It was recently reported that there has been an increase in the number of people dying this winter compared to normal, the first 6 weeks of 2015 revealing a 23% increase from the same period in the previous 5 years, according to the Office of National Statistics (83,000 deaths in real terms). However, this figure is still considerably behind 1999/2000 which was when the last influenza epidemic occurred.
Having said that, it seems that the influenza virus is at least in part the explanation for this recent statistic, and it is a virus that in particular affects the over 75 age bracket. This year there is a particularly virulent strain of influenza – H3N2 – and the flu vaccine has not been very effective against this particular strain. Unfortunately, in the preparation of the vaccine in the summer preceding the winter months, there is always a degree of guesswork as to what strain of flu will emerge, and it cannot be known how effective the vaccine will actually be. This, though, is not a reason not to have the vaccine, especially if you are in a vulnerable group of individuals, but it emphasises that reliance cannot be placed on the vaccine and the need for careful hygiene remains paramount to minimise spread as much as possible.
Whilst there is little or no evidence that the increased deaths are related to any failings in health care (especially in A&E) or social care, and whilst there is no specific treatment for the influenza virus and medical management is generally just supportive, it remains imperative that a correct diagnosis is made as quickly as possible, especially in vulnerable groups of patients such as children, the elderly and immunocompromised patients, and that other, treatable, diagnoses are not missed; for example, bacterial meningitis in a child which can have catastrophic consequences.
Typical features of flu include: a dry cough; malaise; high a temperature (fever), often over 38°C and possibly as high as 40°C, with sweating and/or chills; a headache; sneezing and a runny or a blocked nose; aches and pains in muscles (myalgia) and joints (arthralgia); and a sore throat. These symptoms will typically last a week or so. There is nothing that can “cure” the flu virus, so treatment consists of paracetamol and non-steroidal anti-inflammatory drugs (such as ibuprofen) to reduce the fever and ease the myalgia/arthralgia, decongestant medications to help with nasal symptoms and avoiding dehydration by drinking plenty of fluids. In certain patients it may be necessary to prescribe antiviral medication to avoid complications of flu developing (e.g. oseltamivir or zanamivir), but antibiotics are not necessary unless there is secondary bacterial infection (such as chest or ear).
It is important to seek medical help if a complication of flu occurs or you think you are not getting better within a few days. Complications are rare, but can include:
Primary viral pneumonia, characterised by a progressive cough and shortness of breath (dyspnoea), and which can lead to adult respiratory distress syndrome (ARDS) in the very young, elderly and in pregnant women. The mortality is high (up to 40%) and early recognition and treatment is imperative.
Secondary bacterial pneumonia, especially Staphylococcal pneumonia, which typically manifests as a productive bloody cough, becoming extremely ill quickly and a very high white cell count. Mortality with ‘Staph’ pneumonia is even higher than with viral pneumonia (up to 69% in some series), so again early diagnosis is critical.
A mixed picture of the two above complications occurring together.
Myositis, which is an injurious inflammatory process affecting muscles which may present with severe muscle pain, swelling and a fever. This tends to occur more commonly in children than adults and complete recovery usually occurs, although it can cause kidney failure and, rarely, it can rapidly progress to a life-threatening infective state.
Myocarditis or pericarditis, which are inflammation of the heart muscle (myocardium) and heart lining (pericardium) respectively.
Central nervous system (CNS) involvement, including encephalitis, is uncommon in adults and most reports have arisen from Japan and occur in children. Drowsiness, confusion or a loss of consciousness may be a feature.
Others, all very rare, include multi-organ failure, toxic shock syndrome, transverse myelitis and Guillain-Barré Syndrome.
Ultimately, it is important not to forget that flu can be fatal, especially in vulnerable patient groups, and it is patients in these groups who tend to account for the increase in winter deaths described earlier.
Certain features may also suggest that the problem is not influenza and these should prompt a return to your doctor and a reconsideration of the diagnosis, because it may be necessary to instigate specific treatment. An example of this would be the development of a rash, especially if it consists of dark red spots that do not fade when pressed (blanch), which is often a feature of bacterial meningitis, especially in children, and requires urgent appropriate treatment.
Whilst influenza is generally just an unpleasant winter illness that may result in time off school or work, it occasionally can be more serious. It is vitally important, therefore, that your doctor is alive both to the complications of flu, which although uncommon can be very serious, and the possibility that the diagnosis is not in fact flu but something more severe. If your doctor is not alive to these possibilities, he or she may end up making an unacceptable mistake with catastrophic results, including ultimately the possibility that their patient may die.