Bigfork Valley Hospital has community forum on influenza

Bigfork Valley Hospital sponsored a Community Forum on the risks and symptoms of influenza in cooperation with the Minnesota Department of Health at the Edge Center in Bigfork on April 3.

Welcoming the community guests and introducing the speakers for the forum was Bigfork Valley Chief Executive Officer Dan Odegaard.

"This community forum tonight is a result of discussions with the Minnesota Department of Health," said Odegaard. "We both felt it was important to answer questions community residents might have about influenza." Odegaard then outlined the credentials of the experts at the forum.

These speakers were Timothy Burke, M.D., Infectious Disease Specialist, Duluth Clinic and Amy Westbrook, MPH, District Epidemiologist, Minnesota Department of Health. Itasca County Public Health Director Sue Erzar, RN, PHN, served as the moderator of the question portion of the forum.

Itasca County Public Health Nursing Supervisor Barb Hayes and Northeastern Minnesota Emergency Preparedness Coordinator Bill Maloney were also in attendance, but did not speak at this public forum.

"We will first hear a brief overview of just what influenza is," said Odegaard, "and then we will address your questions. We cannot address questions that impact personal privacy. We ask that your questions be focused on our topic. Please respect the moderator's decision on this point."

Burke was the first speaker. He explained the basic biology of influenza. "It is a virus and affects both humans (Type A & B), and animals and birds (Type A), with the later having the ability to be passed between species. That is not an issue with what we call seasonal flu," said Burke, "but it is a concern with what is called pandemic influenza."

He went on to explain that the virus is unpredictable because it has an error prone reproductive mechanism. "As successive generations emerge," said Burke, "they can be slightly different from the previous virus.

That feature contributes to the unpredictable nature of flu outbreaks and it is the reason that flu vaccine is needed on a yearly basis."

Burke explained what the symptoms and signs of flu are and then went on to talk about the uncommon features. He said, "Uncommon features of the flu include the spread of the virus into the lungs, causing a viral pneumonia. Complications or unusual manifestations can then occur, such as stafforious. This can cause a very severe pneumonia."

The next two items on the uncommon features list were neurologic symptoms, encephalopathy and transverse myelitis. "The first one means abnormal brain function such as an altered level of consciousness, altered language function and/or disorientation," said Burke, "and the second one affects the spinal cord and may cause paralysis of the legs or arms."

Other features usually not associated with flu include myo/pericarditis.

"These are all uncommon, but they are seen. The first one of these can be detected by blood tests," said Burke. "It causes damage to the muscles and can be severe enough that it will lead to other complications as well. Pericarditis refers to inflammation of the sac that surrounds the heart.

"Reye Syndrome is a multi system infection that can often be fatal. We have learned over the years that (it can be brought on) when aspirin is used in a patient who has influenza. That is why the medical profession recommends other ache and pain medication since this connection has been recognized."

This can be especially problematic for those who take aspirin for their heart health since they can have the flu virus in their system a day before symptoms appear.

Prevention and treatment were the next topics and Burke spoke about vaccines and medications, including the intranasal treatment, and who is targeted for vaccinations.

"Vaccinations are not 100 percent effective in preventing influenza," said Burke, "but if a vaccinated person does get influenza their risk of having a severe course of it is reduced."

Flu, like the cold, is spread from coughing or sneezing without proper covering and with direct contact with articles recently contaminated.

The incubation period of the flu virus is about two days, but can be spread a full day before the signs of flu are evident. This spreadability usually subsides in five to seven days.

Westbrook spoke about how the state keeps track of influenza in Minnesota using surveillance methods. "When we talk surveillance," she said, "people first think about police. Our surveillance means a completely different thing, basically it is surveying a particular population to see what is going on with the flu."

The main information sources for tracking flu activity are Centers for Disease Control (CDC), laboratory reports, outbreaks (in schools and long-term care facilities), hospitalized cases, health care facilities, outbreaks outside of the typical season (May-September), suspect novel avian flu cases and sentinel surveillance.

"We have a number of clinics across the state who are part of our sentinel surveillance program," said Westbrook, "but most people who get the flu don't seek medical help."

Westbrook went through some of the flu statistics, which indicated that outbreaks in schools were down in 2008, but the 2008 hospitalizations were higher. These statistics can be found on the Minnesota Department of Health website.

Marcie Lindgren had the first question during the question and answer period of the forum. She asked, "Can a person get the flu more than once in a season?"

Burke said, "Yes. That is because of the many different strains of flu virus out there with this virus' ability to mutate....If anyone has been as unfortunate enough, like me, and they end up having two bouts of respiratory viral infections, it doesn't mean that they were from the same virus."

A nurse in the audience wanted to know how she could convince patients coming into a health care facility that getting the flu shot was a good thing and did not cause the flu.

"It is difficult to undo that notion," said Burke, "of the flu vaccination causing flu. We do know that when someone gets the flu shot for the first time in their life, there is a slightly greater chance that they could experience temperatures in the 99 degree range and have body aches for a day or two. Some people think that is influenza, but it is not. Influenza is more severe than what you might get from that first flu shot.... This doesn't happen if a person gets a flu shot every season."

Another individual in the audience wanted to know if any tracking or study had been done on having been vaccinated and still getting the flu versus not being vaccinated and getting the flu. She also wanted to know if there were any statistics on adverse reactions to the flu vaccination.

Westbrook answered the second question first. She said, "The vaccine is pretty safe. Adverse reactions are pretty minimal. People who have allergies aren't recommended to get the vaccine. Very few people are recommended not to get the vaccine.

"On your question of efficacy of the vaccine or how well it protects a person against flu really depends on a number of host factors....A vaccine is more effective in younger people than in older people or individuals who are not fully developed. It does vary in the general healthy population at about 70 to 80 percent in combating influenza....The main factor is the host factors that are involved. The efficacy across the population is mainly related to your immune system and age. Does that answer your question?"

Dean Sedgwick asked if there were specific foods or things like vitamins a person could take to prevent the flu and/or its ability to spread.

"Not besides the vaccination," said Burke. "I am not aware of any food products, vitamin or herbs a person can take to prevent the flu. The best preventative is to keep the immune system strong and healthy by staying well hydrated, eating well balanced meals and getting enough rest."

Used with permission.