MFM
It’s that time of year again. Everyone’s attention has turned to thoughts of fl u vaccination for the priority groups and prayers are offered to the gods of healthcare that this year won’t be the year when we are bogged down with a fl u epidemic. PAUL LAMBDEN looks at this year’s threat
DR PAUL LAMBDEN is a practising GP and a qualifi ed dentist. He has been a GP for 35 years, over 20 of which have been in practice. He has previously worked as an NHS trust chief executive, principal of a medical defence organisation, LMC secretary and Parliamentary special adviser. He is a writer and broadcaster
Flight of the fl u I
nfl uenza is a viral illness that affects the respiratory tract, not only of humans but also of many animals. For most people the illness is debilitating
and unpleasant but the recovery usually occurs in 10-14 days and doesn’t leave any residual disability. In a proportion of patients, however, and particularly those at high risk because of debility from other diseases, the infl uenza virus may cause a prostrating illness from which some patients die. In an average year the virus is associated with 30-40,000 deaths.
Several times in the last hundred years there have been pandemics (where epidemics occur over a very wide area and affect a very large number of people) and perhaps the best known of these was the Spanish fl u pandemic of 1918, which might have killed as many as 70-100 million people worldwide. With global travel now so easy, future pandemics of virulent viral strains will be inevitable. There are a number of types of infl uenza virus
and their treatment is complicated by their continual mutation, which allows them to avoid being overcome by the host immune system. Because antibodies to existing viruses do not inactivate the new strains that repeatedly form, patients will be subject to continually changing virus exposure throughout life. Viruses of the most virulent strain (Type A) are classifi ed according to two proteins, called H and N and the H1N1 strain, which caused many infections in 2009 is well-recognised. The infl uenza virus will therefore attack any non-immune individual but is much more serious in patients whose immunity is reduced (such as those with pre- existing respiratory or cardiac disease) resulting in severe symptoms and also exposing the patients to attack by bacterial infection, resulting in worsening illness and possible death. Flu symptoms include fever of up to 40°C, dry,
harsh cough, sore throat, cold symptoms, headache and generalised muscle aching and extreme fatigue. People frequently describe being ‘unable to get the head off the pillow’. Sufferers feel ‘terrible’. The symptoms are characteristic and diagnosis is made on the history. There is no specifi c treatment and symptom control is with medication such as paracetamol or ibuprofen to lower temperature, together with plenty of fl uids. Steam inhalations may be helpful. In many cases there is no indication for seeing a doctor because the illness is self-limiting and testing to identify the particular strain of the virus
42 october 2013
management
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