Flu
Influenza A; Influenza B; Oseltamivir (Tamiflu) - flu; Zanamivir (Relenza) - flu; Vaccine - flu
The flu is an infection of the nose, throat, and lungs. It spreads easily from person to person.
This article discusses influenza types A and B. A type of influenza A infection due to the H1N1 influenza strain is commonly called the swine flu.
Your head is throbbing. Your throat is burning. You're coughing nonstop, and your whole body aches. This is no run-of-the-mill cold. You may have the flu. Let's talk about influenza, also known as the flu. Winter is a time for sledding, snowball fights, and flu. Every winter, millions of Americans come down with this respiratory ailment and feel absolutely miserable. Like the common cold, the flu is caused by a virus. But with the flu, it's the influenza virus that makes people so sick. The flu virus comes in a few different forms. Influenza A is most common between early winter and spring. You can catch influenza B year-round. Swine flu, or H1N1, is a specific type of influenza A. You catch the flu from someone who has it. When people with the flu sneeze or cough, they send a spray of droplets filled with the flu virus into the air. If you're unlucky enough to be nearby, you could breathe in those droplets. Or, you might touch a surface that the droplets have fallen on and then touch your nose or mouth. Two to three days later, the first flu symptoms will appear. Usually you'll start running a fever. Then you'll feel achy and tired. You may have the chills and feel sick to your stomach. After a couple of days, the sore throat and cough will set in. So, how do doctors treat the flu? Because a virus causes the flu, antibiotics won't treat it, they only kill bacteria. There are antiviral medicines, but you need to start taking them within the first 2 days after your symptoms appear. Until the illness runs its course, help yourself feel better by getting a lot of rest and drinking extra fluids. You can take an over-the-counter cold medicine to relieve your congestion and cough. Tylenol, Advil, or Motrin can bring down your fever and take some of the pain out of your sore throat. Aspirin isn't recommended during the flu, especially under age 18, because it could increase the risk for a rare, but serious, condition called Reye syndrome. By itself, the flu usually isn't harmful. But it can make existing conditions like asthma and breathing problems worse. In older people or those with a weakened immune system, the flu can turn into pneumonia, bronchitis, and other more serious diseases. For most healthy people, the flu is a short-term annoyance. They're stuck in bed for a week or two, and then their symptoms go away and they're back up and around. But thousands of people each year get very sick from the flu, especially the elderly, young children, and pregnant women. Many are hospitalized, and about 36,000 people die from flu complications. To avoid getting the flu, eat well, get plenty of exercise and sleep, and practice good hygiene. Wash your hands often with warm water and soap or use an alcohol-based hand sanitizer. Don't share cups, plates, or utensils, especially during flu season. And most effective, get your flu shot every fall to protect you through the whole flu season.
Within the respiratory system, air is first inhaled through the nose or mouth into the pharynx. From the pharynx, air is drawn through the larynx and trachea to make its way to the lungs.
They call it the common cold for a reason. Colds are extraordinarily common. Children average 3 to 8 colds a year and adults almost that many. I'm doctor Alan Greene and I want to give you a couple of tips about navigating the cold and flu aisle at the drug store. Many of the offerings that are there will offer relief in several different ways. They may have a decongestant in there to try to reduce nasal congestion. An antihistamine that may help a bit with sleep or may also help with some congestion. They may have a cough suppressant in there to make you cough less. An expectorant to make your cough more productive, so you can cough things out easier and may have something to bring down a temperature or relieve aches and pains, like acetaminophen, or ibuprofen. But if you pick-up more than one of these, it's pretty common for people to double-up on a specific ingredient. So, if you're using more than one, look at the ingredient list. You don't want to see the same thing on both. For instance, if you have the decongestant pseudoephedrine on two different lists, the double-dose is not good for you and doesn't add any extra help. But beyond that, you don't even want to find the same action in two different multisymptom things. So if you have been taking a decongestant, you don't want a decongestant in the other one, whatever kind of decongestant it is. And as a reminder for kids under 6, decongestants, antihistamines, and cough suppressants have not been shown to help them any better than placebo and do have some side-effects. So, I don't recommend them at all for kids under 6.
Influenza is a viral infection of the respiratory tract that causes coughing, breathing difficulty, fever, headache, muscle aches and weakness. The virus is spread from person to person by inhaling infected droplets from the air.
So what's the difference between cold and flu. The two words go together like salt and pepper or like New Year's and weight loss. I'm Dr. Alan Greene and I want to help you figure out what the difference is. Most people have a general idea that they are different, but when pressed have a hard time really saying what the difference is. The cold, the common cold, is something very common you usually get on average 3 or more times during a year. And it is a virus that's primarily in the nose. The cold is focused in the nose. The 3 main symptoms of a cold are sneezing, nasal stuffiness, and runny nose. All are focused in the nose. You may have other symptoms - you may have a fever of 100, 101, maybe you may have some tickling or scratchiness in the back of the throat. In fact, that may be the very first symptom - a little scratch in the back of the throat. Then after a couple days the nasal discharge tends to turn a little bit darker, greener. And then after about a week you're all the way better. But it's focused in the head, focused in the nose. With the flu you're sick all over. It's a whole body disease. It's a much more serious illness. The flu in the United States today still kills about 36,000 people a year. Mostly people who already are weak for some reason or another. But it's a serious illness. And it usually slams into you with a fever. Typically the fever is in the 102 all the way up to a 106 range. A higher fever often the first symptom and you feel sick all over. You have muscle aches, you're tired, you feel out of it, you really feel crummy. And after a couple of days the respiratory symptoms start to come too. And depending where the flu virus settles you might have some sneezing, you might have some coughing. The classic symptom is a dry, hacking kind of cough, could be wheezing, could be other things, but the cough is the most common. Then it's there also for around 7 days or so and then at the end of it you may have another peak of fatigue and a second peak of fever. But usually after about a week you'll start feeling better with most cases of the flu. Colds and flus are very, very different illnesses with a few of the same symptoms.
The flu vaccine can also be administered as a nasal spray instead of the usual injection method. It can be an alternative for healthy, non-pregnant people age 2 to 49 who want to be protected from the flu virus. Unlike the regular vaccine, it is a live virus. Therefore, it is best if the person receiving it does not have close contact with people who have a weakened immune system.
Your head is throbbing. Your throat is burning. You're coughing nonstop, and your whole body aches. This is no run-of-the-mill cold. You may have the flu. Let's talk about influenza, also known as the flu. Winter is a time for sledding, snowball fights, and flu. Every winter, millions of Americans come down with this respiratory ailment and feel absolutely miserable. Like the common cold, the flu is caused by a virus. But with the flu, it's the influenza virus that makes people so sick. The flu virus comes in a few different forms. Influenza A is most common between early winter and spring. You can catch influenza B year-round. Swine flu, or H1N1, is a specific type of influenza A. You catch the flu from someone who has it. When people with the flu sneeze or cough, they send a spray of droplets filled with the flu virus into the air. If you're unlucky enough to be nearby, you could breathe in those droplets. Or, you might touch a surface that the droplets have fallen on and then touch your nose or mouth. Two to three days later, the first flu symptoms will appear. Usually you'll start running a fever. Then you'll feel achy and tired. You may have the chills and feel sick to your stomach. After a couple of days, the sore throat and cough will set in. So, how do doctors treat the flu? Because a virus causes the flu, antibiotics won't treat it, they only kill bacteria. There are antiviral medicines, but you need to start taking them within the first 2 days after your symptoms appear. Until the illness runs its course, help yourself feel better by getting a lot of rest and drinking extra fluids. You can take an over-the-counter cold medicine to relieve your congestion and cough. Tylenol, Advil, or Motrin can bring down your fever and take some of the pain out of your sore throat. Aspirin isn't recommended during the flu, especially under age 18, because it could increase the risk for a rare, but serious, condition called Reye syndrome. By itself, the flu usually isn't harmful. But it can make existing conditions like asthma and breathing problems worse. In older people or those with a weakened immune system, the flu can turn into pneumonia, bronchitis, and other more serious diseases. For most healthy people, the flu is a short-term annoyance. They're stuck in bed for a week or two, and then their symptoms go away and they're back up and around. But thousands of people each year get very sick from the flu, especially the elderly, young children, and pregnant women. Many are hospitalized, and about 36,000 people die from flu complications. To avoid getting the flu, eat well, get plenty of exercise and sleep, and practice good hygiene. Wash your hands often with warm water and soap or use an alcohol-based hand sanitizer. Don't share cups, plates, or utensils, especially during flu season. And most effective, get your flu shot every fall to protect you through the whole flu season.
Causes
The flu is caused by an influenza virus.
Most people get the flu when they breathe in tiny airborne droplets from the coughs or sneezes of someone who has the flu. You can also catch the flu if you touch something with the virus on it, and then touch your mouth, nose, or eyes.
People often confuse colds and flu. They are different, but you might have some of the same symptoms. Most people get a cold several times a year. On the contrary, people generally get the flu only once every few years.
Sometimes, you can get a virus that makes you throw up or have diarrhea. Some people call this the "stomach flu." This is a misleading name because this virus is usually not the actual flu. The flu mostly affects your nose, throat, and lungs.
So what's the difference between cold and flu. The two words go together like salt and pepper or like New Year's and weight loss. I'm Dr. Alan Greene and I want to help you figure out what the difference is. Most people have a general idea that they are different, but when pressed have a hard time really saying what the difference is. The cold, the common cold, is something very common you usually get on average 3 or more times during a year. And it is a virus that's primarily in the nose. The cold is focused in the nose. The 3 main symptoms of a cold are sneezing, nasal stuffiness, and runny nose. All are focused in the nose. You may have other symptoms - you may have a fever of 100, 101, maybe you may have some tickling or scratchiness in the back of the throat. In fact, that may be the very first symptom - a little scratch in the back of the throat. Then after a couple days the nasal discharge tends to turn a little bit darker, greener. And then after about a week you're all the way better. But it's focused in the head, focused in the nose. With the flu you're sick all over. It's a whole body disease. It's a much more serious illness. The flu in the United States today still kills about 36,000 people a year. Mostly people who already are weak for some reason or another. But it's a serious illness. And it usually slams into you with a fever. Typically the fever is in the 102 all the way up to a 106 range. A higher fever often the first symptom and you feel sick all over. You have muscle aches, you're tired, you feel out of it, you really feel crummy. And after a couple of days the respiratory symptoms start to come too. And depending where the flu virus settles you might have some sneezing, you might have some coughing. The classic symptom is a dry, hacking kind of cough, could be wheezing, could be other things, but the cough is the most common. Then it's there also for around 7 days or so and then at the end of it you may have another peak of fatigue and a second peak of fever. But usually after about a week you'll start feeling better with most cases of the flu. Colds and flus are very, very different illnesses with a few of the same symptoms.
Symptoms
Flu symptoms often start quickly. You can start to feel sick about 1 to 7 days after you come in contact with the virus. Most of the time, symptoms appear within 2 to 3 days.
The flu spreads easily. It can affect a large group of people in a very short amount of time. For example, students and co-workers often get sick within 2 or 3 weeks of the flu's arrival in a school or workplace.
The first symptom is a fever between 102°F (39°C) and 106°F (41°C). An adult often has a lower fever than a child.
Other common symptoms include:
- Body aches
- Chills
- Dizziness
- Flushed face
- Headache
- Lack of energy
- Nausea and vomiting
The fever, aches, and pains begin to go away on days 2 through 4. But new symptoms may occur, including:
- Dry cough
- Increased symptoms that affect breathing
- Runny nose (clear and watery)
- Sneezing
- Sore throat
Most symptoms go away in 4 to 7 days. The cough and tired feeling may last for weeks. Sometimes, the fever comes back.
Some people may not feel like eating.
The flu can make asthma, breathing problems, and other long-term (chronic) illnesses and conditions worse.
Exams and Tests
Most people do not need to see a health care provider when they have flu symptoms. This is because most people are not at risk for a severe case of the flu.
If you are very sick with the flu, you may want to see your provider. People who are at high risk for flu complications may also want to see a provider if they get the flu.
When many people in an area have flu, a provider can make a diagnosis after hearing about your symptoms. No further testing is needed.
There is a test to detect the flu. It is done by swabbing the nose or throat. Most of the time, test results are available very fast. The test can help your provider prescribe the best treatment.
Treatment
HOME CARE
Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever. Providers sometimes suggest that you use both types of medicine. Do not use aspirin.
A fever does not need to come all the way down to a normal temperature. Most people feel better when the temperature drops by 1 degree.
Over-the-counter cold medicines may make some of your symptoms better. Cough drops or throat sprays will help with your sore throat.
You will need a lot of rest. Drink plenty of liquids. Do not smoke or drink alcohol.
ANTIVIRAL DRUGS
Most people with milder symptoms feel better in 3 to 4 days. They do not need to see a provider or take antiviral medicines.
Providers may give antiviral medicines to people who get very sick with the flu. You may need these medicines if you are more likely to have flu complications The health problems below may increase your risk of getting sicker with the flu:
- Lung disease (including asthma)
- Heart conditions (except high blood pressure)
- Kidney, liver, nerve, and muscle conditions
- Blood disorders (including sickle cell disease)
- Diabetes
- A weakened immune system due to diseases (such as AIDS), radiation therapy, or certain medicines, including chemotherapy and corticosteroids
- Other long-term medical problems
These medicines may shorten the time you have symptoms by about 1 day. They work better if you start taking them within 2 days of your first symptoms.
Children at risk for a severe case of the flu may also need these medicines.
They call it the common cold for a reason. Colds are extraordinarily common. Children average 3 to 8 colds a year and adults almost that many. I'm doctor Alan Greene and I want to give you a couple of tips about navigating the cold and flu aisle at the drug store. Many of the offerings that are there will offer relief in several different ways. They may have a decongestant in there to try to reduce nasal congestion. An antihistamine that may help a bit with sleep or may also help with some congestion. They may have a cough suppressant in there to make you cough less. An expectorant to make your cough more productive, so you can cough things out easier and may have something to bring down a temperature or relieve aches and pains, like acetaminophen, or ibuprofen. But if you pick-up more than one of these, it's pretty common for people to double-up on a specific ingredient. So, if you're using more than one, look at the ingredient list. You don't want to see the same thing on both. For instance, if you have the decongestant pseudoephedrine on two different lists, the double-dose is not good for you and doesn't add any extra help. But beyond that, you don't even want to find the same action in two different multisymptom things. So if you have, taking a decongestant, you don't want a decongestant in the other one, whatever kind of decongestant it is. And as reminder for kids under 6, decongestants, antihistamines, and cough suppressants have not been shown to help them any better than placebo and do have some side-effects. So, I don't recommend them at all for kids under 6.
Outlook (Prognosis)
Millions of people in the United States get the flu each year. Most people get better within a week or two, but thousands of people with the flu develop pneumonia or a brain infection. They need to stay in the hospital. About 36,000 people in the United States die each year of problems from the flu.
Anyone at any age can have serious complications from the flu. Those at highest risk include:
- People age 65 or over
- Children younger than 2 years old
- Women who are more than 3 months pregnant
- Anyone living in a long-term care facility
- Anyone with chronic heart, lung, or kidney conditions, diabetes, or a weakened immune system
Possible Complications
Complications may include:
- Pneumonia
- Encephalitis (infection of the brain)
- Meningitis
- Seizures
When to Contact a Medical Professional
Contact your provider if you get the flu and think you are at risk for having complications.
Also contact your provider if your flu symptoms are very bad and self-treatment is not working.
Prevention
You can take steps to avoid catching or spreading the flu. The best step is to get a flu vaccine.
If you have the flu:
- Stay in your apartment, dorm room, or home for at least 24 hours after your fever has gone.
- Wear a mask if you leave your room.
- Avoid sharing food, utensils, cups, or bottles.
- Use hand sanitizer often during the day and always after touching your face.
- Cover your mouth with a tissue when coughing and throw it away after use.
- Cough into your sleeve if a tissue is not available. Avoid touching your eyes, nose, and mouth.
The Centers for Disease Control and Prevention (CDC) recommends that everyone 6 months and older should receive the influenza vaccine. Children 6 months through 8 years of age may need 2 doses during a single flu season. Everyone else needs only 1 dose each flu season. For the 2022-2023 season, the CDC recommends use of any type of flu shot for those under age 65 and one of 3 high dose vaccines for those age 65 or older. The nasal spray flu vaccine (live attenuated influenza vaccine, or LAIV) may be given to healthy, non-pregnant people 2 through 49 years of age.
References
Aoki FY. Antiviral drugs for influenza and other respiratory virus infections. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 45.
Centers for Disease Control and Prevention website. Seasonal flu vaccines.
Centers for Disease Control and Prevention website. What you should know about flu antiviral drugs.
Havers FP, Campbell AJP. Influenza viruses. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 285.
Ison MG, Hayden FG. Influenza. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 340.
Treanor JJ. Influenza viruses, including avian influenza and swine influenza. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 165.
Version Info
Last reviewed on: 8/15/2022
Reviewed by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
