Flu season has been slow to arrive

Viruses are doing their dirty work, leaving lots of people coughing and sneezing this winter.

But so far, few of them have influenza.

"This has been a slow flu year," said Angela Smetak, pharmacy manager at a Rite Aid store on Pineville-Matthews Road in Charlotte. "But it's not over yet, so you never know. On average the flu doesn't even peak until February."

Health experts are reluctant to predict whether a flu season will be mild or severe and when the illness will peak. There's really no typical flu season, as we saw in 2009 when the so-called swine flu pandemic swept the globe.

This year, drugstores began offering flu shots in August, earlier than usual. But the flu has been slow to arrive. North Carolina saw a rise in flu-like illness around New Year's Day, followed by a modest drop. Now the numbers are starting to rise again, said Dr. Zack Moore, medical epidemiologist with the N.C. Division of Health in Raleigh.

Actual flu cases are not counted. The state keeps track of "influenza-like illness" by surveying more than 100 "sentinel sites," such as health departments and doctors' offices.

For the second year in a row, health officials recommend flu vaccinations for anyone 6 months of age or older.

This year's vaccine contains the same three viruses as last year, including the swine flu (H1N1) strain. But officials say people should get vaccinated again because protection generally lasts for about a year.

With the proliferation of pharmacy clinics offering flu vaccine at all hours, traditional vaccine providers have seen a decline in demand.

Kay Johnson, whose Health Xpressions business has provided flu vaccine from mobile units in the Charlotte area for nine years, said she saw 25 percent fewer people last year. This year, she said, "We did not even take our mobile units out one time. There just wasn't the demand."

Meanwhile, Rite Aid President John Standley said the pharmacy chain expects to administer about 1.5 million vaccinations nationally this season, doubling last year's number.

Some common questions:

Q: What's new about the vaccine?

For the first time, people can choose from three different shots and one nasal spray.

The traditional shot is approved for people 6 months and older. The spray, which has been offered for years, is for healthy people 50 and under.

People 65 and older can get a high-dose shot that contains four times the amount of antigen as the typical shot. Research shows it produced higher antibody levels for a potentially better response. But it's not yet known whether that will lead to fewer people getting the flu.

And for the first time, there's an "ouchless" shot that uses a tiny needle injected into skin instead of muscle. Approved for people 18 to 64, it's more expensive and less widely available than other vaccine forms.

Q: Is the high-dose shot safe?

The Centers for Disease Control and Prevention website says the high-dose vaccine is as safe as other flu vaccines. But side effects - such as pain, redness and swelling at the injection site, headache, muscle aches, fever and malaise - are reported more frequently.

Q: Does this year's shot cause a painful reaction?

Some people have reported this, but it may have more to do with the person administering the vaccine than the vaccine itself. "I'm putting this down as a myth," said Dr. William Schaffner, president of the National Foundation for Infectious Diseases. At Vanderbilt University this fall, he said, more than 12,000 students and employees were vaccinated, breaking the world record for number of people vaccinated in an eight-hour period. If there had been a problem with painful injections, "we would have heard."

Q: When is it too late to get a vaccination?

October and November are usually the prime months, but health officials say it's not too late to get a vaccination. It takes about two weeks for immunity to kick in. Flu strains showing up around the country are well matched to the vaccine that was formulated for strains that scientists expected this year, according to the CDC.

Q: Does the vaccine work?

It's not perfect. "The effectiveness of flu vaccines is well below that of many other immunizations, such as measles," the CDC website says. The flu vaccine is 70 percent to 90 percent effective in healthy, non-elderly adults, but can be significantly lower in people older than 65 and who have other medical conditions. That's why it's also important to take other precautions to prevent the flu.

Q: What precautions?

Wash your hands frequently with soap and water, or use hand sanitizer. Avoid touching the mouth, nose and eyes. Cover coughs and sneezes with a tissue or your sleeve. Stay home when you are sick and until you are fever-free for at least 24 hours. Get enough sleep, reduce stress and eat a healthy diet (such as avoiding sugar) to maintain a strong immune system.

Q: Is relatively warm winter weather associated with a mild flu season?

If any aspect of the weather has been fighting the flu, it may be that there is less chance of transmitting the virus. "It may be that people just aren't huddled together in buildings spreading germs among themselves as much because they're outside more," said Janice Frohman, administrative director of emergency services at WakeMed Health and Hospitals in Raleigh.

Q: Can you get the flu from the vaccine?

The injectable vaccine is made from a killed virus, and health officials say it does not cause the flu. Flu vaccine does not protect against other viruses that sometimes feel like the flu. The nasal spray vaccine, made from a live attenuated virus, does not cause the flu, but could cause a mild reaction, including lethargy, officials said.

Q: Is there anything to treat the flu?

Antiviral drugs, such as Tamiflu, can reduce the severity and duration. But they work only if they're taken within 48 hours of the onset of symptoms. Health officials have advised doctors to reserve these medicines for patients at high risk for flu complications, such as pregnant women, very young children and people with asthma and other chronic conditions.

Q: What's the difference between a cold and the flu?

Colds bring a runny or stuffy nose, cough and sore throat. Flu symptoms are generally more severe - fever, fatigue, body aches, headache, cough, stuffy nose and sore throat. It usually runs a course of seven to 10 days.

Q: Is the flu really serious?

Health officials say the flu causes 3,000 to 49,000 deaths and more than 200,000 hospitalizations each year. Complications are most common among very young children and people over 50, as well as people with chronic conditions and pregnant women.

News & Observer staff writer Jay Price contributed to this report.