November is traditionally considered a month of cold and flu. And to remain up and about we should take prophylactic measures beforehand. As the saying goes, mend your sails while the weather is fine. And if you fall sick anyway, take the treatment seriously, as influenza is a serious illness and should not be confused with banal cold.

In an interview with Alla Myronenko, doctor of medical science and head of the department of respiratory and viral infections of the Gromashevski Institute for epidemiology and infectious diseases, ForUm has learned what flu strains circulate this season and how to protect ourselves from them.

- Alla Petrovna, when cold weather comes Ukrainians start worrying about influenza - if and when it will come this year. What are the forecasts for this winter season?

- In Ukraine, as well as in other countries of Northern hemisphere, flu epidemic happens almost every year, though the intensity may vary. This winter we also expect the epidemic. Moreover, there is a new flu strain coming to Ukraine - B/Massachusetts (2) B/Yamagata, which is different from the strain circulated in Ukraine last epidemiologic season. The virus will come with the second wave of disease, namely in February-March of the next year. It is as dangerous as any other new virus. 
The main pathogens of the first wave (end of December - beginning of April) are the same as last year - A/California (H1N1) and A/Victoria (H3N2), observed in Ukraine for the third year running. However, we do not expect any considerable increase in number of sick patients.

- How is the new stain different and dangerous for people?

- Viruses of B/Yamagata line have been circulating in Ukraine since 1988. Thus, the population has already faced similar to В/Massachusetts viruses and we do not expect any serious epidemic.
You know, journalists often ask me this question. And I want to explain that after visiting a patient a doctor cannot say what virus strain he has. Infectious process and clinical manifestation of all strains are the same, and lethal outcomes happen because people do not have immunity, especially if a strain is new, like it happened during the pandemic.

- People often confuse acute respiratory disease and acute respiratory viral infection with influenza. Is it possible for a common person to recognize what disease he has?

- Most probably. Flu, as a rule, starts with fever, weakness, joint and muscle pain. Then cold and cough appear. Other respiratory diseases start with sore throat and cold. Then the symptoms intensify, but fever appears after a day or two, though it does not jump too high. These are the main differences. 

- For various reasons people often work through flu. What consequences may it carry?

- Influenza is a serious disease, and if a person has a fever and intoxication I doubt he can make it to work, let alone work through it, as you say. However, I must admit there is also mild flu.

As for consequences, they can be very grave, especially for people with a chronic pathology, as chronic diseases may aggravate after flu. Thus, if you feel like getting sick with flu, go and visit a doctor.  Do you know why young people were dying during flu pandemic? Because they went to the doctor when it was too late, when their respiratory system failed and they could not breathe. If they had asked for help in time, they would have undergone an anti-virus therapy and would have survived.

- And if a person has an acute respiratory disease, is it necessary to visit a doctor?

- Well, you can opt for self-treatment, of course. But in case of children and older people it is better to pay a visit to a doctor, as there is a chance to miss pneumonia.

- And what about flu prevention? What are effective ways to protect ourselves from the virus?

- The only effective preventive measure against flu is vaccine, as it helps the organism to produce immunity against the disease.

Other ways to reinforce the immune system include cold training, physical exercises, fresh air and exercise.

- But parents often muffle their children, making them wear several sweaters at once. Is it a right thing to do?

- Not at all. Small children warm up faster and cool faster. Thus, if he sweats but then cool off, he may take cold. Muffling is wrong, as it decreases the adaptive capacity of the organism. 

- And to cover mouth with a scarf? 

- It is hardly useful, because a person has to breathe moist air, though breathing dry air is not good either. Anyway, I think there isn't much to it, well, may be the face does not feel cold that much. However, unless it is 20 degrees of frost you can do without it.

- You said vaccination is the only effective preventive measure. When should people take it and who can take it?

- For our climate zone, October and November are the best months for vaccination. At the same time, vaccination must be done  not later than two weeks prior to the announced epidemic, as the organism needs time to produce antibodies. An adult person needs 10-14 days. Children, who have never had flu and have not been vaccinated, must undergo double vaccination spaced four weeks apart.

In general, vaccines are clean and do not cause side effects, but those who are allergic to chicken protein or antibiotics should read the instruction first, as a vaccine may contain trace concentration of these allergic agents. However, we have been using vaccines since 1998 and have gained vast experience in their application.

- Vaccines of what countries can be trusted?

- Well, we traditionally use vaccines of western production, where producers themselves control everything thoroughly - France, the Netherlands, Germany. In fact, we do not have others registered. From time to time Russia registers its vaccines, but I never make it time to follow when they do it and when they do not.

- How to tell whether the vaccine is of good quality?

- Expire date of all vaccines is one year, usually from summer to summer. Thus, pay attention to the labeled production date. Moreover, vaccine must be kept in fridge, and it cannot be frozen or heated up. Before use it is better to warm it up to room temperature, otherwise the injection process may be painful.

- There is a popular belief that a flu mask can protect against infection during epidemic. Is it true? And who must wear the mask - a sick person or the one who does not want to get infected?

- If used properly (changed every two hours), a flu mask can indeed help. And it should be worn by a sick person, as when coughing or simply talking this person transmits the virus.

But again, the important thing is to use this mask properly. For example, I melt when saw people walking the streets in masks in 2009. You do not get infected in open air, but in closed premises, thus masks should be worn indoors.

Moreover, wearing the mask indoors one should follow certain rules, which is to change it regularly. Once I saw a cashier sitting in a flu mask. She had it the whole day just to execute the instruction. The mask was wet and the girl herself did not seem comfortable in it. In that case the mask did not make any difference, as it was used improperly.

- TV commercials now advertise so many cures. Are any of them effective against flu?

- Well, there are anti-viral and anti-influenza medications, and in Ukraine there are only two registered - Tamiflu and Relenza. The drugs don't actually keep a person from getting infected with the flu bug. But they keep flu viruses from multiplying in the body. However, it is not recommended to use it always and by everyone, but only in case of complications or acute forms of the disease. Moreover, the World Health Organization does not recommend to use these drugs widely, as viruses may adapt and develop resistance to the drugs, while much effort and means have been spent to create them.

Speaking about such drugs as Coldflu, Teraflu, Coldrex, etc., they serve to remove flu symptoms, but do not kill the virus. In other words, they soothe our condition, while organism is fighting the virus on its own.

- Doctors often prescribe antibiotics to treat flu. Is it justified?

- Well, it depends. Antibiotics are not prescribed before the third day of the disease, as they have no effect on the flu virus, while flu itself may provoke bacterial complications, like pneumonia or bronchitis. Thus, if a doctor sees that regardless of treatment a patient does not show signs of recovery after three days, he may prescribe antibiotics. The only exception is patients with immune deficiency. They might need them immediately.

- It has become popular to take various immunomodulatory drugs to reinforce the immune system. Is it reasonable? And can they be used together with vitamins? 

- In countries, where the system cares about its people, immunomodulators are prohibited by law. It is very risky to interfere with the immune system, as it can affect overall health, especially of children and older people. 

In fact, immunomodulators were created back in the USSR times for the army, when a fighter had to go on a mission but risked to be exposed to some bacterial weapon. Thus, the fighter needed a pill to perform his task and come back home alive. But now the population, especially children, do not participate in this. Experiments with such drugs are rather dangerous. 

And vitamins are good, considering that food we eat does not always provide their necessary daily value.

- And how effective are herbal and phyto drugs?

- I can say that they do not hurt. But herbal drugs should be considered as a supportive treatment. If a person has fever I doubt they can help somehow. The same concerns folk remedies. Raspberry jam does not hurt. In fact, raspberry contains many vitamins, but still it cannot be considered a true medicine.

In general, when a person falls sick with flu he must drink a lot of water. The disease destroys the cells, which in turn intoxicate the organism, while liquids help to remove these toxins through kidneys. Unless a patient has cardiac problems or other counterindication, he must drink at least two liters of water daily.  

Tetyana Matsur, photos by Maxim Trebukhov


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