Ebola vs. The Flu

January 6, 2015

By Ruben J. Rucoba, MD

                       Three months ago, if I asked you which illness you were more afraid of, Ebola virus or the flu, you most likely would have answered, “Ebola.” Now, in the first days of 2015, if I asked the same question, your answer might have changed. But I would argue that both times, the answer should be “the flu.”

                      When I use the phrase “afraid of,” I mean which infection makes you worried that it might cause serious problems for you and your family? As a parent, I know that it is natural for you to worry about the worst possible scenario for your children. But as a physician, I know that it is more productive to worry about the most likely scenario, and work to prevent or mitigate that problem.

So what’s more likely: Ebola or the flu?

                           A few months ago, media attention had everyone fearful that an Ebola epidemic would soon be taking over the US. But the reality is that, so far, only two people in the US have contacted Ebola without going to west Africa, and both of them were healthcare providers who were in close contact with a known Ebola patient who contracted the disease in Liberia. And both of them were treated effectively and are free of the infection.

                           So if you or your family members either are healthcare providers caring for Ebola patients (and I know there are a few of you out there) or are traveling to west Africa, then you should worry about contracting the disease. But if not, then the chances of getting Ebola are practically non-existent.

                            However, it is extremely likely that you could get the flu, especially this season. Many of you probably already have had a family member or friend (or yourself) come down with the flu. The Centers for Disease Control and Prevention recently declared the flu outbreak to officially be an epidemic. The word “epidemic” always seems to cause fear in a lot of people, but it basically means that the number of cases of the infection have exceeded a pre-determined threshold.

                            In fact, in most years, the flu is considered an epidemic at some point. This year is different because that point was reached very early in the flu season, at the end of December rather than the usual peak time for flu, usually around mid-February.

                            In my office, we’ve been swamped with cases of the flu and influenza-like illness since the middle of November. That fits with the statistics: according to the CDC, Illinois is one of the hardest hit states for influenza this year.

                            So far this season, influenza has caused hundreds of deaths, including 15 pediatric deaths across the country. Every year, the flu and its complications cause 20,000 to 40,000 deaths in the US. Most of those deaths are in those over the age of 65, but young children are also at risk. And those with chronic medical problems, such as asthma or diabetes, are also at risk for complications and death from the flu.

                            But the flu can be fatal even in healthy people. Last season, the flu caused 109 pediatric deaths (0-18 years old). Of the 106 cases in which the child’s medical history was known, 54% of the deaths occurred in children with chronic conditions, but the other 46% had no underlying health problems. So last year, almost half the pediatric deaths from flu were in otherwise healthy, normal children.

                             The predominant strain this year is the H3N2 strain of influenza A, which is known to be virulent. In my practice, relatively few of the kids with the flu have had the complications commonly seen: pneumonia, ear infections, sinusitis, strep throat, and croup. And nearly everyone seems to recover from the flu after just a few days. But that picture is not what is seen in the rest of the country, where complications, hospitalizations, and deaths are up in the pediatric population.

                           So don’t fret about Ebola (unless you are traveling to west Africa or caring for an Ebola patient), but do what you can to protect yourself and your family from the flu. Dr. Irwin Benuck wrote a Salubrity post a few weeks ago about how to prevent the flu.

                           I would add only two comments to Dr. Benuck’s post. First, I want to reiterate the importance of the flu vaccine. No doubt, you’ve heard that the vaccine this year is not as effective against the H3N2 strain. That is true, but the vaccine is not completely ineffective: some people make enough antibodies against the strain to be protective or at least to make the illness less severe. And there are other strains of the virus in the vaccine that may be more effective. It’s a long flu season, and people can get the flu several times in the same season from different strains.

                            Second, let’s clarify that the flu is NOT vomiting and diarrhea. It is a seasonal respiratory infection marked by fever (often high fever in children), cough, sore throat, body aches, headache, and fatigue. Profuse vomiting and diarrhea are not symptoms of influenza, but are seen in another common viral infection of the stomach and intestines that health professionals call gastroenteritis. This illness is almost never fatal in the US, but the flu frequently is.

                            To date, Ebola virus has killed a total of two people in the US, both of whom acquired the illness in western Africa. Yet each year, influenza kills tens of thousands of Americans. Which illness do you think you should be worried about?

Dr. Ruben J. Rucoba is a general pediatrician in Wheaton, Illinois. A member of the medical staff at Ann & Robert H. Lurie Children’s Hospital of Chicago and Central DuPage Hospital, he is especially interested in the care of special needs children. Dr. Rucoba is also a medical writer and the father of four children.