How to deal with the H1N1 flu outbreak? Is it too late to get vaccinated now?

Although everyone has made some preparations to deal with the disease after the fever some time ago, more and more people have had fever recently. How should we deal with it if we or our relatives and friends have a fever? What can we prepare in advance to deal with it?

Today we will try to sort out the following points, which are suggestions for everyone on how to deal with fever. Let’s explain them in detail one by one.

Key Points

First determine whether there is a fever

Find the cause of the disease and pay attention to the feelings and changes in your body

Prepare medicine, but don't use it blindly

Take this opportunity to rest

01

Have a correct understanding of fever

Fever is a common symptom of many diseases. Most of the time, fever is caused by the body being infected by pathogens. Fever is like an alarm for the body. Once an enemy comes from outside, fever is like a reminder from a sentinel, calling on the "immune forces" of the whole body to prepare for battle.

Although fever is a bit uncomfortable, it is not necessarily a bad thing for the body.

On the one hand, fever itself seems to play a key role in fighting infection; on the other hand, it also reminds people that if it is a long-term, unexplained fever, the body needs to be systematically tested to deal with more serious causes.

Because fever is also seen in some non-infectious diseases - the enemy does not necessarily come from outside, there is often rebellion from within (for example, tumor cells are discovered by the immune system), or even problems with the sentinel guards themselves (such as autoimmune diseases and some non-infectious autoinflammatory diseases).

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Of course, if it is the flu season, fever is often related to the flu.

So the question is, we all know that fever may be a sign of illness, but what exactly is considered a fever?

02

Touching the forehead, using a mercury needle or using an electronic thermometer, who should you trust?

Fever refers to an increase in the body's core temperature beyond the normal range , but there is a very unfamiliar word here, what is core temperature?

Core temperature refers to the temperature inside the human body. Due to different temperature measurement methods and tools, not all temperatures can represent core temperature. Among them, the temperature measured by rectal and oral thermometers can measure core body temperature most accurately.

The accuracy is roughly as follows:

Rectal temperature > ear (tympanic membrane) > forehead (temporal artery) thermometer > oral > armpit

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So what is considered a fever?

Generally speaking, for adults, the core body temperature should be between 37-37.5°C [1]. Depending on the measurement method, the normal values ​​are axillary temperature (36.0-37.0°C), oral temperature (36.3-37.2°C), and rectal temperature (36.5-37.5°C).

Of course, although we all know that rectal temperature is the most accurate, it is troublesome to take off pants to measure body temperature. Usually we use forehead temperature, ear temperature, armpit temperature, and oral temperature. Taking the simplest forehead temperature as an example, generally speaking, if it exceeds 37℃ and is accompanied by discomfort symptoms, it is considered a fever.

In addition, for children, according to the American Academy of Pediatrics, the standards for children are:

Rectal and ear temperatures are 38°C or above;

Oral temperature is 37.8℃ or above;

Axillary temperature is 37.2°C or above.

03

Find the cause, but don't be too obsessed with it

As mentioned above, there are many diseases that may cause fever. We usually only need to consider factors such as currently prevalent infectious diseases such as influenza, but we don’t need to worry too much about other causes. We just need to pay attention to the patient’s condition and take good care of him. Here are some causes of fever:

Immunization reactions are the most common cause of noninfectious fever in children 3 to 36 months of age.

Then there are infectious diseases . Among children with fever who present to primary care providers or emergency departments, 55% to 60%[2] have a clear bacterial or viral infection on physical examination, with the majority of these children presenting with acute pharyngitis and tonsillitis. Up to 6% of fevers in young children are caused by a clear viral illness, such as bronchiolitis, influenza, or varicella[3].

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Other noninfectious causes of fever are less common and include Kawasaki disease, drug fever, central nervous system dysfunction, malignancies (eg, leukemia), and chronic inflammatory disorders (eg, inflammatory bowel disease, juvenile idiopathic arthritis).

Fever caused by vaccination can be easily ruled out (usually occurs within 48 hours of vaccination) and does not require special treatment. If this cause is ruled out, we mainly consider infectious diseases. Among infectious diseases, we focus on the current infectious diseases prevalent in society. For example, we need to consider influenza A, norovirus or new coronavirus infection in the near future.

Finding the cause of the disease is helpful in determining the course of the disease and the means of treatment. Some diseases also have convenient methods. For example, antigen testing for COVID-19 can be performed at home. Currently, there are also influenza testing reagents for sale that can be operated by patients themselves. If there is diarrhea or vomiting, most people may consider Noru.

For some infectious fevers, the course of the disease is self-limiting. In other words, even if you do not take any medicine or treat it, it will subside after a period of time. What we need to guard against is the progression or deterioration of the disease, observing other symptoms besides fever, paying attention to physical condition, and identifying danger signals in time. In many cases, this is more important than finding a clear source of infection.

04

Prepare medicine but don't take it randomly

There are only two types of medicines to treat infectious fever: symptomatic and causal.

The so-called symptomatic treatment is a drug that improves symptoms, such as most non-steroidal anti-inflammatory drugs. In other words, it is the commonly used acetaminophen or ibuprofen .

However, it should be noted that there are usually different dosage forms and contents for adults and children, so you need to read the label carefully to determine the appropriate dose. For children, it is even more important to avoid repeated use of different dosage forms of drugs containing the same drug ingredient, and avoid giving aspirin to children or adolescents.

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The principle of symptomatic medication for children is to look at their mental state. If the child is in good spirits and eats, drinks and plays normally, then even if the temperature exceeds 38.5℃, you can stop taking medicine and continue to observe; if the child is in poor spirits, does not want to play, and has little appetite, then even if the temperature does not reach 38.5℃, we recommend that parents give the child medication.

This principle also applies to adults.

The use of drugs to treat the cause is more complicated. For some diseases, there are specific drugs that are relatively effective, but not suitable for everyone (such as COVID-19); for some diseases, there are clearly effective drugs that need to be taken at a specific time (such as in the early stages of infection, they are ineffective after 48 hours); for some diseases, there are no clear and effective drugs to treat the cause (such as Norovirus).

So back to the question just now, in infectious fever, many times you need to rest well and relax, while finding the cause and treating it.

05

Take this opportunity to have a good rest and record the following situations

Regardless of which infectious disease is mentioned above, the body will be in a state of fatigue and weakness after a fever, and the disease can be easily spread through frequent social activities. Therefore, after a fever, whether you are an adult or a child, please give yourself a reason to relax and rest at home.

If possible, please record the following information during your medical history and bring it with you to your doctor if your condition changes or if the need arises:

The course of fever: that is, when did the fever begin? It can be counted in days, such as 2 days ago, or in hours, such as 4 hours ago.

Possibility of fever: Briefly describe the cause you think is most likely, such as "Many of my colleagues in the company have been infected with influenza A recently."

Characteristics of fever: how high the body temperature is, how often the fever peaks, when the fever usually occurs. It would be better if it could be described in a concise and clear diagram.

Factors that relieve fever: For example, the fever will gradually drop within 1 hour after taking antipyretics, or the fever can go away on its own without taking any medicine.

Symptoms associated with fever: such as cough, runny nose, vomiting, diarrhea, abdominal pain, ear pain, sore throat, headache, etc.

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If you have been to other medical institutions before, you should inform them in detail, including when and where you went to the hospital, what tests you had, what the diagnosis was, and what medications the doctor gave you. If you have not been to the hospital before, but have taken medication, you also need to tell the doctor.

In addition, you can also record some basic conditions, such as: mental state (especially after the fever subsides), diet, sleep, urination and defecation, etc.

06

A few more words about influenza

Influenza A is currently spreading. Many people have been infected and have developed fever. Many classes have been suspended as a result. Sales of oseltamivir have increased significantly in some areas... In order to prevent this situation from happening again, the best practice is always to get a flu vaccine.

Influenza has a clear peak season, which generally lasts from October of each year to March of the following year. Therefore, it is strongly recommended that everyone make an appointment for influenza vaccination in September and October every year.

In addition, since the flu virus often mutates and the effect of the vaccine will weaken, you should get vaccinated every year when the season comes. It should be noted that after getting the flu vaccine, our immune system still needs 2-4 weeks to produce enough protective antibodies to fight infection . Therefore, when the season comes, it is recommended that you get vaccinated in time, the sooner the better.

Some friends may still face the biggest question: Is it too late to get the H1N1 flu vaccine now? I have to say that although it is a bit late, if you have not been infected with H1N1 and can make an appointment for the vaccine, you might as well get a shot first, after all, there is still a "tail" of this round of H1N1.

References:

[1] Niven DJ, Gaudet JE, Laupland KB, et al. Accuracy of peripheral thermometers for estimating temperature: a systematic review and meta-analysis[J]. Annals of internal medicine, 2015, 163(10): 768-777.

[2] Finkelstein JA, Christiansen CL, Platt R. Fever in pediatric primary care: occurrence, management, and outcomes[J]. Pediatrics, 2000, 105(Supplement_2): 260-266

[3] Greenes DS, Harper M B. Low risk of bacteremia in febrile children with recognizable viral syndromes[J]. The Pediatric infectious disease journal, 1999, 18(3): 258-261.

Author: Chen Mozhao

Reviewer: Zhang Wenjuan, General Medicine Department, Chenzhou Fourth People's Hospital

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