As we approach the official beginning of autumn, we are entering the annual cold and flu season. This year’s flu season is expected to arrive

early, stay late and be more intense than the flu seasons we have experienced in the recent past. The H1N1 influenza pandemic (aka “swine flu”)

continues to intensify throughout the world, and public health officials fully anticipate a second and third wave of illness similar to what was

experienced in the spring of 2009. Given the magnitude of health implications the flu can have on individuals (and their families), Duke Medicine

is recommending the following steps to stay well this fall and winter.

• Understand the facts about the flu. The H1N1 (aka “swine flu”) and seasonal flu are contagious respiratory illnesses caused by influenza
  viruses. They are spread mainly from person to person through coughing or sneezing and less commonly by touching a contaminated surface.
  The circulating strain of H1N1 causes an illness pattern similar in severity and duration to typical seasonal flu in most patients.

• Know if you are in a high-risk group for complications from influenza. The high-risk groups for complications from H1N1 and
  seasonal influenza are similar. The major difference is that pregnant women and younger patients seem to be at a slightly higher risk to
  contract H1N1 (possibly because older patients have developed immunity to similar viruses over the years). The following are high-risk
  groups whose Duke health care provider should be contacted immediately if they become ill with influenza like symptoms: children less
  than 5 years old, pregnant women, adults and children who have chronic illnesses or compromised immune systems, persons aged 65
  years or older, residents of nursing homes and other chronic-care facilities.

• Understand the symptoms associated with the flu. Seasonal and H1N1flu symptoms are indistinguishable. They include: fever,
  sore throat, chills, body aches, cough, runny or stuffy nose, diarrhea, vomiting and headache. Please note that many of the recommendations
  regarding when it is safe to return to work or school are based on knowing your body’s temperature. If you don’t have a thermometer in
  the house, consider purchasing one now.

• Understand when to seek medical care. Most patients recover from the flu completely in a few days and do not require a visit to their
  health care provider. But it is important to know when you should seek medical care. Flu symptoms typically resolve in 5 days, but if your
  symptoms persist beyond 5 days, contact your primary care doctor. If you have any of the following potentially life-threatening symptoms
  while battling the flu, immediately contact your health care provider or go to the closest Emergency Department: difficulty breathing or
  shortness of breath, pain or pressure in the chest or abdomen, sudden dizziness, confusion, severe or persistent vomiting, flu symptoms
  that initially improve but then return with cough and fever. Infants should be taken immediately to the Emergency Department if there is a
  bluish or gray skin color, lack of responsiveness or extreme irritability. 

• Get a seasonal flu shot! The seasonal flu vaccine is the single best way to avoid getting the seasonal flu. It does not protect you from
  the H1N1 (aka “swine”) flu, but is highly effective against most strains of the seasonal flu. Duke Clinics will begin offering seasonal flu shots
  as early as mid-September this year. By obtaining your flu vaccine well before the peak of flu season, you give your body the ability to build
  immunity to the flu before you are exposed. It takes about two weeks for your body to fully build its defenses after receiving the vaccine. 

• Consider getting the H1N1 vaccine. This year in addition to the seasonal flu vaccine there will be a separate vaccine for H1N1. This may
  be a one part or two part vaccine aimed directly at the circulating H1N1 influenza virus. The vaccine is highly recommended (and will be
  prioritized) for pregnant women, people who live with or care for children younger than 6 months of age, health care and emergency medical
  services personnel, persons between the ages of 6 months and 24 years old, and people ages 25 through 64 who are at higher risk for 2009
  H1N1 because of chronic health disorders or compromised immune systems. Once there is adequate supply of the vaccine, we encourage all
  patients to get vaccinated. Talk with your health care provider about when you should be vaccinated for H1N1.

• If you’re sick, stay home! The flu is spread when an infected individual coughs and sneezes. Once it is in the environment, the rest of us
  can get from handshakes, by simply being in close contact with someone who is infected, or by touching contaminated surfaces. If you come
  down with flu-like symptoms, stay home (away from other people) until at least 24 hours after your fever has naturally resolved. 

• Wash your hands frequently. Frequent hand washing is a simple activity to avoid a multitude of infections – including the seasonal flu,
  swine flu and the common cold. Wash your hands well using soap and water; alcohol-based hand gels are a good alternative when you are
  away from a sink. Avoid touching your eyes, nose and mouth, as these are the routes of entry for cold and flu viruses into the body.

• “Eat right and sleep tight. Stay hydrated.” Diet and sleep patterns have a profound effect on your body’s ability to fight infection and disease.
  Eating green, red and yellow fruits and vegetables and sleeping a minimum of 8 hours a night boosts your body’s immune system. A healthy adult
  needs to drink about 64 ounces of water each day. 

• Stay calm and don’t panic. Pandemics can be scary times – but rest assured the federal, state and county governments and Duke University
  Health System are all working together to address this pandemic. Duke Medicine is committed to helping you and your families stay healthy this
  cold and flu season. Please do not hesitate to visit www.dukehealth.org/flu for updates on the flu season, or contact your health care provider
  with questions.

William J. Fulkerson, MD