Ask the Doctors

Dear Doctor: I thought the elderly were at the greatest risk of flu-related death, but I've seen more than a few headlines about children who have died. Who's more at risk?

Dear Reader: Flu season is here and even at this early stage, lives have been lost. According to the Centers for Disease Control and Prevention, several elderly patients and at least one child died from flu-related causes in October. As we'll discuss in a moment, it's not the flu itself that is so dangerous, but the complications that can arise.

The flu is a highly contagious respiratory illness caused by the influenza virus. It can infect the nose, throat and lungs, resulting in symptoms that range from mild to quite severe. Symptoms include fever, chills, sore throat, a persistent cough, congestion of the lungs and sinuses, headache, fatigue, muscle aches, and even diarrhea and vomiting. You also know that you can go from feeling just a little fluish to all-out sick in a short period of time.

While the flu can seem like nothing more than a nasty cold, the risk of grave complications is quite real. The majority of us will recover in a few days up to a week or two, depending on how hard we are hit. But for some individuals, the disease progresses in ways that can be life-threatening.

As you noted, older adults are at greater risk of both the flu as well as complications from the disease. After the age of 65, our immune systems are no longer as robust. The same is true of children. Those younger than 5, and particularly those younger than 2, are at risk of serious complications. They are not alone. Others at risk include pregnant women; individuals with certain medical conditions, like asthma, diabetes, chronic lung and heart disease; and anyone with a suppressed immune system due to chronic disease or immunosuppressive medical treatment.

For most of us, the flu means a few miserable, feverish, coughing, sneezing and achy days in bed as our immune systems rally and fight off the virus. For those at high risk, though, a range of complications is possible. These include bronchitis, sinus infections, ear infections and pneumonia. Even more grave is the chance of developing myocarditis, an inflammation of the heart, and encephalitis, an inflammation of the brain. In extreme cases, the body's inflammatory response to a flu infection can go into overdrive and lead to sepsis, which is a life-threatening condition requiring immediate treatment.

We encourage our patients to get an annual flu vaccine, available in the fall. According to the CDC, children who have received a flu vaccine lower their risk of hospitalization due to complications by 74 percent. In people 50 and older, that risk drops by 57 percent. Yes, the vaccine carries potential side effects that include soreness at the site of injection, headache, nausea and fever. But these are mild, not very common, and last just a day or two. When you compare these side effects to the discomfort, lost time and potential health risks of the flu, we think it's a fair trade-off.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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