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Signs and symptoms of flu

What is influenza (flu)?
What are the symptoms of the flu?
Why is there a week-long lag between the data and when it's reported?
How does the flu spread?
If I got the flu last year, will I have immunity against the flu this year?
Does the flu have complications?
How do I find out if I have the flu?
How soon will I get sick if I am exposed to the flu?
How long is a person with flu virus contagious?
How many people get sick or die from the flu every year?
Is the “stomach flu” really the flu?
What kind of flu vaccines are there?
How do flu vaccines work?
Why should people get vaccinated against the flu?
When should I get a flu vaccination?
Is it too late to get vaccinated after Thanksgiving (or the end of November)?
Does flu vaccine work right away?

Can I get the flu even though I got a flu vaccine this year?
Why do I need to get vaccinated against the flu every year?
How are the viruses for flu vaccine selected?
Why do manufacturers and distributors take a phased approach to vaccine distribution?
What are flu antiviral drugs?
What are the treatment benefits of flu antiviral drugs?
How effective are antiviral drugs at preventing the flu?
What can I do to protect myself against the flu?
What are other steps that can be taken to prevent the flu?
Can herbal, homeopathic or other folk remedies protect against the flu?
There is no scientific evidence that any herbal, homeopathic or other folk remedies have any benefit against influenza. How long can human influenza viruses remain viable on inanimate items (such as books and doorknobs)?
Studies have shown that human influenza viruses generally can survive on surfaces for between 2 and 8 hours. What kills influenza virus?

What is influenza (flu)?
Influenza, commonly called "the flu," is caused by the influenza virus, which infects the respiratory tract (nose, throat, lungs). Unlike many other viral respiratory infections, such as the common cold, the flu causes severe illness and life-threatening complications in many people.

What are the symptoms of the flu?
Influenza is a respiratory illness. Symptoms of flu include fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, and muscle aches. Children can have additional gastrointestinal symptoms, such as nausea, vomiting, and diarrhea, but these symptoms are uncommon in adults. Although the term "stomach flu" is sometimes used to describe vomiting, nausea, or diarrhea, these illnesses are caused by certain other viruses, bacteria, or possibly parasites, and are rarely related to influenza. Please also see "Is it a Cold or the Flu".

* Sentinel physician surveillance for influenza-like illness ( ILI ), which tracks the percentage of doctor visits for flu-like symptoms;

* Mortality surveillance

* State and territorial epidemiologist reports of influenza activity, which indicates the number of states affected by flu and the degree to which they are affected;

* Influenza-associated pediatric mortality

* Influenza-associated pediatric hospitalizations as reported through the Emerging Infections Programs in 9 sites which tracks the number of children reported hospitalized for flu-related complications; and

* Influenza-associated pediatric hospitalization as reported through the New Vaccine Surveillance Network in 3 sites, which also tracks the number of children reported hospitalized for flu-related complications.

How does the flu spread?
The main way that influenza viruses are spread is from person to person in respiratory droplets of coughs and sneezes. (This is called "droplet spread.") This can happen when droplets from a cough or sneeze of an infected person are propelled (generally up to 3 feet) through the air and deposited on the mouth or nose of people nearby. Though much less frequent, the viruses also can be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.

If I got the flu last year, will I have immunity against the flu this year?
In general, a person who is infected with an influenza virus one year will have some immunity to closely related viruses that may persist for one or more years. For example, if someone was infected with the A/New Caledonia/20/99-like strain of H1N1 that predominated during the 2006-07 season, they are likely to have some immunity that will protect them if they are exposed to that strain or a closely related strain again during the 2007-08 season. The degree of protection depends on the health of the person involved. Young and healthy people with normal immune systems will likely have good immunity against the same or closely related strains of virus from one year to the next. However, people with weakened immune systems are less likely to have immunity that carries over in other years. It's important to remember that influenza viruses are constantly changing so antibody made against one strain will become less effective against new strains as influenza strains evolve over time.

Does the flu have complications?
Yes. Some of the complications caused by flu include bacterial pneumonia, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes. Children may get sinus problems and ear infections as complications from the flu. Those aged 65 years and older and persons of any age with chronic medical conditions (such as asthma, diabetes, or heart disease) are at highest risk for serious complications of flu.

How do I find out if I have the flu?
It is very difficult to distinguish the flu from other viral or bacterial causes of respiratory illnesses on the basis of symptoms alone. A test can confirm that an illness is influenza if the patient is tested within the first two to three days after symptoms begin. In addition, a doctor's examination may be needed to determine whether a person has another infection that is a complication of influenza.

How soon will I get sick if I am exposed to the flu?
The time from when a person is exposed to flu virus to when symptoms begin is about one to four days, with an average of about two days.

How long is a person with flu virus contagious?
The period when an infected person is contagious depends on the age and health of the person. Studies show that most healthy adults may be able to infect others from 1 day prior to becoming sick and for 5 days after they first develop symptoms. Some young children and people with weakened immune systems may be contagious for longer than a week.

How many people get sick or die from the flu every year?
Is the “stomach flu” really the flu?
No. Many people use the term "stomach flu" to describe illnesses with nausea, vomiting or diarrhea. These symptoms can be caused by many different viruses, bacteria or even parasites. While vomiting, diarrhea, and being nauseous or "sick to your stomach" can sometimes be related to the flu – more commonly in children than adults – these problems are rarely the main symptoms of influenza. The flu is a respiratory disease and not a stomach or intestinal disease.

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. The flu shot is approved for use among people 6 months of age or older, including healthy people and those with chronic medical conditions (such as asthma, diabetes, or heart disease). A different kind of vaccine, called the nasal-spray flu vaccine (sometimes referred to as LAIV for Live Attenuated Influenza Vaccine or FluMist®), 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 2-49 years of age who are not pregnant.

How do flu vaccines work?
Both flu vaccines (the flu shot and the nasal-spray flu vaccine (LAIV)) cause antibodies to develop in the body. 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 and lessen the chance that you will transmit to others.

When should I get a flu vaccination?
In addition, there are other people who may benefit from vaccination as late or April or May, even if influenza viruses are no longer circulating in the United States. This includes:

1. Persons likely to be traveling to the Southern Hemisphere where influenza may be circulating before the 2009-10 vaccine is available, and
2. Children younger than 9 being vaccinated for the first time who still have not received their second recommended dose of vaccine. (If they get their second dose, then they will only need one dose of vaccine next season. If they do not get their second dose, they will still need to get two doses of vaccine the next season in order to best be protected by the vaccine. This is because studies have shown that two doses are needed in children younger than 9 the first year they are vaccinated in order to maximize the protective benefit from vaccination.)

Once you get vaccinated, your body makes protective antibodies in about two weeks. However, children younger than 9 years old who are being vaccinated for the first time still need a second dose 4 or more weeks later in order to be protected.

Does getting vaccinated against flu early in the season pose a risk that immunity may wane before the end of the season?

Flu vaccination provides protection against the influenza strains contained in the vaccine through one influenza season. Vaccination can begin as soon as vaccine is available. Studies have not demonstrated a benefit of receiving more than one dose during an influenza season, even among elderly persons with weakened immune systems.

Is it too late to get vaccinated after Thanksgiving (or the end of November)?

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 vaccinated, and 2) the similarity or "match" between the virus strains in the vaccine and those circulating in the community. If the viruses in the vaccine and the influenza viruses circulating in the community are closely matched, vaccine effectiveness is higher. If they are not closely matched, vaccine effectiveness can be reduced. However, it's important to remember that even when the viruses are not closely matched, the vaccine can still protect many people and prevent flu-related complications. Such protection is possible because antibodies made in response to the vaccine can provide some protection (called cross-protection) against different, but related strains of influenza viruses. For more information about vaccine effectiveness, visit How Well Does the Seasonal Flu Vaccine Work?

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 declines over time and may be too low to provide protection after a year. How are the viruses for flu vaccine selected?

Why do manufacturers and distributors take a phased approach to vaccine distribution?
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 in the United States and the large number of doses that are 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. This system can leave doctors and other vaccine providers with uncertainty about when they can expect to receive their full order of vaccine and can make it difficult for them to plan their vaccination activities. Manufacturers and distributors work 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.

What are flu antiviral drugs?
Flu antiviral drugs are prescription drugs (pills, liquid, or inhaler) that decrease the ability of flu viruses to reproduce. While getting a flu vaccine each year is the first and most important step in protecting against flu, antiviral drugs are a second line of defense in the prevention and treatment of flu.

What are the treatment benefits of flu antiviral drugs?
For treatment, antiviral drugs should be started within 2 days after becoming sick. When used this way, these drugs can reduce the severity of flu symptoms and shorten the time you are sick by 1 or 2 days.

How effective are antiviral drugs at preventing the flu?
When used to prevent the flu, antiviral drugs are about 70% to 90% effective against susceptible viruses (i.e. viruses that are not resistant to the antiviral medication). It’s important to remember that flu antiviral drugs are not a substitute for getting a flu vaccine.

What can I do to protect myself against the flu?
By far, the single best way to prevent the flu is for individuals, especially people at high risk for serious complications from the flu, to get a vaccination each fall. To learn more, see Key Facts about Flu Vaccine.

What are other steps that can be taken to prevent the flu?
There are other good health habits that can help prevent the flu. These are:

* Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.

* If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness.

* Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.

* Washing your hands often will help protect you from germs.

* Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.

Also, antiviral medications may be used to prevent the flu. See Questions and Answers: Antiviral Medications.

Can herbal, homeopathic or other folk remedies protect against the flu?

There is no scientific evidence that any herbal, homeopathic or other folk remedies have any benefit against influenza. How long can human influenza viruses remain viable on inanimate items (such as books and doorknobs)?

Studies have shown that human influenza viruses generally can survive on surfaces for between 2 and 8 hours. What kills influenza virus?

Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against influenza viruses if used in proper concentration for sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed until they are dry.