Influenza (Flu)

Signs and Symptoms

The flu is often confused with the common cold, but flu symptoms usually are more severe than the typical sneezing and stuffiness of a cold.

Symptoms, which usually begin about 2 days after exposure to the virus, can include:

• fever
• chills
• headache
• muscle aches
• dizziness
• loss of appetite
• tiredness
• cough
• sore throat
• runny nose
• nausea or vomiting
• weakness
• ear pain
• diarrhea

Infants with the flu also may seem fussy all of a sudden or just "not look right."

Duration

After 5 days, fever and other symptoms have usually disappeared, but a cough and weakness may continue.

All symptoms are usually gone within a week or two. However, it's important to treat the flu seriously because it can lead to pneumonia and other life-threatening complications, particularly in infants, senior citizens, and people with long-term health problems.

Contagiousness

The flu is contagious, spread by virus-infected droplets that are coughed or sneezed into the air. People who are infected are contagious from a day before they feel sick until their symptoms have ended (about 1 week for adults, but this can be longer for young kids).

The flu usually occurs in small outbreaks, but epidemics — when the illness spreads rapidly and affects many people in an area at the same time — tend to occur every few years. Epidemics often peak within 2 or 3 weeks after the first cases occur.

When an epidemic spreads worldwide, it's called a pandemic. The most recent flu pandemic occurred in 2009, with the H1N1 ("swine") flu.

The Flu Vaccine

Routine annual influenza vaccination is recommended for everyone 6 months old and older. It's usually offered between September and mid-November, but may be given at other times of the year. Vaccination reduces the average person's chances of catching the flu by up to 80% during flu season.

The vaccine prevents against infection from the flu viruses that researchers predict will be most common in the upcoming year. While the vaccine doesn't completely guarantee against getting sick, someone who's been vaccinated and still gets the flu will have fewer and milder symptoms.

Flu vaccines are available as a shot or nasal mist:

• Given as an injection, the flu shot contains killed flu viruses that will not cause the flu, but will prepare the body to fight off infection from that particular type of live flu virus if someone comes into contact with it.
• The nasal mist contains weakened live flu viruses that cannot cause the severe symptoms typically associated with the flu, but can cause some mild symptoms. As a result, people with weakened immune systems or certain health conditions should not get the nasal mist vaccine. It is only for healthy, non-pregnant people between 2 and 49 years old.

When & Where to Get It

People who got the vaccine one year aren't protected from getting the flu the next because the protection wears off and flu viruses constantly change. That's why the vaccine is updated each year to include the most current strains of the virus.

So to have the best protection against the flu, it's important to get the vaccine every year.

The seasonal flu vaccine becomes available each fall. It is given in places like hospitals, clinics, community centers, pharmacies, doctor's offices, and schools. Many kids receive the flu vaccine at school.

Kids under 9 years old who get a flu shot for the first time will receive two separate shots a month apart. It can take about 2 weeks after the shot for the body to build up protection to the flu.

Getting the shot before the flu season is in full force gives the body a chance to build up immunity to, or protection from, the virus. Although you can get a flu shot well into flu season, it's best to try to get it earlier rather than later. However, even as late as January there are still 2 or 3 months left in the flu season, so it's still a good idea to get protection.

If you are traveling outside the country, be sure to check with your doctor because the flu season may be different in other countries. If you are traveling to a place with flu activity, make sure you are vaccinated at least 2 weeks before travel.

Possible Side Effects

While very few people get side effects from the seasonal flu vaccine, those who do may have soreness or swelling at the site of the injection or mild side effects, such as headache or low-grade fever.

Some people who get the nasal spray vaccine also may develop mild flu-like symptoms, including runny nose, headache, vomiting, muscle aches, and fever.

Although these side effects might last for a day or so, flu viruses can potentially sicken someone for weeks and cause health problems that could require hospitalization, especially in young children or people with chronic diseases. As a result, doctors believe that the benefits of getting the flu vaccine outweigh any potential risks.

Who Is Considered High Risk?

Although flu vaccine is recommended for everyone aged 6 months or older, in times when the vaccine is in short supply, certain people need it more than others. The Centers for Disease Control and Prevention (CDC) often will recommend that certain high-risk groups be given priority when flu shot supplies are limited. Call your doctor or local public health department about vaccine availability in your area.

The American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and the CDC recommend that certain high-risk groups — and those in close contact with them — be given priority for receiving the flu shot in times of shortage: 

• all kids 6 months through 4 years old
• anyone 50 years and older
• women who will be pregnant during the flu season
• anyone with a weakened immune system
• residents of long-term care facilities, such as nursing homes
• any adult or child with chronic medical conditions, such as asthma
• anyone who lives or works with: infants under 6 months old, children under 5, adults 50 or older 
• health care personnel who have direct contact with patients
• caregivers of anyone in a high-risk group
• those who live with someone in a high-risk category

People who should not get the flu shot include:

• infants under 6 months old
• anyone who's severely allergic to eggs and egg products. (People with a mild egg allergy can receive the vaccine, but it should be given in a doctor's office so that they can be monitored for side effects for 30 minutes after the shot is given.)
• anyone who's ever had a severe reaction to a flu vaccination
• anyone with Guillain-Barré syndrome (a rare condition that affects the immune system and nerves)

If you are sick and have a fever, talk to your doctor about rescheduling your flu shot.

Preventing the Flu From Spreading

There's no guaranteed way — including being vaccinated — to prevent anyone from getting the flu. Avoiding large crowds can help, but it's often impossible to keep kids cooped up.

Here are some practical ways to help prevent the spread of the flu:

• Wash your hands thoroughly and frequently with soap, especially after using the bathroom, after coughing or sneezing, and before eating.
• Never pick up used tissues.
• Never share cups and eating utensils.
• Stay home from work or school when you're sick with the flu.
• Cover your mouth and nose with a tissue when you cough or sneeze, then put it in the trash. If a tissue isn't available, cough or sneeze into your upper arm, not into your hands. 

Treatment

Cases of the flu rarely require specific medical treatment. But some kids with chronic medical conditions (such as asthma, diabetes, and HIV) or children under 2 years old might become sicker with the flu and may have a greater risk of complications. Some kids with the flu need to be hospitalized.

For a severely ill child or one with other special circumstances, a doctor may prescribe an antiviral medicine that can decrease the duration of illness by 1-2 days and prevent potential complications of the flu. This medicine can only be helpful if it's given within 48 hours of the onset of the flu. Most healthy people who get the flu do not need to take an antiviral medication. If an antiviral medication is prescribed, be sure to discuss any possible side effects with your doctor.

These at-home tips can help most otherwise healthy kids cope with the flu. Have them:

• drink lots of fluids to prevent dehydration
• get plenty of sleep and take it easy
• take acetaminophen or ibuprofen to relieve fever and aches (do not give aspirin to children or teens as it may cause a rare but serious illness called Reye syndrome)
• wear layers, since the flu often makes them cold one minute and hot the next (wearing layers — like a T-shirt, sweatshirt, and robe — makes it easy to add or subtract clothes as needed)

Kids who are sick should stay home from school and childcare until they are without fever for at least 24 hours without the use of a fever-reducing medicine. Some might need to stay home longer, depending on how they feel. If you have questions or concerns, talk to your doctor.

When to Call the Doctor

Call the doctor if your child:

• has flu symptoms
• has a high fever, or fever with a rash
• has trouble breathing or rapid breathing
• has bluish skin color
• is not drinking enough fluids
• seems very sleepy or lethargic
• seems confused
• has flu symptoms that get better, but then get worse

For the most part, though, the flu is usually gone in a week or two with a little rest and tender loving care.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: October 2011