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Don't go viral

Get the shot, not the flu

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Flu facts

Influenza by the numbers

Take care of yourself

4 quick ways to help prevent influenza

Common questions about the flu

Winnipeg Health Region
Wave, September / October 2010

It's a familiar scenario for many.

You wake up one morning feeling a bit out of sorts. Your throat is scratchy, your muscles are sore and your head aches.

Naturally, your first instinct is to stay home and rest. After all, it's not as though you're going to get much work done in this condition. But then the guilt sets in: Can you really afford a sick day after just two months on the job? What would your boss think? After thinking about it for a few moments, you decide to tough it out and head to work.

It's a decision hundreds, if not thousands, of Manitobans are faced with making every year, especially during the influenza season in the late fall and winter months. One study, for example, suggests that as many as one in four people 18 years of age and over is infected by influenza in a given year. And in some cases, people with influenza are choosing to go to work.

A story published by last spring illustrates the point. It noted that 61 per cent of Canadian respondents to a survey of visitors at admitted to going to work when sick. Only 26 per cent of respondents said they would stay at home when sick. Some of these individuals go to work sick because they fear taking time off could cost them their job or a possible promotion; others may feel the need to soldier on, disregarding their aches and pains, in order to ensure their team is not left short-handed.

Whatever the reason, the fact is that some individuals may actually be doing more harm than they realize, especially if they have "the flu." That's because a person with influenza could infect as many as a dozen people during the course of a day without even knowing it.

It's a problem that public health officials like Dr. Michael Routledge understand well. "Most people are sensitive to the risk of spreading influenza," says Routledge, Medical Director of Population and Public Health with the Winnipeg Health Region. "But people often go to work sick because they feel they have to."

The problem is that when infected individuals go to work or attend a gathering where they come into contact with people, they run the risk of infecting others, including those who may be more susceptible to complications associated with the virus.

So how should someone prepare for the upcoming flu season?

Well, the first thing is to think about reducing your risk of becoming infected with the influenza virus in the first place. Health officials say the best way to do that is to get vaccinated every fall before the start of influenza season. Not only does a vaccination reduce your risk of getting sick, it limits the possibility that you will transmit the virus to someone else.

That's partly why Manitoba Health has decided to make flu vaccinations available at no charge to anyone who wants one this year. Previously, the seasonal vaccine was free only to people deemed to be most at risk of becoming infected with influenza and their care providers. And it's also why the Winnipeg Health Region is staging 12 immunization clinics throughout the city from Oct. 19 to 23.

Routledge welcomes the move to make the influenza vaccine more readily available, and hopes people will take advantage of the offer - especially those in the priority categories. "We need to continue to get out the message that there are certain populations who are at more risk of complications from seasonal influenza, and those are the people in particular we want to protect."

Canada's National Advisory Committee on Immunization encourages all Canadians over the age of six months to get a flu shot. Key target groups for immunization include care providers, and those with conditions that put them at high risk of complications from influenza such as people over 65, young children, pregnant women, and people with chronic health conditions.

Three additional new target groups were identified this year by the advisory committee - persons with morbid obesity, Aboriginal peoples and children two to four years of age. The rationale for the target groups is that health-care workers and others in contact with those at high risk have the potential to infect the most vulnerable people, while the other priority groups are most likely to have serious consequences from influenza.

Brenda Dyck, Director of Infection, Prevention and Control for the Region, says she's worried that some people may become blasé about "seasonal" influenza this year. She explains that last year's H1N1 influenza pandemic raised concerns because it came on suddenly, killed a significant number of younger people and left many others sick. Seasonal influenza also kills a significant number of people - as many as 4,000 a year - but many of these cases involve those who are elderly and frail, so there is less media attention.

"During a pandemic, everyone gets a little uptight. But when it is normal seasonal influenza, people become complacent," says Dyck. The result is people sometimes forget that when they pass on a virus, it may have significant consequences.

"Who knows who you will infect or whether they may have any underlying illnesses that might make them more susceptible to complications? It's not just you having the infection. It's who you might infect," she says.

As for those who do not get the shot and become sick with influenza, the message is clear. "Whether it is influenza or some other kind of infection, we don't want people coming out into the community, into the workplace or schools . . . and transmitting infection. The message is, stay home when you are sick."

Of course, some people can be contagious and not even know it. In fact, some studies have suggested that as many as one in five may have an influenza virus and not have any symptoms.

Generally speaking, the influenza virus is spread among humans through tiny droplets in the air, usually when an infected person sneezes or coughs close to someone else. The virus can also spread when the droplets are transmitted from one person to another by physical contact - like shaking hands - or via a surface touched by the infected person, such as bus railings, door handles, and coffee pots. When the infected person covers a cough with his or her hand, that hand gets covered with influenza virus droplets. Those droplets are then left on everything that hand touches, and can survive 24 to 48 hours on a hard surface, says Routledge.

People infected with the influenza virus, which is an infection of the respiratory tract, are most contagious just before they have symptoms and then for several days after symptoms have first appeared. When the non-infected person picks up the droplets and touches his or her mouth, the disease can find a new host. And if that new infected person has a chronic health condition, the infection can progress to viral pneumonia. Likewise, if the newly infected person visits somebody in the hospital, the virus can spread to more vulnerable people.

The bottom line, Routledge says is everyone needs to take influenza seriously.

"If you wake up in the morning and you're not feeling well, consider staying home," says Routledge. "I'd say to a work supervisor, 'If that person stays home, they aren't infecting other people at work.'"

Routledge also underscores the importance of taking precautions in the first days of sickness. "People who are sick are particularly infectious in the first couple of days, and the more we can get people to stay home and take care of themselves, the better for everybody."

There are signs that the message is being received. Mark Hollingsworth, Executive Director of the Human Resources Association of Manitoba, says that when it came time to updating the office computer system, he opted to have everyone outfitted with a laptop.

The idea was to provide for increased opportunities for people to work from home, which meant that anyone who felt under the weather did not feel like they had to make a choice between missing work or infecting colleagues at the office.

"We talked about the idea that we are in an enclosed environment, where we are interacting with each other, (and) could be spreading contagious diseases. Being that we are with the HR association, we thought if we have the opportunity to showcase what can be done, we should. At a small level, we're just thinking through creating a culture that is effective, efficient, but looks after people."

The Region, meanwhile, continues to develop new strategies to contain the spread of influenza. This year, for example, the Region decided to hold its influenza immunization clinics from Oct. 19 - 23 in a bid to reach as many people as possible at the beginning of influenza season, which usually runs from November to March.

Each year, the seasonal influenza vaccine includes three strains, or types, of influenza virus. This year, the vaccine includes the 2009 pandemic influenza A/ H1N1 component, as well as influenza A/ H3N2 and B components.

The Region is also making an effort to promote respiratory etiquette as a means of helping prevent the spread of influenza. For example, the Region and other health organizations have been urging people to cover their coughs by sneezing into a tissue or the crook of your elbow, says Dyck. After coughing or sneezing, clean hands with soap and water or use an alcohol-based hand rub (sanitizer). This will prevent influenza droplets from ending up on your hand.

Infection Prevention and Control is also promoting "hand hygiene," an approach that goes beyond keeping hands clean. Training programs for Region staff focus on when to wash the hands and when to use an alcohol-based hand rub (sanitizer).

The Region has placed dispensers of alcohol-based hand rub at the entrance of every facility so that everybody coming in to work or to visit can clean their hands before they enter. "There's lots of research to show that alcohol-based products in health-care settings are the first line of defence," Dyck says.

Promoting good hand hygiene and respiratory etiquette has value beyond preventing influenza. "It could be any type of infection that's carried on the hands. We want to prevent these kind of infections."

Of course, preventing the spread of influenza is a tall order. "The reality is, it's such a ubiquitous virus, it's very hard to contain," says Routledge. "But that doesn't mean we shouldn't be doing things to try and prevent its spread."

Bob Armstrong is a Winnipeg writer.


About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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