The flu affects 3 million to 5 million people worldwide each year. In the U.S., medical costs resulting from influenza totaled $8.7 billion in 2013. Influenza is also responsible for substantial indirect costs from lost productivity estimated at $6.2 billion annually. Each year 17 million workdays are lost to influenza-related illness. Attention to prevention and prompt treatment is worth the effort.

Influenza, or flu, is a viral infection that causes fever, dry cough, headache, body aches, sore throat and a runny nose. In most places it starts in late fall and spreads throughout the winter. Influenza outbreaks typically begin abruptly, peak over a two- to three-week period and last for two to three months. Most outbreaks have attack rates of 10 to 20 percent in the general population, but rates can exceed 50 percent in pandemics. Because Hawaii hosts 8 million visitors, the timing and severity of the flu is more unpredictable than on the mainland.

Globally, the strain changes each year. Small changes are called “antigenic drift” and occur over time as the virus replicates. That is why the flu vaccine is slightly different each year and must be given annually. “Antigenic shift,” on the other hand, is an abrupt, major change in the influenza virus that results in a new subtype. For example, in spring 2009 H1N1 emerged, a human-swine-avian virus that infected many people quickly in different parts of the world.

Vaccination: The Advisory Committee on Immunization Practices recommends that all individuals 6 months or older get the influenza vaccination, which represents a change from previous guidelines that recommended vaccination in only high-risk individuals. Adverse reactions are rare but can result in soreness at the injection site, hypersensitivity reactions and an increased risk of developing a neurological condition known as Guillain-Barre syndrome. The live version of the influenza vaccine is not recommended in immunocompromised patients, pregnant women and adults over the age of 50.

Under development is a patch for the flu vaccine that replaces the need for a needle poke and does not need to be refrigerated.

Medication: Most people who get the flu (with or without vaccination) get better on their own within one to two weeks. But for some, particularly in years when there is a mean strain going around, convalescence can be extended, and the flu can even be life-threatening. While it is true that antibiotics are not effective for treating the flu, antiviral medications such as oseltamivir (Tamiflu) are effective in minimizing and shortening the course of the illness. However, for medication to work, it is of paramount importance to start the course within the first 72 hours — even better in the first 24 to 48 hours. Many people miss this window and try to “fight it off” during the first several days. When they finally come to their health provider, the window of opportunity to take antivirals has passed.

Lifestyle prevention: A proactive approach to prevent the flu includes hand washing with soap and water, avoiding individuals who are sick, and getting the flu vaccine every year.

Maintaining a balanced sleep routine helps keep our immune systems healthy. Adults need seven to nine hours of sound sleep each night to rejuvenate for the next day. Poor sleep quality or inadequate sleep lowers the body’s defenses needed for fighting viral infections. A diet rich in fruits, vegetables and high-quality protein is important for a healthy immune system. Studies have shown that eating a sugary snack or meal can depress the immune system for several hours, creating a window of time during which it is easier to get the flu. Avoiding excessive sugar can keep the immune system working at the level needed to fend off viral infections such as the flu.

Natural approaches: Research has demonstrated that elderberry extract from the fruit of the Sambucus nigra tree has immune-modulating and antioxidant properties that neutralize the activity of viruses so they can no longer penetrate the cells of our bodies and replicate. The berries also contain vitamins A and C, and the flavonoids quercetin, anthocyanin and rutin, all of which boost immune function. Echinacea contains immune-stimulating polysaccharides that naturally enhance the body’s resistance to infection. The mineral zinc plays an important role in maintaining healthy immune function. Low levels of zinc are associated with a decrease in T cell function, a vital white blood cell that helps fight infections.

Many clinics, including Manakai o Malama, support patients in taking a more proactive approach to prevent the flu by encouraging a healthy lifestyle, offer reminders on preventive hygiene, provide flu vaccination and respond with prompt treatment if prevention fails. Speak to your health care provider about whether the flu vaccine is the right choice for you. The flu season is around the corner.