Winnipeg Free Press - PRINT EDITION

Infectious disease specialist bugged by the flu

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You're washing your hands like a surgeon, eating your vegetables and trying to stay away from people who may be sick with the flu.

But is it enough to get you through the influenza season uninfected?

Should you ask your physician for the flu shot?

If you've already been vaccinated this year, does that mean you won't get sick?

We chatted with infectious disease specialist Dr. Fred Aoki about the influenza facts. Here's our conversation with the University of Manitoba professor of medicine who happens to be one of Winnipeg's top doctors in his field. (The interview has been edited and shortened for clarity and space constraints):

FP: Why are you so concerned about the flu?

Aoki: It causes a virus that makes people sick and it actually causes people to die prematurely.


FP: Can you share an example of a previously healthy patient who unexpectedly got really sick from the flu?

Aoki: I work at the HSC. We see people who get sick with influenza, often if not from influenza itself, it's with some complication of it.

During the pandemic in 2009 we saw people who came in with pure influenza. They came into the hospital and were so sick. They went into the intensive care units because their organs had failed. Usually their lungs had failed -- they needed artificial breathing (ventilators).


FP: I read about a phenomenon noted in Canada (in the 2008-2009 flu season) when people who were immunized against influenza had a higher chance of getting it. Can you comment?

Aoki: That was the first time that was observed. The lead author was from the British Columbia Centres for Disease Control. It may be related to original antigenic sin. (That's when prior exposure to a virus leads a person's immune system to respond weakly to a shot.) We still don't entirely understand it.


FP: Should we be asking our doctors for antiviral medication if we think we have the flu? Should we keep a prescription on hand in case we need it?

Aoki: People in high-risk groups -- with chronic disease and over 65 -- should. On Saturday night when you get a fever and a cough and it's winter and there's flu in Winnipeg, take the medicine. If you do that, it will work very, very well. The trick is to give them the drug early enough in their illness. If (patients) get sick on a Saturday night and they can't get in to see the doctor until Monday, the drugs have very much less of an impact.


FP: What does the flu virus look like this year? What are we in for?

Aoki: We are dealing with three viruses. In Canada we have these three viruses in our vaccine. What went around in South Africa, South America and Australia in the spring -- we'll have a virus that's the brother or child of that. It's changed a bit from the H1N1 of 2009. There's also one that's a slightly different variation of a virus that went around in 1968, and there's one called Influenza B.


FP: Why was the 2009 virus so virulent?

Aoki: Our bodies had never seen it before and as a result it caused large-spread disease around the world. What we do know is that its predecessor had been around since 1918, so people that were very old seemed to have some protection against it, but younger people did not.


FP: Are we really nervous about the three viruses going around this year?

Aoki: They aren't expected to cause catastrophic illness like what we saw in 2009.


FP: Why do the viruses come around now? Does it have to do with the cold?

Aoki: We're not sure why we have this thing called the winter flu season. We're not sure if it's the temperature, whether it's the crowding that occurs in September when kids go back to school or whether it's the decline in humidity. We know that two out of every three years we'll get an epidemic. We'll get enough disease that we'll see people dying in unusual numbers much more than would normally occur in the wintertime.


FP: How does the vaccine protect us?

Aoki: When it's injected into the arm, there is nothing alive in it. What happens then is those inactivated virus particles are engaged by the person's immune system. The immune system pumps out antibodies which go into the blood and which also go across the lines of the nose and the trachea and the bronchi -- the breathing tubes.

If the viruses are inhaled into our nose and into our throat and into our lungs, if the antibodies are there, these virus particles will collide with the antibodies. They will be neutralized and won't be able to infect our cells.


FP: To what degree does the flu shot protect us?

Aoki: In a year where the vaccine is a good match for the viruses that come around -- which is what we are expecting this year -- in young people it can be as good 80 per cent likelihood in preventing them from getting sick. In old people, even in a good year, it's probably not much more than 50 per cent protection. In some years, what actually comes around is another mutation which is slightly different from what's in the vaccine. And then that vaccine is rendered less effective.


FP: Is a vaccine mismatch one of the biggest challenges you face?

Aoki: It is. It's one of the nightmares. We spend all this effort putting together a vaccine and then promoting it to people and then finding out mother nature has gone out and generated a mutant virus which is just different enough that our vaccine is not going to be as effective as it ought to be.


FP: Once you've been exposed to the flu, how long until you get symptoms?

Aoki: The incubation period is somewhere between 12 hours an 48 hours. It's on you like a bomb. People will know if they get the flu -- the get a sudden fever and cough and they feel sick. They will be quite sick and the whole thing will be over in about five or seven days -- if they are going to recover.


FP: How long does the flu shot protect you for?

Aoki: We think six months.


FP: What's the connection between the flu shot and Guillain-Barré syndrome? (A disorder in which a person's own immune system damages their nerves resulting in muscle weakness and sometimes paralysis.)

Aoki: Just getting influenza will sometimes trigger getting this paralyzing illness afterwards. There's a germ that affects the stomach which has been associated with GBS, as well. Back in 1976 when there was the outbreak of the first swine flu virus, we thought there would be a pandemic, so we made a vaccine quickly and gave it to many, many people. That was the only time where in the six weeks after we gave the flu vaccine there seemed to be many more cases of GBS than there were usually.


FP: Do you get the flu shot?

Aoki: I got it when it first came out (several weeks ago). My kids get it, and my wife as well. I get it every year. I don't even think about it.


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Republished from the Winnipeg Free Press print edition November 18, 2013 D5

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