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Flu Can Be Fatal

The last major pandemic was the 1918 Spanish flu.

For most people, a bout of influenza is inconvenient - a week or more at home coping with fever, chills, headache, cough and being bone-tired. For those who have heart disease, flu can be fatal.

Among people who have been diagnosed with heart disease, studies show that those who get the flu vaccine are less likely to have a heart attack, suffer recurrent chest pain that is not controlled with medication or die from cardiovascular causes within one year than those who do not get vaccinated, says Matthew M. Davis, M.D., M.A.P.P., an associate professor of pediatrics, internal medicine and public policy at the University of Michigan in Canton. "For people with cardiovascular disease [CVD], getting the flu shot each year is as important as controlling your cholesterol and your blood pressure," he adds.

The 2004 FLUVACS study clearly demonstrated the protective effect of the flu shot. In the study, 301 patients in the hospital recovering from a heart attack or about to undergo angioplasty to clear clogged arteries were randomly assigned to receive the flu vaccine or to remain unvaccinated. A year later, the unvaccinated group was 30 percent more likely to die from heart disease than the vaccinated group, and had more than twice the risk of a fatal or nonfatal cardiovascular event.

A paper published in the April issue of the European Heart Journal by scientists at Texas Heart Institute in Houston also showed a link between flu epidemics and CVD by correlating fatal heart attacks - confirmed by autopsy - with years in which flu epidemics occurred between 1993 and 2000 in St. Petersburg, Russia. "With almost every [flu epidemic], we had a surge in the number of ... heart attacks. It was seen in all ages and in both sexes," says Mohammed Madjid, M.D., who headed the study.

While researchers are still trying to puzzle out why flu increases the risk of fatal and nonfatal heart problems, "we're much more sure of the benefits of flu vaccine," says Davis, the lead author of a 2006 joint American Heart Association - American College of Cardiology Science Advisory recommending flu shots for people who have heart disease.

Among the theories being batted about by experts: an acute viral infection, flu stresses the immune, respiratory and cardiovascular systems, which overburdens a diseased heart; the body's immune response to the flu causes inflammation in the lining of blood vessel walls, which exacerbates cholesterol-related damage; and the virus adversely affects endothelial cells that line the walls of blood vessels to promote atherosclerosis.

According to the AHA/ACC Science Advisory, children and adults who have been diagnosed with a chronic cardiovascular condition (except high blood pressure) should get a flu shot. People who have diabetes, a condition common to patients with cardiovascular disease, should also get an annual flu shot. If you're not sure whether you fall into one of these groups, talk to your doctor. In addition, the Centers for Disease Control and Prevention (CDC) recommends annual flu shots for children ages six months through four years old, and adults over age 50.

If someone in your family is at risk of, or has been diagnosed with, heart disease it's not a bad idea for you to get vaccinated as well, advises Mary Ann McLaughlin, M.D., M.P.H., medical director of the cardiac health program at Mount Sinai Medical Center in New York City. Children, in particular, should be vaccinated, since they bring flu viruses home from school or group activities, she adds.

The best time to get a flu shot is between September and November, says McLaughlin. Flu season usually peaks in January so if you get inoculated early, you'll be covered during the period when you're most likely to catch the flu. People who have heart disease, in particular, should make sure they're vaccinated before flu season really gets going. But if you forget or don't get around to getting your shot in autumn, you haven't missed the boat altogether. You'll still benefit by getting the shot in December or January, because flu season can last well into the spring in the U.S.

Flu shots are very safe even for people with serious heart disease, says McLaughlin. The only people who should avoid flu vaccination are those who are allergic to eggs, as they may also be allergic to one of the components of the shot. If you have no such allergy, the worst side effects you may experience are soreness at the site of the injection and minor aches or low-grade fever that evening. If you have a fever, you should probably postpone vaccination, says McLaughlin, because "you might not form as many ... antibodies against the flu if you're trying to fight off another infection."

One myth Madjid would like to puncture: The flu shot cannot give you the flu, because the virus is killed. Yes, some people do get sick after a flu shot, but they could have been exposed to the flu virus before the vaccination or in the two-week period afterward, which is the period of time it takes to develop full immunity, In other cases, the flu shot may coincide with your coming down with a severe cold that you mistake for the flu.

Having said that, people who hate needles and prefer getting inoculated with the nasal spray should know that this Inhaled vaccine uses live - but weakened - flu virus, and if your immune system is not working properly, you could possibly get the flu. Plus, the safety and effectiveness of the inhaled vaccine has not been tested in people with heart disease so doctors recommend that they stick with getting stuck.

What if you have heart disease and get the flu, despite all your precautions? See your doctor right away. Antiviral drugs taken within 48 hours after you come down with symptoms can help reduce the severity and duration of the flu. Failing that, drink plenty of liquids to avoid dehydration, and stay home - so you can rest, and can avoid passing the virus to others.

Over-the-counter (OTC) drugs can help relieve symptoms, but consult your doctor or pharmacist, because the decongestant pseudoephedrine can exacerbate high blood pressure, and some painkillers should not be used with certain drugs used to treat heart disease. For instance, many OTC pain relievers and cough/cold/flu medicines can alter the effects of blood thinners, so ask your doctor or pharmacist before beginning any of these medicines. Experts strongly urge everyone who has heart disease to get a flu shot. The once-a-year flu shot can be as important to your cardiovascular health as taking your cholesterol-lowering or blood pressure-controlling medication every day.

Flu season comes around every year, and many people cope by getting a flu shot, washing their hands frequently and stocking up on pain relievers, tissues and chicken noodle soup, in case preventive measures fail. Public health experts do a pretty good job predicting which strain of flu will be going around the following year so that vaccine manufacturers can tweak the inoculation to provoke a healthy immune system response, should you come into contact with that viral strain after getting the shot.

There are small changes in the flu virus from year to year, and that's why people have to get a different flu shot each year, explains Gwen A. Huitt, M.D., M.S., a flu expert at National Jewish Medical and Research Center in Denver. Pandemics occur because the viral strain changes significantly enough that an effective vaccine cannot be manufactured in time for that year's flu season, so more people become sick. Pandemics typically last for weeks to months as the virus spreads from person to person, and from one community to another.

The second time you come into contact with the flu strain that caused the pandemic, you are better able to fight it off - it's like getting a vaccination from Mother Nature. As more and more people become resistant, fewer people become infected, and the pandemic peters out, explains Gary J. Nabel, M.D., Ph.D., Director of the National Institutes of Health Vaccine Research Center.

The last major pandemic was the 1918 Spanish flu. According to the World Health Organization, between 40 and 50 million people died worldwide. Two smaller pandemics, the Asian flu in 1957 and the Hong Kong flu in 1968, killed a combined total of three million people.

Today, public health experts on the lookout for the next pandemic are keeping a wary eye on a strain of flu that has been infecting birds in Asia for several years now. The concern is that the bird flu virus - H5N 1 - could cause a mutation in one of the flu viruses that infect people, creating an exotic new strain that could be particularly lethal, says Huitt. "We don't want people to be overly concerned," says Huitt, adding, "there are lots of talented scientists all over the world working on [potential] vaccines."

Nabel is heading up one group of scientists trying to develop a bird flu vaccine before the virus jumps to humans. He is studying a protein called hemagglutinin - that's the "H" in H5N1 - that helps the avian flu virus bind to cells in your body and turn them into virus-producing factories. If Nabel and his team can find a way to neutralize this protein, their work will point the way toward developing an effective bird flu vaccine.

In the event that bird flu begins infecting large numbers of humans before scientists like Nabel come up with a "magic bullet," Huitt says the best protection against pandemic is to avoid spending prolonged periods in public places among large crowds - for instance, the mall or a commuter train.

Alison Palkhivala / Angela Munasque. Roll Up Your Sleeve, Reduce Heart Risk / Flu Pandemic: Cause For Panic? Heart Insight. November 2007.

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