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Flu season strikes Northeast Georgia region swift and hard

Wrong guess means this year's vaccine doesn't include virulent strain local doctors are fighting

POSTED: March 7, 2008 5:01 a.m.
ROBIN MICHENER NATHAN/The Times

Within a 48-hour period after first coming down with the flu, you can take Tamiflu, available by a prescription. However, this only lessens the symptoms - and has that pesky time limit for effectiveness, too.

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Misery loves company.

If you’ve been sidelined by influenza, you can take comfort in the fact that you’re not alone. Flu season has just reached its peak in Georgia, and doctors’ offices have been inundated with feverish patients seeking relief.

"We’re seeing 20 to 30 people a day with flu," said Belinda Moore, manager of the Urgent Care walk-in clinic on Friendship Road. "A lot of them are coming to us because they can’t get a same-day appointment with their regular doctor."

Seeing a doctor promptly is crucial, because drugs that attack the flu virus are only effective if given within 48 hours of the onset of illness.

Dr. Andy Jaffal, an internal medicine physician at the Longstreet Clinic, said he’s seeing plenty of patients with respiratory viruses, but he has to administer a screening test to make sure they have the flu.

"If the test is positive, we usually give (the anti-viral drug) Tamiflu for five days," he said. "It decreases the severity and duration of the illness."

Without treatment, patients may be flat on their back for a week.

"They’re usually pretty sick, with fever, severe body aches, bone pain, dry cough and fatigue," Jaffal said. "It’s a bedridden disease. You can’t go to work."

This year’s flu season surprised health officials because it came on so quickly. On New Year’s Day, flu activity in Georgia was rated by the Centers for Disease Control and Prevention as "sporadic." But the incidence quickly surged to "local," then "regional," then "widespread," all within the month of January.

"In late January and early February, there was a significant rise in people with flu symptoms at Quick Care, in the ER, and at our Neighborhood Healthcare Centers," said Bette Meisch, director of infection control for Northeast Georgia Health System. "We’ve continued to see a rise since then. It hasn’t started to drop yet."

Among children, the worst of the flu epidemic may have passed, according to Dr. Eugene Cindea, a Longstreet Clinic pediatrician.

"We were seeing a ton of it a couple weeks ago," he said. "About 25 to 30 percent of the patients who walked through our door had influenza. We were diagnosing 60, 80, sometimes as many as 100 cases a day. But I think it may be starting to taper off a bit. I hope so."

Cindea said doctors verify a flu diagnosis with a rapid test that involves taking a swab of nasal secretions. Results come back in about 15 minutes.

Although Tamiflu can be given to children, Cindea said many patients come to his office too late for the drug to be effective. Some have already developed secondary infections as the flu weakens their immune system.

"We’ve seen some cases of pneumonia, both viral and bacterial, as a complication," he said. "We’ve had to hospitalize a few kids."

But Cindea said children seem to be weathering the flu better than adults.

"Most of the kids aren’t feeling all that bad," he said. "They’ve got scratchy sore throats, cough, and moderate fevers, but usually not the muscle aches."

Yet even if the child doesn’t seem very sick, Cindea said it’s best to keep them out of school until the flu has run its course to avoid infecting others.

"I know it’s hard for the parents to keep them at home, but this strain (of flu) is pretty virulent," he said. "It goes from person to person quickly. That’s why we’re seeing so many kids with it."

Ariane Reeves, influenza surveillance coordinator for the Georgia Division of Public Health, said the strain of flu that’s most prevalent in Georgia is one that wasn’t included in this year’s vaccine.

"This flu season seems to be a little more severe than the last two we’ve seen," she said.

The problem is that flu prevention is a guessing game, and this time, the scientists got it wrong. Drug companies have to begin manufacturing vaccines months ahead of the start of flu season in October, so health officials have to pick the three flu strains they think will be dominant in the coming year.

This year, only one of the three strains in the vaccine matches the viruses that are widely circulating among the population. That’s why many people are getting sick even though they received a flu shot.

Nevertheless, Dave Palmer, spokesman for District 2 Public Health in Gainesville, said it’s worth getting a shot if you haven’t had one yet.

"We’re still recommending that people get the vaccine," he said. "The strains that the vaccine was made for are still circulating, and there’s some cross-protection against the other strains."

That means if a vaccinated person does get the flu, their illness may be less severe.

Palmer said flu shots are still available at the health department.

"But we haven’t had many people ask for it," he said.

Without a truly effective vaccine, medical professionals are advising that everyone be vigilant about infection control.

"I recommend that people really pay attention to hand-washing," Reeves said. "Cover coughs with your sleeve, not your hand. And if you’re sick, stay home."

But there’s a Catch-22. If you do think you have the flu, you need to go to the doctor as soon as possible and get tested, so he can prescribe an anti-viral drug. Yet if you go out in public, you may be spreading germs around."There’s concern about people transmitting the illness to other patients in the elevator or the waiting room," said Jaffal, adding that he will phone in a prescription for Tamiflu if the patient has a family member with a documented case of influenza, sparing them a trip to the doctor.

At Urgent Care, Moore said it’s tough to keep the virus under control when dozens of flu-ridden patients are coming in each day.

"We’re disinfecting surfaces in the waiting room, and we’ve even put out surgical masks if people want to wear them," she said.

At Northeast Georgia Medical Center, they’ve taken a proactive approach. Three weeks ago, the hospital temporarily banned visitors younger than 16, because children are the most likely carriers of influenza. The restrictions will remain in place until the flu season wanes.

The impact of flu is already evident in the hospital’s "census," the number of inpatient beds that are occupied each day. The census is always highest during the winter, when elderly people catch the flu and then develop complications such as pneumonia.

"Twice this year we have gotten to ‘level red,’ where every bed on both campuses is full," said Shannon Garner, administrative nursing supervisor at the medical center.

Because the hospital can’t add more beds until the new North Patient Tower is completed next year, Garner said they’ve had to get creative about managing space.

"About a year ago, we developed a plan to expedite discharge of patients who are ready to go home anyway," she said. "We get all their lab work and paperwork done early in the day, freeing up beds for new patients. We also have some places we can use as overflow areas, which eliminates the backlog in the ER."

But for every flu victim who is sick enough to be hospitalized, there are many more who just plain feel lousy. If Tamiflu is not an option, there’s not much else doctors can do.

"We just tell people to rest, drink plenty of fluids, and take Tylenol or Motrin for the fever," Jaffal said.

Cindea said it’s important for parents to remember that when children have a viral infection such as the flu, they should not be given aspirin.

"It can put them at risk for Reye’s syndrome, which is a life-threatening disease," he said.



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