12/19/2000

Influenza as the criminal
[Health Matters Column]

Editor’s Note: PoliceOne.com inaugurates a new health-related column with information for men and women “on the job,”featuring a health subject with special emphasis on its relationship with officers.

Please e-mail suggestions for future columns to "editor@policeone.com."

There is a stealthy culprit that stalks this nation's law enforcement officers. It is silent but sure, swift and sometimes deadly. No, it's not a villain out of super-hero comics: it's influenza, a/k/a "the flu."

This flu season, your department or government health office can provide you with the information necessary to arm yourself with the protection you need to avoid becoming the victim of this viral crime.

Influenza, commonly known as the flu, is not the mild-mannered milquetoast nuisance that it's so tempting to consider it to be. Officers especially, who are exposed to greater dangers-such as guns, knives and out-of-control bad guys-during the course of any one shift, may want to put the risk of getting the flu out of their minds in order to concentrate on more pressing matters.

But, like closing your eyes to a terrorist bent on bombing a government building, ignoring the flu will not make it go away on its own. It will not stop wreaking havoc or attempting to slaughter people, and this flu season will not end without seeing a significant loss of life. As melodramatic as these statements sound, healthcare providers and government agencies are sounding the alarm about the dangerous nature of the flu.

According to the Atlanta, Ga.-based U.S. Center for Disease Control (CDC), the flu is a major cause of illness and death in the U.S. each year. On average, it leads to approximately 20,000 deaths and more than 110,000 hospitalizations each year.

The flu is actually an infection of the respiratory tract that is caused by a virus. One of the most common severe complications of influenza is bacterial pneumonia. (Pneumonia caused by the virus itself is less common.) Pneumonia and influenza together are the sixth most common cause of death in this country. Compared with other respiratory infections, such as the common cold, the flu can cause severe illness and lead to serious and life threatening complications in all age groups.

Even if flu symptoms don't develop into serious complications, sufferers can become very sick, causing them to be confined to bed for a week or more and disrupting their busy lifestyles.

The most common symptoms of influenza include the sudden onset of fever (often as high as 104ºF) with shaking chills, moderate-to-severe muscle and joint aches and pains, sweating, a dry nonproductive cough, nasal congestion and headache.

In addition, people infected with influenza complain of moderate to severe malaise (a feeling of overall "cruddiness") and fatigue. Children may experience gastrointestinal problems like nausea, vomiting and diarrhea, but such symptoms are not common in adults. (Although the term "stomach flu" is sometimes used to describe gastrointestinal illnesses, this illness actually is caused by other organisms and is not related to "true" flu.)

Law enforcement officers are at risk for contracting influenza simply because they are in proximity to so many people during the course of a shift. The flu generally spreads to its next victim when an infected person coughs or sneezes. Interaction with the public or sick fellow workers in an office environment multiplies the opportunities to catch this deadly virus.

On the positive side, there is a vaccine that will work to protect against the flu. But unlike vaccines for diseases such as polio — which has been all but eradicated from the earth — flu vaccine is not universally effective, working better for some, not as well for others. Modern medicine has not discovered a one-size-fits-all solution-in-a-shot to conquer the flu.

Part of the reason is that "the flu" is not just one virus. Rather, it is the name given to the three major types of influenza that are known to exist and which are referred to as Types A, B and C. Influenza A most often causes flu epidemics. Type B influenza also commonly causes illness. Type C does not cause epidemics, and it usually leads to a mild, cold-like illness.

The reason that a new flu shot must be taken each year is that proteins of Types A and B viruses change, or "mutate," leading to the development and spread of new strains of influenza. The "drift" in the types of flu strains is an ongoing process. Since viruses constantly change their "disguises," immunity or protection against earlier flu strains may not offer protection against currently circulating varieties.

The influenza vaccine contains three different inactivated (killed) influenza virus strains. (Because the flu vaccine that is used in the United States is made from killed influenza viruses, it cannot cause influenza infection and does not cause the flu.)

The World Health Organization (WHO) makes recommendations for the vaccines' composition for the upcoming influenza seasons, and each January through March, the U.S. Public Health Service (USPHS) begins the selection of influenza virus strains that will be included in that year's U.S. vaccine. In the United States two influenza type A virus strains and one type B virus strain are chosen for inclusion.

For the shots being given this year, two new influenza Type A virus strains were recommended and the third strain remains unchanged from last year's vaccine.

The Bethesda, Md.-based National Coalition for Adult Immunization (NCAI) says that anyone wishing to reduce his chances of becoming ill from influenza should get the flu shot, particularly someone who provides essential community services, such as LEOs.

Government health organizations also recommend yearly influenza vaccinations for those who come in contact with people in high-risk groups, those at risk of developing severe complications if they contract the flu, those 50 years of age and older, and others who meet certain health criteria. Although the flu shot is a valuable tool, the vaccine does not provide 100-percent protection from contracting the disease. However, it is 70-90-percent effective in preventing influenza among healthy adults and statistically effective in reducing flu-related hospitalizations and deaths, especially among older adults.

The vaccine carries relatively few risks. The most common side effect is arm soreness and swelling at the injection site. Children who have not been exposed to influenza virus in the past-may develop fever and body aches after vaccination. If these symptoms occur, they generally begin 6-12 hours after vaccination and can continue for one or two days. Less common side effects after vaccination include allergic reactions (particularly in people who have severe allergies to eggs).

Guillain-Barre syndrome ("GBS"), a severe paralytic illness, is an extremely rare reaction that may have been associated with the swine flu vaccine of 1976. Influenza vaccines since then have not been clearly linked to GBS. However, if there is a risk of GBS from current influenza vaccines, it is estimated at 1 or 2 cases per million people vaccinated, according to the NCAI which states that the potential risks associated with influenza illness are much greater than the potential risks associated with the influenza vaccine.

Access to flu-vaccine has been complicated this year by a shortage of vaccines. Most vaccine doses usually become available to providers by October; some 99 percent of distributed doses are usually available before December.

This year, however, many doctors and clinics will not have the vaccine until the end of the month, while production of the flu shots will continue. For those who can avoid getting the flu, the CDC is recommending that vaccination efforts continue into this month and extend as long as influenza vaccine is available.

If your department does not offer an immunization program and your doctor doesn't have the vaccine available, you can search for other vaccine sources by logging onto the CDC's National Immunization Information Hotline page at http://www.vaccines.ashastd.org/fluvaccines/states.html and searching for locations by state and county, or by calling toll-free, 800/232-2522. If you should contract the flu there are some hopes for relief, four anti-viral medications that are FDA-approved for the treatment of acute, uncomplicated influenza.

Amantadine and rimantadine are active against influenza A viruses, while zanamivir and oseltamivir are active against influenza A and influenza B viruses. These drugs are effective only if treatment begins within two days of the onset of symptoms. All four of these antiviral agents can reduce the duration of influenza symptoms by about one day. However, the CDC stresses that antiviral medications are not a substitute for influenza vaccination.

There are also potential downside risks with using these medications, which your physician will weigh in deciding whether or not to prescribe them for you.

by Liz Martinez DeFranco

We are pleased to announce that Liz Martinez DeFranco will be writing a weekly column for PoliceOne.com.
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