Pediatric nurse practitioner and College of Nursing assistant teaching professor Elise Schaller teaches pediatric and advance practice nursing. (Photo by Jessica Rogen).

Influenza is a highly contagious viral respiratory illness with outbreaks that infect millions of Americans every year. During the 2017-2018 flu season, the Centers for Disease Control and Prevention estimated flu affected 48.8 million people, making last year the most active since the 2009 H1N1 pandemic.

Elise Schaller is an assistant teaching professor in the College of Nursing, where she teaches pediatric nursing and advanced practice nursing. She earned a BSN from Saint Louis University in 2008 and an MSN in 2011. She comes to the University of Missouri–St. Louis from St. Louis Children’s Hospital, where she works as a pediatric nurse practitioner.

Midway through the season of sniffles, UMSL Daily spoke with Schaller about all things flu for the latest installment of the “Ask an Expert” series.

How is the flu different than other illnesses?

It’s a virus, and viruses are treated differently than bacteria. We can’t give antibiotics to clear the infection.

Why are the flu and other colds more prevalent in the winter?

There’s not hard evidence about why the flu is a winter virus. Flu season starts as early as October and then peaks in February and ends in March. It is not caused by cold temperatures but a contributing factor in colder temperatures is that we stay inside and lead our lives differently. We spend more time indoors with the windows sealed. The way the flu is contracted is by contact with an infected droplet from someone’s sneezing, someone’s nose, some droplet of their secretions, so spending time closer to other people, we put ourselves as high risk for contagious viruses or other contagious illnesses.

There’s also some thought that the influenza virus may survive better in colder climates.

What are the treatment options for the flu?

We treat bacteria with antibiotics that help kill the bacteria circulating in the body. But the treatment option for the flu is antiviral medication. Antivirals stop the replication of the virus, so it won’t stop the course of the illness, but it could shorten it.

Then your body fights it off?

Exactly. I could give you the antiviral, it’s called Tamiflu, yet the virus will still be in your body. The flu is a 10-to-14-day-long illness, and it has a peak. It lasts so long because the virus replicates and grows, and then your body fights the virus and destroys it over time. The antiviral will stop that replication.

As patients, we often hear, “It’s a virus, wait it out.” How do you know if you’re sick enough to go to the doctor, and when should you simply be staying home?

You need to stay home and avoid contact with others if you have fever and flu-like symptoms, which would be cough, sore throat, body aches, headaches, chills. All these symptoms are going to vary by case, so if you’re having symptoms like this, as soon as possible, avoid further contact and start resting.

You should go to the hospital if you’re in a high-risk group – those older than 65, young children, people with weakened immune systems from conditions like HIV/AIDS, an autoimmune condition or cancer. Someone that has lived in a long-term care facility, with a history of asthma or someone with chronic lung disease. I’d say kids because that’s what I do.

Serious flu complications could be high fever, cough, concern for pneumonia, dehydration or respiratory distress or difficulty breathing. Those would be the signs where I’d say you should go see a medical provider, either your primary care physician or to an emergency room.

Are there any pediatrics-specific flu concerns?

Young children, younger than 2, are at a higher risk for more complications. That goes along with any respiratory illness because the airways are smaller in young children.

When people do die from the flu is it the flu that causes that or does it come from complications like pneumonia?

Both. It could be complications, or it could be a respiratory failure from the flu.

A lot of people are afraid of the flu shot. What are the most common concerns you hear, and are they valid?

I hear that people are going to get the flu from the flu shot. But flu vaccines do not cause flu illness. The flu vaccine has an inactivated, or killed, version of the virus. It’s not infectious. Or it gives you a single gene of the flu virus but not the full virus. Your body will respond with an immune response, so you’re building the antibodies toward it without getting the infection.

I’ve also heard something about having a bad reaction to it. But serious allergic reactions are rare to the vaccine. Anytime you get a flu shot you will be screened for potential allergy to the ingredients, like eggs. If you don’t have a risk for allergic reaction it’s very unlikely that you would have a reaction to the vaccine.

There’s also the nasal vaccine; how is it different?

The nasal spray vaccine is the live attenuated vaccine, which is the single gene version. They will both produce an immune response in your body but by two different routes. Now, you cannot get the nasal spray if you have a history of asthma because they don’t want your asthma to be exacerbated with a spray. You also can’t get if you’re too young for it. But anyone older than 6 months can get the shot.

That’s too bad because I’d think little kids would prefer the nose spray

Anyone 2 years and older can get the spray. That’s pretty good.

Is the flu shot safe for pregnant women and does the immunity transfer to the child?

Pregnant women can’t get the nose spray, but they can get the shot. It’s actually encouraged to get the shot to protect their infants. The thought behind vaccinating pregnant women, and really anyone around infants, is because it provides herd immunity. Basically, that’s protecting the child that we can’t vaccinate yet by vaccinating and protecting all the people around them to decrease their likelihood of getting the flu. It’s indirect protection. Also, the mother could potentially pass on her antibodies to the flu if she got the shot during pregnancy.

Do you have a sense of how bad this flu season is?

Looking at my hospital’s weekly virology update from the week of January 20th to the 26th, we had 113 patients out of 820 tested positive for the flu. Nationally, from October 1 to now, the CDC has recorded 69,300 to 83,500 hospitalizations from the flu. And that’s just hospitalizations – there’s over a million medical visits.

That seems like a huge number to me.

It is huge. The CDC, on January 11, estimated so far this season that 6 million to 7 million have been sick with the flu. Up to half of these people have sought medical care.

Does this strain care at hospitals to have so many patients over this relatively short period of time?

Just thinking out loud, a children’s hospital – the one I work at – has 350 beds, and that’s a pretty decent size hospital. To think nationally 83,500 hospital hospitalizations – that’s a ton. Thinking, if every bed was filled at Children’s for the flu, that would be 238 hospitals full with just flu patients. That’s crazy. That’s a lot. Only this season, and this season is not over.