Posted in flu, Health, news

Flu Shot Found to be More Effective Than Nasal Mist Flu Vaccine

A new study published in Pediatrics reports the nasal FluMist vaccine to be less effective in treating the flu as compared to the traditional flu shot.

Study authors combined data from 5 US studies and found of the 17,173 children aged 2-17 reviewed, the flu shot was 67% effective where as the nasal spray (FluMist) was only 20% effective and protecting against the flu.

FluMist is a live attenuated vaccine that is not recommended in infants and pregnant women. It is indicated for those between the ages of 2-49 and introduces a live, weakened version of the flu virus to incite an immune response.  This differs from the injectable flu vaccine which uses killed versions of the flu strains to induce a flu response.

Children prefer the FluMist as the nasal spray offers a less painful option than an injection.

The US Centers for Disease Control and Prevention advisory committee voted last Fall to return the FluMist, nasal spray flu vaccine, to the recommended options for the 2018-2019 flu season.

In 2016 it was not recommended and discouraged as they found its effectiveness against seasonal flu to be approximately 46%, when 65% efficacy was touted by the injectable flu shot.  However during the 2017-2018 flu season, the current flu vaccine was found to be only 35% effective with one of the worst flu seasons in years taking the lives of healthy young adults and children.

Why was last season so severe? The H3N2 strain was the predominant one, notorious for bad flu seasons, and is crafty, able to mutate before the vaccine is finalized.  Hence our flu vaccine was not able to be as close a match as desired.

The panel voted 12-2 to include FluMist as an option for medical providers to recommend against the upcoming 2018-2019 flu season.

Why was FluMist removed?  Experts found it to be ineffective against one of the influenza A H1N1 strains. With its overall efficacy found to be lower than the flu shot it was deemed a less ideal option than the shot.

This year the H1N1 strain appears to be more prevalent.

The FluMist Quadrivalent nasal spray, manufactured by MedImmune of AstraZeneca PLC, offers protection against 4 strains of flu including H1N1, H3N2 and two influenza B strains.  According to FluMist’s prescribing information, the FluMist proved 90% effective against H3N2 as opposed to influenza B where it scored 44.3% effectiveness.   Another review found its efficacy against H3N2 to be 79%.

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Now that’s not to say the FluMist would have been immune to the vaccine issues experienced with last year’s flu shot as H3N2 is a highly virulent and mutable virus, and could have snowed the FluMist vaccine makers as well.

Yet we may need to consider that the FluMist may be more efficacious for some strains of the flu whereas the flu shot may better protect us against others.  More research needs to be done in this area. As of now choosing which flu shot to get for the next flu season may be a crap shoot.

For more on the study click here. 

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

Posted in flu, Health, news

Flu Now Widespread in Multiple States

The CDC has reported an increase in flu activity during our 52nd week of the year ending on 12/29/18.

The CDC reports outpatient visits for influenza-like illness (ILI) jumped to 4.1%, above the national baseline of 2.2%.

 

cdc map.gif

The CDC states the following:

New York City and 19 states experienced high ILI activity; nine states experienced moderate ILI activity; the District of Columbia and 10 states experienced low ILI activity; and Puerto Rico and 12 states experienced minimal ILI activity.

States experiencing high ILI activity include:

  • Alabama
  • Arizona
  • Colorado
  • Georgia
  • Illinois
  • Indiana
  • Kansas
  • Kentucky
  • Louisiana
  • Massachusetts
  • Mississippi
  • Nevada
  • New Jersey
  • New Mexico
  • Oklahoma
  • South Carolina
  • Texas
  • Utah
  • Virginia

 

States experiencing moderate ILI activity include:

  • Arkansas
  • California
  • Michigan
  • Missouri
  • New York
  • North Carolina
  • Pennsylvania
  • Rhode Island
  • Vermont

 

Low and minimal activity (noted in yellow and green) has been reported in the remaining states as well as Puerto Rico.

flu-survey-map (1)

Image from CDC

 

Currently it appears the majority of flu cases are caused by the H1N1 Influenza A strain. Even though the H1N1 caused an epidemic in 2009, this may forbode a less severe flu season from last year’s H3N2 epidemic.

The Flu – Your Questions Answered

__________________________________________________________

When does flu season begin and how long does it last?

Flu season has begun already. It typically starts in the Fall, and ends late Spring.  So the range is described as October to May with it peaking December to March.

How bad will this flu season be?

It is difficult to predict, but already this early in the season we’ve had multiple flu related deaths reported by the CDC’s Flu View.

What is the flu?  How can one die from it?

The flu is caused by a virus. Multiple strains of virus’ can cause the flu.  The virus itself can be lethal, however the greatest risk comes with what it does to your immune system, thereby putting one at risk of secondary infections.  Pneumonia is the number one cause of flu-related deaths.  Secondly, it can exacerbate existing conditions such as asthma, seizures, even promote preterm birth, hence those who are pregnant or have preexisting medical conditions are urged to get vaccinated against the flu.  Moreover those who qualify should get the pneumonia vaccine as well.

 

h1n1-swine-flu-virus
h1n1 virus

 

What does this year’s flu vaccine cover?

According to the CDC, the trivalent vaccine covers for these three strains of flu virus:

  • A/Michigan/45/2015 (H1N1)pdm09–like virus
  • A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus
  • B/Colorado/06/2017–like virus (Victoria lineage)

Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).

These vaccines are aimed at providing protection against the Swine flu, and some influenza A and B strains.

What about older individuals?

This year, those over 65 will have three options for their flu vaccine.

Fluzone High-Dose – a higher dose flu vaccine that will hopefully allow their immunity to protect against the flu longer

FLUAD – the trivalent flu vaccine with an adjuvant to stimulate more of an immune response.

Flublock Quadrivalent – provides protection against 4 strains.

What about the nasal spray vaccine?

This year, the CDC allows use of the nasal spray vaccine as it has shown to have improved efficacy from  prior years. However it is only recommended for  those who are between the ages of 2 and 49 and cannot be given to those who are pregnancy or who have compromising medical conditions as outlined by the CDC.

Who should get the flu shot?

All individuals 6 months old and older unless specified by their medical provider.

What if I’m allergic to eggs?

Most individuals allergic to eggs can still get the flu vaccine, but if the allergy to eggs is severe (anaphylaxis, angioedema, difficulty breathing), the CDC recommends notifying your medical provider and being in a facility to monitor you if you do get the flu vaccine.

Will I get the flu from the flu shot?

No.  The flu vaccine has a “killed” version of the virus meaning it’s not an active virus (as opposed to a live attenuated vaccine, a weakened down version of it).   A “killed” or “inactivated” vaccine merely has the pathogen particles to induce an immune response.  Additionally, when one states they got the flu despite the flu shot it could be that the flu shot only protects against 3 – 4 strains and they were infected with a more rare strain not covered by the vaccine.

How effective is the flu vaccine?

The average effectiveness each year hovers around 60%.  Last year’s efficacy was much lower and this year’s has not been predicted as of yet. Australia is still reporting active cases on their Department of Health website.

I feel sick after the flu shot, why?

For some, the immune response that ensues can make one feel mildly ill, but should not resemble the flu. Those who state they got the flu “immediately” after receiving the shot, might have already been exposed and had not had a chance to produce immunity prior to their exposure.

sneezing

 

What are symptoms of the flu? How is it different from a cold?

A cold comes on slower and less severe.  Flu symptoms are more abrupt and can include:

  • Fever
  • Body Aches
  • Cough
  • Sneezing
  • Sore Throat
  • Shortness of Breath
  • Fatigue
  • Headache
  • Nausea
  • Vomiting

Are there medications to treat the flu? Will antibiotics work?

There are antiviral medications available, such as Tamiflu, to treat the flu.  Antibiotics, however, will not work since the flu is not caused by a bacteria but rather a virus. However if a secondary bacterial infection takes over, antibiotics may be used.

How can I prevent getting the flu?

Besides vaccination, avoid being around those who are sick, thorough hand washing, and take good care of yourself.  A balanced diet, exercise and sleep regimen can help boost your immune system.

Wishing you health this season!!

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in Health, news

Where Should I Go….An Emergency Room or Urgent Care?

It’s night time, your doctor’s office is closed, and the unsettling feeling you had all day in your tummy has now begun to ache.  You’re worried so you want to get it checked out. Where do you go?  An urgent care or emergency room?
 
This scenario occurs all to often and patients get confused on which facility is better suited for their needs.
 
As a physician who has worked in both emergency room and urgent care settings, I can attest that many people would come to the latter, unaware that they are having a severe medical issue, resulting in me calling an ambulance to take them to an ER.
 
Moreover some would come to the ER when the medical issue could have easily been treated in a less acute facility, and therefore less expensively.
 
Now, if you’re ever in doubt and are experiencing a life threatening emergency, call 911.
 
 
 
 
01-heart-disease-in-women-heart-attack-symptoms
 
 
 
 
However, if the situation is not life threatening, here’s the breakdown:

 

Emergency Rooms

 
ER’s are staffed and stocked for emergencies hence many are equipped for issues such as heart attacks, appendicitis, meningitis, large lacerations, and varying levels of trauma. They can run blood work on site, perform imaging such as xrays, ultrasounds and CT scans, perform EKGs, a variety of procedures, and prep one for surgery which may be done at a connecting hospital.
 
So any of the below issues are examples of what we would treat in an emergency room:
 
  • Severe bleeding
  • Overdose
  • Severe burns
  • Chest pain
  • Dizziness
  • Severe headache
  • Severe abdominal pain
  • Acute onset incontinence
  • Vomiting blood
  • Coughing up blood
  • Stooling bright blood
  • Severe neck pain
  • Trauma
  • Loss of consciousness
  • Seizure
  • New onset weakness, numbness, garbled speech
  • Flu with severe respiratory symptoms
  • Severe asthma, COPD
  • Suspected miscarriage
  • Severe nose bleed
  • Foreign body in the eye
  • Fractures of the femur, hip
  • Crush injuries

to name a few.

 

Urgent Cares

Urgent cares, on the other hand, have less staff and are equipped for less severe medical emergencies.  They will have EKG, xray, and some blood testing capabilities, but may need to refer you to an emergency room if you require more specialized testing.
 
 
Medical issues that may be addressed in an urgent care include:
 
  • Minor cuts, scrapes, bites, burns
  • Ankle sprain
  • Upper Respiratory Infection
  • Urinary Tract Infection
  • Test for pregnancy
  • Sexually Transmitted Illness Testing
  • Rash without fever
  • Early Flu without severe respiratory symptoms
  • Mild asthma
  • Back pain
  • Joint pain
  • Strep throat
  • Minor nose bleed
  • Certain fractures of the arm, hand, finger, foot, toe

 

Keep in mind, if your local urgent care does have ultrasound and CT scan capability they may be able to see a higher level of acuity.

 

kid bandaid.jpg

 

 

When in doubt you can also ask yourself, “Is this an issue I would wait to see my medical provider for?”

If your answer is, “Yes it can wait,” then make an appointment with your medical provider.

 

If your answer is, “Uh I think so but maybe I should get it checked out,” then go to an urgent care.

If your answer is, “No way, I need a doctor now!”, then go to an ER.

 
I also recommend that before an emergency arises, check with your insurance on which hospitals, emergency rooms, urgent cares are in your network. Too many times we’re in a panic and end up at the wrong facility only to get a surprise bill unpaid by your insurance provider.
 

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 
dw sketch.jpg

 

 

Posted in food, Health, news

You’re mom’s chicken soup – healthier than you think

Updated from Dec. 2011

 

We all endured it…our mothers forcing us to drink “Zoup” to help our sore throats, coughs, even menstrual cramps.  “But Mom…you’re not a doctor”…well moms have more medical wisdom than we give them credit for.

Chicken soup was the cure for everything in my household…and I mean it..it cured.  Was it because of its warmth, its taste, the fact that Mommy was doting over me?  Nope… it was because we were ingesting a bowl full of antioxidants, antiinflammatories, amino acids, and anti-histamines.  Tasty, huh!!!

So what has to be in chicken soup to make it healthy?

First, it will go down easier if it’s in the form of a liquid…just a suggestion.  The warmness soothes the throat and stimulates circulation.

 

steam.jpg

 

The salt helps fight bacteria.

 

soup salt.jpg

 

And even though as kids we picked out the vegetables, the carrots, celery, and onions provide much needed vitamins, fiber, and antioxidants that seep into the juice.

 

soup and veg.jpg

Moreover whole chicken pieces, including the cartilage, have been proven to be antiinflammatory.

 

chicken soup.jpg

 

No wonder we feel better.  It’s an antibiotic, pain pill, antiinflammatory, steroid, and fluid bolus all in one!!  Just wait….some pharmaceutical company will realize they can capitalize on this and cram it into a pill, or better yet, suppository.   Hope they master grinding down the celery stick.

Either way, Mom has her hands full.  So next time you see your Mom, take a deep breath, suck it in, and tell her that she was right.

mommy.jpg

My Mommy xoxo

 

And if the thought of Mom saying “I told you so” sickens you….just have her whip up a batch of chicken soup.  Looks like it works like a charm.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network and Board Certified Family Physician

Posted in flu, Health, news

How to Soothe Your Sore Throat

It’s cough and cold season and with this may come the notorious sore throat.  But many who suffer don’t know when to see a medical provider or when to whisper prayers that it goes away on its own. Here are your questions answered.

What causes a sore throat?

The throat comprises the pharynx and the larynx (voice box).  For those of us who still own tonsils, they reside within the pharynx.

sore-throat-lg.jpg

If the throat becomes inflamed, pain and swelling can ensue.

Causes of sore throats include:

  • infection
  • post nasal drip
  • stomach acid from GERD (gastroesophageal reflux disease)
  • allergies
  • voice strain
  • pollution
  • smoke
  • environmental irritants
  • tumors
  • and more….

 

How can I tell if I need antibiotics for my sore throat?

If we have a virally-induced cold that starts off with the sniffles followed by a sore throat, then a cough, and doesn’t come with a fever, we watch the symptoms closely but hold off on antibiotics if we feel its viral in nature.

If however symptoms come on aggressively such as a fever persists, neck glands swell, pus/exudates cover the tonsils, and the sore throat gets worse each day, your medical provider may perform a strep screen to check for streptococcus bacteria, or perform a culture.  If positive, he/she may offer a prescription for antibiotics.

strep.JPG

 

What soothes a sore throat?

Assuming you don’t need antibiotics to treat a bacterial infection, any of the following may provide some temporary relief:

Gargling with salt water also offers relief as it introduces fluids and attracts more fluid to the area due to the salt content.

To help quell your cough, read below:

Winter Cold or Flu? How to Quell Your Cough

 

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

 

 

Posted in Health, news

Winter Cold or Flu? How to Quell Your Cough

Alcohol and narcotics are not recommended to cure your cough and the FDA has urged children under 2 years of age to not be given any kind of cough and cold product that contains a decongestant or antihistamine.

So if you or your child cannot get rid of a cough, what can you do?  Here’s the breakdown…..

Why do we cough?

Coughs are actually a brilliant defense mechanism designed to spew out unwanted irritants that make it to our respiratory tree. Its lining has sensory neurons, that when triggered, tell the brain to induce a mechanism that will help clear the airway.  This can, simplistically stated, include a cough but also immune cells mobilized to fight possible infection or heal inflammation.  If the act of mechanically coughing irritates the respiratory tree, you may cough more. Likewise, if inflammatory cells produce excess mucous, this could cause a cycle of continued coughing.

What causes a cough?

We’re well aware that infections caused by virusesbacteria and fungi can cause coughs. But the following need to also be considered.

GERD – Gastroesophageal reflux disease – the acid that is refluxing out of the stomach and into the esophagus can, while lying down sleeping, makes its way up into the respiratory tree, irritating the lungs

Medications – such as ACE inhibitors used for high blood pressure – cause accumulation of bradykinin which can induce coughing

Pollution – including dust, pollen, and smoke

Chemicals – such as household products who’s aerosol irritate the lung lining

Mold spores

Cold weather

Exercise

Allergies 

Post nasal drip

Lung conditions – such as asthma, sarcoidosis, emphysema

Heart conditions – such a heart failure

Tumors

Psychological coughing – such as a tic

and more……

What can cure a cough?

We don’t actually “cure” the cough, because remember, it’s a well received defense mechanism.  But to control the cough requires us knowing why you’re coughing in the first place.

If one has pneumoniaantibiotics will be needed to kill the bacteria causing the lung infection.

If one has GERDmedications that decrease acid production and secretion may be required.

If its due to allergiesavoidance of the allergen and medications such as antihistamines, or corticosteroids might be utilized.

If it’s a tumor, then surgery, radiation and/or chemotherapy may be necessary.

But for the common viral nagging cough that many of us are dealing with this season, here is what we recommend:

Steam

Whether its holding your head over a pot on the stove, humidifier, vaporizer or steam shower, the cough reflex subsides and the moisture helps decrease inflammation.

Stay hydrated

Mucous thickens when water content is low, so loosening it up with hydration will make it less irritating.  A dry throat doesn’t do us any good either so keep your fluids up.

Honey

Studies have found this to be an effective cough suppressant. Add it to some warm water, lemon juice or tea and your throat will be soothed as well. Avoid in children under one year of age.

Cough drops

Menthol cough drops work by causing a local anesthetic effect on the back of the throat, temporarily decreasing irritation.

Cough suppressants and expectorants

Decrease the cough reflex and thin the mucous respectively.  One, however, should not self treat using these chronically without having their cough evaluated first.

Natural remedies

Natural remedies (without much scientific evidence) such as Peppermint, Thyme, Eucalyptus, Licorice, Ginger may also provide some relief.

Chocolate

Yes chocolate.  This yummy treat has theobromine, which can suppress cough, and a study in late 2015 found it to work better than codeine.

 

What about alcohol and narcotics for cough?

These are not medically recommended, however, many people choose to self-medicate with alcohol and pain pills to control their cough.  Here’s why. Older cough syrups used to contain alcohol, as alcohol may dry up mucous, and induce sleep which may lessen the cough.  Narcotics decrease respiratory drive and provide analgesia which also decreases the cough reflex.  But alcohol is a no no as it can increase acid reflux, worsening cough, and narcotics are a bad idea as they decrease respiratory drive.  However, many prescription cough medications do include codeine and are used when the cough is severe.  However, the FDA does not recommend use of opioid containing cough medicine in those under the age of 18.

 

Posted in flu, Health, news

80,000 Americans Died From Flu-Related Illness Last Year

We knew last year’s flu season was deadly, but we didn’t expect this.    The CDC has this week revealed the following: over 80,000 Americans died last year from flu-related illness. This is double and even triple previous flu seasons.  Thus the 2017-2018 season was one the deadliest in decades, nearly matching the 1976-1977 swine flu outbreak.

Last year’s pandemic was most notably caused by H3N2.  This notorious strain can sneakily avoid being replicated in a vaccine, hence our flu shot efficacy last year was only 16%.

Flu Deaths: Are We Missing a Severe Pneumonia Season?

The most common cause of death was pneumonia.  Which makes us wonder if we are dealing with more severe pneumonia causing strains as well.

 

When does flu season begin and how long does it last?

Flu season has begun already. It typically starts in the Fall, and ends late Spring.  So the range is described as October to May with it peaking December to March.

How bad will this flu season be?

It is difficult to predict, but already this early in the season we’ve had multiple flu related deaths reported by the CDC’s Flu View.

What is the flu?  How can one die from it?

The flu is caused by a virus. Multiple strains of virus’ can cause the flu.  The virus itself can be lethal, however the greatest risk comes with what it does to your immune system, thereby putting one at risk of secondary infections.  Pneumonia is the number one cause of flu-related deaths.  Secondly, it can exacerbate existing conditions such as asthma, seizures, even promote preterm birth, hence those who are pregnant or have preexisting medical conditions are urged to get vaccinated against the flu.  Moreover those who qualify should get the pneumonia vaccine as well.

 

h1n1-swine-flu-virus
h1n1 virus

 

What does this year’s flu vaccine cover?

According to the CDC, the trivalent vaccine covers for these three strains of flu virus:

  • A/Michigan/45/2015 (H1N1)pdm09–like virus
  • A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus
  • B/Colorado/06/2017–like virus (Victoria lineage)

Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).

These vaccines are aimed at providing protection against the Swine flu, and some influenza A and B strains.

What about older individuals?

This year, those over 65 will have three options for their flu vaccine.

Fluzone High-Dose – a higher dose flu vaccine that will hopefully allow their immunity to protect against the flu longer

FLUAD – the trivalent flu vaccine with an adjuvant to stimulate more of an immune response.

Flublock Quadrivalent – provides protection against 4 strains.

What about the nasal spray vaccine?

This year, the CDC allows use of the nasal spray vaccine as it has shown to have improved efficacy from  prior years. However it is only recommended for  those who are between the ages of 2 and 49 and cannot be given to those who are pregnancy or who have compromising medical conditions as outlined by the CDC.

Who should get the flu shot?

All individuals 6 months old and older unless specified by their medical provider.

What if I’m allergic to eggs?

Most individuals allergic to eggs can still get the flu vaccine, but if the allergy to eggs is severe (anaphylaxis, angioedema, difficulty breathing), the CDC recommends notifying your medical provider and being in a facility to monitor you if you do get the flu vaccine.

Will I get the flu from the flu shot?

No.  The flu vaccine has a “killed” version of the virus meaning it’s not an active virus (as opposed to a live attenuated vaccine, a weakened down version of it).   A “killed” or “inactivated” vaccine merely has the pathogen particles to induce an immune response.  Additionally, when one states they got the flu despite the flu shot it could be that the flu shot only protects against 3 – 4 strains and they were infected with a more rare strain not covered by the vaccine.

How effective is the flu vaccine?

The average effectiveness each year hovers around 60%.  Last year’s efficacy was much lower and this year’s has not been predicted as of yet. Australia is still reporting active cases on their Department of Health website.

I feel sick after the flu shot, why?

For some, the immune response that ensues can make one feel mildly ill, but should not resemble the flu. Those who state they got the flu “immediately” after receiving the shot, might have already been exposed and had not had a chance to produce immunity prior to their exposure.

sneezing

 

What are symptoms of the flu? How is it different from a cold?

A cold comes on slower and less severe.  Flu symptoms are more abrupt and can include:

  • Fever
  • Body Aches
  • Cough
  • Sneezing
  • Sore Throat
  • Shortness of Breath
  • Fatigue
  • Headache
  • Nausea
  • Vomiting

Are there medications to treat the flu? Will antibiotics work?

There are antiviral medications available, such as Tamiflu, to treat the flu.  Antibiotics, however, will not work since the flu is not caused by a bacteria but rather a virus. However if a secondary bacterial infection takes over, antibiotics may be used.

How can I prevent getting the flu?

Besides vaccination, avoid being around those who are sick, thorough hand washing, and take good care of yourself.  A balanced diet, exercise and sleep regimen can help boost your immune system.

Wishing you health this season!!

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada