In addition to delivering delightful rains and milder temperatures, the monsoon season also brings prevalent water-borne-air-borne illnesses and bacterial and viral infections. This article elaborates on the clinical symptoms, management and prevention of the monsoon flu.

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Monsoon flu

Influenza is one of the most widespread monsoon-related illnesses. During the monsoon season, there is an increase in the incidence of fever and chills. The common cold and influenza are rampant during the monsoon season. The abrupt weather shift produces temperature variations that result in colds and influenza. Due to the fast viral transmission affecting the upper respiratory tract, the common cold is a highly infectious illness. Cold and influenza symptoms include a runny or stuffy nose, throat inflammation and pain, and fever.

Influenza is an infectious respiratory infection caused by viruses that infect the nose, throat, and lungs. Some individuals, including the elderly, small children, and those with specific health issues, are at a greater risk of developing significant flu complications. Types A and B are the two most common influenza (flu) viruses. Each year, seasonal flu epidemics are caused by the influenza A and B viruses that normally circulate in humans (human influenza viruses).

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Clinical symptoms 

According to the Centers for Disease Control and Prevention (CDC), a person with flu may experience - a high temperature that lasts 3–4 days, a stuffy or runny nose, cold sweats and shivers, aches that may be severe, a headache, fatigue, a feeling of being unwell, a low appetite.

Not all influenza patients will exhibit all of these symptoms. For instance, a temperature sometimes may not be present while suffering from the flu.

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Flu or a cold?

Due to several symptoms being similar, the flu and a nasty cold are often confused.

Both a cold and the flu involve :

• A runny or blocked nose.
• Sore throat
• Cough
• Chest discomfort
• Fatigue

Though, there are a few differences :

1. A cold does not often entail a temperature, but influenza does.
2. The symptoms of cold often develop gradually, but the symptoms of influenza may grow swiftly.
3. Typically, cold symptoms are less severe than influenza symptoms.
4. A person who has had the flu may continue to feel exhausted for many weeks.
5. Influenza is more prone to cause complications and may be fatal.

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Infectivity

The infected person may spread the virus for up to 5–7 days after the onset of symptoms. Immune-compromised individuals, the elderly, and small children may be able to transmit the virus for longer than this. Flu is most infectious within the first 3–4 days following the onset of symptoms.

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How long does it continue?

Typically, flu symptoms start rapidly, roughly two days after infection. The majority of symptoms resolve after one week, however, a cough might continue for up to two weeks. In some instances, a person may remain infectious for up to one week after their symptoms have subsided. If complications develop, their resolution may take longer. Some of the most serious problems, such as renal failure, may have long-term effects on a person's health. Some individuals experience post-viral fatigue for approximately one week after the main symptoms have subsided. They may experience persistent feelings of fatigue and illness.

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Chronology

1. Typically, the virus infects a person via the nose or mouth.
2. Patient could be able to spread the illness to others after one day.
3. Symptoms manifest one to two days after infection.
4. The risk of spreading the virus is greatest 3–4 days following the onset of symptoms.
5. The fever and muscular pains lessen after four days.
6. After 1 week, most symptoms disappear.
7. The danger of spreading the virus diminishes five to seven days after the onset of symptoms.
8. The cough and fatigue may persist for an additional week.

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Management 

It should be decided whether to offer antiviral medication to outpatients within 48 hours of the beginning of symptoms if they are not at high-risk risk for complications. In general, treatment is suggested for those who have been exposed to individuals who are at high risk for influenza complications, such as home contacts and healthcare professionals.

Early antiviral therapy (within 48 hours of symptom start) for outpatients with uncomplicated influenza may be correlated with a slight decrease in illness duration (by about 24 hours), reduced respiratory tract complications, and hospitalization. Antiviral therapy is not required for outpatients with uncomplicated disease presenting >48 hours after symptoms start due to lack of benefit.

Other antiviral medicines for the treatment of influenza without complications include baloxavir (oral single dose), zanamivir (inhaled regimen twice daily for five days), or peramivir (parenteral single dose). Clinical considerations for selection among these agents include:

1. Baloxavir should not be administered to immunocompromised hosts, since its usage has been linked to the emergence of resistance.
2. In individuals with asthma or chronic obstructive pulmonary disease, zanamivir is contraindicated.
3. Peramivir should only be administered to individuals who cannot take oral or inhalation medications.

Antiviral duration - Oseltamivir and zanamivir have a five-day treatment duration for individuals with uncomplicated influenza; peramivir and baloxavir have a single-dose therapy duration.

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Prevention 

Is the flu vaccination beneficial?

Although the flu vaccination is not 100 per cent effective, there are several reasons to receive one annually. First, the flu vaccination minimizes the likelihood of being ill. In addition to being very unpleasant, influenza may develop consequences that are potentially life-threatening and may need hospitalization.

Even if a flu illness is not life-threatening, it may nevertheless cause a person to miss work or school. Second, the vaccination may provide protection even if a person contracts influenza. Those who take the vaccination but become unwell may have milder disease.

Lastly, by obtaining the flu vaccine, you protect those who cannot get the immunization or who are prone to major flu consequences, such as older adults, infants less than 6 months, those with a compromised immune system, and those with chronic health issues.

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This is the next article of our monsoon series. To read the earlier articles of the series, click here: Malaria in monsoon: Recent updates ; Managing dengue fever: What you should knowLeptospirosis: A commonly misdiagnosed disease; Know cholera: Diagnosis and treatment approach; Chikungunya: An overview of diagnosis and treatment; Typhoid Treatment in OPD: Recent Updates; Treating Skin Infections in Monsoon

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Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.