic conditions.

For more information and details too extensive to include here, the following site is recommended: http://www.cdc.gov/flu/professionals/acip/index.htm.

What is the prognosis for patients who get the flu? What are possible complications of the flu?

In general, the majority (about 90%-95%) of people who get the disease feel terrible (see symptoms) but recover with no problems. People with suppressed immune systems historically have worse outcomes than uncompromised individuals; current data suggest that pregnant individuals, children under 2 years of age, young adults, and individuals with any immune compromise or debilitation are likely to have a worse prognosis. Complications from the flu may worsen medical conditions such as asthma, congestive heart failure, and diabetes. Other complications may include ear infections, sinus infections, dehydration, pneumonia, and even death. In most outbreaks, epidemics, and pandemics, the mortality rates are highest in the older population (usually above 50 years old). Complications of any flu virus infection, although relatively rare, may resemble severe viral pneumonia or the SARS (severe acute respiratory syndrome caused by a coronavirus strain) outbreak in 2002-2003, in which the disease spread to about 10 countries with over 7,000 cases, over 700 deaths, and had a 10% mortality rate.

Can the flu be deadly?

Yes. However, associated deaths per year depend upon the virulence of the particular strain of virus that is circulating. That means for any given year, the likelihood of dying from the flu varies according to the specific infecting viruses. For example, from 1976-2007 (the most reliable available data according to the CDC), deaths associated with the flu range from a low of about 3,000 per year to a high of about 49,000 per year. The CDC estimates about 36,000 deaths/year in the U.S. in recent years. The 1918 flu pandemic (1918-1919) was estimated to cause 20-50 million deaths worldwide.

What is the bird (avian) flu?

The bird flu, also known as avian influenza and H5N1, is an infection caused by avian influenza A. Bird flu can infect many bird species, including domesticated birds such as chickens. In most cases, the disease is mild; however, some subtypes can be pathogenic and rapidly kill birds within 48 hours. Rarely, humans can be infected by these bird viruses. People who get infected with bird flu usually have direct contact with the infected birds or their waste products. Depending on the viral type, the infections can range from mild influenza to severe respiratory problems or death. Human infection with bird flu is rare but frequently fatal. More than half of those people infected (over 650 infected people) have died (current estimates of the mortality [death] rates in humans is about 60%). Fortunately, this virus does not seem to be easily passed from person to person. The major concern among scientists and physicians about bird flu is that it will change (mutate) its viral RNA enough to be easily transferred among people and produce a pandemic similar to the one of 1918. There have been several isolated instances where a person had been reported to get avian flu in 2010; the virus was detected in South Korea (three human cases), resulting in a quarantine of two farms, and in 2012, over 10,000 turkeys died in a H5N1 outbreak with no human infections recorded. Recent research suggests that some people may have had exposure to H5N1 in their past but had either mild or no symptoms.

In addition, researchers, in an effort to understand what makes an animal or bird flu become easily transmissible to humans, developed a bird flu strain that is likely easily transmitted from person to person. Although it exists only in research labs, there is controversy about both the synthesis and the scientific publication of how this potentially highly pathogenic strain was created.

Do antiviral agents protect people from the flu?

Vaccination is the primary method for control of influenza; however, antiviral agents have a role in the prevention and treatment of mainly influenza type A infection. Regardless, antiviral agents should not be considered as a substitute or alternative for vaccination. Most effectiveness of these drugs are reported to occur if the antivirals are given within the first 48 hours after infection; some researchers maintain there is little or no solid evidence these drugs can protect people from getting the flu so some controversies exist regarding these agents.

Is it safe to get a flu shot that contains thimerosal?

Thimerosal is a preservative that contains mercury and is used in multidose vials of conventional flu vaccines to prevent contamination when the vial is repeatedly used to extract the vaccine. Although thimerosal is being phased out as a vaccine preservative, it is still used in flu vaccines in low levels. There is no data that indicates thimerosal in these vaccines has caused autism or other problems in individuals. However, flu vaccine that is produced for single use (not a multidose vial) contains no thimerosal; however, these vials are not as readily available to doctors and likely cost more to produce. Consequently, the FDA has published these two questions with clear answers that are quoted below:

"Is it safe for children to receive an influenza vaccine that contains thimerosal?"
"Yes. There is no convincing evidence of harm caused by the small doses of thimerosal preservative in influenza vaccines, except for minor effects like swelling and redness at the injection site."

"Is it safe for pregnant women to receive an influenza vaccine?"
"Yes. A study of influenza vaccination examining over 2,000 pregnant women demonstrated no adverse fetal effects associated with influenza vaccine. Case reports and limited studies indicate that pregnancy can increase the risk for serious medical complications of influenza. One study found that out of every 10,000 women in their third trimester of pregnancy during an average flu season, 25 will be hospitalized for flu-related complications."

However, as stated above, the FDA goes on to say that single-dose vial of conventional and other flu vaccines will not contain the preservative thimerosal, so that if a person wants to avoid the thimerosal, they can ask for vaccine that comes in a single-dose vial. The nasal spray vaccine contains no thimerosal, but it is not recommended for use in pregnant women. The CDC further states, that after numerous studies, there is no established link between flu shots with or without thimerosal and autism.

Where can people find additional information about the flu?

During a flu pandemic, guidelines and situations can change rapidly. People are advised to be aware that several sources are available to them to keep current with developments. The web sites below are frequently updated, especially when a pandemic is declared. The first web site contains an update written for the public and caregivers; the government and WHO sites provide detailed information that are updated as guidelines and developments occur.





Lambert, L., and Fauci, A. "Influenza Vaccines for the Future." New Eng. J. Med. 361.21 (2010): 2036-2044.

Monto, A.S., Ohmit, S.E., Petrie, J.G., Johnson, E., Truscon, R., Teich, E., Rotthoff, J., Boulton, M., Victor, J.C. "Comparative Efficacy of Inactivated and Live Attenuated Influenza Vaccines." N Engl J Med 361 Sept. 24, 2009: 1260.

Nguyen, H. "Influenza." Medscape.com. Aug. 22, 2016. <http://emedicine.medscape.com/article/219557-overview>.

Perez-Padilla, R., de la Rosa-Zamboni, D., Ponce de Leon, S.P., Hernandez, M., Quinones-Falconi, F., Bautista, E., Ramirez-Venegas, A., Rojas-Serrano, J., Ormsby, C.E., Corrales, A., Higuera, A., Mondragon, E., Cordova-Villalobos, J.A. "Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico." N Engl J Med 361 Aug. 13, 2009: 680.

Switzerland. World Health Organization. "Cumulative number of confirmed human cases for avian influenza A(H5N1) reported to WHO, 2003-2014." Jan. 24, 2014. <http://www.who.int/influenza/human_animal_interface/

United States. Centers for Disease Control and Prevention. "Influenza (Flu)." Nov. 10, 2016. <https://www.cdc.gov/flu/>.

United States. Centers for Disease Control and Prevention. "Seasonal Influenza (Flu): Influenza Antiviral Medications: Summary for Clinicians." Sept. 4, 2014. <http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm>.

United States. Centers for Disease Control and Prevention. "Seasonal Influenza (Flu): Use of Antivirals." Sept. 1, 2011. <http://www.cdc.gov/flu/professionals/antivirals/antiviral-use-influenza.htm>.

United States. Centers for Disease Control and Prevention. "2011-2012 Trivalent Influenza Vaccine Data From the U.S. Vaccine Adverse Event Reporting System (VAERS)." <http://vaers.hhs.gov/resources/SeasonalFluSummary_2011-2012.pdf>.

United States. Centers for Disease Control and Prevention. "2009 H1N1 Flu (Swine Flu)." Oct. 12, 2009. <http://www.cdc.gov/H1N1FLU/>.

United States. Flu.gov. "H5N1 Avian Flu (H5N1 Bird Flu)." <http://www.flu.gov/about_the_flu/h5n1/>.

Last Editorial Review: 11/15/2016

Reviewed on 11/15/2016

Lambert, L., and Fauci, A. "Influenza Vaccines for the Future." New Eng. J. Med. 361.21 (2010): 2036-2044.

Monto, A.S., Ohmit, S.E., Petrie, J.G., Johnson, E., Truscon, R., Teich, E., Rotthoff, J., Boulton, M., Victor, J.C. "Comparative Efficacy of Inactivated and Live Attenuated Influenza Vaccines." N Engl J Med 361 Sept. 24, 2009: 1260.

Nguyen, H. "Influenza." Medscape.com. Aug. 22, 2016. <http://emedicine.medscape.com/article/219557-overview>.

Perez-Padilla, R., de la Rosa-Zamboni, D., Ponce de Leon, S.P., Hernandez, M., Quinones-Falconi, F., Bautista, E., Ramirez-Venegas, A., Rojas-Serrano, J., Ormsby, C.E., Corrales, A., Higuera, A., Mondragon, E., Cordova-Villalobos, J.A. "Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico." N Engl J Med 361 Aug. 13, 2009: 680.

Switzerland. World Health Organization. "Cumulative number of confirmed human cases for avian influenza A(H5N1) reported to WHO, 2003-2014." Jan. 24, 2014. <http://www.who.int/influenza/human_animal_interface/

United States. Centers for Disease Control and Prevention. "Influenza (Flu)." Nov. 10, 2016. <https://www.cdc.gov/flu/>.

United States. Centers for Disease Control and Prevention. "Seasonal Influenza (Flu): Influenza Antiviral Medications: Summary for Clinicians." Sept. 4, 2014. <http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm>.

United States. Centers for Disease Control and Prevention. "Seasonal Influenza (Flu): Use of Antivirals." Sept. 1, 2011. <http://www.cdc.gov/flu/professionals/antivirals/antiviral-use-influenza.htm>.

United States. Centers for Disease Control and Prevention. "2011-2012 Trivalent Influenza Vaccine Data From the U.S. Vaccine Adverse Event Reporting System (VAERS)." <http://vaers.hhs.gov/resources/SeasonalFluSummary_2011-2012.pdf>.

United States. Centers for Disease Control and Prevention. "2009 H1N1 Flu (Swine Flu)." Oct. 12, 2009. <http://www.cdc.gov/H1N1FLU/>.

United States. Flu.gov. "H5N1 Avian Flu (H5N1 Bird Flu)." <http://www.flu.gov/about_the_flu/h5n1/>.

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