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Flu shots play an important role in protecting against bird flu. But not for the reason you might think

<a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> A current strain of highly pathogenic avian influenza, commonly known as bird flu, has become a global problem. The virus has affected <a href="https://www.cdc.gov/bird-flu/situation-summary/data-map-commercial.html">many millions</a> of birds, some other <a href="https://www.cdc.gov/bird-flu/situation-summary/mammals.html">animal species</a>, and a <a href="https://cdn.who.int/media/docs/default-source/influenza/avian-and-other-zoonotic-influenza/joint-fao-oie-who-preliminary-risk-assessment-associated-with-avian-influenza-a(h5n1)-virus.pdf?sfvrsn=faa6e47e_28&download=true">small number of people</a>. Last week, the Australian government <a href="https://www.sbs.com.au/news/article/australians-issued-new-health-risks-travel-warning-for-europe-asia-and-the-americas/gmh1hk9py">issued a warning</a> to residents travelling to Europe, North America, South America and Asia about the risk of bird flu. The alert, published on the <a href="https://www.smartraveller.gov.au/news-and-updates/highly-pathogenic-avian-influenza-outbreak">Smartraveller website</a>, included advice to ensure your flu vaccine is up to date. If you are about to go travelling, this generally means if you’ve had a flu jab this year, although if it has been 3–6 months since your vaccine you should discuss this with your doctor. But the seasonal flu vaccine we get each year doesn’t actually prevent bird flu in humans. So why is it being recommended in this context? <h2>Some bird flu background</h2> Smartraveller notes <a href="https://www.smartraveller.gov.au/news-and-updates/highly-pathogenic-avian-influenza-outbreak">several strains</a> of bird flu are currently circulating. The most concerning strain, called the <a href="https://www.nature.com/articles/s41467-023-38415-7">2.3.4.4b clade</a>, emerged a few years ago from a type of influenza A (H5, or A/H5) that has been circulating for several decades. Clade 2.3.4.4b primarily affects birds, including wild birds and poultry. It has had <a href="https://theconversation.com/uk-poultry-can-roam-free-outside-again-but-bird-flu-risk-hasnt-gone-away-203361">devastating effects</a> on bird populations, as well as farmers and others involved in the poultry industry. In recent years, clade 2.3.4.4b has adapted to <a href="https://www.nature.com/articles/s44298-024-00039-z">infect some mammals</a>. Unfortunately it seems to cause severe disease in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11083745/">certain animals</a>. Some marine mammals have been hit particularly hard, with mass mortality events <a href="https://www.theguardian.com/environment/2023/dec/08/mass-deaths-elephant-seals-penguins-bird-flu-antarctic-ecological-disaster-aoe">reported</a> in elephant seals and sea lions. In the United States, bird flu has also spread <a href="https://www.cdc.gov/bird-flu/situation-summary/mammals.html">among dairy cows</a>. Compared to the huge number of animal cases, there have been a relatively small number of <a href="https://www.who.int/publications/m/item/joint-fao-who-woah-preliminary-assessment-of-recent-influenza-a(h5n1)-viruses">humans infected with bird flu</a>. Since 2003, <a href="https://www.who.int/publications/m/item/cumulative-number-of-confirmed-human-cases-for-avian-influenza-a(h5n1)-reported-to-who--2003-2023--3-october-2023">878 cases</a> of A/H5N1 influenza have been reported in humans, with a small proportion of these reported since 2020 when <a href="https://www.outbreak.gov.au/emerging-risks/high-pathogenicity-avian-influenza">clade 2.3.4.4b first emerged</a>. The reported cases have been people who have had close contact with infected animals. It does not appear to spread from person to person. As such, the <a href="https://www.ecdc.europa.eu/en/infectious-disease-topics/z-disease-list/avian-influenza/threats-and-outbreaks/risk-assessment-h5">risk to travellers is low</a>. There are some situations where the risk may be greater, such as for people visiting live markets, or those who are travelling specifically to work with wildlife or animals in food production. <a href="https://www.who.int/publications/m/item/joint-fao-who-woah-preliminary-assessment-of-recent-influenza-a(h5n1)-viruses">Infections in humans</a> with H5 influenza can vary significantly in severity, from mild conjunctivitis up to fatal pneumonia. H5 influenza strains appear to be <a href="https://asm.org/articles/2024/june/what-you-should-know-about-avian-influenza-a-h5n1">sensitive to antivirals</a> (oseltamivir, also known as Tamiflu) and they are generally <a href="https://www.cdc.gov/bird-flu/hcp/novel-av-treatment-guidance/">recommended</a> as treatment for human infection, but it’s <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01307-2/fulltext">not clear</a> whether they reduce the risk of death in those with severe disease. To date, one case of A/H5 influenza (not 2.3.4.4b) has been <a href="https://www.abc.net.au/news/2024-05-22/bird-flu-avian-influenza-human-detection/103879886">reported in Australia</a>, in a child who had recently returned from overseas. While <a href="https://www.fao.org/animal-health/situation-updates/global-aiv-with-zoonotic-potential/en">clade 2.3.4.4b has been detected</a> in all continents <a href="https://www.outbreak.gov.au/emerging-risks/high-pathogenicity-avian-influenza">except Australia</a>, other avian influenza strains (A/H7) <a href="https://www.outbreak.gov.au/current-outbreaks/avian-influenza">have been reported here</a> earlier this year. <h2>Seasonal flu vaccines are not effective against bird flu</h2> Seasonal influenza refers to the flu strains that circulate each year. Since the COVID pandemic, three different strains have circulated in various proportions – influenza A H1N1 (descended from the <a href="https://www.nature.com/articles/nature08182">2009 swine flu strain</a>), influenza A H3N2 (which has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149781/">circulated since 1968</a>) and an influenza B strain. Interestingly, a second influenza B strain (the Yamagata lineage) <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2314801">appears to have vanished</a> during the COVID pandemic. Seasonal influenza vaccines contain up-to-date variants of these types (A/H1N1, A/H3N2 and B) that are recommended by the World Health Organization each year. They are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5912669/">moderately effective</a>, reducing the risk of hospitalisation by about 40–60%. Influenza vaccines are quite specific in the protection that they provide. For seasonal vaccines, even the very small changes that occur in the virus from year to year are enough to allow them to “escape” vaccine-induced immunity. Therefore seasonal flu vaccines <a href="https://www.cdc.gov.au/topics/avian-influenza-bird-flu">do not provide any protection</a> against A/H5 influenza. <h2>Preventing a hybrid bird-human strain</h2> The rationale for recommending travellers have a flu shot in the context of the current bird flu outbreak is that seasonal flu vaccines may help reduce the risk of simultaneous infection with both A/H5 and a seasonal influenza strain. When this occurs, there is potential for a “recombination” of the genetic code from both viral strains. This could have the transmissibility of a seasonal human virus with the severity of an avian influenza virus. The 2009 swine flu strain <a href="https://www.nejm.org/doi/full/10.1056/NEJMra0904322">arose from the recombination</a> of several strains over years to become more transmissible in humans. Obviously a more effective vaccine would include a H5 strain, to generate immune responses specific to the H5 flu strain. Vaccine manufacturers have <a href="https://www.ema.europa.eu/en/medicines/human/EPAR/celldemic">developed H5 vaccines</a> over the years, but to date <a href="https://thl.fi/en/-/avian-influenza-vaccinations-begin-vaccine-to-be-offered-to-persons-at-increased-risk-of-infection">only Finland</a> has deployed a H5 vaccine in a small group of people who work closely with potentially infected animals. Currently the <a href="https://www.ecdc.europa.eu/en/infectious-disease-topics/z-disease-list/avian-influenza/threats-and-outbreaks/risk-assessment-h5">level of risk</a> posed by H5 to humans is not thought to be sufficient to require a specific vaccine program, as the potential benefits are small compared to the costs and the potential risks associated with any new vaccine program. <h2>The value of a flu shot for travellers</h2> Seasonal flu vaccines protect against influenza infection, and may also reduce the risk of simultaneous infection with human and bird flu strains. Bird flu aside, for most travellers who haven’t received a flu shot this year, reducing the risk of illness disrupting travel plans should be enough of a reason to get one. For those who have already received a flu shot this season, similar to COVID jabs, protection after vaccination appears to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8499703/">wane over time</a>. So if you’re travelling to the northern hemisphere during the winter months, and it’s been more than 3–6 months since you received a flu vaccine, your doctor may recommend you have another. Bird flu is only a small risk to most travellers, but people may want to take sensible precautions, such as avoiding close contact with birds at markets.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/237859/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, Professor of Infectious Diseases, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/flu-shots-play-an-important-role-in-protecting-against-bird-flu-but-not-for-the-reason-you-might-think-237859">original article</a>.

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I feel sick. How do I know if I have the flu, COVID, RSV or something else?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> You wake with a sore throat and realise you are sick. Is this going to be a two-day or a two-week illness? Should you go to a doctor or just go to bed? Most respiratory illnesses have very similar symptoms at the start: sore throat, congested or runny nose, headache, fatigue and fever. This may progress to a dry cough. Best case scenario is that you have “<a href="https://lungfoundation.com.au/wp-content/uploads/2018/09/Factsheet-Common-Cold-Mar2016.pdf">a cold</a>” (which can be any one of hundreds of viruses, most commonly rhinovirus), which is short-lived and self-limiting. But some respiratory illnesses can be much more serious. Here is a brief guide to some important bugs to know about that are circulating this winter, and how to work out which one you have. <h2>Respiratory syncytial virus (RSV)</h2> For most people an RSV infection will feel like “a cold” – annoying, but only lasting a few days. However, for babies, older adults and people with immune issues, it can lead to <a href="https://www.rch.org.au/kidsinfo/fact_sheets/bronchiolitis/">bronchiolitis</a> or pneumonia, and even become life-threatening. RSV isn’t seasonal, which means you are just as likely to get it in summer as in winter. However, it is highly contagious so we noticed it <a href="https://pubmed.ncbi.nlm.nih.gov/32986804">disappearing almost completely</a> during COVID lockdowns. There is now a <a href="https://www.tga.gov.au/sites/default/files/2024-02/covid-19-rapid-antigen-self-tests-are-approved-australia-ifu-406813.PDF">rapid-antigen test (RAT) for RSV</a> which also checks for influenza and COVID, and is the best way of finding out if RSV is what is causing symptoms. Recently, a preventative immune therapy has become available for high risk babies (<a href="https://www.schn.health.nsw.gov.au/respiratory-syncytial-virus-rsv-monoclonal-antibody-factsheet">nirsevimab</a>) and there are also <a href="https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked">vaccines for higher risk adults</a>. Nirsevimab is also available to all babies for free in <a href="https://www.health.wa.gov.au/Articles/N_R/Respiratory-syncytial-virus-RSV-immunisation">Western Australia</a> and <a href="https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/immunisation/paediatric-rsv-prevention-program">Queensland</a>. But there are no specific treatments. Adults who get it simply have to ride it out (using whatever you need to <a href="https://www.mayoclinic.org/diseases-conditions/common-cold/diagnosis-treatment/drc-20351611">manage symptoms</a>). Babies and higher risk patients need to present to an emergency department if they test positive for RSV and are also looking or feeling very unwell (this might mean rapid shallow breathing, fevers not coming down with paracetamol or ibuprofen, a baby not feeding, mottled-looking skin, or going blue around the mouth). If a patient has developed a bronchiolitis or pneumonia, they may need to be hospitalised. <h2>Influenza</h2> Once you have had the “true flu” (influenza), you will find it frustrating when people call their sniffly cold-like symptoms a “flu”. Influenza infections generally start with a sore throat and headache which quickly turns into high fevers, generalised aches and excessive fatigue. You feel like you have been hit by a truck and may struggle to get out of bed. This can last a week or more, even in people who are generally fit and healthy. Influenza is a major public health issue internationally, with 3–5 million cases of severe illness and <a href="https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)">290,000 to 650,000 respiratory deaths annually</a>. People who are at <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu">greater risk of complications</a> from influenza include pregnant women, children under five, adults aged 65 and over, First Nations peoples, and people with chronic or immunosuppressive medical conditions. For this reason, annual vaccination is <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">recommended and funded</a> for vulnerable people. Vaccination is also readily available for <a href="https://www.health.gov.au/topics/immunisation/immunisation-contacts">all Australians who want it</a>, through pharmacies as well as medical clinics, usually at a cost of less than A$30. In <a href="https://www.vaccinate.initiatives.qld.gov.au/what-to-vaccinate-against/influenza#:%7E:text=The%20flu%20vaccine%20is%20free,.qld.gov.au">some states</a>, it’s free for all residents. Influenza is seasonal, with definite peaks in the winter months. This is why vaccines are offered from early autumn. If you think you may have influenza, there are now home-testing RATs: all current influenza RATs are in combination with COVID RATs, as the symptoms overlap. Treatment for most people is to manage symptoms and try to avoid spreading it around. Doctors can also <a href="https://theconversation.com/i-think-i-have-the-flu-should-i-ask-my-gp-for-antivirals-210457">prescribe antivirals</a> to vulnerable patients; these work best if started within 48 hours of symptoms. <h2>COVID</h2> It has been less than five years since COVID-19, caused by SARS-CoV-2, started to spread around the world in pandemic proportions. Although COVID is no longer a <a href="https://www.health.gov.au/news/ahppc-statement-end-of-covid-19-emergency-response">public health emergency</a>, it still causes <a href="https://www.abs.gov.au/articles/deaths-due-covid-19-influenza-and-rsv-australia-2022-may-2024">more deaths than influenza and RSV combined</a>. Unlike RSV and influenza, only those <a href="https://www.health.gov.au/topics/covid-19/protect-yourself-and-others/high-risk-groups">aged over 70</a> are in a high-risk age group for COVID. Other <a href="https://www.cdc.gov/covid/risk-factors/?CDC_AAref_Val=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html">factors besides age</a> may put you at higher risk of becoming very unwell when infected by this virus. This includes having other respiratory diseases (such as asthma or chronic obstructive pulmonary disease, also known as COPD), diabetes, cancer, kidney disease, obesity or heart disease. Unlike most respiratory viruses, SARS-CoV-2 tends to set off inflammation beyond the respiratory system. This can involve a range of other organs including the heart, kidneys and blood vessels. Although most people are back to their usual work or study after a week or two, a significant proportion go on to experience extended symptoms such as fatigue, breathlessness, brain fog and mood changes. When these last <a href="https://aci.health.nsw.gov.au/statewide-programs/critical-intelligence-unit/post-acute-sequelae">more than 12 weeks</a>, without any other explanation for symptoms, it’s called <a href="https://www.healthdirect.gov.au/covid-19/post-covid-symptoms-long-covid">long COVID</a>. COVID vaccines can prevent serious illness and have been <a href="https://pubmed.ncbi.nlm.nih.gov/38282394/">monitored</a> for several years now for their safety and effectiveness. Current vaccination recommendations are <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024?language=en">based on age and immune status</a>. It’s worth discussing them with your doctor if you are unsure whether you would benefit or not. <a href="https://www.health.gov.au/topics/covid-19/oral-treatments">Antivirals</a> can treat COVID in higher-risk people who contract it, whether vaccinated or not. Specific advice about what to do if you test positive on a RAT will vary according to your current state guidelines and workplace, however the <a href="https://www.health.gov.au/topics/covid-19/testing-positive">general principles</a> are always: avoid spreading the virus to others, and give yourself time to rest and recover. <hr /> <iframe id="ConNR" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/ConNR/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>What if it’s not one of those?</h2> So you’ve done your combined RSV/flu/COVID RAT and the result is negative. But you still have symptoms. What else could it be? More than 200 different viruses can cause cold and flu symptoms, including rhinovirus (mentioned above), adenovirus and sometimes even <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2130424/">undefined pathogens</a>. If an illness progresses to a cough which will not go away, and/or you start coughing up sputum, this could be a bacterial infection, such as pertussis (whooping cough), streptococcus pneumoniae, haemophilus influenzae or moraxella catarrhalis. So it’s worth <a href="https://www.racgp.org.au/getattachment/0a637812-c8f0-45a2-af9c-fa215b64f8e4/attachment.aspx">getting assessed by a GP</a> who may do a chest Xray and/or <a href="https://www.rcpa.edu.au/Manuals/RCPA-Manual/Pathology-Tests/M/MCS-sputum">test your sputum</a>, particularly if they suspect pneumonia. You also may also start out with what is clearly a viral infection but then get a secondary bacterial infection later. So if you are getting more unwell over time, it’s worth getting tested, in case antibiotics will help. However, taking antibiotics for a purely viral illness will not only be useless, it can contribute to harmful <a href="https://www.nps.org.au/consumers/antibiotic-resistance-the-facts">antibiotic resistance</a> and give you unwanted side effects.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234266/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-feel-sick-how-do-i-know-if-i-have-the-flu-covid-rsv-or-something-else-234266">original article</a>. </div>

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Are you up to date with your COVID, flu and other shots? It might depend on who your GP is

<a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/anika-stobart-1014358">Anika Stobart</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Too many older Australians are <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">missing out</a> on recommended vaccinations for COVID, flu, shingles and pneumococcal that can protect them from serious illness, hospitalisation and even death. A new <a href="https://grattan.edu.au/">Grattan Institute report</a> shows vaccination rates vary widely from GP to GP, highlighting an important place to look for opportunities to boost vaccination. Many people get vaccinated at pharmacies, and those vaccinations are counted in our analysis. But we looked at GPs because they have a unique role overseeing someone’s health care, and an important role promoting vaccination. We found that for some GPs, nine in ten of their older patients were vaccinated for flu. For others, the rate was only four in ten. The differences for shingles and COVID were even bigger. For pneumococcal disease, there was a 13-fold difference in GPs’ patient vaccination rates. While some variation is inevitable, these differences are large, and they result in too many people missing out on recommended vaccines. <h2>Some GPs treat more complex patients</h2> A lot of these differences reflect the fact that GPs see different types of patients. Our research shows older people who aren’t proficient in English are up to 15% less likely to be vaccinated, even after other factors are taken into account. And the problem seems to be getting worse. COVID vaccination rates for people 75 years and older fell to just 36% in May 2024. But rates were even lower – a mere 11% – for people who don’t speak English proficiently, and 15% for those who speak a language other than English at home. Given these results, it’s no surprise that GPs with fewer patients who are vaccinated also have more patients who struggle with English. For GPs with the lowest vaccination rates, one-quarter of their patients aren’t proficient in English. For GPs with the highest vaccination rates, it is only 1%. GPs with fewer vaccinated patients also saw more people who live in rural areas, are poorer, didn’t go to university, and don’t have regular access to a GP, all of which reduce the likelihood of getting vaccinated. Many of these barriers to vaccination are difficult for GPs to overcome. They point to structural problems in our health system, and indeed our society, that go well beyond vaccination. But GPs are also a key part of the puzzle. A <a href="https://www.ijidonline.com/article/S1201-9712(14)01379-4/fulltext">strong</a> <a href="https://www.tandfonline.com/doi/full/10.1080/21645515.2020.1780848">recommendation</a> from a GP can make a big difference to whether a patient gets vaccinated. <a href="https://www.aihw.gov.au/reports/primary-health-care/general-practice-allied-health-primary-care">Nearly all</a> older Australians visit a GP every year. And some GPs have room for improvement. <h2>But GPs seeing similar patients can have very different vaccination rates</h2> We compared GPs whose patients had a similar likelihood of being vaccinated, based on a range of factors including their health, wealth and cultural background. Among the GPs whose patients were least likely to get a flu vaccination, some saw less than 40% of their patients vaccinated, while for others in that group, the rate was over 70%. Among GPs with patients who face few barriers to vaccination, the share of their patients who were vaccinated also varied widely. Even within neighbourhoods, GP patient vaccination rates vary a lot. For example, in Bankstown in Sydney, there was a seven-fold difference in COVID vaccination rates and an 18-fold difference for pneumococcal vaccination. Not everything about clinics and patients can be measured in data, and there will be good reasons for some of these differences. But the results do suggest that some GPs are beating the odds to overcome patient barriers to getting vaccinated, while other GPs could be doing more. That should trigger focused efforts to raise vaccination rates where they are low. <h2>So what should governments do?</h2> A comprehensive national reform agenda is <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">needed to increase adult vaccination</a>. That includes clearer guidance, national advertising campaigns, SMS reminders, and tailored local programs that reach out to communities with very low levels of vaccination. But based on the big differences in GPs’ patient vaccination rates, Australia also needs a three-pronged plan to help GPs lift older Australians’ vaccination rates. First, the way general practice is funded needs to be overhauled, providing more money for the GPs whose patients face higher barriers to vaccination. Today, clinics with patients who are poorer, sicker and who struggle with English tend to get less funding. They should get more, so they can spend more time with patients to explain and promote vaccination. Second, GPs need to be given data, so that they can easily see how their vaccination rates compare to GPs with similar patients. And third, Primary Health Networks – which are responsible for improving primary care in their area – should give clinics with low vaccination rates the help they need. That might include running vaccination sessions, sharing information about best practices that work in similar clinics with higher vaccination rates, or offering translation support. And because pharmacies also play an important role in promoting and providing vaccines, governments should give them data too, showing how their rates compare to other pharmacies in their area, and support to boost vaccination uptake. These measures would go a long way to better protect some of the most vulnerable in our society. Governments have better data than ever before on who is missing out on vaccinations – and other types of health care. They shouldn’t miss the opportunity to target support so that no matter where you live, what your background is, or which GP or pharmacy you go to, you will have the best chance of being protected against disease.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234175/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, Program Director, Health and Aged Care, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/anika-stobart-1014358">Anika Stobart</a>, Senior Associate, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/are-you-up-to-date-with-your-covid-flu-and-other-shots-it-might-depend-on-who-your-gp-is-234175">original article</a>.

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What’s the difference between ‘man flu’ and flu? Hint: men may not be exaggerating

<a href="https://theconversation.com/profiles/thea-van-de-mortel-1134101">Thea van de Mortel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> The term “man flu” takes a <a href="https://www.oxfordlearnersdictionaries.com/definition/english/man-flu">humorous poke</a> at men with minor respiratory infections, such as colds, who supposedly exaggerate their symptoms. According to the stereotype, a man lies on the sofa with a box of tissues. Meanwhile his female partner, also with a snotty nose, carries on working from home, doing the chores and looking after him. But is man flu real? Is there a valid biological reason behind men’s symptoms or are men just malingering? And how does man flu differ from flu? <h2>What are the similarities?</h2> Man flu could refer to a number of respiratory infections – a cold, flu, even a mild case of COVID. So it’s difficult to compare man flu with flu. But for simplicity, let’s say man flu is actually a cold. If that’s the case, man flu and flu have some similar features. Both are caused by viruses (but different ones). Both are improved with rest, fluids, and if needed painkillers, throat lozenges or decongestants to <a href="https://activities.nps.org.au/nps-order-form/Resources/NPS-Cold-and-Flu-Brochure-May-2014.pdf">manage symptoms</a>. Both <a href="https://www.cdc.gov/flu/symptoms/coldflu.htm">can share</a> similar symptoms. Typically, more severe symptoms such as fever, body aches, violent shivering and headaches are more common in flu (but sometimes occur in colds). Meanwhile sore throats, runny noses, congestion and sneezing are more common in colds. A cough is common in both. <h2>What are the differences?</h2> <a href="https://www.cdc.gov/flu/about/keyfacts.htm">Flu</a> is a more serious and sometimes fatal respiratory infection caused by the influenza virus. Colds are caused by various viruses such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553670/">rhinoviruses</a>, <a href="https://www.cdc.gov/adenovirus/about/?CDC_AAref_Val=https://www.cdc.gov/adenovirus/symptoms.html">adenoviruses</a>, and common cold <a href="https://journals.lww.com/pidj/citation/2022/03000/proving_etiologic_relationships_to_disease_.18.aspx">coronaviruses</a>, and are rarely serious. Colds tend to <a href="https://www.cdc.gov/flu/symptoms/coldflu.htm">start gradually</a> while flu tends to start abruptly. Flu can be <a href="https://www.cdc.gov/flu/professionals/diagnosis/overview-testing-methods.htm">detected</a> with laboratory or at-home tests. Man flu is not an official diagnosis. Severe flu symptoms may be prevented with <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm">a vaccine</a>, while cold symptoms cannot. Serious flu infections may also be <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/racf-antiviral-treatments-and-prophylaxis.aspx">prevented or treated</a> with antiviral drugs such as Tamiflu. There are no antivirals for colds. <h2>OK, but is man flu real?</h2> Again, let’s assume man flu is a cold. Do men really have worse colds than women? The picture is complicated. <a href="https://www.sciencedirect.com/science/article/pii/S0022399922003324?via%3Dihub">One study</a>, with the title “Man flu is not a thing”, did in fact show there were differences in men’s and women’s symptoms. This study looked at symptoms of acute rhinosinusitis. That’s inflammation of the nasal passages and sinuses, which would explain a runny or stuffy nose, a sinus headache or face pain. When researchers assessed participants at the start of the study, men and women had similar symptoms. But by days five and eight of the study, women had fewer or less-severe symptoms. In other words, women had recovered faster. But when participants rated their own symptoms, we saw a somewhat different picture. Women rated their symptoms worse than how the researchers rated them at the start, but said they recovered more quickly. All this suggests men were not exaggerating their symptoms and did indeed recover more slowly. It also suggests women feel their symptoms more strongly at the start. <h2>Why is this happening?</h2> It’s not straightforward to tease out what’s going on biologically. There are <a href="https://www.nature.com/articles/nri.2016.90">differences</a> in immune responses between men and women that provide a plausible reason for worse symptoms in men. For instance, women generally produce antibodies more efficiently, so they <a href="https://www.nature.com/articles/nri.2016.90">respond more effectively</a> to vaccination. Other aspects of women’s immune system also appear to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2735332/">work more strongly</a>. So why do women tend to have <a href="https://www.nature.com/articles/nri.2016.90">stronger immune responses</a> overall? That’s probably partly because women have two X chromosomes while men have one. X chromosomes carry important <a href="https://www.nature.com/articles/nri.2016.90#Tab3">immune function genes</a>. This gives women the benefit of immune-related genes from two different chromosomes. Oestrogen (the female sex hormone) also seems to <a href="https://www.nature.com/articles/nri.2016.90">strengthen</a> the immune response, and as levels vary throughout the lifespan, so does <a href="https://www.science.org/doi/10.1126/sciimmunol.aan2946">the strength</a> of women’s immune systems. Men are certainly more likely to die from some infectious diseases, such as <a href="https://www.aihw.gov.au/reports/life-expectancy-deaths/deaths-in-australia/contents/covid-10-deaths">COVID</a>. But the picture is less clear with other infections such as the flu, where the incidence and mortality between men and women <a href="https://iris.who.int/bitstream/handle/10665/44401/9789241500111_eng.pdf?sequence=1&isAllowed=y">varies widely</a> between countries and particular flu subtypes and outbreaks. Infection rates and outcomes in men and women can also depend on the way a virus is <a href="https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2021.712688/full">transmitted</a>, the person’s age, and social and behavioural factors. For instance, women seem to be more likely to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077589/#R20">practice protective behaviours</a> such as washing their hands, wearing masks or avoiding crowded indoor spaces. Women are also <a href="https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-016-0440-0">more likely</a> to seek medical care when ill. <h2>So men aren’t faking it?</h2> Some evidence suggests men are not over-reporting symptoms, and may take longer to clear an infection. So they may experience man flu more harshly than women with a cold. So cut the men in your life some slack. If they are sick, gender stereotyping is unhelpful, and may discourage men from seeking medical advice.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231161/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/thea-van-de-mortel-1134101">Thea van de Mortel</a>, Professor, Nursing, School of Nursing and Midwifery, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whats-the-difference-between-man-flu-and-flu-hint-men-may-not-be-exaggerating-231161">original article</a>.

Body

"Worst nightmare": Teen dies one day after flu diagnosis

William Jones was complaining of a sore throat and cough last month and when his mum called the doctor, they were told that it was most likely the flu. However, the following morning when Rebecca Rollason went to check on her 16-year-old son, he was found unresponsive in his bed in their Wellington home. "We ask ourselves how what started as a sore throat, snotty nose and a cough on Tuesday to no longer with us three days later," the grieving mum told the NZ Herald. "No one understands, we don't know what happened... it feels like the worst nightmare that we cannot wake from." Rollason explained that her family have to "wait for results" in hopes of understanding what happened and how the teenager, who was barely sick, passed away so suddenly. "We just don’t understand how this can happen to a boy who was barely ever sick and was very healthy," she said. "It is an incredibly hard and devastating time for us." A family friend has helped set up a <a href="https://givealittle.co.nz/cause/rebecca-lost-her-son-william-last-friday" target="_blank" rel="noopener">fundraising page</a> to help relieve the financial pressure on her and William's two brothers while they grieve. "It is every parents worst nightmare and a shocking tragedy to lose a healthy child from a sudden and brief illness," a statement from the fundraising page read. "The money will help the family with funeral costs and ease Financial burden while they grieve and come to terms with Williams passing." On July 1 they shared an update on the fundraising page, saying: "Rebecca and family would like all to know that are incredibly grateful for all the support and kindness." Image: Givealittle

Caring

With all this bird flu around, how safe are eggs, chicken or milk?

<a href="https://theconversation.com/profiles/enzo-palombo-249510">Enzo Palombo</a>, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> Recent outbreaks of bird flu – in <a href="https://www.cdc.gov/flu/avianflu/avian-flu-summary.htm">US dairy herds</a>, <a href="https://www.abc.net.au/news/rural/2024-06-04/third-victorian-poultry-farm-declares-outbreak-avian-influenza/103932694">poultry farms in Australia</a> and elsewhere, and <a href="https://theconversation.com/bird-flu-is-hitting-australian-poultry-farms-and-the-first-human-case-has-been-reported-in-victoria-heres-what-we-know-230691">isolated cases</a> <a href="https://www.statnews.com/2024/05/30/bird-flu-third-case-human-infection-caused-respiratory-symptoms/">in humans</a> – have raised the issue of food safety. So can the virus transfer from infected farm animals to contaminate milk, meat or eggs? How likely is this? And what do we need to think about to minimise our risk when shopping for or preparing food? <h2>How safe is milk?</h2> Bird flu (or avian influenza) is a bird disease caused by specific types of influenza virus. But the virus can also infect cows. <a href="https://www.cdc.gov/flu/avianflu/avian-flu-summary.htm">In the US</a>, for instance, to date more than 80 dairy herds in at least nine states have been infected with the H5N1 version of the virus. Investigations are <a href="https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/livestock">under way</a> to confirm how this happened. But we do know infected birds can shed the virus in their saliva, nasal secretions and faeces. So bird flu can potentially contaminate animal-derived food products during processing and manufacturing. Indeed, fragments of bird flu genetic material (RNA) were found in <a href="https://theconversation.com/how-bird-flu-virus-fragments-get-into-milk-sold-in-stores-and-what-the-spread-of-h5n1-in-cows-means-for-the-dairy-industry-and-milk-drinkers-228689">cow’s milk</a> from the dairy herds associated with <a href="https://www.statnews.com/2024/05/30/bird-flu-third-case-human-infection-caused-respiratory-symptoms/">infected US farmers</a>. However, the spread of bird flu among cattle, and possibly to humans, is likely to have been caused through contact with <a href="https://www.agriculturedive.com/news/contaminated-milk-equipment-potential-source-of-bird-flu-spread-to-cattle/712555/">contaminated milking equipment</a>, not the milk itself. The test used to detect the virus in milk – which uses similar PCR technology to lab-based COVID tests – is also highly sensitive. This means it can detect very low levels of the bird flu RNA. But the test does not distinguish between live or inactivated virus, just that the RNA is present. So from this test alone, we cannot tell if the virus found in milk is infectious (and capable of infecting humans). Does that mean milk is safe to drink and won’t transmit bird flu? Yes and no. In Australia, where bird flu has not been reported in dairy cattle, the answer is yes. It is safe to drink milk and milk products made from Australian milk. In the US, the answer depends on whether the milk is <a href="https://www.sciencedirect.com/science/article/abs/pii/B978184569216250013X?via%3Dihub">pasteurised</a>. We know pasteurisation is a common and reliable method of destroying concerning microbes, including influenza virus. Like most viruses, influenza virus (including bird flu virus) is inactivated by heat. Although there is little direct research on whether pasteurisation inactivates H5N1 in milk, we can extrapolate from what we know about heat inactivation of H5N1 in <a href="https://www.sciencedirect.com/science/article/pii/S0362028X22060732?via%3Dihub">chicken</a> and <a href="https://www.mdpi.com/2036-7481/13/4/60">eggs</a>. So we can be confident there is no risk of bird flu transmission via pasteurised milk or milk products. However, it’s another matter for unpasteurised or “raw” US milk or milk products. A recent <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2405495">study</a> showed mice fed raw milk contaminated with bird flu developed signs of illness. So to be on the safe side, it would be advisable to avoid raw milk products. <h2>How about chicken?</h2> Bird flu has caused sporadic outbreaks in wild birds and domestic poultry worldwide, including <a href="https://theconversation.com/bird-flu-is-hitting-australian-poultry-farms-and-the-first-human-case-has-been-reported-in-victoria-heres-what-we-know-230691">in Australia</a>. In recent weeks, there have been <a href="https://www.abc.net.au/news/rural/2024-06-04/third-victorian-poultry-farm-declares-outbreak-avian-influenza/103932694">three reported outbreaks</a> in <a href="https://agriculture.vic.gov.au/biosecurity/animal-diseases/poultry-diseases/avian-influenza-bird-flu#h2-0">Victorian poultry farms</a> (two with H7N3 bird flu, one with H7N9). There has been <a href="https://www.abc.net.au/news/rural/2024-05-23/bird-flu-detected-western-australia-chicken-farm/103880002">one</a> reported outbreak in <a href="https://www.agric.wa.gov.au/livestock-biosecurity/avian-influenza">Western Australia</a> (H9N2). The strains of bird flu identified in the Victorian and Western Australia outbreaks can cause human infection, although these <a href="https://agriculture.vic.gov.au/biosecurity/animal-diseases/poultry-diseases/avian-influenza-bird-flu#h2-8">are rare</a> and typically result from close contact with infected live birds or <a href="https://www.who.int/emergencies/situations/avian-influenza-a-(h7n9)-virus-outbreak">contaminated environments</a>. Therefore, the chance of bird flu transmission in chicken meat is remote. Nonetheless, it is timely to remind people to handle chicken meat with caution as many dangerous pathogens, such as Salmonella and Campylobacter, can be found on chicken carcasses. Always handle chicken meat carefully when shopping, transporting it home and storing it in the kitchen. For instance, make sure no meat juices cross-contaminate other items, consider using a cool bag when transporting meat, and refrigerate or freeze the meat within two hours. <a href="https://theconversation.com/no-you-shouldnt-wash-raw-chicken-before-cooking-it-so-why-do-people-still-do-it-192723">Avoid washing your chicken</a> before cooking to prevent the spread of disease-causing microbes around the kitchen. Finally, cook chicken thoroughly as viruses (including bird flu) <a href="https://www.sciencedirect.com/science/article/pii/S0362028X22060732?via%3Dihub">cannot survive</a> cooking temperatures. <h2>Are eggs safe?</h2> The recent Australian outbreaks have occurred in egg-laying or mixed poultry flocks, so concerns have been raised about bird flu transmission via contaminated chicken eggs. Can flu viruses contaminate chicken eggs and potentially spread bird flu? It appears so. A <a href="https://www.sciencedirect.com/science/article/pii/S0196655306011862?via%3Dihub">report</a> from 2007 said it was feasible for influenza viruses to enter through the eggshell. This is because influenza virus particles are smaller (100 nanometres) than the pores in eggshells (at least 200 nm). So viruses could enter eggs and be protected from cleaning procedures designed to remove microbes from the egg surface. Therefore, like the advice about milk and meat, cooking eggs is best. The <a href="https://www.fda.gov/food/egg-guidance-regulation-and-other-information/questions-and-answers-regarding-safety-eggs-during-highly-pathogenic-avian-influenza-outbreaks">US Food and Drug Administration</a> recommends cooking poultry, eggs and other animal products to the proper temperature and preventing cross-contamination between raw and cooked food. <h2>In a nutshell</h2> If you consume pasteurised milk products and thoroughly cook your chicken and eggs, there is nothing to worry about as bird flu is inactivated by heat. The real fear is that the virus will evolve into highly pathogenic versions that can be transmitted from <a href="https://theconversation.com/bird-flu-is-hitting-australian-poultry-farms-and-the-first-human-case-has-been-reported-in-victoria-heres-what-we-know-230691">human to human</a>. That scenario is much more frightening than any potential spread though food.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231280/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/enzo-palombo-249510">Enzo Palombo</a>, Professor of Microbiology, <a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/with-all-this-bird-flu-around-how-safe-are-eggs-chicken-or-milk-231280">original article</a>.

Food & Wine

There are new flu vaccines on offer for 2024. Should I get one? What do I need to know?

<a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Influenza is a common respiratory infection. Although most cases are relatively mild, flu can cause more severe illness in young children and older people. Influenza virtually <a href="https://pubmed.ncbi.nlm.nih.gov/33243355/">disappeared</a> from Australia during the first years of the COVID-19 pandemic when public health restrictions reduced contact between people. Since 2022, it has returned to a seasonal pattern, although the flu season has started and peaked a few months earlier than before 2020. It’s difficult to predict the intensity of the flu season at this point in the year, but we can sometimes get clues from the northern hemisphere. There, the season <a href="https://www.who.int/tools/flunet">started</a> <a href="https://gis.cdc.gov/grasp/fluview/flu_by_age_virus.html">earlier</a> than usual for the third year running (peaking in early January rather than late February/March), with a similar number of reported cases and hospitalisations to the previous year. Influenza vaccines are recommended annually, but there are now an increasing number of different vaccine types. Here’s what to know about this year’s shots, available from <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">this month</a>. <h2>What goes into a flu vaccine?</h2> Like other vaccines, influenza vaccines work by “training” the immune system on a harmless component of the influenza virus (known as an antigen), so it can respond appropriately when the body encounters the real virus. Influenza strains are constantly changing due to genetic mutation, with the pace of genetic change <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10421855">much higher</a> than for SARS-CoV-2 (the virus that causes COVID). The strains that go into the vaccine are <a href="https://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations">reviewed</a> twice each year by the World Health Organization (WHO), which selects vaccine strains to match the next season’s predicted circulating strains. All current influenza vaccines in <a href="https://www.tga.gov.au/resources/publication/meeting-statements/aivc-recommendations-composition-influenza-vaccines-australia-2024">Australia</a> contain four different strains (known as quadrivalent vaccines). One of the strains appeared to <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2314801">disappear</a> during the COVID pandemic, and the WHO has recently <a href="https://cdn.who.int/media/docs/default-source/influenza/who-influenza-recommendations/vcm-southern-hemisphere-recommendation-2024/202309_qanda_recommendation.pdf?sfvrsn=7a6906d1_5">recommended</a> dropping this strain from the vaccine. It’s expected trivalent (three strain) vaccines will become available in the near future. <h2>What’s different about new flu vaccines?</h2> There are eight brands of flu vaccines <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">available</a> in Australia in 2024. These include egg-based vaccines (Vaxigrip Tetra, Fluarix Tetra, Afluria Quad, FluQuadri and Influvac Tetra), cell-based vaccines (Flucelvax Quad), adjuvanted vaccines (Fluad Quad) and high-dose vaccines (Fluzone High-Dose Quad). Until recently, the process of manufacturing flu vaccines has remained similar. Since the development of the influenza vaccine in the <a href="https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-influenza-vaccination">1940s</a>, influenza viruses were grown in chicken eggs, then extracted, inactivated, purified and processed to make up the egg-based vaccines that are still used widely. However, there have been several enhancements to influenza vaccines in recent years. Older people’s immune systems tend not to respond as strongly to vaccines. In some flu vaccines, adjuvants (components that stimulate the immune system) are included with the influenza antigens. For example, an adjuvant is used in the Fluad Quad vaccine, recommended for over 65s. Studies <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">suggest</a> adjuvanted influenza vaccines are slightly better than standard egg-based vaccines without adjuvant in older people. An alternative approach to improving the immune response is to use higher doses of the vaccine strains. An example is Fluzone High-Dose Quad – another option for older adults – which contains the equivalent of four doses of a standard influenza vaccine. Studies <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">suggest</a> the high dose vaccine is better than the standard dose vaccine (without an adjuvant) in preventing hospitalisation and complications in older people. Other manufacturers have updated the manufacturing process. Cell-based vaccines, such as Flucelvax Quad, use cells instead of eggs in the manufacturing process. Other vaccines that are <a href="https://www.cdc.gov/flu/prevent/advances.htm">not yet available</a> also use different technologies. In the past, <a href="https://pubmed.ncbi.nlm.nih.gov/31151913/">manufacturing issues</a> with egg-based vaccines have reduced their effectiveness. Using an alternative method of production provides some degree of insurance against this in the future. <h2>What should I do this year?</h2> Given indications this year’s flu season may be earlier than usual, it’s probably safest to get your vaccine early. This is particularly <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">important</a> for those at highest risk of severe illness, including older adults (65 years and over), those with chronic medical conditions, young children (six months to five years) and Aboriginal and Torres Strait Islander people. Influenza vaccines are also recommended in pregnancy to protect both the mother and the baby for the first months of life. Influenza vaccines are widely available, including at GP clinics and pharmacies, while many workplaces have occupational programs. For high-risk groups, <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">four of the vaccines</a> are subsidised by the Australian government through the <a href="https://www.health.gov.au/our-work/national-immunisation-program">National Immunisation Program</a>. In older people, a number of vaccines are now recommended: <a href="https://www.health.gov.au/sites/default/files/2024-03/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024.pdf">COVID</a> and influenza, as well as one-off courses of <a href="https://www.health.gov.au/sites/default/files/documents/2020/06/national-immunisation-program-pneumococcal-vaccination-schedule-from-1-july-2020-clinical-advice-for-vaccination-providers.pdf">pneumococcal</a> and <a href="https://www.health.gov.au/topics/immunisation/vaccines/shingles-herpes-zoster-immunisation-service">shingles</a> vaccines. In general, most vaccines can be given in the same visit, but talk to your doctor about which ones you need. <h2>Are there side effects?</h2> All influenza vaccines can <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">cause</a> a sore arm and sometimes more generalised symptoms such as fever and tiredness. These are expected and reflect the immune system reacting appropriately to the vaccine, and are mostly mild and short-term. These side effects are slightly more common in <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">adjuvanted</a> and <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">high dose</a> vaccines. As with all medications and vaccines, allergic reactions such as anaphylaxis can occur after the flu vaccine. All vaccine providers are trained to recognise and respond to anaphylaxis. People with egg allergies should discuss this with their doctor, but in general, <a href="https://www.allergy.org.au/patients/food-allergy/egg-allergy-flu-vaccine">studies suggest</a> they can safely receive any (including egg-based) influenza vaccines. Serious side effects from the influenza vaccine, such as Guillain-Barré syndrome, a neurological complication, are very rare (one case per million people vaccinated). They are <a href="https://pubmed.ncbi.nlm.nih.gov/23810252/">thought</a> to be less common after influenza vaccination than after infection with influenza.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226623/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, Professor of Infectious Diseases, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/there-are-new-flu-vaccines-on-offer-for-2024-should-i-get-one-what-do-i-need-to-know-226623">original article</a>.

Body

I think I have the flu. Should I ask my GP for antivirals?

<a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/wesley-freppel-1408971">Wesley Freppel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>, and <a href="https://theconversation.com/profiles/yong-qian-koo-1457640">Yong Qian Koo</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> If you test positive for COVID and you’re eligible for antivirals, you’ll likely ask your GP for a script to protect you from severe disease. <a href="https://healthdispatch.com.au/news/immunisation-coalition-urging-people-with-flu-like-symptoms-to-g">Antivirals</a> are also available to fight influenza viruses, via a doctor’s prescription. But they have a mixed history, with their benefits at times <a href="https://theconversation.com/controversies-in-medicine-the-rise-and-fall-of-the-challenge-to-tamiflu-38287">overstated</a>. It can be difficult to get an appointment to see your GP. So when should you make the effort to see a GP for a prescription for influenza antivirals? And how effective are they? <h2>What exactly is influenza?</h2> The flu is primarily a viral infection of the respiratory system that can spread through sneezing, coughing, or touching contaminated objects then touching your nose or mouth. Common symptoms include headache, sore throat, fever, runny or blocked nose and body aches that last a week or more. Influenza is actually a group of viruses, divided into several <a href="https://www.cdc.gov/flu/about/viruses/types.htm#:%7E:text=There%20are%20four%20types%20of,global%20epidemics%20of%20flu%20disease,%20https://www.cdc.gov/flu/professionals/acip/background-epidemiology.htm">sub-groups</a>. Flu A and B are the <a href="https://www.health.gov.au/resources/collections/aisr?language=en,%20https://www.health.gov.au/resources/collections/australian-influenza-surveillance-reports-2023?language=en">most common groups</a> that circulate in humans. <h2>What are flu antivirals?</h2> Influenza antivirals, target specific parts of the viral life cycle, which prevents the virus replicating and spreading. Most flu antivirals <a href="https://www.nejm.org/doi/full/10.1056/NEJMra050740">target</a> neuraminidase, an important enzyme the virus uses to release itself from cells. On the other hand, COVID antivirals work by inhibiting other parts of the viral life cycle involved in the <a href="https://www.tga.gov.au/news/media-releases/tga-provisionally-approves-two-oral-covid-19-treatments-molnupiravir-lagevrio-and-nirmatrelvir-ritonavir-paxlovid">virus replicating itself</a>. Three influenza antivirals are <a href="https://australianprescriber.tg.org.au/articles/influenza-overview-on-prevention-and-therapy.html#r20">used in Australia</a>. Relenza (zanamivir) is an inhaled powder and Tamiflu (oseltamivir) is a capsule; both are five-day treatments. Rapivab (peramivir) is a single injection. These antivirals may also come with <a href="https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm">side effects</a>, such as a headache, vomiting, cough, or <a href="https://www.immunisationcoalition.org.au/resources/antiviral-treatments-for-influenza/">fever</a>. Tamiflu and Relenza generally cost A$40-50 in Australia, plus the cost of the consultation fee with your doctor, if applicable. <h2>How effective are antivirals for the flu?</h2> Antivirals have the greatest effect if started 24-72 hours after symptoms. This is to prevent the virus from reaching <a href="https://www.mdpi.com/1660-4601/19/5/3018">high levels in the body</a>. Among healthy adults, if Relenza or Tamiflu are started within 48 hours from your first symptoms, they can <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008965.pub4/full">reduce the duration</a> of symptoms such as cough, blocked nose, sore throat, fatigue, headache, muscle pain and fever by just under a day. For people who have developed severe flu symptoms or who have existing health conditions such as heart disease or chronic obstructive pulmonary disease (COPD), antivirals that start later (but still before day five of symptoms) can still reduce the <a href="https://academic.oup.com/cid/article/52/4/457/378776?login=true">severity of infection</a> and reduce the <a href="https://thorax.bmj.com/content/thoraxjnl/65/6/510.full.pdf?frbrVersion=3">chance of</a> <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/215903">hospitalisation</a> and <a href="https://academic.oup.com/jac/article/72/11/2990/4091484?login=false">death</a>. In a study from the 2009 swine flu (H1N1) pandemic in the United States, treatment with antivirals (Tamiflu and Relenza) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358088/">reduced</a> the chance of needing to be hospitalised. Around 60% of hospitalisations prevented were among 18-64 years olds, around 20% in children 0-17 years, and 20% in adults aged over 65. The research is less clear about whether antivirals prevent the development of flu complications such as secondary bacterial pneumonia. They might, but so far the data aren’t clear. <h2>Are flu antivirals becoming less effective?</h2> Antiviral resistance to Tamiflu has been <a href="https://link.springer.com/article/10.1007/s10096-020-03840-9">reported</a> around the world, mostly in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223162/">immunocompromised people</a>, as they <a href="https://link.springer.com/article/10.1007/s10096-020-03840-9">have</a> a weakened immune system that allows higher viral loads and prolonged viral shedding. The impact of the antiviral resistance is unclear but there is evidence indicating resistant strains can uphold their ability to replicate effectively and spread. So far it’s not clear if these stains cause more severe disease. However, government agencies and surveillance programs are constantly monitoring the spread of antiviral resistance. Currently there is <a href="https://www.cdc.gov/flu/treatment/antiviralresistance.htm">minimal concern</a> for strains that are resistant to Tamiflu or Relenza. <h2>Antivirals can also prevent the flu if you’ve been exposed</h2> Tamiflu and Relenza can also be used to <a href="https://onlinelibrary.wiley.com/doi/10.1111/irv.12046">prevent flu infections</a>, if we’re exposed to the virus or come into contact with infected people. Some studies suggest Tamiflu and Relenza can <a href="https://www.bmj.com/content/326/7401/1235.long">reduce the chance of developing symptomatic influenza</a> by 70-90%. Many health agencies around the world <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165743/">recommend</a> “prophylactic” treatment for high-risk patients in hospitals or age care setting when people have been in contact with others infected with influenza. <h2>So who should talk to their GP about a prescription?</h2> <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/racf-antiviral-treatments-and-prophylaxis.aspx#:%7E:text=The%20Australian%20Therapeutic%20Guidelines*%20recommends,of%20severe%20disease%20from%20influenza.&text=people%20with%20chronic%20conditions%20including,heart%20disease">Australian guidelines recommend</a> doctors offer antivirals to people with influenza who have severe disease or complications. Doctors can also consider treatment for people at higher risk of developing severe disease from influenza. This includes: <ul> <li>adults aged 65 years or older</li> <li>pregnant women</li> <li>people with certain chronic conditions (heart disease, Down syndrome, obesity, chronic respiratory conditions, severe neurological conditions)</li> <li>people with compromised immunity</li> <li>Aboriginal and Torres Strait Islander people</li> <li>children aged five years or younger</li> <li>residents of long-term residential facilities</li> <li>homeless people.</li> </ul> Doctors can prescribe antivirals for the prevention of influenza <a href="https://australianprescriber.tg.org.au/articles/influenza-overview-on-prevention-and-therapy.html#r20">in</a> vulnerable people who have been exposed to the virus. Antiviral treatment also can be <a href="https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#:%7E:text=Antiviral%20treatment%20also%20can%20be,48%20hours%20of%20illness%20onset">considered</a> for otherwise healthy symptomatic patients who have confirmed or suspected influenza, if they can start treatment within 48 hours of developing symptoms. In some instances a doctors can make a clinical diagnosis of influenza based on the symptoms and known close flu positive contacts of the patient. However, it is preferred to have flu diagnosed by one of the approved diagnostic tests, such as a <a href="https://24-7medcare.com.au/influenza/australian-gp-influenza-2023-guide/">rapid antigen test</a> (RAT) or the more accurate <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/influenza_factsheet.aspx">PCR test</a>, similar to what is perfomed for COVID. There are also now combo tests that can <a href="https://www.tga.gov.au/news/media-releases/first-combination-covid-19-and-influenza-self-tests-approved-australia">distinguish between SARS-CoV-2 and influenza virus</a>. Remember, the flu can cause <a href="https://www.abc.net.au/news/2023-07-23/flu-season-hitting-children-hard-antivirals-may-help/102633722">severe illness or death</a>, particularly among people from the high-risk groups. So if you think you might have the flu, wear a mask and stay away to avoid spreading the virus to others. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/210457/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, Research Leader in Virology and Infectious Disease, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/wesley-freppel-1408971">Wesley Freppel</a>, Research Fellow, Institute for Glycomics, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>, and <a href="https://theconversation.com/profiles/yong-qian-koo-1457640">Yong Qian Koo</a>, , <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-think-i-have-the-flu-should-i-ask-my-gp-for-antivirals-210457">original article</a>.

Body

Taking an antidepressant? Mixing it with other medicines – including some cold and flu treatments – can be dangerous

<a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> In the depths of winter we are more at risk of succumbing to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522168/">viral respiratory infections</a> – from annoying sore throat, common cold and sinusitis, to the current resurgence of respiratory syncytial virus (RSV), influenza and COVID. Symptoms of upper respiratory tract infection range in severity. They can include fever, chills, muscle or body aches, cough, sore throat, runny or stuffy nose, earache, headache, and fatigue. Most antibiotics target bacteria so are <a href="https://pubmed.ncbi.nlm.nih.gov/32495003/">not effective</a> for viral infections. Many people seek relief with over-the-counter medicines. While evidence varies, guidelines suggest medicines taken by mouth (such as cough syrups or cold and flu tablets) have a <a href="https://pubmed.ncbi.nlm.nih.gov/25420096/">limited but potentially positive</a> short-term role for managing upper respiratory infection symptoms in adults and children older than 12. These include: <ul> <li>paracetamol or ibuprofen for pain or fever</li> <li>decongestants such as phenylephrine or pseudoephedrine</li> <li>expectorants and mucolytics to thin and clear mucus from upper airways</li> <li>dry cough suppressants such as dextromethorphan</li> <li>sedating or non-sedating antihistamines for runny noses or watery eyes.</li> </ul> But what if you have been prescribed an antidepressant? What do you need to know before going to the pharmacy for respiratory relief? <h2>Avoiding harm</h2> An audit of more than 5,000 cough-and-cold consumer enquiries to an Australian national medicine call centre found questions frequently related to drug-drug interactions (29%). An 18-month analysis showed 20% of calls <a href="https://pubmed.ncbi.nlm.nih.gov/26590496/">concerned</a> potentially significant interactions, particularly with antidepressants. Australia remains in the “<a href="https://www.aihw.gov.au/mental-health/topic-areas/mental-health-%20prescriptions#Prescriptionsbytype">top ten</a>” antidepressant users in the <a href="https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_PHMC">OECD</a>. More than <a href="https://www.aihw.gov.au/mental-health/topic-areas/mental-health-prescriptions">32 million</a> antidepressant prescriptions are dispensed on the Pharmaceutical Benefits Scheme each year. Antidepressants are commonly prescribed to manage symptoms of anxiety or depression but are also used in chronic pain and incontinence. They are classified primarily by how they affect chemical messengers in the nervous system. These classes are: <ul> <li>selective serotonin reuptake inhibitors (SSRI) such as fluoxetine, escitalopram, paroxetine and sertraline</li> <li>serotonin and noradrenaline reuptake inhibitors (SNRI) such as desvenlafaxine, duloxetine and venlafaxine</li> <li>tricyclic antidepressants (TCA) such as amitriptyline, doxepin and imipramine</li> <li>monoamine oxidase inhibitors (MAOI) such as tranylcypromine</li> <li>atypical medicines such as agomelatine, mianserin, mirtazapine, moclobemide, reboxetine and vortioxetine</li> <li>complementary medicines including St John’s wort, S-adenosyl methionine (SAMe) and L-tryptophan</li> </ul> Medicines within the same class of antidepressants have similar actions and side-effect profiles. But the molecular differences of individual antidepressants mean they may have different interactions with medicines taken at the same time. <h2>Types of drug interactions</h2> Drug interactions can be: <ul> <li>pharmacokinetic – what the body does to a drug as it moves into, through and out of the body. When drugs are taken together, one may affect the absorption, distribution, metabolism or elimination of the other</li> <li>pharmacodynamic – what a drug does to the body. When drugs are taken together, one may affect the action of the other. Two drugs that independently cause sedation, for example, may result in excessive drowsiness if taken together.</li> </ul> There are many <a href="https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/pnp.429">potential interactions</a> between medications and antidepressants. These include interactions between over-the-counter medicines for upper respiratory symptoms and antidepressants, especially those taken orally. Concentrations of nasal sprays or inhaled medicines are generally lower in the blood stream. That means they are less likely to interact with other medicines. <h2>What to watch for</h2> It’s important to get advice from a pharmacist before taking any medications on top of your antidepressant. Two symptoms antidepressant users should monitor for shortly after commencing a cough or cold medicine are central nervous system effects (irritability, insomnia or drowsiness) and effects on blood pressure. For example, taking a selective SSRI antidepressant and an oral decongestant (such as pseudoephedrine or phenylephrine) can cause irritability, insomnia and affect blood pressure. Serotonin is a potent chemical compound produced naturally for brain and nerve function that can also constrict blood vessels. Medicines that affect serotonin are common and include most antidepressant classes, but also decongestants, dextromethorphan, St John’s wort, L-tryptophan, antimigraine agents, diet pills and amphetamines. <a href="https://reference.medscape.com/drug-interactionchecker">Combining drugs</a> such as antidepressants and decongestants that both elevate serotonin levels can cause irritability, headache, insomnia, diarrhoea and blood pressure effects – usually increased blood pressure. But some people experience orthostatic hypotension (low blood pressure on standing up) and dizziness. For example, taking both a serotonin and SNRI antidepressant and dextromethorphan (a cough suppressant) can add up to high serotonin levels. This can also occur with a combination of the complementary medicine St John’s Wort and an oral decongestant. Where serotonin levels are too high, <a href="https://pubmed.ncbi.nlm.nih.gov/15666281/">severe symptoms</a> such as confusion, muscle rigidity, fever, seizures and even death have been reported. Such symptoms are rare but if you notice any of these you should stop taking the cold and flu medication straight away and seek medical attention. <h2>Ways to avoid antidepressant drug interactions</h2> There are a few things we can do to prevent potentially dangerous interactions between antidepressants and cold and flu treatments. 1. Better information Firstly, there should be more targeted, consumer-friendly, <a href="https://www.webmd.com/interaction-checker/default.htm">online drug interaction information</a> available for antidepressant users. 2. Prevent the spread of viral infections as much as possible Use the non-drug strategies that have worked well for COVID: regular hand washing, good personal hygiene, social distancing, and facemasks. Ensure adults and children are up to date with immunisations. 3. Avoid potential drug interactions with strategies to safely manage symptoms Consult your pharmacist for strategies most appropriate for you and only use cold and flu medications while symptoms persist: <ul> <li>treat muscle aches, pain, or a raised temperature with analgesics such as paracetamol or ibuprofen</li> <li>relieve congestion with a nasal spray decongestant</li> <li>clear mucus from upper airways with expectorants or mucolytics</li> <li>dry up a runny nose or watery eyes with a non-sedating antihistamine.</li> </ul> Avoid over-the-counter cough suppressants for an irritating dry cough. Use a simple alternative such as honey, steam inhalation with a few drops of eucalyptus oil or a non-medicated lozenge instead. 4. Ask whether your symptoms could be more than the common cold Could it be influenza or COVID? Seek medical attention if you are concerned or your symptoms are not improving. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/208662/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, Assistant Director of Pharmacy, Mater Health SEQ in conjoint appointment as Associate Professor of Pharmacology, Bond University and as Associate Professor (Clinical), <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/taking-an-antidepressant-mixing-it-with-other-medicines-including-some-cold-and-flu-treatments-can-be-dangerous-208662">original article</a>.

Body

What happens in our body when we encounter and fight off a virus like the flu, SARS-CoV-2 or RSV?

Body

6 habits of people who don’t get sick

Winter is a dangerous time. Although cold temperatures themselves don’t cause us to get sick, our winter habits invite the spread of germs and risk of contagion is high. If you find yourself sick every winter, here are some useful habits of those healthy people to take up. 1. They get enough sleep It’s easy to experience disrupted sleep during winter. When air is too cold, it will negatively affect melatonin production and cause the body's sleep cycle to be disrupted. However, research shows that people who sleep only five to six hours a night have a 30 per cent chance of catching a cold when exposed to the virus; those who get more than seven hours reduce their risk to 17 per cent. 2. They pay extra attention to hygiene With more germs in the air, now is the time to stay conscious about where they may be festering. Key areas include bathroom door handles, taps, fridges, elevator buttons and public transport. Keep antibacterial wipes on you so whenever you touch a high risk surface, you can cleanse you hand before eating, or touching your face and eyes. 3. They exercise regularly Winter is notorious for zapping our work-out motivation. However, exercise strengthens the immune system and makes you less likely to catch upper respiratory infections. 4. The get their flu shot Flu shots, approved for all adults, are effective 50 to 60 per cent of the time in preventing the flu and may also reduce the severity of symptoms. 5. They don’t smoke Cigarette smoke appears to damage the mucus membranes, which act as the frontline barrier to infectious agents, making smokers twice as likely to catch a cold and several times more likely to develop the flu. 6. They enjoy a drink Harvard University School of Public Health researchers found that red wine was particularly protective against colds, probably due to the anti-inflammatory action of the phenol, resveratrol. Just keep in mind that drinking more than two glasses a day raises the risk for infections. Image credit: Shutterstock

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Should I get a flu vaccine this year? Here’s what you need to know

<a href="https://theconversation.com/profiles/paul-griffin-1129798">Paul Griffin</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> After having low rates of influenza (flu) transmission in recent years thanks to our COVID control strategies, case numbers are now rising. So far this year, Australia has had <a href="https://www.immunisationcoalition.org.au/news-data/influenza-statistics/">more than 32,000</a> lab-confirmed cases of the flu and 32 deaths. Getting a flu vaccine is the best way to protect against getting the flu. These are reformulated each year to protect against the most widely circulating strains – if our predictions are right. Below you’ll find everything you need to know about the 2023 flu vaccine. But first, some flu basics. <h2>What are the different types of flu?</h2> There are two main types of influenza: influenza A and influenza B. On the surface of the influenza virus there are two main proteins, the hemagglutinin (HA or H) and neuraminidase (NA or N). Different strains are named after their versions of the H and N proteins, as in H1N1 or “swine flu”. <figure class="align-center "><img src="https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" alt="" /><figcaption>HA is the yellow spike, while the NA is the green oval. <a class="source" href="https://www.shutterstock.com/image-vector/structure-influenza-virus-infographics-vector-illustration-542924464?src=ixiW0w-59I3I17RpN4L3wQ-1-12">Shutterstock</a></figcaption></figure> Minor changes in the proteins (HA and NA) on the surface are common because the enzyme the virus uses to make copies of itself is prone to errors. Sometimes the influenza virus can change more abruptly when it mixes up components from different influenza viruses – including influenza viruses that typically infect birds, pigs or bats – to create a virus that’s basically new. The regular change in the virus is the reason the vaccine is updated every year. The <a href="https://www.tga.gov.au/about-tga/advisory-bodies-and-committees/australian-influenza-vaccine-committee-aivc">Australian Influenza Vaccine Committee</a> meets late in the year to plan what should be included in the vaccine for the following season, after considering what happened in our last flu season and in the Northern hemisphere winter. <h2>What strains does this year’s flu shot protect against?</h2> Modern flu vaccines typically protect against four strains. For this year’s vaccine, the committee <a href="https://www.tga.gov.au/resources/publication/meeting-statements/aivc-recommendations-composition-influenza-vaccines-australia-2023">has recommended</a> it includes: <ul> <li> an A/Sydney/5/2021 (H1N1)pdm09-like virus </li> <li> an A/Darwin/9/2021 (H3N2)-like virus </li> <li> a B/Austria/1359417/2021 (B/Victoria lineage)-like virus </li> <li> a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus. </li> </ul> The naming of the viral components can sometimes be confusing. The name is <a href="https://www.cdc.gov/flu/about/viruses/types.htm">derived from</a> the virus type (A or B)/the place it was first isolated/strain number/year isolated (virus subtype). This year’s vaccine therefore includes an influenza A virus similar to the 2009 pandemic-causing H1N1 isolated from Sydney in 2021 and a second influenza A virus (H3N2) isolated in Darwin in 2021. Influenza B viruses are classified into 2 lineages: Victoria and Yamagata. This year’s vaccine includes an influenza B isolated from Austria in 2021 (Victoria lineage) and an influenza B isolated in Phuket in 2013 (Yamagata lineage). <h2>Who should get a flu shot?</h2> Health authorities <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">recommend</a> everyone aged six months of age or over should get the flu vaccine every year. <a href="https://www.health.gov.au/news/2023-national-immunisation-program-influenza-vaccination-early-advice-for-vaccination-providers">Some groups</a> are at greater risk of significant disease from the flu and can access the flu vaccine for free. This includes: <ul> <li> Aboriginal and Torres Strait Islander people aged six months and over </li> <li> children aged six months to five years </li> <li> pregnant women at any stage of pregnancy </li> <li> people aged 65 years or over </li> <li> people aged five years to 65 years who have certain underlying health conditions affecting the heart, lungs, kidneys or immune system, and those with diabetes. </li> </ul> <h2>How can I get it?</h2> You can get a flu shot from your local general practice or pharmacy. Or you may have an opportunity to get vaccinated at your workplace if your employer supplies it. While the vaccine is free for those in the <a href="https://www.health.gov.au/sites/default/files/2023-02/fighting-flu-starts-with-you-consumer-fact-sheet.pdf">above groups</a>, there can be a consultation or administration fee, depending on where you get your vaccine. If you aren’t eligible for a free vaccine, it usually costs around A$20-$30. <h2>Are there different options?</h2> For over 65s, whose immune systems may not work as well as when they were younger, a <a href="https://www.health.gov.au/sites/default/files/2023-03/atagi-advice-on-seasonal-influenza-vaccines-in-2023.pdf">specific vaccine</a> is available that includes an adjuvant which boosts the immune response. This is free for over-65s under the national immunisation program. A high-dose vaccine is also available for people aged 60 and over. However this isn’t currently funded and costs around $70 on a private prescription. People with egg allergies can safely get the egg-based flu vaccine. However there is also a cell-based immunisation for people who don’t want a vaccine made in eggs. When vaccines are grown in eggs, sometimes the virus can change and this might affect the level of protection. Cell-based vaccines aim to address this issue. The cell-based vaccine isn’t funded so patients will pay around $40 for a private prescription. <h2>How well do they work?</h2> The vaccine’s effectiveness depends on how well the strains in the vaccine match those circulating. It generally <a href="https://www.health.gov.au/resources/publications/aisr-2022-national-influenza-season-summary">reduces</a> the chance of being admitted to hospital with influenza by <a href="https://www.health.gov.au/sites/default/files/documents/2022/08/influenza-vaccine-efficacy-effectiveness-and-impact-explained.docx">30-60%</a>. <h2>What are the side effects?</h2> You can’t get the flu from the vaccine as there’s no live virus in it. When people get a flu-like illness after the vaccine, it can be due to mild effects we sometimes see after vaccination, such as headaches, tiredness or some aches and pains. These usually go away <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine#possible-side-effects-of-influenza-vaccination">within a day or two</a>. Alternatively, symptoms after getting a flu shot may be due to another respiratory virus such as respiratory syncytial virus (RSV) that circulates in winter. <h2>When’s the best time to get your flu shot?</h2> The vaccine provides <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu#vaccine-information">peak protection</a> around three to four months <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine#when-to-get-the-influenza-vaccine">after</a> you get it. The <a href="https://www.immunisationcoalition.org.au/news-data/influenza-statistics/">peak of the flu season</a> is usually between June and September, however this changes every year and can vary in different parts of the country. Given this, the best time to get the vaccine is usually around late April or early May. So if you haven’t already, now would be a good time to get it.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/203406/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/paul-griffin-1129798">Paul Griffin</a>, Associate Professor, Infectious Diseases and Microbiology, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/should-i-get-a-flu-vaccine-this-year-heres-what-you-need-to-know-203406">original article</a>.

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Are flu cases already 100 times higher than last year? Here’s what we really know about the 2023 flu season

Alarming <a href="https://www.9news.com.au/national/flu-cases-australia-update-warning-vulnerable-numbers-rise-100-fold-last-year/55ccbb1d-9613-4e45-85aa-43c905efc8e6">headlines</a> and media coverage <a href="https://www.sbs.com.au/news/article/the-flu-nearly-disappeared-during-the-pandemic-now-cases-are-soaring-in-australia/a98cybrj8">have said</a> we’ve had 100 times as many influenza cases in the first two months of 2023 compared with the same time the previous year. The coverage suggested we’re in for a bumper flu season, starting early and your best protection was to get a flu vaccine, when available. But that scary sounding 100 figure is misleading. Here’s what’s behind the figures and what we can really expect from the 2023 flu season. <h2>Comparing apples with oranges</h2> In the first two months of 2023, there were 8,474 laboratory-confirmed cases of influenza. In 2022, over the same period, there were 79 cases. So it might seem this year’s figures are indeed more than 100 times higher than last year’s. But we shouldn’t be alarmed. That’s because in early 2022, influenza cases were artificially low. Strict COVID measures <a href="https://www.bmj.com/content/379/bmj.o2998">almost eliminated</a> influenza outbreaks in 2020 and 2021. Shutting international borders, quarantining, social distancing and mask-wearing stopped influenza coming into the country and spreading. Many COVID restrictions weren’t relaxed until late February/March 2022. So, in January and February of that year there were fewer opportunities for us to mingle and spread the influenza virus. It’s hardly surprising there were few cases then. In fact, the rate of flu in 2023 is actually very similar to pre-COVID years (that is before 2020). As always, the reported cases represent just a fraction of the actual influenza cases. That’s because many people do not seek medical care when infected with influenza or their GP doesn’t always test them for it. <h2>How about an earlier flu season?</h2> Every year, it seems, influenza throws a new curve ball making predictions tricky. Flu rates in the northern hemisphere <a href="https://www.cnet.com/health/medical/early-signs-point-to-this-years-flu-season-being-the-worst-one-in-years/">largely peaked</a> in December 2022, two months earlier than usual. But there has been some late-season influenza B activity in the northern hemisphere this year. This is one type of influenza that causes seasonal flu. So travellers arriving/returning from the northern hemisphere have been bringing influenza to Australia for several months. So we expect more cases of influenza. Australia may even have an autumn surge. This occurred <a href="https://www.bmj.com/content/379/bmj.o2998">last year</a>, where influenza cases rose sharply in May, and peaked by June. That’s two months earlier than the five-year average pre-COVID. Before COVID, influenza cases usually began to rise in April/May. This progressed to a full epidemic from June to August, often extending into September, before waning in October. <h2>So what can we expect in 2023?</h2> The start, length and severity of influenza seasons vary and are often unpredictable. Community immunity will be less than in pre-COVID times. That’s because of fewer influenza infections during COVID restrictions plus <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/national-influenza-vaccination-coverage-all-people">lower influenza vaccine uptake</a> in recent years. So the 2023 flu season may be at least moderately severe. This remains speculation. Flu routinely surprises us. The severity of the coming Australian influenza season will be influenced by the types of influenza that circulate, when the surge starts and when the season peaks. The effectiveness, uptake and timing of vaccinations and the degree of remaining herd immunity will all be important. <h2>Plan to get vaccinated</h2> Only about 40% of those eligible were vaccinated against influenza in 2022, according to the <a href="https://www.servicesaustralia.gov.au/australian-immunisation-register">Australian Immunisation Register</a> database. Rates <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/national-influenza-vaccination-coverage-all-people">were highest</a> in people aged 65 or older. However, as we saw an early influenza season in 2022 (peaking in May/June) this meant many Australians were not vaccinated during the early stages of the epidemic. With this knowledge, it’s important to be vaccinated in April/May before influenza becomes common. Now is a good time to start preparing to get your flu vaccine. Ask your GP or pharmacist when you can book yourself in. Vaccination is our best defence against influenza and is recommended from the age of <a href="https://www.health.gov.au/news/2023-national-immunisation-program-influenza-vaccination-early-advice-for-vaccination-providers">6 months</a>. Younger infants <a href="https://www.health.gov.au/influenza-vaccination-in-pregnancy">receive protection</a> if their mum was vaccinated during pregnancy. The 2023 vaccine has been updated to protect against more recently circulating strains. There are also <a href="https://www.health.gov.au/sites/default/files/2023-03/atagi-advice-on-seasonal-influenza-vaccines-in-2023.pdf">different types</a> of influenza vaccine, some more effective in elderly people, some free under the <a href="https://www.health.gov.au/resources/publications/national-immunisation-program-schedule?language=en">National Immunisation Program</a>, some not. Other vaccines are available for people with egg allergies and for small children. It’s best to discuss the vaccine options with your GP or pharmacist. Image credit: Shutterstock This article originally appeared on <a href="https://theconversation.com/are-flu-cases-already-100-times-higher-than-last-year-heres-what-we-really-know-about-the-2023-flu-season-201559" target="_blank" rel="noopener">The Conversation</a>

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What is my PCR test testing for?

As <a href="https://cosmosmagazine.com/australia/2022-flu-season-australia-influenza/" target="_blank" rel="noreferrer noopener">COVID and flu collide</a> to create a <a href="https://cosmosmagazine.com/health/covid-changing-flu-season-flurona/" target="_blank" rel="noreferrer noopener">winter of sick days</a>, it’s not obvious <a href="https://cosmosmagazine.com/australia/explainer-do-i-have-covid-or-flu/" target="_blank" rel="noreferrer noopener">which illness you have</a>. And some people undergoing PCR (polymerase chain reaction) tests for COVID have discovered that their samples are also being tested for influenza and other bugs. How does this work, and where are COVID tests being used to find more than just COVID? At this point, we’re all well-versed on the <a href="https://cosmosmagazine.com/health/covid/rise-of-rapid-antigen-testing/" target="_blank" rel="noreferrer noopener">different COVID tests you can get</a> – RATs can be done at home but are less accurate, while <a href="https://cosmosmagazine.com/science/what-is-pcr/" target="_blank" rel="noreferrer noopener">PCR tests</a> are more reliable. In brief, PCR tests work by identifying and amplifying viral DNA or RNA. If you’re looking for the presence of SARS-CoV-2, you add a primer (a specific type of DNA) for SARS-CoV-2 to the sample and it amplifies the presence of SARS-CoV-2 in the sample. (You can learn about PCR tests in more detail in <a href="https://cosmosmagazine.com/science/what-is-pcr/" target="_blank" rel="noreferrer noopener">these</a> <a href="https://cosmosmagazine.com/science/how-is-rt-pcr-used-to-diagnose-covid-19/" target="_blank" rel="noreferrer noopener">articles</a>.) <div class="newsletter-box"> <div id="wpcf7-f6-p196191-o1" class="wpcf7" dir="ltr" lang="en-US" role="form"> </div> </div> Looking for influenza uses the same trick: you just use an influenza primer rather than one for SARS-CoV-2. The DNA primer added has a different “code”, but all the other parts of the test and equipment used to do it are the same. You can also use PCR to find other viruses that cause cold symptoms – like rhinoviruses, respiratory syncytial viruses (RSV), or adenoviruses. All of these tests can be undertaken using the same original swab sample. If it’s possible to test for all these viruses with PCR, why haven’t we been doing so until recently? Many of us over the past two years have used a PCR test to establish we don’t have COVID, but we definitely have something. Testing for a variety of things is often done on healthcare workers or people with specific vulnerabilities, but most people don’t benefit from knowing whether they’re sick with a rhinovirus or an adenovirus. Additional tests use additional resources for little advantage. However, with the unusually early arrival of the flu season, it has become more useful to monitor for influenza. Private providers, in particular, may check for viruses other than SARS-CoV-2, depending on the resources and government rebates available to them. <img id="cosmos-post-tracker" style="opacity: 0; height: 1px!important; width: 1px!important; border: 0!important; position: absolute!important; z-index: -1!important;" src="https://syndication.cosmosmagazine.com/?id=196191&title=What+is+my+PCR+test+testing+for%3F" width="1" height="1" /> <div id="contributors"> <a href="https://cosmosmagazine.com/health/pcr-covid-influenza-rsv/" target="_blank" rel="noopener">This article</a> was originally published on <a href="https://cosmosmagazine.com" target="_blank" rel="noopener">Cosmos Magazine</a> and was written by <a href="https://cosmosmagazine.com/contributor/ellen-phiddian" target="_blank" rel="noopener">Ellen Phiddian</a>. Ellen Phiddian is a science journalist at Cosmos. She has a BSc (Honours) in chemistry and science communication, and an MSc in science communication, both from the Australian National University. Image: Getty Images </div>

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Why can you still get influenza if you’ve had a flu shot?

Restrictions have eased, international borders are open and influenza is back in Australia after a two-year absence. Suddenly, major <a href="https://www.abc.net.au/news/2022-06-08/medical-evacuations-as-flu-arrives-early-in-nt/101132294" target="_blank" rel="noopener">flu outbreaks</a> are occurring across the country, catching many off guard. Flu vaccinations aim to protect against four influenza viruses that cause disease in humans (two subtypes from influenza A and two from influenza B). But vaccine-mediated protection varies each year depending on how well the vaccine matches the disease-causing influenza viruses that are circulating at a given time. Vaccine effectiveness – a real-world measure based on the proportion of vaccinated people who still develop the flu – <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm" target="_blank" rel="noopener">ranges</a> from <a href="https://www.clinicaltrialsarena.com/comment/us-flu-vaccine-efficacy/" target="_blank" rel="noopener">16%</a> to <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/%24File/Vacc-efficacy-effect-impact-Oct18.pdf" target="_blank" rel="noopener">60%</a>. However, it’s still important to get your flu shot. If you’ve been vaccinated and still get the flu, you’re <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm" target="_blank" rel="noopener">less likely</a> to get as sick. <h2>Why it’s difficult to predict which subtypes will dominate</h2> Of the four types of influenza viruses that exist in nature, two cause significant disease in humans: influenza A and influenza B. The 2022 influenza vaccine is quadrivalent (targets four distinct viruses): two influenza A viruses (subtypes H3N2 and H1N1) and two influenza B viruses from distinct lineages. Within each flu A subtype further genetic variation can arise, with mutations (known as genetic drift) generating many viral variants that are classified into “clades” and sub-clades. H3N2 is particularly good at generating lots of diversity in this way. So predicting exactly which H3N2 virus to target in the vaccine is especially difficult. A key challenge for flu vaccines is the decision for which virus to target has to be made months ahead of time. The the H3N2 virus in the Australian flu vaccine (A/Darwin/9/2021) was chosen in September 2021 to enable the vaccine to be manufactured and distributed in time for the 2022 winter. There is no guarantee a different H3N2 virus that isn’t so well targeted by the vaccine won’t arrive in the country in the months leading into winter and start causing disease. Another factor that has made predicting which H3N2 virus to target in the vaccine uniquely difficult for 2022 is the lack of data on which viruses were dominant in the preceding flu seasons, both in Australia and on the other side of the Equator. With travel restrictions easing towards the end of 2021, flu cases did start to reappear during the northern hemisphere 2021-22 winter. But the lack of flu cases during the preceding seasons (due to COVID) meant the data used to predict which viruses to target was inadequate. The US Centers for Disease Control (CDC) analysed data from more than 3,000 children and <a href="https://www.clinicaltrialsarena.com/comment/us-flu-vaccine-efficacy/" target="_blank" rel="noopener">found</a> a vaccine effectiveness of just 16% protection from mild to moderate disease from H3N2. Protection from more severe disease was just 14%. <h2>We don’t know which subtypes will circulate in Australia</h2> Data about flu vaccine effectiveness in the southern hemisphere 2022 winter isn’t yet available, and it’s unclear how protective the current vaccine is against the currently circulating disease-causing subtypes. While H3N2 viruses appears to be <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/%24File/flu-05-2022.pdf" target="_blank" rel="noopener">driving some disease now</a>, other flu viruses may become more prevalent later in the season. The flu vaccine is a quadrivalent vaccine, so in addition to influenza A H3N2, it will protect against another influenza A subtype (H1N1) and two distinct lineages of influenza B virus. These viruses don’t change as rapidly as H3N2, so it’s more likely the vaccine will give better protection against these other influenza viruses. Even if vaccine protection against H3N2 is lower than usual this year, the vaccine <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm" target="_blank" rel="noopener">could make the difference</a> between recovering at home versus ending up in hospital. <h2>So who should get a flu shot and when?</h2> The flu vaccine offers the highest level of protection in the first three to four months months after vaccination. The season <a href="https://www.health.gov.au/health-topics/immunisation/vaccines/influenza-flu-vaccine" target="_blank" rel="noopener">generally peaks</a> between June and September – although this year we have seen a much earlier than usual start to the flu season. It’s unclear whether this early start will mean a longer flu season or an early finish. So it’s not too late to get vaccinated. Flu vaccines <a href="https://www.health.gov.au/health-topics/immunisation/vaccines/influenza-flu-vaccine" target="_blank" rel="noopener">are recommended</a> for everyone aged six months and over, but are particularly important for people who are more at risk of complications from influenza, including: <ul> <li>Aboriginal and Torres Strait Islander people aged six months and over</li> <li>children aged six months to five years</li> <li>pregnant women</li> <li>people aged 65 years or over</li> <li>people aged six months or over who have medical conditions that mean they have a higher risk of getting serious disease.</li> </ul> <h2>What if you still get the flu?</h2> If you develop flu symptoms, isolate and <a href="https://www.health.gov.au/health-topics/flu-influenza#diagnosis" target="_blank" rel="noopener">see your GP</a> for an influenza PCR test to determine whether you are indeed infected with influenza, particularly if you’re in the higher-risk groups. Specific antivirals for influenza <a href="https://www.health.gov.au/health-topics/flu-influenza#treatment" target="_blank" rel="noopener">can help</a>, if given early. To ensure rapid access to particularly vulnerable aged-care residents, aged-care facilities are being <a href="https://www1.racgp.org.au/newsgp/clinical/plans-ramp-up-for-tamiflu-deployment-in-aged-care" target="_blank" rel="noopener">stocked</a> with the flu antiviral drug Tamiflu. In New South Wales, free <a href="https://www.newsofthearea.com.au/4cyte-drive-through-covid-19-testing-centres-to-conduct-conduct-influenza-and-rsv-testing-94671" target="_blank" rel="noopener">drive-through clinics</a> now offer testing for influenza, respiratory syncytial virus (RSV) and SARS-CoV-2, the virus that causes COVID. Other states and territories may follow. This article originally appeared on <a href="https://theconversation.com/why-can-you-still-get-influenza-if-youve-had-a-flu-shot-184327" target="_blank" rel="noopener">The Conversation</a>. Image: Shutterstock

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13 foods doctors eat when they have a cold

That age-old advice is dead-on: when you’re sick, your body needs extra fuel in the form of kilojoules to defend against germs and mount an immune response. “What you eat can be one of the best weapons in your arsenal,” says pulmonologist, Dr Gustavo Ferrer. The right nutrients can give your immune system a much-needed boost, help clear up some of those irritating symptoms, and get you back on your feet faster. Doctors shared their favourite home remedies when they feel a cold coming on – and some of their recommendations may surprise you. Chicken soup It’s not just for your soul – chicken soup may actually help fight upper respiratory tract infections, according to an older, but classic study published in the journal Chest that looked at how immune cells responded in the laboratory. “When we get attacked by a virus, our natural defences can cause an inflammatory response,” says Dr Ferrer. Some combination of ingredients in the soup may inhibit the white blood cell activity that can cause inflammation. Strawberries These berries are brimming with antioxidant power – they’re among the top 20 richest fruits when it comes to free radical slaying compounds – particularly vitamin C. And last year, a study in the journal Nutrients found that getting up to eight grams of vitamin C a day can help shorten the length of a cold. Adding a cup of sliced strawberries to your smoothie will net you about 100 milligrams of vitamin C. Garlic This potent bulb contains a compound known as allicin, which has antibacterial and antiviral properties that may help fight off the common cold. Chopping or crushing garlic activates this compound, so for maximum results, prep it and let it sit for several minutes before eating it. In research published in the Cochrane Database of Systemic Reviews, people who took a garlic supplement daily reported fewer colds over a three-month span than those who popped a placebo. Honey Sore throat? The sticky, sweet nectar was found to be superior to many over-the-counter cough suppressants, Dr Ferrer says. For a soothing elixir that’s the bee’s knees, combine honey with lemon juice for a little vitamin C antioxidant action, he adds. Carrots These may be one of the ingredients that give chicken soup its curative properties. Carrots and other orange-hued produce contain beta-carotene. Your body converts this compound to vitamin A, a building block of your immune system, says Dr Eudene Harry. Onions These aromatics contain quercetin, an antioxidant with antiviral and anti-inflammatory properties. “A lot of the symptoms you get when you’re sick is your body hyper-responding to things that are not necessarily a threat,” says Dr Harry. “Antioxidants help quell some of that response so it doesn’t get out of control. They remove waste products and reduce inflammation,” she says. Capsicum Research shows that being cold may suppress your immune system a bit, but vitamin C has natural immune-boosting properties. Loading up on C-rich foods can be a good way to compensate for a suppressed immune function during the chillier months, Dr Harry says. A cup of chopped capsicum has two times as much vitamin C as a medium orange. Green tea Fluids are important when you’re sick because, Dr Harry says, “Everything works better when you’re hydrated.” Green tea is a good choice because it contains the potent antioxidants catechins, along with theanine, an amino acid. Both have been linked to immunity, research shows. Ginger If the dreaded stomach flu is going around, stock up on this relieving root. It’s known for its anti-nausea properties. It also contains compounds known as gingerols that have an anti-inflammatory effect, which makes it an ideal addition to a cup of tea for soothing a sore throat. Dr Harry likes to take hers with ginger, pomegranate and lemon. Mushrooms These fungi are one of the few edible sources of vitamin D, which we normally get from the sun. Shorter daylight hours during the autumn and winter months can mean we’re not getting enough of that nutrient, which can open the door to lowered immunity. Mushrooms don’t naturally contain that much vitamin D, but if they are grown in the presence of ultraviolet light they will produce more. (Check the package for actual content of vitamin D.) Shiitake mushrooms, in particular, may help in this regard, says associate professor of medicine, Dr Gerard Mullin. A study published in the Journal of the American College of Nutrition showed that people who ate 5 or 10 grams of shiitake mushrooms a day had improved markers of immunity, including better-functioning gamma delta T cells and reductions in inflammatory proteins in their blood. Hot sauce A big hit of wasabi or sriracha can feel like it’s clearing your sinuses even when you’re not sick – and it turns out, that could very well be the case. A Cochrane review of research on nasal sprays containing capsaicin, the active compound in chilli peppers and other spicy foods, improves symptoms of nonallergic rhinitis (aka sneezing, congestion) better than a placebo, possibly because of its anti-inflammatory effect. Plus, spicy peppers are another good source of vitamin C. Turmeric Spiking your coffee with this spice, aka a golden latte, won’t hurt. Curcumin, the active compound in the vibrant yellow powder, has anti-inflammatory, antibacterial and antiviral properties. “Oxidative stress goes up when your body is under attack,” says Dr Mullin. That can cause residual damage beyond what the invading germs cause. Turmeric, he says, can help with that. YoghurtFermented dairy products may not be your go-to when you’re feeling under the weather, but they should be, says Dr Mullin. “Most of your immune system is in your gut,” he explains, and probiotic-containing foods like yoghurt help keep your gastrointestinal tract teeming with healthy bacteria. Indeed, research has found that the benefits go beyond digestive health: a 2017 study in the journal Nutrients found that eating yoghurt daily increase the activity of killer T cells, whose job it is to destroy infected cells in the body. And there’s no evidence that dairy creates phlegm or contributes to congestion, so spoon away! This article originally appeared on <a href="https://www.readersdigest.com.au/healthsmart/13-foods-doctors-eat-when-they-have-a-cold" target="_blank" rel="noopener">Reader’s Digest</a>.

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Three reasons you haven’t caught Covid yet

Most of us have been in close contact with someone who contracted Covid but never tested positive ourselves. It raises questions as to why you would not test positive yourself despite being in the same room as a positive case, sharing food and drink despite how infectious the virus is. There are three possible reasons as to why you still haven’t caught Covid, despite the situation leaving doctors stumped. Australian National University lecturer and epidemiologist Dr Katrina Roper helps explain the three main reasons why some don’t test positive. Common cold Before Covid, we’d all be exposed to the common cold which would help build immunity against other viruses. “Having a prior infection to another cold virus can confer some protection to Covid, or other respiratory viruses,” Dr Roper told <a href="https://www.news.com.au/lifestyle/health/health-problems/a-doctor-explains-why-you-havent-caught-covid-yet/news-story/d57a08a08278abf27f43c29fcfe87196" target="_blank" rel="noopener">news.com.au</a>. ”Exposure to other respiratory viruses can prime parts of the immune system, leading to better defence against infection by the SARS CoV-2 infection”. Research published in the Nature Communications journal in January 2022, confirmed the theory that being exposed to Covid won’t always cause an infection. “Being exposed to the SARS-CoV-2 virus doesn’t always result in infection, and we’ve been keen to understand why,” lead author Dr Rhia Kundu wrote. “We found that high levels of pre-existing T cells, created by the body when infected with other human coronaviruses like the common cold, can protect against COVID-19 infection.” Immunologist Professor Stuart Tangye insists that there’s also a possibility that you were infected with Covid but you didn’t know it. Your immune system When it comes to avoiding Covid it could be that your immune system is pretty strong, or the vaccine worked better for you. Dr Roper however did point out that it could also all depend on the individuals’ circumstance - such as their age, weight and how healthy they are. She noted that even the healthiest of people could still have weakened immune systems - citing professional athletes who push themselves and in turn feel worse afterwards. The exposure Again, everyone has been exposed differently to Covid and while some may have contracted it, you didn’t. The circumstances of where you are could be affected such as a large house but only two people living there, giving you ample space to stay away despite sharing the same areas. Genetics Professor Tangye suggested a fourth reason as to why you haven’t contracted Covid despite your exposure. Put simply, your genetics. “There are going to be people who are less susceptible to viral infection because they have differences in their genes, such as genes that are important for viral entry into your cells,” he said. Image: Shutterstock

Caring

New swine flu with pandemic potential found in China

Researchers in China have discovered a strain of swine flu that is capable of triggering another pandemic. A report published in peer-reviewed science journal Proceedings of the National Academy of Sciences earlier this week identified the G4 EA H1N1 strain of flu, which is genetically descended from the H1N1 strain that caused a pandemic in 2009. It has “all the essential hallmarks of a candidate pandemic virus”, scientists at Chinese universities and China’s Center for Disease Control and Prevention said in the study. Researchers took 30,000 nasal swabs from pigs between 2011 and 2018. A total of 179 swine flu viruses were isolated, the majority of which were a new kind that has been dominant among pigs since 2016. Following various experiments, G4 was found to be highly infectious, replicating in human cells and causing more severe symptoms in ferrets than other viruses do. Any immunity humans gain from exposure to seasonal flu does not protect against G4, <a rel="noopener" href="https://www.cbsnews.com/news/new-swine-flu-china-researchers-pandemic/" target="_blank">tests also showed</a>. As many as 4.4 per cent of the general population appeared to have been exposed to the virus, therefore showing that it has passed from animals to humans. There is no evidence yet that the virus can be passed between humans. “Controlling the prevailing G4 EA H1N1 viruses in pigs and close monitoring in human populations, especially the workers in swine industry, should be urgently implemented,” the study authors said. The World Health Organisation will read the Chinese report carefully, spokesman Christian Lindmeier told a Geneva briefing on Tuesday. “It … highlights we cannot let our guard down on influenza and need to be vigilant and continue surveillance even in the coronavirus pandemic,” he said. There is no imminent threat of a new pandemic despite the virus’ capability to infect humans, said Carl Bergstrom, a biologist at the University of Washington. “There’s no evidence that G4 is circulating in humans, despite five years of extensive exposure,” he said on Twitter. “That’s the key context to keep in mind.” The new swine flu is still “in the stage of examination”, said Anthony Fauci, the director of the US National Institute of Allergy and Infectious Diseases. It’s not “an immediate threat where you’re seeing infections, but it’s something we need to keep our eye on, just the way we did in 2009 with the emergence of the swine flu.”

Travel Trouble

Fleas to flu to coronavirus: how ‘death ships’ spread disease through the ages

One of the haunting images of this pandemic will be stationary cruise ships – deadly carriers of COVID-19 – at anchor in harbours and unwanted. Docked in ports and feared. The news of the dramatic spread of the virus on the <a href="https://www.bmj.com/content/369/bmj.m1632">Diamond Princess</a> from early February made the news real for many Australians who’d enjoyed holidays on the seas. Quarantined in Yokohama, Japan, over 700 of the ship’s crew and passengers became infected. To date, <a href="https://www.cruisemapper.com/accidents/Diamond-Princess-534">14 deaths</a> have been recorded. The Diamond Princess’s sister ship, the Ruby Princess, brought the pandemic to Australian shores. Now under <a href="https://www.smh.com.au/national/nsw/police-to-probe-second-ruby-princess-voyage-as-part-of-criminal-investigation-20200417-p54kpo.html">criminal investigation</a>, the events of the Ruby Princess forced a spotlight on the petri dish cruise ships can become. The ship has been <a href="https://www.theguardian.com/australia-news/2020/may/05/ruby-princess-was-initially-refused-permission-to-dock-over-coronavirus-fears-inquiry-told">linked to 21 deaths</a>. History shows the <a href="https://www.ncbi.nlm.nih.gov/pubmed/29737663">devastating role ships can play</a> in transmitting viruses across vast continents and over many centuries. Rats in the ranks Merchant ships carrying rats with infected fleas were transmitters of the <a href="https://academic.oup.com/past/article-abstract/244/1/3/5532056?redirectedFrom=fulltext">Plague of Justinian</a> (541-542 AD) that devastated the Byzantine Empire. Ships carrying grain from Egypt were home to flea-infested rats that fed off the granaries. Contantinople was especially inflicted, with estimates as high as <a href="https://www.history.com/news/microbe-behind-black-death-also-caused-devastating-plague-800-years-earlier">5,000 casualties a day</a>. Globally, up to 50 million people are estimated to have been killed – half the world’s population. The <a href="https://www.historyextra.com/period/medieval/plague-black-death-quarantine-history-how-stop-spread/">Black Death</a> was also carried by rats on merchant ships through the trade routes of Europe. It struck Europe in 1347, when 12 ships docked at the Sicilian port of Messina. Subsequently called “death ships”, those on board were either dead or sick. Soon, the Black Death spread to ports around the world, such as Marseilles, Rome and Florence, and by 1348 had reached London with devastating impact. The Italian writer, poet and scholar, Giovanni Boccaccio, <a href="https://www.historyextra.com/period/medieval/black-death-oh-father-why-have-you-abandoned-me/">wrote</a> how terror swept through Florence with relatives deserting infected family members. Almost inconceivably, he wrote, “fathers and mothers refused to nurse their own children, as though they did not belong to them”. Ships started being <a href="https://www.historyextra.com/period/medieval/plague-black-death-quarantine-history-how-stop-spread/">turned away</a> from European ports in 1347. Venice was the first city to close, with those permitted to enter forced into a 40-day quarantine: the word “quarantine” derives from the Italian quarantena, or 40 days. By January 1349, mass graves proliferated outside of London to bury the increasing numbers of dead. Army and naval ships, as well as travellers around the globe, also carried cholera pandemics throughout the 19th century. In the first pandemic <a href="https://www.history.com/topics/inventions/history-of-cholera">in 1817</a>, British army and navy ships are believed to have spread cholera beyond India where the outbreaks originated. By the 1820s, cholera had spread throughout Asia, reaching Thailand, Indonesia, China and Japan through shipping. British troops spread it to the Persian Gulf, eventually moving through Turkey and Syria. Subsequent outbreaks from the 1820s through to the 1860s relied on trade and troops to spread the disease across continents. At war with the Spanish Flu The Spanish influenza of 1918-1919 was originally carried by soldiers on overcrowded troop ships during the first world war. The rate of transmission on these ships was rapid, and soldiers died in large numbers. One New Zealand rifleman <a href="http://dx.doi.org/10.3201/eid1811.AD1811">wrote</a> in his diary in September 1918: More deaths and burials total now 42. A crying shame but it is only to be expected when human beings are herded together the way they have been on this boat. The flu was transmitted throughout Europe in France, Great Britain, Italy and Spain. Three-quarters of French troops and over half of British troops fell ill in 1918. Hundreds of thousands of US soldiers travelling on troop ships across the Atlantic and back provided the perfect conditions for transmission. The fate of cruising A new and lethal carrier in the 21st century has emerged in the pleasure industry of cruise ships. The <a href="https://www.forbes.com/sites/joemicallef/2020/01/20/state-of-the-cruise-industry-smooth-sailing-into-the-2020s/#364b397665fa">explosion</a> of cruise holidays in the past 20 years has led to a proliferation of luxury liners plying the seas. Like historical pandemics, the current crisis shares the characteristic of rapid spread through ships. The unknown is in what form cruise ships will continue to operate. Unlike the port-to-port trade and armed forces that carried viruses across continents centuries ago, the services cruise lines offer are non-essential. Whatever happens, the global spread of COVID-19 reminds us “death ships” are an enduring feature of the history of pandemics. Written by Joy Damousi. Republished with permission of <a href="https://theconversation.com/fleas-to-flu-to-coronavirus-how-death-ships-spread-disease-through-the-ages-137061">The Conversation.</a>

Cruising

Health check: How long should you stay away when you have a cold or the flu?

Most adults get around <a href="https://www.cdc.gov/features/rhinoviruses/index.html">two to three colds a year</a>, and children get even more. In terms of the flu, there are around <a href="http://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)">3-5 million severe cases of influenza</a> worldwide each year and 290,000 to 650,000 deaths. The symptoms of a cold and the flu are similar, so it’s hard to tell the difference. But the flu is usually more severe and develops more quickly than a cold. Colds and flus can be easily passed from person to person through the air, when an infected person coughs or sneezes, and touch, when a person touches an infected surface or object like doorknobs and light switches. So what’s the difference between colds and flus, and how long should you stay away? Colds Cold <a href="https://www.cdc.gov/features/rhinoviruses/index.html">symptoms</a> include a sore throat, cough, runny or stuffy nose, tiredness and headache. Most people become contagious with cold symptoms one to two days after exposure to a cold virus. These symptoms usually peak two to four days later. The <a href="https://www.ncbi.nlm.nih.gov/pubmed/17397266">common cold usually lasts</a> about ten days. There is nothing you can take to shorten the duration of a cold, and most people will get better without needing to see a doctor. But some over-the-counter medications can help alleviate the symptoms. These include anti-inflammatories (to reduce inflammation or swelling), analgesics (to reduce pain), antipyretics (to reduce fever) and decongestants (to relieve nasal congestion). But be careful you follow the instructions and recommended dosage for these medications. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/29516533">recent study of US adults</a> who used paracetamol, the active ingredient in many cold and flu medicines, found 6.3% of users exceeded the maximum recommended daily dose. This mostly occurred during the cold and flu season. Natural products such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/23440782">vitamin C</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4068831/">echinacea</a> are sometimes recommended to prevent and treat a cold, but there is limited evidence to support their effectiveness. The flu <a href="https://www.cdc.gov/flu/index.htm">Common symptoms of the flu</a> include fever (a temperature of 38°C or higher), cough, chills, sore throat, headache, runny or stuffy nose, tiredness and muscle aches. An infected person can <a href="https://www.cdc.gov/flu/keyfacts.htm">spread the flu</a> for five to seven days after becoming infected. The infectious period can begin 24 hours before the onset of symptoms. This means you can spread the flu without even knowing you’re sick. Influenza viruses can cause mild to severe illness in people of all ages. Most people will fully recover within one to two weeks and won’t require any medical attention. Similar to a cold, people can take some over-the-counter medications and other remedies to help alleviate symptoms. But some people can become acutely unwell with the flu. They may require <a href="http://www.who.int/features/qa/seasonal-influenza/en/">antiviral medication</a> and, in severe cases, hospitalisation. Those at <a href="http://www.who.int/features/qa/seasonal-influenza/en/">high risk</a> include pregnant women, children, the elderly, and people with certain medical conditions such as HIV/AIDS, asthma, diabetes and heart and lung diseases. The flu virus strains that circulate usually change every year, so the <a href="https://www.cdc.gov/flu/protect/vaccine/general.htm">best way to prevent getting the flu</a> is to get the annual flu vaccine. The vaccine is <a href="https://www.sciencedirect.com/science/article/pii/S147330991170295X">moderately effective</a> and recommended for adults and children over the age of six months. Some common side effects may occur, such as temporary soreness, redness and swelling at the injection site, fever, headache, muscle aches and nausea. Avoid passing it on If you feel unwell, stay home from work or school and rest (and get plenty of fluids) until you feel better. If you’ve had a fever, <a href="https://www.cdc.gov/flu/takingcare.htm">stay home for at least 24 hours</a> after the fever has broken. When you go back to work or school, you may still be infectious, so avoid passing the virus on by: <ul> <li>regularly washing your hands with soap and water for at least 20 seconds and drying them properly – if soap and water are not available, use an alcohol-based hand sanitiser</li> <li>practising good cough and sneeze etiquette: cover your mouth and nose with a tissue or your upper shirtsleeve when you cough or sneeze, and throw away used tissues immediately</li> <li>not touching your eyes, nose and mouth</li> <li>frequently cleaning the surfaces and objects you’ve touched.</li> </ul> Written by Nadia Charania. Republished with permission of <a href="https://theconversation.com/health-check-how-long-should-you-stay-away-when-you-have-a-cold-or-the-flu-98702">The Conversation</a>.

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