Influenza 

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What is Influenza (Also Called Flu)?

The flu is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccination each year.

Every year in the United States, on average:

• 5% to 20% of the population gets the flu;
• more than 200,000 people are hospitalized from flu complications, and;
• about 36,000 people die from flu.

Some people, such as older people, young children, and people with certain health conditions, are at high risk for serious flu complications.

Symptoms of Flu

Symptoms of flu include:

Complications of Flu

Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

How Flu Spreads

Flu viruses spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

Preventing the Flu: Get Vaccinated

The single best way to prevent the flu is to get a flu vaccination each year. There are two types of vaccines:

• The "flu shot" – an inactivated vaccine (containing killed virus) that is given with a needle. The flu shot is approved for use in people 6 months of age and older, including healthy people and people with chronic medical conditions.
• The nasal-spray flu vaccine – a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for “Live Attenuated Influenza Vaccine”). LAIV is approved for use in healthy people 5 years to 49 years of age who are not pregnant.

About two weeks after vaccination, antibodies develop that protect against influenza virus infection. Flu vaccines will not protect against flu-like illnesses caused by non-influenza viruses.

When to Get Vaccinated

October or November is the best time to get vaccinated, but getting vaccinated in December or even later can still be beneficial since most influenza activity occurs in January or later in most years. Though it varies, flu season can last as late as May.

Who Should Get Vaccinated?

In general, anyone who wants to reduce their chances of getting the flu can get vaccinated. However, certain people should get vaccinated each year either because they are at high risk of having serious flu-related complications or because they live with or care for high risk persons. During flu seasons when vaccine supplies are limited or delayed, the Advisory Committee on Immunization Practices (ACIP) makes recommendations regarding priority groups for vaccination.

People who should get vaccinated each year are:

1. People at high risk for complications from the flu, including:

• Children aged 6 months until their 5th birthday,
• Pregnant women,
• People 50 years of age and older,
• People of any age with certain chronic medical conditions, and
• People who live in nursing homes and other long term care facilities.

2. People who live with or care for those at high risk for complications from flu, including:

• Household contacts of persons at high risk for complications from the flu (see above)
• Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
• Health care workers.

3. Anyone who wants to decrease their risk of influenza.

Use of the Nasal Spray Flu Vaccine

Vaccination with the nasal-spray flu vaccine is an option for healthy persons aged 5-49 years who are not pregnant, even healthy persons who live with or care for those in a high risk group. The one exception is healthy persons who care for persons with severely weakened immune systems who require a protected environment; these healthy persons should get the inactivated vaccine.

Who Should Not Be Vaccinated

Some people should not be vaccinated without first consulting a physician. They include:

• People who have a severe allergy to chicken eggs.
• People who have had a severe reaction to an influenza vaccination in the past.
• People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.
• Children less than 6 months of age (influenza vaccine is not approved for use in this age group).
• People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.

Preventing the Flu

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There are many actions you can take to protect yourself and others from the flu:

• Vaccination
  The single best way to prevent the flu is to get vaccinated each year.
• Good Health Habits
  Simple steps you can take in your day-to-day life can help you stay healthy during flu season.
• Antiviral Drugs
  Four antiviral drugs (amantadine, rimantadine, zanamavir, and oseltamivir) are approved for use in preventing the flu.
• More Information
• Protecting Children
  Parents, schools, and child care providers can take steps to reduce the risk of flu among children under their care…
• Information for Health Professionals
  Guidance for vaccination, treatment, infection control, and more…

What kind of flu vaccines are there?
There are two types of vaccines that protect against the flu. The "flu shot" is an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. A different kind of vaccine, called the nasal-spray flu vaccine (sometimes referred to as LAIV for Live Attenuated Influenza Vaccine), was approved in 2003. The nasal-spray flu vaccine contains attenuated (weakened) live viruses, and is administered by nasal sprayer. It is approved for use only among healthy people between the ages of 5 and 49 years. The flu shot is approved for use among people over 6 months of age, including healthy people and those with chronic medical conditions.

Each of the two vaccines contains three influenza viruses, representing one of the three groups of viruses circulating among people in a given year. Each of the three vaccine strains in both vaccines – one A (H3N2) virus, one A (H1N1) virus, and one B virus – are representative of the influenza vaccine strains recommended for that year. Viruses for both vaccines are grown in eggs.

How do flu vaccines work?
Both flu vaccines (the flu shot and the nasal-spray flu vaccine (LAIV)) work in the same way; they cause antibodies to develop in the body, and these antibodies provide protection against influenza virus infection.

Why should people get vaccinated against the flu?
Influenza is a serious disease, and people of any age can get it. In an average year, the flu causes 36,000 deaths (mostly among those aged 65 years or older) and more than 200,000 hospitalizations in the United States. The "flu season" in the United States is usually from November through April each year. During this time, flu viruses are circulating in the population. An annual flu vaccine (either the flu shot or the nasal-spray flu vaccine) is the best way to reduce the chances that you will get the flu.

When should I get a flu vaccination?
Beginning each September, the flu shot should be offered to people when they are seen by health-care providers for routine care or as a result of hospitalization. See the ACIP Recommendations for Using Inactivated Influenza Vaccine.

Try to get vaccinated in October or November because flu activity in the United States generally peaks between late December and early March.

You can still benefit from getting vaccinated after November, even if flu is present in your community. Vaccine should continue to be offered to unvaccinated people throughout the flu season as long as vaccine is still available. Once you get vaccinated, your body makes protective antibodies in about two weeks.

Does flu vaccine work right away?
No. It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against influenza virus infection. In the meantime, you are still at risk for getting the flu. That's why it's better to get vaccinated early in the fall, before the flu season really gets under way.

Can I get the flu even though I got a flu vaccine this year?
Yes. The ability of flu vaccine to protect a person depends on two things: 1) the age and health status of the person getting the vaccine, and 2) the similarity or "match" between the virus strains in the vaccine and those in circulation.

Why do I need to get vaccinated against the flu every year?
Flu viruses change from year to year, which means two things. First, you can get the flu more than once during your lifetime. The immunity (natural protection that develops against a disease after a person has had that disease) that is built up from having the flu caused by one virus strain doesn't always provide protection when a new strain is circulating. Second, a vaccine made against flu viruses circulating last year may not protect against the newer viruses. That is why the influenza vaccine is updated to include current viruses every year.

Another reason to get flu vaccine every year is that after you get vaccinated, your immunity to the disease declines over time and may be too low to provide protection after one year.

How are the viruses for flu vaccine selected?
Each year, many laboratories throughout the world, including in the United States, collect flu viruses. Some of these flu viruses are sent to one of four World Health Organization (WHO) reference laboratories, one of which is at the Centers for Disease Control and Prevention (CDC) in Atlanta, for detailed testing. These laboratories also test how well antibodies made to the current vaccine react to the circulating virus and new flu viruses. This information, along with information about flu activity, is summarized and presented to an advisory committee of the U.S. Food and Drug Administration (FDA) and at a WHO meeting. These meetings result in the selection of three viruses (two subtypes of influenza A viruses and one influenza B virus) to go into flu vaccines for the following fall and winter. Usually, one or two of the three virus strains in the vaccine are changed each year.

Is there enough influenza vaccine for the 2006-'07 season?
Yes. At the current time, the 4 U.S. influenza vaccine manufacturers are projecting that as many as 110-115 million doses of influenza vaccine will be available in the U.S. for use during the 2006-07 influenza season. This will be the most flu vaccine ever distributed in the U.S. during a single influenza season.

When will supplies be made available?
Manufacturers have begun to ship this season’s influenza vaccine. Approximately 40 million doses were distributed by the second week of October and 75 million doses are expected to be distributed by the end of October.

We wish that the nation's full supply of flu vaccine could be produced and distributed by the beginning of October of each year. But, given how flu vaccine is currently produced that is not possible. The influenza manufacturing process is complex. Influenza viruses vary from year to year, so influenza vaccine must be updated annually to include the viruses that are expected to circulate in the upcoming season. Once viruses are selected for the new vaccine, manufacturers must operate under a very tight timeline. Influenza vaccine production begins as early as 6-9 months before the beginning of vaccine distribution. Even with this early start, it isn't possible to complete the entire production and distribution process prior to the vaccination season, particularly given the limited number of influenza vaccine manufacturing plants that we have in the United States and the large number of doses that are required to be produced each year. Instead, influenza vaccine distribution takes place in a phased fashion over a number of months. It begins in late summer for some manufacturers and vaccine products and usually completes near the end of November or early in December. Unfortunately, this situation leaves doctors and other vaccine providers with uncertainty about when they can expect to receive their full order and makes it difficult for them to plan their vaccination activities. Manufacturers and distributors are working to try to get some vaccine to as many providers as possible as soon as possible so that they can begin vaccinating their patients. Getting some vaccine to all providers early in the season is important, because all providers serve at least some high-risk patients (such as people 50 years of age and older or those with chronic health conditions such as asthma, kidney disease, diabetes, lung disease and weakened immune system) and their household contacts.

Influenza vaccine production and distribution are primarily private sector endeavors. The Department of Health and Human Services and CDC do not have the authority to control influenza vaccine distribution nor the resources to manage such an effort. However, the Department has made significant efforts to enhance production capacity of seasonal influenza vaccines, including supporting manufacturers as they invest in processes to stabilize and increase their production capacity and improving guidance about the approval process at the Food and Drug Administration.