Fighting the Flu: Harder Than Ever? by Mary Wells

Katja Van Herle

The beloved drug Tamiflu isn’t working with this year’s flu, so Mary Wells asks Dr. Katja Van Herle what we should do about it

Friday, January 9, The New York Times wrote that virtually all the dominant strains of flu in the United States are resistant to the most effective antiviral drug, Tamiflu. The Times says this has been a below-average flu season SO FAR,  but last winter about 11 percent of throat swabs from patients who had common flu showed the Tamiflu-resistant strain of flu. This season, 99 percent do. In other words, 99 percent tested had a flu that was resistant to the best treatment. This strain is called H1N1 and is more likely to cause pneumonia.

New York had tested only two flu samples as of January 6 and both were Tamiflu resistant. Dr.Henry Niman, a biochemist in Pittsburgh who runs a website that tracks the genetics of flu cases worldwide has been warning for months that Tamiflu resistance to H1N1 was spreading.

Disease control agencies suggest taking a drug called Relenza; it is harder to take because it is a powder you have to inhale and it can cause lung spasms. It isn’t recommended for children under seven or anyone with sensitivity in breathing. Alternatively, you can take a mixture of Tamiflu and rimantadine, an older generic drug that, by chance, the new Tamiflu-resistant H1N1 strain is not resistant to.  I wonder, though, how many drugstores have rimantadine around now – not many I bet. I am planning to ask the terrific pharmacist at Newton Pharmacy to stock up.

The trouble with all this is that antiviral drugs work only if taken within the first 48 hours of infection. Did you get that? They only work the first 48 hours you have the flu. Now, suppose you tell your doctor you have the flu and he gives you Tamiflu as most doctors would for most flus. With this H1N1 strain of flu, Tamiflu won’t help you – and flu typically kills 36,000 people a year in the United States.

I don’t know about you but I have never known I had the flu right away to get the help I need within 48 hours. So I called our Super Doctor, Katja Van Herle, and asked her what to do about all this. She told me that we do not have an epidemic of flu in the U.S., but that when people do get the flu this year, there is a resistance to the normally effective Tamiflu. She said it is critical this year that people get tested immediately with nasal/salivary swabs for Influenza A or B. This matters because you treat one with two agents and one with just Tamiflu. She says that each of us should go to the CDC – Centers for Disease Control – website because they give all the recommendations for treatment very clearly, in lay language. Ramatidine and amantidine and zanamivir (the Relenza powder drug I mentioned above) are all agents against the flu – but only if used against a flu strain that is not resistant to them.

So, if you feel sick, have fever or congestion, a cough, you should go to your doctor or to an urgent-care clinic for rapid testing for Influenza A or B, and then it will be clear by the type of flu you have if Tamiflu will work, or if you need one of the other agents or a combination.

Ready. Set. Get your mind around this especially if you have young or old people in your care. You will have 48 hours to find the agent that will probably do what is needed to cure the flu.

I then asked Dr. Van Herle: If people get pneumonia from the flu, should we all get pneumonia shots? She told me that Pneumovax, the pneumonia shot, is recommended for diabetics, asthmatics, cancer patients, as well as people who are immunocompromised, like people with emphysema or transplant patients. She believes – as many doctors do – that the pneumonia shot should be given to healthy people one time only after the age of 65.

She also said to remember that vaccines are only prompters to keep your own immune system on the alert, ready to shoot if the bacteria they were designed to recognize actually presents itself, sort of like the Most Wanted List at the post office. Vaccines give your body a heads-up to make the antibodies in advance, so that if the virus or bacteria shows its face your own immune system will kill it. But your immune system isn’t perfect, she said. You have to take good care of yourself in the flu season. Get enough sleep.

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