tag:theconversation.com,2011:/us/topics/winter-health-15625/articlesWinter health – The Conversation2024-03-25T19:05:37Ztag:theconversation.com,2011:article/2241442024-03-25T19:05:37Z2024-03-25T19:05:37ZSummer’s over, so how much sun can (and should) I get?<figure><img src="https://images.theconversation.com/files/583381/original/file-20240321-22-89ys3l.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6016%2C3998&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-sitting-on-beach-shore-during-daytime-f9HmXiFNKXM">Tamara Bellis/Unsplash</a></span></figcaption></figure><p>As we slide of out summer, you might be wondering how careful you need to be about sun exposure. Excessive exposure causes <a href="https://www.cancer.org.au/about-us/policy-and-advocacy/prevention-policy/national-cancer-prevention-policy/skin-cancer-statistics-and-issues/uv-radiation">skin cancer</a>, but sun exposure also has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">benefits</a>. How do you balance the two? </p>
<p>A new <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">position statement</a> from cancer, bone health and other experts <a href="https://www.assc.org.au/wp-content/uploads/2023/01/Sun-Exposure-Summit-PositionStatement_V1.9.pdf">aims to help</a> Australians balance the good and bad effects of sun exposure by taking into account their skin colour, risk of skin cancer, and where they live.</p>
<h2>What are the benefits of sunlight?</h2>
<p>Ultraviolet (UV) radiation (the wavelengths in sunlight that cause skin cancer) also leads to vitamin D production. <a href="https://dermnetnz.org/topics/vitamin-d">Vitamin D</a> is very important for maintaining strong bones, and is likely to have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">multiple other health benefits</a>. </p>
<p>But vitamin D probably isn’t the whole story. Sunshine, including UV radiation, is thought to affect health in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">other ways</a> such as improving our mood and reducing the risk of autoimmune diseases and infections. So for many people, avoiding the sun and taking a vitamin D supplement may not be the best approach.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vitamin-d-supplements-can-keep-bones-strong-but-they-may-also-have-other-benefits-to-your-health-219521">Vitamin D supplements can keep bones strong – but they may also have other benefits to your health</a>
</strong>
</em>
</p>
<hr>
<h2>How much time does it take to make vitamin D?</h2>
<p>It’s complicated, but for most people and most of the year across most of Australia, it’s a lot less than you think.</p>
<p>The <a href="https://onlinelibrary.wiley.com/doi/10.1111/php.13854">amount of time needed</a> depends on the amount of skin covered by clothing and the intensity of UV radiation (indicated by the UV index). More skin exposed and higher UV index equate to less time needed. </p>
<p>Both the UV index and the amount of the year that UV radiation is high increase as you get closer to the equator. In summer, all of Australia is bathed in sunshine. But in winter, opposite ends of the country have <a href="https://onlinelibrary.wiley.com/doi/10.1111/php.13854">very different exposures</a>. </p>
<p>In summer, everybody except those with deeply pigmented skin can make enough vitamin D in <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">just five minutes</a> between 9am and 3pm, anywhere in Australia, provided they are wearing shorts and a T-shirt. </p>
<p>In winter it’s a different story. In <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">Darwin and Brisbane</a>, 5–10 minutes between 10am and 3pm will do the trick, but in <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">Hobart</a>, factoring in winter clothing, it will take nearly an hour in the middle of the day.</p>
<p>Hover your mouse over the lines below to see the length of exposure needed at specific times of day.</p>
<p><iframe id="X5szQ" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/X5szQ/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Staying out for longer than needed doesn’t necessarily make more vitamin D, but it <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub#bib25">does cause skin damage</a>. </p>
<h2>Hang on, what about those with darker skin?</h2>
<p>People with deeply pigmented, brown to black skin accumulate both vitamin D and DNA damage at a much slower rate than people with lighter skin tones. </p>
<p>When UV radiation hits a DNA strand, it causes the DNA to become distorted. If the distortion isn’t fixed, it will cause a mistake when the DNA is copied for a new cell, causing a permanent mutation that sometimes leads to cancer. </p>
<p>Melanin, the brown pigment in the skin, absorbs UV photons before that can happen, and the high melanin content in the darkest skin tones provides <a href="https://faseb.onlinelibrary.wiley.com/doi/full/10.1096/fj.201701472R">60 times</a> as much UV protection as the small amount in very fair skin. </p>
<p>The flip side is the risk of vitamin D deficiency is much higher than the risk of skin cancer. </p>
<p>The new statement accounts for this by putting people into <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">three groups</a> based on their risk of skin cancer, with specialised advice for each group.</p>
<h2>Highest skin cancer risk</h2>
<figure class="align-center ">
<img alt="Red-headed woman" src="https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583354/original/file-20240321-22-qfrbj0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with pale skin that burns easily are in the high-risk group.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/close-up-photo-of-person-with-nose-ring-2146042/">Luriko Yamaguchi/Pexels</a></span>
</figcaption>
</figure>
<p>This includes people with very pale skin that burns easily and tans minimally, but also people with darker white or olive skin who can tan easily but have extra skin cancer risk factors because they: </p>
<ul>
<li>have had <strong>skin cancer</strong> before</li>
<li>have a <strong>family history</strong> of melanomas</li>
<li>have many <strong>moles</strong></li>
<li>are taking <strong>immunosuppressant</strong> medications.</li>
</ul>
<p>For these people, the harms of sun exposure almost certainly <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">outweigh the benefits</a>.</p>
<p>These people should wear sunscreen every day the <a href="https://www.arpansa.gov.au/our-services/monitoring/ultraviolet-radiation-monitoring/ultraviolet-radiation-index">UV index</a> is forecast to get to <a href="https://www.assc.org.au/peak-health-bodies-recommend-new-approach-to-sunscreen-use/">three or more</a>, and use the <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/be-sunsmart">five sunsmart steps</a> whenever the UV index is above three: </p>
<ul>
<li><strong>slip</strong> on clothing covering as much of the body as possible</li>
<li><strong>slop</strong> on SPF30+ sunscreen on areas that can’t be covered up</li>
<li><strong>slap</strong> on a hat</li>
<li><strong>seek</strong> shade</li>
<li><strong>slide</strong> on sunglasses.</li>
</ul>
<p>They shouldn’t spend time outdoors deliberately to make vitamin D, but should discuss vitamin D supplements with their doctor. </p>
<h2>Intermediate skin cancer risk</h2>
<figure class="align-center ">
<img alt="Man drinks soda from a cup" src="https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583358/original/file-20240321-20-42mfoy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with skin that tans easily are at intermediate risk.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/man-in-gray-shirt-drinking-from-white-ceramic-mug-TfqM6Kg2Rh4">Jarritos/Unsplash</a></span>
</figcaption>
</figure>
<p>This means people with dark white/olive skin that sometimes burns but tans easily, and who don’t have other skin cancer risk factors. </p>
<p>These people should still apply sunscreen as part of their usual routine on all days when the UV index is forecast to get to <a href="https://www.assc.org.au/peak-health-bodies-recommend-new-approach-to-sunscreen-use/">three or more</a>, but they can spend enough time outdoors to get a “dose” of vitamin D on most days of the week. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-how-does-the-sun-help-your-body-make-vitamin-d-139670">Curious Kids: how does the Sun help your body make vitamin D?</a>
</strong>
</em>
</p>
<hr>
<p>Once the time needed for their vitamin D dose is up, they should also use the <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/be-sunsmart">slip-slop-slap-seek-slide</a> steps to avoid accumulating DNA damage. </p>
<p>If they’re unable to do this because of health or lifestyle factors, like being housebound, working night shifts, or always covering up with clothing, they should see their doctor about whether they need vitamin D supplements.</p>
<h2>Lowest skin cancer risk</h2>
<figure class="align-center ">
<img alt="Family members sit outside, laughing" src="https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583359/original/file-20240321-16-fk5ehb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with skin that rarely burns have the lowest risk of cancer.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/two-persons-staring-at-each-other-jg_t3PBq5Jo">Eye for Ebony/Unsplash</a></span>
</figcaption>
</figure>
<p>This covers people with deeply pigmented brown to black skin that rarely or never burns. </p>
<p>These people can <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub#bib14">safely spend enough time outdoors</a> to make vitamin D and get the other benefits of sunshine. But because more time is needed, it can be difficult, particularly when the weather is cold. Vitamin D supplements might be needed. </p>
<p>They don’t need to routinely protect their skin, but might need to <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/be-sunsmart">slip-slop-slap-seek-slide</a> if they are outdoors for more than two hours.</p>
<h2>How do I get the feel-good effects of sunshine?</h2>
<p>Spending time outdoors in the early morning is the best way to get the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">feel-good effects</a> of sunshine. An early morning walk is a great idea for all of us, but it won’t make vitamin D.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-be-getting-my-vitamin-d-levels-checked-211268">Should I be getting my vitamin D levels checked?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/224144/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Lee receives funding from the National Health and Medical Research Council for a student stipend. </span></em></p><p class="fine-print"><em><span>Rachel Neale receives funding from the National Health and Medical Research Council for grants related to vitamin D and sunscreen. She was the lead author of the manuscript describing the revised position statement and chaired the Summit that led to the revised recommendations.</span></em></p>Excessive exposure causes skin cancer, but sun exposure also has benefits. How do you balance the two?Katie Lee, PhD Candidate, Dermatology Research Centre, The University of QueenslandRachel Neale, Principal research fellow, QIMR Berghofer Medical Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2208672024-01-16T14:55:38Z2024-01-16T14:55:38ZCOVID barely gets a mention these days – here’s why that’s a dangerous situation<figure><img src="https://images.theconversation.com/files/568841/original/file-20240111-25-3s8lzt.jpeg?ixlib=rb-1.1.0&rect=21%2C0%2C4635%2C3060&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">COVID is not getting milder. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/news-photo/sentence-of-i-miss-you-mum-seen-on-the-national-covid-19-news-photo/1901345432?adppopup=true">Hesther Ng/SOPA Images/LightRocket via Getty Images</a></span></figcaption></figure><p>The <a href="https://fortune.com/well/2024/01/05/us-reachest-second-highest-covid-peak-pirola-jn1-omicron-pi-rho/">United States</a> experienced its second largest COVID wave of the pandemic in January 2024. For the year to December 2023, in England COVID rates <a href="https://www.gov.uk/government/statistics/winter-coronavirus-covid-19-infection-study-estimates-of-epidemiological-characteristics-england-and-scotland-2023-to-2024/winter-coronavirus-covid-19-infection-study-estimates-of-epidemiological-characteristics-11-january-2024">peaked</a> at around <a href="https://www.gov.uk/government/statistics/winter-coronavirus-covid-19-infection-study-estimates-of-epidemiological-characteristics-england-and-scotland-2023-to-2024/winter-coronavirus-covid-19-infection-study-estimates-of-epidemiological-characteristics-21-december-2023">one in 24</a> people. During the same month, <a href="https://www.wionews.com/world/singapore-witnesses-record-surge-in-number-of-covid-19-cases-mask-mandate-returns-671031">Singapore</a> also experienced record COVID cases and a spike in hospitalisations. </p>
<p>COVID, then, is still a major public health problem, accounting for 10,000 deaths in 50 countries and a 42% increase in hospitalisations <a href="https://twitter.com/WHO/status/1745092955558354961?s=20">during December 2023 alone</a>. </p>
<p>COVID may not be a global health emergency at the moment, but it is still killing and harming far too many people worldwide. </p>
<p>Yet, judging by the lack of media coverage and social media attention, at least compared to earlier in the pandemic, you might be forgiven for thinking that COVID is no longer a big deal.</p>
<p>But acting as though COVID doesn’t exist or isn’t a problem is a dangerous situation. </p>
<p><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01012-7/fulltext">COVID complacency</a>, by governments, the media and the public, <a href="https://inews.co.uk/news/science/covid-19-scientists-complacency-who-pandemic-over-2321071">is a threat</a> to the overall health of the population, to health services and particularly to those <a href="https://www.who.int/news/item/28-03-2023-sage-updates-covid-19-vaccination-guidance">most vulnerable</a>, including older adults and those with pre-existing health conditions. </p>
<p>Contrary to the popular misbelief, COVID is not getting milder. We have <a href="https://theconversation.com/six-common-covid-myths-busted-by-a-virologist-and-a-public-health-expert-188396">known this for a while</a>, but <a href="https://fortune.com/well/2024/01/08/covid-omicron-variants-pirola-ba286-jn1-more-severe-disease-lung-gi-tract-symptoms/">new research</a> is starting to suggest that Omicron variants might be evolving into more severe forms. </p>
<p>Another common misapprehension is that once we have had COVID, which most of us have by now, our immune system is all the better for it. </p>
<p>While infection does lead the body to produce antibodies, getting our antibodies from vaccines and boosters is a safer option, particularly in light of <a href="https://time.com/6553340/covid-19-reinfection-risk/">growing evidence</a> that repeat COVID infections increase the risk of <a href="https://pubmed.ncbi.nlm.nih.gov/36357676/">long COVID symptoms, hospitalisation and death</a>. </p>
<p>Also, high COVID rates add pressure to already strained health systems. COVID, along with flu and other respiratory viruses are playing their part in the healthcare crisis being experienced in the <a href="https://www.bmj.com/content/bmj/383/bmj.p2962.full.pdf">UK</a> and a number of <a href="https://www.ft.com/content/449c4748-ef63-4f0a-b26e-4e528889fac4">EU countries</a>, for example – and long COVID is responsible for <a href="https://link.springer.com/article/10.1186/s12875-023-02196-1">substantial financial burden</a> on health services. </p>
<p>It’s perhaps understandable why many people are less interested in COVID these days. It’s been a long four years. </p>
<p>In my <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258781">research</a> with colleagues on public attitudes to COVID, we found as early as winter 2020 that people were getting fatigued by COVID news and information. But raising awareness of the ongoing risks posed by COVID remains as important as ever.</p>
<h2>How to fight COVID complacency</h2>
<p>First, we need to ensure vaccine uptake is as high as possible. In <a href="https://assets.publishing.service.gov.uk/media/6596accec23a10000d8d0b7e/Weekly-flu-and-COVID-19-surveillance-report-week-1.pdf">the UK</a>, like many countries, booster uptake amongst those eligible this year has been significantly lower compared to last year, and fewer population groups have been offered the vaccine. In future campaigns, boosters should be offered <a href="https://www.theguardian.com/world/2023/sep/08/uk-mps-press-for-wider-covid-vaccine-access-amid-concern-over-new-variant">more broadly</a>. </p>
<p>But broadening vaccine access is only one part of the puzzle - for example in the US, where new boosters are available to everyone, <a href="https://www.cdc.gov/respiratory-viruses/data-research/dashboard/vaccination-trends-adults.html">only two-in-ten</a> have taken the offer up, including only four-in-ten of those aged over 65. </p>
<p>One of the <a href="https://www.usnews.com/news/health-news/articles/2023-12-20/why-arent-americans-getting-the-new-covid-19-vaccine">most common reasons</a> for not getting boosted is the misconception that once a person has been infected there is no point in getting vaccinated. Vaccine campaigns should be accompanied by proactive, visible and clear public health messaging to inform the public that boosters can still <a href="https://www.who.int/news/item/13-12-2023-statement-on-the-antigen-composition-of-covid-19-vaccines">help to reduce the risk</a> of illness, hospitalisation, and defend against newer COVID variants such as <a href="https://doi.org/10.1136/bmj.p2975">JN.1</a>, which was named by the <a href="https://www.who.int/docs/default-source/coronaviruse/18122023_jn.1_ire_clean.pdf?sfvrsn=6103754a_3">World Health Organization</a> (WHO) on December 19 2023 as a “variant of interest” and may be more infectious than other variants.</p>
<p>Second, we can still make use of protections that work. For example, fundamental investment in better ventilation is much needed. Cleaner air is essential for public health and will have benefits that <a href="https://theconversation.com/an-investment-in-clean-indoor-air-would-do-more-than-help-us-fight-covid-it-would-help-us-concentrate-with-lasting-benefits-176547">extend beyond COVID</a>. </p>
<p><a href="https://www.epa.gov/coronavirus/ventilation-and-coronavirus-covid-19#:%7E:text=Ensuring%20proper%20ventilation%20with%20outside,air%20and%20land%20on%20surfaces.">Good ventilation</a> can not only <a href="https://royalsociety.org/-/media/policy/projects/impact-non-pharmaceutical-interventions-on-covid-19-transmission/the-royal-society-covid-19-examining-the-effectiveness-of-non-pharmaceutical-interventions-report.pdf">reduce the spread of COVID</a> and other respiratory viruses, but can generally help reduce indoor air pollution, and can even improve things such as <a href="https://www.tes.com/magazine/analysis/general/attendance-focus-shows-why-good-ventilation-schools-still-matters">school attendance</a> and <a href="https://theconversation.com/an-investment-in-clean-indoor-air-would-do-more-than-help-us-fight-covid-it-would-help-us-concentrate-with-lasting-benefits-176547">concentration</a> in the classroom.</p>
<figure class="align-center ">
<img alt="Older male seated on a bus, wearing a brown coat, hat and white COVID mask" src="https://images.theconversation.com/files/568885/original/file-20240111-23-i3s8bx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568885/original/file-20240111-23-i3s8bx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568885/original/file-20240111-23-i3s8bx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568885/original/file-20240111-23-i3s8bx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568885/original/file-20240111-23-i3s8bx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568885/original/file-20240111-23-i3s8bx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568885/original/file-20240111-23-i3s8bx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Masks are still effective protection against COVID.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/news-photo/february-2023-brandenburg-cottbus-pensioner-horst-becker-news-photo/1246713249?adppopup=true">Frank Hammerschmidt/picture alliance via Getty Images</a></span>
</figcaption>
</figure>
<p><a href="https://www.theguardian.com/world/2024/jan/09/spain-facemasks-mandatory-hospitals-flu-covid-cases-surge">Spain</a>, for example, has just reintroduced face mask rules in hospitals and other healthcare settings. <a href="https://royalsociety.org/topics-policy/projects/impact-non-pharmaceutical-interventions-on-covid-19-transmission/">Existing evidence</a> suggests that masks do work to help reduce the transmission of COVID. Masks have been controversial, but can be thought of <a href="https://theconversation.com/living-with-covid-how-treating-masks-like-umbrellas-could-help-us-weather-future-pandemic-threats-187377">like umbrellas</a> - we can use them as, when and where needed. </p>
<p>Other countries would also do well to follow <a href="https://www.cidrap.umn.edu/covid-19/who-designates-jn1-separate-covid-19-variant-interest">WHO advice</a> and reintroduce face mask regulation in medical settings, to reduce hospital acquired infections, protect vulnerable patients and reduce sickness and absenteeism amongst healthcare workers.</p>
<p>We can still live with COVID and at the same time respect, and try to reduce, the harm it can cause.</p><img src="https://counter.theconversation.com/content/220867/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Nicholas Williams has received funding from Senedd Cymru, Public Health Wales and the Wales Covid Evidence Centre for research on COVID-19, and has consulted for the World Health Organization. However, this article reflects the views of the author only, in his academic capacity at Swansea University, and no funding or organizational bodies were involved in the writing or content of this article.</span></em></p>COVID complacency is a serious threat to public health. COVID hasn’t gone away. Vaccines haven’t become pointless – and it’s a good idea to keep wearing your mask.Simon Nicholas Williams, Lecturer in Psychology, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2104572023-08-29T02:25:36Z2023-08-29T02:25:36ZI think I have the flu. Should I ask my GP for antivirals?<figure><img src="https://images.theconversation.com/files/544456/original/file-20230824-29-51fiyz.jpg?ixlib=rb-1.1.0&rect=613%2C0%2C5497%2C4086&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-lying-on-bed-while-blowing-her-nose-3807629/">Andrea Piacquadio/Pexels</a></span></figcaption></figure><p>If you test positive for COVID and you’re eligible for antivirals, you’ll likely ask your GP for a script to protect you from severe disease. </p>
<p><a href="https://healthdispatch.com.au/news/immunisation-coalition-urging-people-with-flu-like-symptoms-to-g">Antivirals</a> are also available to fight influenza viruses, via a doctor’s prescription. But they have a mixed history, with their benefits at times <a href="https://theconversation.com/controversies-in-medicine-the-rise-and-fall-of-the-challenge-to-tamiflu-38287">overstated</a>. </p>
<p>It can be difficult to get an appointment to see your GP. So when should you make the effort to see a GP for a prescription for influenza antivirals? And how effective are they?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/controversies-in-medicine-the-rise-and-fall-of-the-challenge-to-tamiflu-38287">Controversies in medicine: the rise and fall of the challenge to Tamiflu</a>
</strong>
</em>
</p>
<hr>
<h2>What exactly is influenza?</h2>
<p>The flu is primarily a viral infection of the respiratory system that can spread through sneezing, coughing, or touching contaminated objects then touching your nose or mouth. </p>
<p>Common symptoms include headache, sore throat, fever, runny or blocked nose and body aches that last a week or more.</p>
<p>Influenza is actually a group of viruses, divided into several <a href="https://www.cdc.gov/flu/about/viruses/types.htm#:%7E:text=There%20are%20four%20types%20of,global%20epidemics%20of%20flu%20disease,%20https://www.cdc.gov/flu/professionals/acip/background-epidemiology.htm">sub-groups</a>. Flu A and B are the <a href="https://www.health.gov.au/resources/collections/aisr?language=en,%20https://www.health.gov.au/resources/collections/australian-influenza-surveillance-reports-2023?language=en">most common groups</a> that circulate in humans. </p>
<h2>What are flu antivirals?</h2>
<p>Influenza antivirals, target specific parts of the viral life cycle, which prevents the virus replicating and spreading. </p>
<p>Most flu antivirals <a href="https://www.nejm.org/doi/full/10.1056/NEJMra050740">target</a> neuraminidase, an important enzyme the virus uses to release itself from cells.</p>
<p>On the other hand, COVID antivirals work by inhibiting other parts of the viral life cycle involved in the <a href="https://www.tga.gov.au/news/media-releases/tga-provisionally-approves-two-oral-covid-19-treatments-molnupiravir-lagevrio-and-nirmatrelvir-ritonavir-paxlovid">virus replicating itself</a>.</p>
<p>Three influenza antivirals are <a href="https://australianprescriber.tg.org.au/articles/influenza-overview-on-prevention-and-therapy.html#r20">used in Australia</a>. Relenza (zanamivir) is an inhaled powder and Tamiflu (oseltamivir) is a capsule; both are five-day treatments. Rapivab (peramivir) is a single injection. </p>
<p>These antivirals may also come with <a href="https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm">side effects</a>, such as a headache, vomiting, cough, or <a href="https://www.immunisationcoalition.org.au/resources/antiviral-treatments-for-influenza/">fever</a>.</p>
<p>Tamiflu and Relenza generally cost A$40-50 in Australia, plus the cost of the consultation fee with your doctor, if applicable. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-a-flu-vaccine-this-year-heres-what-you-need-to-know-203406">Should I get a flu vaccine this year? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>How effective are antivirals for the flu?</h2>
<p>Antivirals have the greatest effect if started 24-72 hours after symptoms. This is to prevent the virus from reaching <a href="https://www.mdpi.com/1660-4601/19/5/3018">high levels in the body</a>.</p>
<p>Among healthy adults, if Relenza or Tamiflu are started within 48 hours from your first symptoms, they can <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008965.pub4/full">reduce the duration</a> of symptoms such as cough, blocked nose, sore throat, fatigue, headache, muscle pain and fever by just under a day. </p>
<p>For people who have developed severe flu symptoms or who have existing health conditions such as heart disease or chronic obstructive pulmonary disease (COPD), antivirals that start later (but still before day five of symptoms) can still reduce the <a href="https://academic.oup.com/cid/article/52/4/457/378776?login=true">severity of infection</a> and reduce the <a href="https://thorax.bmj.com/content/thoraxjnl/65/6/510.full.pdf?frbrVersion=3">chance of</a> <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/215903">hospitalisation</a> and <a href="https://academic.oup.com/jac/article/72/11/2990/4091484?login=false">death</a>.</p>
<figure class="align-center ">
<img alt="Older man coughs, while his partner looks concerned" src="https://images.theconversation.com/files/544481/original/file-20230824-17-g9r2zk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544481/original/file-20230824-17-g9r2zk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544481/original/file-20230824-17-g9r2zk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544481/original/file-20230824-17-g9r2zk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544481/original/file-20230824-17-g9r2zk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544481/original/file-20230824-17-g9r2zk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544481/original/file-20230824-17-g9r2zk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Antivirals need to be started early.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/man-in-gray-sweater-sitting-beside-woman-5790716/">Vlada Karpovich/Pexels</a></span>
</figcaption>
</figure>
<p>In a study from the 2009 swine flu (H1N1) pandemic in the United States, treatment with antivirals (Tamiflu and Relenza) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358088/">reduced</a> the chance of needing to be hospitalised. Around 60% of hospitalisations prevented were among 18-64 years olds, around 20% in children 0-17 years, and 20% in adults aged over 65.</p>
<p>The research is less clear about whether antivirals prevent the development of flu complications such as secondary bacterial pneumonia. They might, but so far the data aren’t clear.</p>
<h2>Are flu antivirals becoming less effective?</h2>
<p>Antiviral resistance to Tamiflu has been <a href="https://link.springer.com/article/10.1007/s10096-020-03840-9">reported</a> around the world, mostly in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223162/">immunocompromised people</a>, as they <a href="https://link.springer.com/article/10.1007/s10096-020-03840-9">have</a> a weakened immune system that allows higher viral loads and prolonged viral shedding.</p>
<p>The impact of the antiviral resistance is unclear but there is evidence indicating resistant strains can uphold their ability to replicate effectively and spread. So far it’s not clear if these stains cause more severe disease.</p>
<p>However, government agencies and surveillance programs are constantly monitoring the spread of antiviral resistance. Currently there is <a href="https://www.cdc.gov/flu/treatment/antiviralresistance.htm">minimal concern</a> for strains that are resistant to Tamiflu or Relenza.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-there-so-many-drugs-to-kill-bacteria-but-so-few-to-tackle-viruses-137480">Why are there so many drugs to kill bacteria, but so few to tackle viruses?</a>
</strong>
</em>
</p>
<hr>
<h2>Antivirals can also prevent the flu if you’ve been exposed</h2>
<p>Tamiflu and Relenza can also be used to <a href="https://onlinelibrary.wiley.com/doi/10.1111/irv.12046">prevent flu infections</a>, if we’re exposed to the virus or come into contact with infected people.</p>
<p>Some studies suggest Tamiflu and Relenza can <a href="https://www.bmj.com/content/326/7401/1235.long">reduce the chance of developing symptomatic influenza</a> by 70-90%.</p>
<p>Many health agencies around the world <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165743/">recommend</a> “prophylactic” treatment for high-risk patients in hospitals or age care setting when people have been in contact with others infected with influenza. </p>
<figure class="align-center ">
<img alt="Woman at supermarket reaches for an orange" src="https://images.theconversation.com/files/544484/original/file-20230824-8994-y4fyo6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544484/original/file-20230824-8994-y4fyo6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544484/original/file-20230824-8994-y4fyo6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544484/original/file-20230824-8994-y4fyo6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544484/original/file-20230824-8994-y4fyo6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544484/original/file-20230824-8994-y4fyo6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544484/original/file-20230824-8994-y4fyo6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Antivirals can stop people who have been exposed to influenza from developing severe illness.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-wearing-mask-in-supermarket-3962289/">Anna Shvets/Pexels</a></span>
</figcaption>
</figure>
<h2>So who should talk to their GP about a prescription?</h2>
<p><a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/racf-antiviral-treatments-and-prophylaxis.aspx#:%7E:text=The%20Australian%20Therapeutic%20Guidelines*%20recommends,of%20severe%20disease%20from%20influenza.&text=people%20with%20chronic%20conditions%20including,heart%20disease">Australian guidelines recommend</a> doctors offer antivirals to people with influenza who have severe disease or complications. </p>
<p>Doctors can also consider treatment for people at higher risk of developing severe disease from influenza. This includes:</p>
<ul>
<li>adults aged 65 years or older</li>
<li>pregnant women</li>
<li>people with certain chronic conditions (heart disease, Down syndrome, obesity, chronic respiratory conditions, severe neurological conditions)</li>
<li>people with compromised immunity</li>
<li>Aboriginal and Torres Strait Islander people</li>
<li>children aged five years or younger</li>
<li>residents of long-term residential facilities</li>
<li>homeless people.</li>
</ul>
<p>Doctors can prescribe antivirals for the prevention of influenza <a href="https://australianprescriber.tg.org.au/articles/influenza-overview-on-prevention-and-therapy.html#r20">in</a> vulnerable people who have been exposed to the virus.</p>
<p>Antiviral treatment also can be <a href="https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#:%7E:text=Antiviral%20treatment%20also%20can%20be,48%20hours%20of%20illness%20onset">considered</a> for otherwise healthy symptomatic patients who have confirmed or suspected influenza, if they can start treatment within 48 hours of developing symptoms.</p>
<p>In some instances a doctors can make a clinical diagnosis of influenza based on the symptoms and known close flu positive contacts of the patient. However, it is preferred to have flu diagnosed by one of the approved diagnostic tests, such as a <a href="https://24-7medcare.com.au/influenza/australian-gp-influenza-2023-guide/">rapid antigen test</a> (RAT) or the more accurate <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/influenza_factsheet.aspx">PCR test</a>, similar to what is perfomed for COVID. There are also now combo tests that can <a href="https://www.tga.gov.au/news/media-releases/first-combination-covid-19-and-influenza-self-tests-approved-australia">distinguish between SARS-CoV-2 and influenza virus</a>.</p>
<p>Remember, the flu can cause <a href="https://www.abc.net.au/news/2023-07-23/flu-season-hitting-children-hard-antivirals-may-help/102633722">severe illness or death</a>, particularly among people from the high-risk groups. So if you think you might have the flu, wear a mask and stay away to avoid spreading the virus to others. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-happens-in-our-body-when-we-encounter-and-fight-off-a-virus-like-the-flu-sars-cov-2-or-rsv-207023">What happens in our body when we encounter and fight off a virus like the flu, SARS-CoV-2 or RSV?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/210457/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lara Herrero receives funding from NHMRC. </span></em></p><p class="fine-print"><em><span>Wesley Freppel and Yong Qian Koo do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It can be difficult to an appointment to see your GP. So when should you make the effort to see a GP for a prescription for influenza antivirals? And how effective are they?Lara Herrero, Research Leader in Virology and Infectious Disease, Griffith UniversityWesley Freppel, Research Fellow, Institute for Glycomics, Griffith UniversityYong Qian Koo, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2105652023-08-24T20:20:43Z2023-08-24T20:20:43ZWhy do I crave sugar and carbs when I’m sick?<figure><img src="https://images.theconversation.com/files/544126/original/file-20230823-24-jor56l.jpg?ixlib=rb-1.1.0&rect=0%2C179%2C5991%2C3808&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/imAfCYq7KH0">Adrian Swancar/Unsplash</a></span></figcaption></figure><p>Your nose is running, your head hurts and you feel like you’re coming down with a cold. You’re settling in on the couch for a sick day. Then you reach for the snacks. </p>
<p>When you’re sick, your appetite often decreases. So why, at other times, do you crave sugary treats and carbohydrate-loaded comfort foods?</p>
<p>A food <a href="https://pubmed.ncbi.nlm.nih.gov/28375878/">craving</a> goes beyond a mere desire to eat, it encompasses a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399671/#CR1">complex mix</a> of emotional, behavioural, cognitive and physiological processes. Whether it’s the need for a quick energy source or a temporary relief from discomfort, our bodies and minds work in tandem to drive our food preferences.</p>
<p>Here we’ll explore the science behind why our bodies crave sugar and carbs – especially when we’re sick.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-reasons-you-feel-hungrier-and-crave-comfort-foods-when-the-weather-turns-cold-202831">3 reasons you feel hungrier and crave comfort foods when the weather turns cold</a>
</strong>
</em>
</p>
<hr>
<h2>Fuelling the immune system</h2>
<p>When sickness strikes, our immune system springs into action, requiring additional energy to combat invaders. </p>
<p>This heightened activity often leads to an increase in our <a href="https://pubmed.ncbi.nlm.nih.gov/36505552/">metabolic rate</a>, energy demands and nutritional requirements. </p>
<p>Sugary treats and carbs are quick sources of energy, satisfying this increased demand. </p>
<figure class="align-center ">
<img alt="Person eats a biscuit" src="https://images.theconversation.com/files/544124/original/file-20230823-5286-u508sw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544124/original/file-20230823-5286-u508sw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544124/original/file-20230823-5286-u508sw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544124/original/file-20230823-5286-u508sw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544124/original/file-20230823-5286-u508sw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544124/original/file-20230823-5286-u508sw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544124/original/file-20230823-5286-u508sw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sugary treats are a quick source of energy.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/person-holding-biscuit-with-both-hands-1204222/">Cats coming/Pexels</a></span>
</figcaption>
</figure>
<p>But while a high sugar diet during times of illness may help meet increased metabolic demands, it could also exacerbate the immune and inflammatory response, potentially impeding recovery. </p>
<p>In the longer term, high-sugar diets promote chronic <a href="https://pubmed.ncbi.nlm.nih.gov/33339337/">inflammation</a>, <a href="https://www.science.org/doi/10.1126/scitranslmed.aay6218?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">alter gut microbiota</a> composition, and are associated with chronic disease. For a <a href="https://www.mdpi.com/2072-6643/12/4/1181">well-functioning immune system</a>, aim for a <a href="https://www.who.int/news-room/fact-sheets/detail/healthy-diet">balanced intake</a> of <a href="https://pubmed.ncbi.nlm.nih.gov/31267783/">fruits, vegetables</a>, fibre, protein, and low-glycaemic carbohydrates.</p>
<h2>The stress response</h2>
<p>Being sick is stressful for the body. Acute mild or intense stress, like we’d see if we’re sick, boosts the “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5921333/">flight or fight</a>” hormones adrenaline and cortisol. This mobilises stored energy to meet increased demands, but it can also curb appetite. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/31125634/">Prolonged stress</a> can disrupt energy balance, and cause nutritional deficiencies and alterations in gut and brain functions. This can reduce a person’s threshold for craving sugar and salt, increasing their preferences towards energy-dense foods.</p>
<p>The stress hormone cortisol can also increase your <a href="https://pubmed.ncbi.nlm.nih.gov/24123563/">preference</a> for high-calorie, comfort foods, which can <a href="https://pubmed.ncbi.nlm.nih.gov/36615866/">temporarily alleviate stress</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-happens-in-our-body-when-we-encounter-and-fight-off-a-virus-like-the-flu-sars-cov-2-or-rsv-207023">What happens in our body when we encounter and fight off a virus like the flu, SARS-CoV-2 or RSV?</a>
</strong>
</em>
</p>
<hr>
<h2>The brain’s reward system</h2>
<p>Comfort foods trigger your brain’s reward system, releasing feel-good neurotransmitters like <a href="https://pubmed.ncbi.nlm.nih.gov/30595479/">dopamine</a> and serotonin. </p>
<p>But “<a href="https://pubmed.ncbi.nlm.nih.gov/30951762/">sugar rushes</a>” are often short-lived and can lead to decreased alertness and heightened fatigue within an hour of consumption. </p>
<p>The link between carbohydrates (which the body converts to sugar) and serotonin can be traced back to 1971 when <a href="https://www.science.org/doi/10.1126/science.174.4013.1023?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">researchers</a> found elevated tryptophan levels (serotonin’s precursor) in rats’ plasma and brains after a carbohydrate-rich diet. </p>
<p>Subsequent studies in humans established connections between carbohydrates and mood, especially in relation to <a href="https://pubmed.ncbi.nlm.nih.gov/2903717/">obesity, depression and seasonal affective disorder</a>. Therapies enhancing serotonin have since been shown to <a href="https://pubmed.ncbi.nlm.nih.gov/2903717/">reduce carbohydrate intake</a>.</p>
<figure class="align-center ">
<img alt="McDonald's French fries" src="https://images.theconversation.com/files/544140/original/file-20230823-27-lqld1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544140/original/file-20230823-27-lqld1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544140/original/file-20230823-27-lqld1n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544140/original/file-20230823-27-lqld1n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544140/original/file-20230823-27-lqld1n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544140/original/file-20230823-27-lqld1n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544140/original/file-20230823-27-lqld1n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There’s more to our cravings than just a desire to eat.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/MyuR5q3KDmw">Unsplash/Brett Jordan</a></span>
</figcaption>
</figure>
<p>Remarkably, around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8911970/pdf/molecules-27-01680.pdf">90% of serotonin</a> production occurs in the gut. The vast microbial population in our gut exerts a potent influence on <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106557/">immunity, metabolism</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293578/pdf/40168_2021_Article_1093.pdf">appetite</a>. </p>
<p>Recent mouse studies have even identified specific microbes linked to <a href="https://www.cell.com/current-biology/fulltext/S0960-9822(22)01750-X">sugar binges after antibiotic treatment</a>.</p>
<h2>Some people eat less when they’re sick</h2>
<p>Not everyone craves sugar and carbs when they are sick. Some people eat less for a few reasons:</p>
<ul>
<li><p>they have less of an appetite. While <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610818/pdf/JDR2017-4527980.pdf">ghrelin</a> (the “hunger” hormone) levels might initially rise, prolonged illness can suppress appetite due to nausea, fatigue and discomfort. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5921333/">Critically ill</a> patients have reduced food intake and are at risk of malnutrition</p></li>
<li><p><a href="https://pubmed.ncbi.nlm.nih.gov/30777142/">metabolic adaptation</a>. The body might slow specific metabolic processes to conserve energy, reducing overall calorie requirements</p></li>
<li><p>altered taste perception. <a href="https://pubmed.ncbi.nlm.nih.gov/32195512/#:%7E:text=The%20ability%20of%20an%20individual%20to%20perceive%20tastes,intake%2C%20playing%20an%20important%20role%20in%20promoting%20satiation%2Fsatiety.">Taste</a> is an important component that affects both appetite and energy intake. Alterations in taste and smell is a common symptom when we are sick and was common with <a href="https://doi.org/10.1101/2020.04.05.20048421">COVID</a></p></li>
<li><p>consuming fluids like water, tea or broths might be more appealing and manageable than solid foods. These fluids provide hydration but contribute minimally to calorie intake.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-to-eat-when-you-have-covid-and-why-reaching-for-the-chicken-soup-is-not-a-bad-idea-202338">What to eat when you have COVID – and why reaching for the chicken soup is not a bad idea</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/210565/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hayley O'Neill is a wellness coach for Hayley M O'Neill Enterprises.</span></em></p>A quick energy source or a temporary relief from discomfort? Here’s what drives our food preferences when we’re sick.Hayley O'Neill, Assistant Professor, Faculty of Health Sciences and Medicine, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2040272023-06-01T20:00:40Z2023-06-01T20:00:40ZI need a flu shot and a COVID booster. Can I get them at the same time?<figure><img src="https://images.theconversation.com/files/529244/original/file-20230531-23-t3j8la.jpg?ixlib=rb-1.1.0&rect=55%2C66%2C7293%2C4836&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/uN8TV9Pw2ik">CDC/Unsplash</a></span></figcaption></figure><p>Cases of influenza (the flu) and COVID are set to rise over winter, with many Australians looking to protect themselves from both of these respiratory viruses. </p>
<p>For most adults, if it has been <a href="https://www.health.gov.au/our-work/covid-19-vaccines/advice-for-providers/clinical-guidance/clinical-recommendations#timing-of-administration-of-other-vaccines-including-influenza-vaccine">six months</a> since you had COVID or your last vaccination, you’re likely eligible to book in your next dose. </p>
<p>Meanwhile, the flu vaccine is <a href="https://www.health.gov.au/news/2023-national-immunisation-program-influenza-vaccination-early-advice-for-vaccination-providers">recommended</a> for everyone over the age of six months.</p>
<p>But can you get both at once? Yes, you can get your flu vaccine and COVID booster safely at the same time, saving you a trip to the GP, nurse or pharmacy. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/havent-had-covid-or-a-vaccine-dose-in-the-past-six-months-consider-getting-a-booster-199096">Haven't had COVID or a vaccine dose in the past six months? Consider getting a booster</a>
</strong>
</em>
</p>
<hr>
<h2>Why has the advice changed?</h2>
<p>When COVID vaccines were first rolled out, a gap was recommended between COVID and flu vaccines. This is because we didn’t have adequate data of the individual and long-term effects of the new COVID vaccines.</p>
<p>After examining the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8952219/">latest available evidence</a> on safety and efficacy, the World Health Organization updated its <a href="https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-vaccines-SAGE_recommendation-coadministration-influenza-vaccines">interim guidelines</a>. It suggests getting an influenza vaccine and any dose of any approved COVID vaccine at the same time is a practical option.</p>
<p>However, until more data becomes available, the WHO advises <a href="https://www.who.int/news/item/14-10-2022-influenza-in-the-northern-hemisphere-is-back">using different arms</a> for vaccination. This is to prevent the ingredients of the vaccines mixing and to limit the initial immune response to a different group of lymph nodes. </p>
<p>The <a href="https://www.coronavirus.vic.gov.au/sites/default/files/2022-05/Appendix34_Guidance_on_co-administration.pdf">Australian Technical Advisory Group on Immunisation</a> updated its vaccination guidelines in <a href="https://www.health.gov.au/sites/default/files/documents/2022/02/atagi-advice-on-seasonal-influenza-vaccines-in-2022.pdf">March 2022</a>, advising that influenza and COVID vaccines can be <a href="https://www.health.gov.au/sites/default/files/2023-03/2023-influenza-vaccination-program-advice-for-vaccination-providers.pdf">administered on the same day</a>. </p>
<figure class="align-center ">
<img alt="Clinician vaccinates man" src="https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s practical to get both at once.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-american-black-female-doctor-prepares-1897028242">Shutterstock</a></span>
</figcaption>
</figure>
<h2>What happens when you get two shots at once?</h2>
<p>Getting multiple vaccinations at once isn’t new. Childhood vaccinations are routinely and safely administered at the same time.</p>
<p>For COVID and flu vaccines, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8952219/">randomised controlled trials</a> show no significant difference in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9746457/">immune responses</a> of the people who had both vaccines at once compared to those who had them on different days. </p>
<p>Participants who had both vaccines at once reported the same types of side effects from the body’s inflammatory response to vaccination (injection-site pain, redness, swelling at the injection site) as well as general symptoms associated with both COVID and flu vaccines, such as fever, muscle pain and a headache. </p>
<p>These minor side-effects were of similar intensity and duration to those who had either vaccine administered alone. </p>
<figure class="align-center ">
<img alt="Person sick with COVID or the flu sits in the dark" src="https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Side effects are similar when you have the vaccines individually or at once.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/d_mzrEx6ytY">Annie Sprat/Unsplash</a></span>
</figcaption>
</figure>
<p>Getting both COVID and flu vaccines is also more cost-effective, the uptake is higher when people don’t have to make multiple trips, and it saves health practitioners’ time. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-a-flu-vaccine-this-year-heres-what-you-need-to-know-203406">Should I get a flu vaccine this year? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>What about the viruses? Can you get COVID and the flu at the same time?</h2>
<p>Although simultaneous infections with two different viruses are common, SARS-CoV-2 has been infecting humans for a relatively short time. We therefore have limited data on how influenza strains and SARS-CoV-2 interact with the host at the same time, and if there is any interaction between the viruses. </p>
<p>However, one <a href="https://pubmed.ncbi.nlm.nih.gov/33942104/">large study in England</a> reported that people positive for influenza had lower odds of also testing positive for SARS-CoV-2. This was attributed to possible <a href="https://pubmed.ncbi.nlm.nih.gov/36134660/">cross-reactive immunity</a> between viruses. </p>
<p>It did, however, find people infected with both viruses at the same time had worse outcomes and were twice as likely to die as those who were only infected with SARS-CoV-2. </p>
<p>Some experimental evidence <a href="https://pubmed.ncbi.nlm.nih.gov/33603116/">suggested</a> prior infection with type A influenza virus promotes SARS-CoV-2 entry and infectiousness. This could be due to a unique feature of the influenza A virus which allows COVID to take hold more easily. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flu-covid-and-flurona-what-we-can-and-cant-expect-this-winter-177826">Flu, COVID and flurona: what we can and can’t expect this winter</a>
</strong>
</em>
</p>
<hr>
<h2>Where can I get vaccinated and how much will it cost?</h2>
<p><a href="https://www.health.gov.au/sites/default/files/2023-03/2023-influenza-vaccination-program-advice-for-vaccination-providers.pdf">Influenza</a> and <a href="https://www.health.gov.au/our-work/covid-19-vaccines/who-can-get-vaccinated">COVID</a> vaccines are available at GP clinics and pharmacies. </p>
<p>Australians aged five years and over are eligible for a free COVID vaccination. The flu vaccine is free for people at higher risk of complications, including:</p>
<ul>
<li>pregnant women</li>
<li>people six months and older with selected chronic conditions</li>
<li>Aboriginal and Torres Strait Islander people. </li>
</ul>
<p>For the rest of the population, the flu vaccine costs around A$20-30. Some practitioners also charge a consultation fee. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1540220689273192449"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/im-over-65-and-worried-about-the-flu-which-vaccine-should-i-have-204810">I'm over 65 and worried about the flu. Which vaccine should I have?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/204027/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Cases of the flu and COVID are set to rise over winter, with many people looking to get vaccinated against both viruses.Vasso Apostolopoulos, Professor of Immunology and Pro Vice-Chancellor, Research Partnerships, Victoria UniversityMaja Husaric, Senior Lecturer; MD, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2048102023-05-31T20:07:11Z2023-05-31T20:07:11ZI’m over 65 and worried about the flu. Which vaccine should I have?<figure><img src="https://images.theconversation.com/files/529223/original/file-20230531-22-s5vazx.jpg?ixlib=rb-1.1.0&rect=8%2C516%2C2748%2C1322&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/Y5VBtBgswLQ">Philippe Leone/Unsplash</a></span></figcaption></figure><p>Influenza, or the flu, is a virus transmitted by respiratory droplets from coughing and sneezing. It can cause the sudden onset of a fever, cough, runny nose, sore throat, headache, muscle and joint pain. </p>
<p>In Australia, the flu is responsible for <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4004f.htm">more than 5,000 hospitalisation and 100 deaths</a> a year. The highest rates are among those over 65, whose immune systems aren’t as effective as they used to be, and children under five, whose immune systems are yet to mature. </p>
<p>To combat the decline in immunity as we age, specific vaccines are available for people aged 65 and over. So how do they work, and why exactly are they needed? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-a-flu-vaccine-this-year-heres-what-you-need-to-know-203406">Should I get a flu vaccine this year? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>Remind me, how does the immune system work?</h2>
<p>The immune system uses multiple mechanisms to fight viral infections, which can be divided into two major arms of the immune system, called innate and adaptive immunity. </p>
<p>Innate immunity involves multiple inflammatory cells and chemicals that are triggered immediately, or within hours of encountering an infection. They activate the immune system to clear the infection. </p>
<p>Adaptive immunity takes a little longer (weeks) to work and involves memory T cells and antibody-producing B cells, which can be reactivated when the body encounters a virus or other pathogen.</p>
<p>The combined innate and adaptive immune response determines how well we respond to an invading virus like influenza. </p>
<h2>Why are older people more at risk from the flu?</h2>
<p>Generally, as we age past 65, the innate cells become less effective at their job of clearing infections. They also start <a href="https://www.annualreviews.org/doi/full/10.1146/annurev-cellbio-100616-060718">producing more inflammation</a>. </p>
<p>New T and B cell numbers also decrease with increasing age and hence the adaptive immune response is also not as effective as when we are younger. This immune system decline is called immunosenescence, which leads to increased susceptibility, hospitalisation and death from influenza. </p>
<figure class="align-center ">
<img alt="Older woman wearing a beanie sorts papers in her living room" src="https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">As we age, our immune system can’t clear infections as effectively.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/aODtyhXEAjg">Mariia Chalaya/Unsplash</a></span>
</figcaption>
</figure>
<p>Certain medical conditions, such as cancer and heart and lung conditions, increase susceptibility to severe influenza, with older people being more likely to have additional medical conditions than younger people.</p>
<h2>What flu vaccines are available?</h2>
<p><a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">Annual flu vaccines</a> are recommended to protect against the common circulating strains of influenza, which can differ from year to year. </p>
<p>The standard flu vaccines offered to adults aged under 65 consist of surface proteins of the virus or inactivated (killed) virus from four influenza strains: two A strains (H1N1 and H3N2) and two B strains. </p>
<p>When you’re vaccinated, your immune system makes antibodies from B cells which protect you if you become exposed to these strains of the virus. </p>
<p>However, the standard influenza vaccine is less effective in older people. </p>
<figure class="align-center ">
<img alt="Older people look out over an ocean" src="https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The standard flu vaccines aren’t as effective for older people.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/sRAWQyoUiVQ">Katarzyna Grabowska</a></span>
</figcaption>
</figure>
<p>Two stronger or augmented vaccines have been made targeting this age group. They contain the same components as the standard vaccine, but one vaccine – called <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2020-CMI-01074-1&d=20230529172310101">Fluad</a> – uses a strong adjuvant (an agent used to increase the immune response to vaccination) called MF59 to stimulate better immunity. </p>
<p>The other augmented vaccine, called <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2020-CMI-02062-1">Fluzone</a>, uses a four-fold higher dose of each influenza strain to increase immunity. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-can-you-still-get-influenza-if-youve-had-a-flu-shot-184327">Why can you still get influenza if you've had a flu shot?</a>
</strong>
</em>
</p>
<hr>
<h2>How do they compare?</h2>
<p><a href="https://academic.oup.com/cid/article/73/11/e4251/5992287?login=false">Studies comparing Fluad and Fluzone</a> show both vaccines stimulate stronger immunity against influenza than the standard flu vaccine and are therefore likely to provide better protection. </p>
<p>Studies directly testing for improved clinical outcomes with vaccines for over-65s show a small benefit of receiving either of the vaccines over the standard vaccine, including a modest decrease in lab-confirmed influenza, <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(17)30235-7/fulltext">hospitalisations</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563546/">emergency department visits</a> compared to the standard influenza vaccine. </p>
<p>They are however yet to show and impact on flu-related deaths.</p>
<figure class="align-right ">
<img alt="Woman pushes mother in a wheelchair" src="https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1067&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1067&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1067&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1341&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1341&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1341&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fluad and Fluzone provide better protection for older people against the flu than the regular vaccine.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/yk7F8bdD0eU">Raychan/Unsplash</a></span>
</figcaption>
</figure>
<p>In the few studies comparing <a href="https://academic.oup.com/cid/article/73/11/e4251/5992287?login=false">Fluad and Fluzone directly</a>, there is little evidence of a difference between them in reducing influenza and serious flu outcomes. <a href="https://www.health.gov.au/resources/publications/atagi-advice-on-seasonal-influenza-vaccines-in-2023">The Australian Technical Advisory Group on Immunisation therefore recommends</a> using either Fluad or Fluzone.</p>
<p>While both have been Therapeutic Goods Administration (TGA) approved since 2020, only Fluad is available for free on the National Immunisation Program for people aged 65 and over. </p>
<p>Fluzone is only available with a private prescription if you’re 60 years and over, at a cost of around A$65-70. </p>
<p>If neither augmented vaccine is available, a standard influenza vaccine is also acceptable for older people, since any influenza vaccine is preferable to receiving none. </p>
<p>Flu vaccines can also be given at the same time as COVID vaccines. </p>
<h2>How else can we protect against the flu?</h2>
<p>While influenza vaccination is the single most effective way of preventing influenza, other measures such as social distancing and wearing a mask or N95 respirator can also provide some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779801/">community protection</a>.</p>
<p>Wearing a mask or N95 respirator significantly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779801/">reduces the risk</a> of infecting others when infected.</p>
<p>The evidence for protecting oneself against infection is less conclusive, mainly because it’s linked to early, consistent and, importantly, the <a href="https://cdn.who.int/media/docs/default-source/influenza/advice-on-the-use-of-masks-in-the-community-setting-in-influenza-a-(h1n1)-outbreaks.pdf?sfvrsn=24a45a95_1&download=true">correct use of masks</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/over-half-of-eligible-aged-care-residents-are-yet-to-receive-their-covid-booster-and-winter-is-coming-205403">Over half of eligible aged care residents are yet to receive their COVID booster. And winter is coming</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/204810/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Magdalena Plebanski receives Grant funding from National Health and Medical Research Council (NHMRC) to conduct fundamental immunology research on Flu and DTP vaccines in older adults. She conducts research on ovarian cancer, including a Phase II human trial part funded by Astrazeneca and ANZGOG (Australia and New Zealand Gynecological and Oncological Group). </span></em></p><p class="fine-print"><em><span>Katie Louise Flanagan receives funding from NHMRC, MRFF, BMGF and Clifford Craig Foundation. She was previously on Vaccine Advisory Boards for Seqiris (2016-19) and Sanofi-Pasteur (2016-18). She is President of the Australasian Society for Infectious Diseases and a member of the Australian Technical Advisory Group on Immunisation. These are her own personal views. </span></em></p><p class="fine-print"><em><span>Jennifer Boer and Kirsty Wilson do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To combat the decline in immunity as we age, specific boosters are available for people aged over 65. Here’s how they work, and why they are needed.Magdalena Plebanski, Professor of Immunology, RMIT UniversityJennifer Boer, Postdoctoral Research Fellow, RMIT UniversityKatie Louise Flanagan, Infectious Diseases Specialist and Clinical Professor, University of TasmaniaKirsty Wilson, Postdoctoral Research Fellow, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2034062023-05-16T20:09:39Z2023-05-16T20:09:39ZShould I get a flu vaccine this year? Here’s what you need to know<figure><img src="https://images.theconversation.com/files/525558/original/file-20230511-27-mu2hpj.jpg?ixlib=rb-1.1.0&rect=53%2C152%2C5937%2C3835&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/photo-of-woman-holding-her-head-4064177/">Pexels/Marcus Aurelius</a></span></figcaption></figure><p>After having low rates of influenza (flu) transmission in recent years thanks to our COVID control strategies, case numbers are now rising. </p>
<p>So far this year, Australia has had <a href="https://www.immunisationcoalition.org.au/news-data/influenza-statistics/">more than 32,000</a> lab-confirmed cases of the flu and 32 deaths. </p>
<p>Getting a flu vaccine is the best way to protect against getting the flu. These are reformulated each year to protect against the most widely circulating strains – if our predictions are right. </p>
<p>Below you’ll find everything you need to know about the 2023 flu vaccine. But first, some flu basics. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-flu-cases-already-100-times-higher-than-last-year-heres-what-we-really-know-about-the-2023-flu-season-201559">Are flu cases already 100 times higher than last year? Here's what we really know about the 2023 flu season</a>
</strong>
</em>
</p>
<hr>
<h2>What are the different types of flu?</h2>
<p>There are two main types of influenza: influenza A and influenza B. On the surface of the influenza virus there are two main proteins, the hemagglutinin (HA or H) and neuraminidase (NA or N).</p>
<p>Different strains are named after their versions of the H and N proteins, as in H1N1 or “swine flu”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">HA is the yellow spike, while the NA is the green oval.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/structure-influenza-virus-infographics-vector-illustration-542924464?src=ixiW0w-59I3I17RpN4L3wQ-1-12">Shutterstock</a></span>
</figcaption>
</figure>
<p>Minor changes in the proteins (HA and NA) on the surface are common because the enzyme the virus uses to make copies of itself is prone to errors. </p>
<p>Sometimes the influenza virus can change more abruptly when it mixes up components from different influenza viruses – including influenza viruses that typically infect birds, pigs or bats – to create a virus that’s basically new. </p>
<p>The regular change in the virus is the reason the vaccine is updated every year. The <a href="https://www.tga.gov.au/about-tga/advisory-bodies-and-committees/australian-influenza-vaccine-committee-aivc">Australian Influenza Vaccine Committee</a> meets late in the year to plan what should be included in the vaccine for the following season, after considering what happened in our last flu season and in the Northern hemisphere winter. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flu-or-covid-you-can-now-test-for-both-at-home-with-a-single-swab-heres-what-you-need-to-know-204119">Flu or COVID? You can now test for both at home with a single swab. Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>What strains does this year’s flu shot protect against?</h2>
<p>Modern flu vaccines typically protect against four strains. For this year’s vaccine, the committee <a href="https://www.tga.gov.au/resources/publication/meeting-statements/aivc-recommendations-composition-influenza-vaccines-australia-2023">has recommended</a> it includes:</p>
<ul>
<li><p>an A/Sydney/5/2021 (H1N1)pdm09-like virus</p></li>
<li><p>an A/Darwin/9/2021 (H3N2)-like virus</p></li>
<li><p>a B/Austria/1359417/2021 (B/Victoria lineage)-like virus </p></li>
<li><p>a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.</p></li>
</ul>
<p>The naming of the viral components can sometimes be confusing. The name is <a href="https://www.cdc.gov/flu/about/viruses/types.htm">derived from</a> the virus type (A or B)/the place it was first isolated/strain number/year isolated (virus subtype).</p>
<p>This year’s vaccine therefore includes an influenza A virus similar to the 2009 pandemic-causing H1N1 isolated from Sydney in 2021 and a second influenza A virus (H3N2) isolated in Darwin in 2021. </p>
<p>Influenza B viruses are classified into 2 lineages: Victoria and Yamagata. This year’s vaccine includes an influenza B isolated from Austria in 2021 (Victoria lineage) and an influenza B isolated in Phuket in 2013 (Yamagata lineage).</p>
<figure class="align-center ">
<img alt="People on a beach in Darwin" src="https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This year’s flu vaccine protects against a strain isolated in Darwin.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sunset-over-mindil-beach-darwin-northern-494537734">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Who should get a flu shot?</h2>
<p>Health authorities <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">recommend</a> everyone aged six months of age or over should get the flu vaccine every year.</p>
<p><a href="https://www.health.gov.au/news/2023-national-immunisation-program-influenza-vaccination-early-advice-for-vaccination-providers">Some groups</a> are at greater risk of significant disease from the flu and can access the flu vaccine for free. This includes:</p>
<ul>
<li><p>Aboriginal and Torres Strait Islander people aged six months and over</p></li>
<li><p>children aged six months to five years</p></li>
<li><p>pregnant women at any stage of pregnancy</p></li>
<li><p>people aged 65 years or over</p></li>
<li><p>people aged five years to 65 years who have certain underlying health conditions affecting the heart, lungs, kidneys or immune system, and those with diabetes. </p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-the-flu-shot-if-im-pregnant-96408">Should I get the flu shot if I'm pregnant?</a>
</strong>
</em>
</p>
<hr>
<h2>How can I get it?</h2>
<p>You can get a flu shot from your local general practice or pharmacy. Or you may have an opportunity to get vaccinated at your workplace if your employer supplies it. </p>
<p>While the vaccine is free for those in the <a href="https://www.health.gov.au/sites/default/files/2023-02/fighting-flu-starts-with-you-consumer-fact-sheet.pdf">above groups</a>, there can be a consultation or administration fee, depending on where you get your vaccine. </p>
<p>If you aren’t eligible for a free vaccine, it usually costs around A$20-$30.</p>
<figure class="align-center ">
<img alt="Nurse vaccinates woman" src="https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some people can get the shot for free, while others pay $20 to $30.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-african-american-woman-getting-flu-1906058728">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Are there different options?</h2>
<p>For over 65s, whose immune systems may not work as well as when they were younger, a <a href="https://www.health.gov.au/sites/default/files/2023-03/atagi-advice-on-seasonal-influenza-vaccines-in-2023.pdf">specific vaccine</a> is available that includes an adjuvant which boosts the immune response. This is free for over-65s under the national immunisation program.</p>
<p>A high-dose vaccine is also available for people aged 60 and over. However this isn’t currently funded and costs around $70 on a private prescription. </p>
<p>People with egg allergies can safely get the egg-based flu vaccine. However there is also a cell-based immunisation for people who don’t want a vaccine made in eggs. When vaccines are grown in eggs, sometimes the virus can change and this might affect the level of protection. Cell-based vaccines aim to address this issue. </p>
<p>The cell-based vaccine isn’t funded so patients will pay around $40 for a private prescription. </p>
<h2>How well do they work?</h2>
<p>The vaccine’s effectiveness depends on how well the strains in the vaccine match those circulating. It generally <a href="https://www.health.gov.au/resources/publications/aisr-2022-national-influenza-season-summary">reduces</a> the chance of being admitted to hospital with influenza by <a href="https://www.health.gov.au/sites/default/files/documents/2022/08/influenza-vaccine-efficacy-effectiveness-and-impact-explained.docx">30-60%</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-can-you-still-get-influenza-if-youve-had-a-flu-shot-184327">Why can you still get influenza if you've had a flu shot?</a>
</strong>
</em>
</p>
<hr>
<h2>What are the side effects?</h2>
<p>You can’t get the flu from the vaccine as there’s no live virus in it. </p>
<p>When people get a flu-like illness after the vaccine, it can be due to mild effects we sometimes see after vaccination, such as headaches, tiredness or some aches and pains. These usually go away <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine#possible-side-effects-of-influenza-vaccination">within a day or two</a>.</p>
<p>Alternatively, symptoms after getting a flu shot may be due to another respiratory virus such as respiratory syncytial virus (RSV) that circulates in winter. </p>
<h2>When’s the best time to get your flu shot?</h2>
<p>The vaccine provides <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu#vaccine-information">peak protection</a> around three to four months <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine#when-to-get-the-influenza-vaccine">after</a> you get it. </p>
<p>The <a href="https://www.immunisationcoalition.org.au/news-data/influenza-statistics/">peak of the flu season</a> is usually between June and September, however this changes every year and can vary in different parts of the country.</p>
<p>Given this, the best time to get the vaccine is usually around late April or early May. So if you haven’t already, now would be a good time to get it.</p><img src="https://counter.theconversation.com/content/203406/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Griffin has been a Medical Advisory Board Member including for AstraZeneca, GSK, MSD, Moderna, Biocelect/Novavax, Seqirus and Pfizer and has received speaker honoraria including from Seqirus, Novartis, Gilead, Sanofi, MSD and Janssen.
Paul Griffin is also a Director and Scientific Advisory Board Member of the Immunisation Coalition. </span></em></p>As people flock back to offices and pack public transport, we’re seeing more cases of the flu than in recent years. The flu shot isn’t perfect but it cuts your chance of being hospitalised.Paul Griffin, Associate Professor, Infectious Diseases and Microbiology, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2053962023-05-15T04:06:09Z2023-05-15T04:06:09ZMy child has a cough, so what’s wrong with using cough syrup?<figure><img src="https://images.theconversation.com/files/526078/original/file-20230515-124801-1buxmk.jpg?ixlib=rb-1.1.0&rect=26%2C0%2C5955%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-girl-sick-lies-bed-coughs-1878376429">Shutterstock</a></span></figcaption></figure><p>As winter approaches, many parents will be bracing for the cold and flu season. Young children typically get at least <a href="https://raisingchildren.net.au/toddlers/health-daily-care/health-concerns/colds">six colds a year</a>. </p>
<p>In previous generations, parents might have reached for the cough syrup to relieve a dry or chesty cough. </p>
<p>But we now know cough syrups <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001831.pub5/full">aren’t very effective</a> at treating children’s coughs.</p>
<p>And amid <a href="https://pubmed.ncbi.nlm.nih.gov/19101060/">mounting evidence of harms</a> from poisoning and deaths, many countries including Australia have restricted cough medicines so they can’t be given to children aged under six. </p>
<h2>What’s in cough medicine?</h2>
<p>Active ingredients in cough syrups vary depending on their claimed benefit. They can contain cough suppressants (dampening the body’s cough reflex), expectorants and mucolytics (both of which help clear phlegm). </p>
<p>Other medicines marketed for cold and flu often contain decongestants (to relieve a blocked nose) and sedating antihistamines to relieve sneezing, stop a runny nose and to aid sleep. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-why-do-i-have-a-cough-and-what-can-i-do-about-it-119172">Health Check: why do I have a cough and what can I do about it?</a>
</strong>
</em>
</p>
<hr>
<p>The riskiest medications are those with a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1754.2010.01780.x">sedative action</a>, such as sedating antihistamines or opioid-based cough suppressants. While sedation may be a desired effect for parents with a sleepless child, young children are particularly at risk of serious harm or death. Sedatives can also cause agitation and hyperactivity. </p>
<p>While cough syrups that don’t contain sedatives are likely safer, there are very few studies of safety and efficacy of these products in children. Adverse events including <a href="https://pubmed.ncbi.nlm.nih.gov/10195488/">agitation and psychosis</a>
have been reported, especially with overuse. </p>
<p>Overuse may result from parents misreading the label, intentionally using more in the hope it will work better, inadvertent extra doses and the use of inaccurate measuring devices such as household spoons. </p>
<h2>How are cough syrups restricted?</h2>
<p>Young children under two years old are <a href="https://pubmed.ncbi.nlm.nih.gov/19101060/">most at risk of a fatal overdose</a> from cough syrups. But Australia’s drug regulator <a href="https://web.archive.org/web/20140717013231/http://tga.gov.au/industry/otc-notices-cough-cold-review-outcomes.htm#.U8cntK3P0Q8">recommends against</a> using cough syrups for anyone under six years of age. As such, there are no dosing instructions for children under six years on the labels of these products.</p>
<p>Cough syrups are still available for older children and adults. Pharmacists are likely to ask the age of the person who will take it and provide guidance on dosing and appropriate use. </p>
<figure class="align-center ">
<img alt="Person pours cough syrup onto a spoon" src="https://images.theconversation.com/files/526082/original/file-20230515-201419-kifs2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526082/original/file-20230515-201419-kifs2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526082/original/file-20230515-201419-kifs2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526082/original/file-20230515-201419-kifs2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526082/original/file-20230515-201419-kifs2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526082/original/file-20230515-201419-kifs2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526082/original/file-20230515-201419-kifs2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dosing errors can be made when using a household spoon.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/healthcare-people-medicine-concept-woman-pouring-657897406">Shutterstock</a></span>
</figcaption>
</figure>
<p>Our research, published today in the <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.51865">Medical Journal of Australia</a>, shows restricting the use of cough and cold medicines in children results in a significant and sustained decrease in poisonings. </p>
<p>Our study looked at dosing errors, adverse events at correct doses, and accidental “exploratory ingestions”, such as when a toddler helps themselves to the medicine cabinet. </p>
<p>The government mandated labelling changes in 2012 and 2020 for these products. In 2012, labels for medicated cough and cold products could no longer list dosing instructions for children under six, and had to carry additional warnings. In 2020, warnings were put on sedating antihistamines saying they were not to be used in children under two years for <em>any</em> reason (including allergy and hayfever). </p>
<p>This resulted in a halving of the rate of poisons centre calls, and a halving in the rate of hospitalisations. Despite this, hundreds of calls are still made to Australian poisons centres per year regarding these products in young children.</p>
<h2>When is it OK to use cough syrups?</h2>
<p>Harms have mostly been documented in younger children. This is likely due to their smaller size, meaning it takes less medicine to cause harm, and also their susceptibility to sedative effects due to their developing brains. </p>
<p>Cough syrups can be used for in children aged six to 11 years, however <a href="https://web.archive.org/web/20140717013231/http://tga.gov.au/industry/otc-notices-cough-cold-review-outcomes.htm#.U8cntK3P0Q8">caution is still needed</a>. These products should only be given in consultation with a doctor, pharmacist or nurse practitioner.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-do-cough-medicines-work-62425">Health Check: do cough medicines work?</a>
</strong>
</em>
</p>
<hr>
<p>Some herbal products are available and marketed for children, such as <em>Hedera helix</em> (ivy leaf extract). Unfortunately, there is no convincing evidence these medications <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275562/">meaningfully improve cough symptoms</a>. But the risk of poisoning is low. </p>
<p>Simple syrups containing no medication can also be effective: <a href="https://link.springer.com/article/10.1007/s00408-019-00305-5">up to 85% of the effectiveness</a> of cough medicines has been put down to the “placebo effect”. This could be due to syrups coating the throat and dampening that irritating tickling sensation.</p>
<h2>So what can I do for my kid?</h2>
<p>The best thing you can do for your child is give them rest and reassurance. </p>
<p>Antibiotics will only be needed if a doctor diagnoses them with <a href="https://www.healthdirect.gov.au/pneumonia#:%7E:text=Bacterial%20pneumonia%20may%20be%20caused,Haemophilus%20influenzae%20and%20Moraxella%20catarrhalis.">acute bacterial pneumonia</a> or with a chronic cough due to a bacterial infection, such as protracted bacterial bronchitis, whooping cough or a <a href="https://healthinfo.healthengine.com.au/lung-abscess">lung abscess</a>.</p>
<figure class="align-center ">
<img alt="Girl with a fever looks at her Dad, whose arm is touching her head" src="https://images.theconversation.com/files/526085/original/file-20230515-154092-smbbsw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526085/original/file-20230515-154092-smbbsw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526085/original/file-20230515-154092-smbbsw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526085/original/file-20230515-154092-smbbsw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526085/original/file-20230515-154092-smbbsw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526085/original/file-20230515-154092-smbbsw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526085/original/file-20230515-154092-smbbsw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Treat fevers with over-the-counter medicines such as paracetamol.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-sleeping-sickness-on-bed-796939429">Shutterstock</a></span>
</figcaption>
</figure>
<p>Paracetamol or ibuprofen can be used if they have fever, aches and pains along with their cough. Check the correct dosage on the packaging for your child’s weight and age.</p>
<p>If your child is older than 12 months and has a wet cough (producing phlegm in their throat), consider giving them honey. There is growing evidence <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264806/">honey can reduce the production of mucus</a> and therefore, the amount of coughing.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/still-coughing-after-covid-heres-why-it-happens-and-what-to-do-about-it-179471">Still coughing after COVID? Here's why it happens and what to do about it</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/205396/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rose Cairns receives funding from the National Health and Medical Research Council (NHMRC, Investigator Grant). She is also the recipient of an untied educational grant from Reckitt to fund a PhD stipend into over-the-counter analgesic research. She has previously recieved honoraria/speaker fees from Reckitt, HealthEd and The Pharmacy Guild of Australia for giving educational presentations on poisoning.</span></em></p><p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vairea Skincare LLC, a director of SetDose Pty Ltd a medical device company, and a Standards Australia panel member for sunscreen agents.</span></em></p>Children aged under six years shouldn’t have cough syrup. It’s not only ineffective, it can be harmful.Rose Cairns, Lecturer in Pharmacy, University of SydneyNial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1843272022-06-20T05:13:56Z2022-06-20T05:13:56ZWhy can you still get influenza if you’ve had a flu shot?<figure><img src="https://images.theconversation.com/files/469645/original/file-20220620-15-f1kw0e.jpg?ixlib=rb-1.1.0&rect=49%2C0%2C5472%2C3645&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctors-vaccinating-new-strain-flu-patients-1667918548">Shutterstock</a></span></figcaption></figure><p>Restrictions have eased, international borders are open and influenza is back in Australia after a two-year absence. </p>
<p>Suddenly, major <a href="https://www.abc.net.au/news/2022-06-08/medical-evacuations-as-flu-arrives-early-in-nt/101132294">flu outbreaks</a> are occurring across the country, catching many off guard. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1534157860988497920"}"></div></p>
<p>Flu vaccinations aim to protect against four influenza viruses that cause disease in humans (two subtypes from influenza A and two from influenza B). </p>
<p>But vaccine-mediated protection varies each year depending on how well the vaccine matches the disease-causing influenza viruses that are circulating at a given time. Vaccine effectiveness – a real-world measure based on the proportion of vaccinated people who still develop the flu – <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm">ranges</a> from <a href="https://www.clinicaltrialsarena.com/comment/us-flu-vaccine-efficacy/">16%</a> to <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/%24File/Vacc-efficacy-effect-impact-Oct18.pdf">60%</a>. </p>
<p>However, it’s still important to get your flu shot. If you’ve been vaccinated and still get the flu, you’re <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm">less likely</a> to get as sick. </p>
<h2>Why it’s difficult to predict which subtypes will dominate</h2>
<p>Of the four types of influenza viruses that exist in nature, two cause significant disease in humans: influenza A and influenza B. </p>
<p>The 2022 influenza vaccine is quadrivalent (targets four distinct viruses): two influenza A viruses (subtypes H3N2 and H1N1) and two influenza B viruses from distinct lineages. </p>
<p>Within each flu A subtype further genetic variation can arise, with mutations (known as genetic drift) generating many viral variants that are classified into “clades” and sub-clades. </p>
<p>H3N2 is particularly good at generating lots of diversity in this way. So predicting exactly which H3N2 virus to target in the vaccine is especially difficult. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-the-2022-flu-vaccine-and-how-effective-is-it-179309">Should I get the 2022 flu vaccine? And how effective is it?</a>
</strong>
</em>
</p>
<hr>
<p>A key challenge for flu vaccines is the decision for which virus to target has to be made months ahead of time. The the H3N2 virus in the Australian flu vaccine (A/Darwin/9/2021) was chosen in September 2021 to enable the vaccine to be manufactured and distributed in time for the 2022 winter. </p>
<p>There is no guarantee a different H3N2 virus that isn’t so well targeted by the vaccine won’t arrive in the country in the months leading into winter and start causing disease. </p>
<figure class="align-center ">
<img alt="Nurse vaccinate older woman" src="https://images.theconversation.com/files/469659/original/file-20220620-20-39rl77.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469659/original/file-20220620-20-39rl77.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469659/original/file-20220620-20-39rl77.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469659/original/file-20220620-20-39rl77.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469659/original/file-20220620-20-39rl77.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469659/original/file-20220620-20-39rl77.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469659/original/file-20220620-20-39rl77.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The subtypes contained in the seasonal flu vaccine are selected months in advance.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-face-mask-getting-vaccinated-coronavirus-1814780726">Shutterstock</a></span>
</figcaption>
</figure>
<p>Another factor that has made predicting which H3N2 virus to target in the vaccine uniquely difficult for 2022 is the lack of data on which viruses were dominant in the preceding flu seasons, both in Australia and on the other side of the Equator.</p>
<p>With travel restrictions easing towards the end of 2021, flu cases did start to reappear during the northern hemisphere 2021-22 winter. But the lack of flu cases during the preceding seasons (due to COVID) meant the data used to predict which viruses to target was inadequate. </p>
<p>The US Centers for Disease Control (CDC) analysed data from more than 3,000 children and <a href="https://www.clinicaltrialsarena.com/comment/us-flu-vaccine-efficacy/">found</a> a vaccine effectiveness of just 16% protection from mild to moderate disease from H3N2. Protection from more severe disease was just 14%. </p>
<h2>We don’t know which subtypes will circulate in Australia</h2>
<p>Data about flu vaccine effectiveness in the southern hemisphere 2022 winter isn’t yet available, and it’s unclear how protective the current vaccine is against the currently circulating disease-causing subtypes. </p>
<p>While H3N2 viruses appears to be <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/$File/flu-05-2022.pdf">driving some disease now</a>, other flu viruses may become more prevalent later in the season. </p>
<p>The flu vaccine is a quadrivalent vaccine, so in addition to influenza A H3N2, it will protect against another influenza A subtype (H1N1) and two distinct lineages of influenza B virus. These viruses don’t change as rapidly as H3N2, so it’s more likely the vaccine will give better protection against these other influenza viruses. </p>
<p>Even if vaccine protection against H3N2 is lower than usual this year, the vaccine <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm">could make the difference</a> between recovering at home versus ending up in hospital. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/which-flu-shot-should-i-choose-and-what-are-cell-based-and-adjuvanted-vaccines-184325">Which flu shot should I choose? And what are cell-based and 'adjuvanted' vaccines?</a>
</strong>
</em>
</p>
<hr>
<h2>So who should get a flu shot and when?</h2>
<p>The flu vaccine offers the highest level of protection in the first three to four months months after vaccination. The season <a href="https://www.health.gov.au/health-topics/immunisation/vaccines/influenza-flu-vaccine">generally peaks</a> between June and September – although this year we have seen a much earlier than usual start to the flu season. It’s unclear whether this early start will mean a longer flu season or an early finish. So it’s not too late to get vaccinated. </p>
<p>Flu vaccines <a href="https://www.health.gov.au/health-topics/immunisation/vaccines/influenza-flu-vaccine">are recommended</a> for everyone aged six months and over, but are particularly important for people who are more at risk of complications from influenza, including:</p>
<ul>
<li>Aboriginal and Torres Strait Islander people aged six months and over</li>
<li>children aged six months to five years</li>
<li>pregnant women</li>
<li>people aged 65 years or over<br></li>
<li>people aged six months or over who have medical conditions that mean they have a higher risk of getting serious disease. </li>
</ul>
<h2>What if you still get the flu?</h2>
<p>If you develop flu symptoms, isolate and <a href="https://www.health.gov.au/health-topics/flu-influenza#diagnosis">see your GP</a> for an influenza PCR test to determine whether you are indeed infected with influenza, particularly if you’re in the higher-risk groups. </p>
<p>Specific antivirals for influenza <a href="https://www.health.gov.au/health-topics/flu-influenza#treatment">can help</a>, if given early. To ensure rapid access to particularly vulnerable aged-care residents, aged-care facilities are being <a href="https://www1.racgp.org.au/newsgp/clinical/plans-ramp-up-for-tamiflu-deployment-in-aged-care">stocked</a> with the flu antiviral drug Tamiflu. </p>
<p>In New South Wales, free <a href="https://www.newsofthearea.com.au/4cyte-drive-through-covid-19-testing-centres-to-conduct-conduct-influenza-and-rsv-testing-94671">drive-through clinics</a> now offer testing for influenza, respiratory syncytial virus (RSV) and SARS-CoV-2, the virus that causes COVID. Other states and territories may follow.</p><img src="https://counter.theconversation.com/content/184327/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathan Bartlett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Flu vaccinations protect against four subtypes of influenza. But we don’t know what subtypes will circulate this flu season.Nathan Bartlett, Associate Professor, School of Biomedical Sciences and Pharmacy, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1843252022-06-15T20:01:34Z2022-06-15T20:01:34ZWhich flu shot should I choose? And what are cell-based and ‘adjuvanted’ vaccines?<figure><img src="https://images.theconversation.com/files/468692/original/file-20220614-19-phg91o.jpg?ixlib=rb-1.1.0&rect=40%2C26%2C2955%2C1836&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.health.gov.au/sites/default/files/documents/2022/02/atagi-advice-on-seasonal-influenza-vaccines-in-2022.pdf">CDC/Unsplash</a></span></figcaption></figure><p>With Australians learning to live with COVID and resuming international travel, cases of influenza are <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm">steadily rising</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1534157860988497920"}"></div></p>
<p>Getting a flu shot <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm">reduces your chance of catching the flu</a> caused by four flu virus strains covered by the vaccine, and reduces the risk of severe complications and hospitalisations. </p>
<p>An annual flu vaccine is <a href="https://www.health.gov.au/resources/publications/atagi-advice-on-seasonal-influenza-vaccines-in-2022">recommended</a> for adults and children six months and older – unless you have a history of anaphylactic reactions to the vaccine or your doctor advises against it. </p>
<p>There are different brands and types of flu vaccines. So when booking in for your shot, your health provider will discuss the best option for you. </p>
<h2>What are the options?</h2>
<p>If you’re over 65, you’re likely to be offered an “adjuvanted” (Fluad Quad) vaccine. Those aged over 60 can also access the high-dose vaccine (Fluzone High-Dose Quad). </p>
<p>If you want to avoid vaccines made with eggs, you can ask for a cell-based vaccine (Flucelvax Quad). </p>
<p>But for most other Australians, there isn’t much of a difference between <a href="https://www.health.gov.au/sites/default/files/documents/2022/02/atagi-advice-on-seasonal-influenza-vaccines-in-2022.pdf">brands</a> – Vaxigrip Tetra, Fluarix Tetra, Afluria Quad, FluQuadri, Influvac Tetra – aside from their suitability for different age groups. </p>
<p>GPs and pharmacists will generally stock one or two of these brands or whichever their state or territory governments supplies.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-the-2022-flu-vaccine-and-how-effective-is-it-179309">Should I get the 2022 flu vaccine? And how effective is it?</a>
</strong>
</em>
</p>
<hr>
<p>Unlike in previous years, all eight flu vaccines available this year are “quadrivalent”, meaning each vaccine protects against four strains of flu viruses. </p>
<p>The strains are predicted to be the most commonly circulating strains, based on trends observed in the Northern Hemisphere winter. </p>
<p>Flu vaccines are “inactivated”, which means they don’t contain live viruses and can never give anyone the flu. </p>
<h2>Over 65s</h2>
<p>For people 65 years and older, “adjuvanted” or immune-boosting (Fluad Quad®) or high-dose vaccines (Fluzone High-Dose Quad®) <a href="https://immunisationhandbook.health.gov.au/recommendations/adults-aged-65-years-are-strongly-recommended-to-receive-influenza-vaccine-every-year">are recommended</a>, as older people tend to have weaker immune systems. </p>
<p>Vaccines work by activating a person’s own immune system. The “adjuvanted” vaccine activates a <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu#adverse-events">stronger immune response</a> and is therefore <a href="https://pubmed.ncbi.nlm.nih.gov/22940713/">more effective</a> at preventing the flu in older age groups than the standard vaccines. </p>
<p>High-dose vaccines deliver a higher dose than standard flu vaccines and are also <a href="https://pubmed.ncbi.nlm.nih.gov/28329311/">more effective</a> than the standard vaccines at reducing transmission and preventing severe disease in older age groups. </p>
<p>Adjuvanted vaccines are <a href="https://www.health.gov.au/sites/default/files/documents/2022/02/atagi-advice-on-seasonal-influenza-vaccines-in-2022.pdf">free for over-65s</a> under the National Immunisation Program. </p>
<p>If you’re 60 or over, you can choose a high-dose vaccine, although you may have to pay for it, depending on local government programs. </p>
<figure class="align-center ">
<img alt="Nurse vaccinated older man in a facemask" src="https://images.theconversation.com/files/468675/original/file-20220614-26-xxuqfh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/468675/original/file-20220614-26-xxuqfh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/468675/original/file-20220614-26-xxuqfh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/468675/original/file-20220614-26-xxuqfh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/468675/original/file-20220614-26-xxuqfh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/468675/original/file-20220614-26-xxuqfh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/468675/original/file-20220614-26-xxuqfh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Adjuvanted vaccines boost older people’s immune systems to better protect against the flu.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-man-receives-booster-shot-covid-2097158878">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Cell-based vaccines don’t use eggs</h2>
<p>The flu vaccines are either egg-based or cell-based. Traditionally, flu vaccines were egg-based, meaning the flu viruses were grown in fertilised hens’ eggs.</p>
<p>But people with egg allergies can <a href="https://www.allergy.org.au/patients/food-allergy/egg-allergy-flu-vaccine">safely get</a> the egg-based flu vaccine. The amount of egg protein left in each vaccine at the end of the production process is less than 1 microgram, much less than the estimated amount of 130 micrograms required to cause an allergic reaction.</p>
<p>In recent years, newer medical technology has led to the production of cell-based flu vaccines. Here, the virus is grown in host cells. So people who wish to avoid egg products may choose a cell-based vaccine instead. </p>
<p>Currently, Flucelvax Quad is the only cell-based flu vaccine approved for use in Australia and is also suitable for children from two years of age.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flu-vaccine-wont-definitely-stop-you-from-getting-the-flu-but-its-more-important-than-you-think-75778">Flu vaccine won't definitely stop you from getting the flu, but it's more important than you think</a>
</strong>
</em>
</p>
<hr>
<p>Some studies <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036483/">have shown</a> cell-based vaccines <a href="https://www.ncirs.org.au/sites/default/files/2022-03/Influenza%20vaccines-FAQs_update_March%202022_Final.pdf">are better</a> at triggering the body’s immune response. </p>
<p>This is because the viruses used to make cell-based vaccines are more similar to circulating wild flu viruses – and the closer it resembles the real thing, the more effective it is. </p>
<p>However, Flucelvax Quad isn’t currently funded under the National Immunisation Program, so you’ll need to pay yourself, even if you’re eligible for a free vaccine under the national program. </p>
<h2>When is the best time to get vaccinated?</h2>
<p>It takes seven to 14 days for our body to respond to a vaccine. Once you receive the vaccine, your body starts to recognise the four strains of flu viruses and starts to develop an immune response over the course of about two weeks.</p>
<p>Once this occurs, when you come into contact with one or more of these four strains of viruses, your body’s own immune response will be able to protect and prevent you from getting sick. </p>
<p>The flu season <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm">typically peaks</a> in Australia between July to September. The vaccine will provide the highest level of protection for <a href="https://www.health.gov.au/sites/default/files/documents/2022/02/atagi-advice-on-seasonal-influenza-vaccines-in-2022.pdf">three to four months</a>. So late May to early June is <a href="https://www.health.gov.au/sites/default/files/documents/2022/02/atagi-advice-on-seasonal-influenza-vaccines-in-2022.pdf">generally the best time</a> to get it. </p>
<p>For people travelling overseas, your doctor or pharmacist can advise you on what’s best for you based on where and when you’re travelling. </p>
<figure class="align-center ">
<img alt="Older couple wheel suitcases through an airport." src="https://images.theconversation.com/files/468744/original/file-20220614-15-erv7u9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/468744/original/file-20220614-15-erv7u9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/468744/original/file-20220614-15-erv7u9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/468744/original/file-20220614-15-erv7u9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/468744/original/file-20220614-15-erv7u9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/468744/original/file-20220614-15-erv7u9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/468744/original/file-20220614-15-erv7u9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Consider getting the flu shot before heading overseas.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/couple-two-seniors-mature-people-walking-1725913618">Shutterstock</a></span>
</figcaption>
</figure>
<p>The flu vaccine can also be given at the same time as most other vaccines, including COVID vaccines. It’s also safe – and recommended – in pregnancy. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-the-flu-shot-if-im-pregnant-96408">Should I get the flu shot if I'm pregnant?</a>
</strong>
</em>
</p>
<hr>
<h2>What are the side effects?</h2>
<p>People <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu">may experience</a> cold and flu-like symptoms for up to 24–48 hours after getting the vaccine. This shows the body’s immune response is kicking in and the vaccine is working.<br>
You can take over-the-counter pain medications such as paracetamol or ibuprofen to relieve these symptoms. </p>
<p>Other common side effects may include local injection site reactions such as redness, mild swelling and tenderness. This should subside within 48 hours without any treatment. Applying ice or a cold pack can help. </p>
<p>Some people may develop more severe reactions, including anaphylaxis (a severe, life-threatening allergic reaction) in extremely rare circumstances. This is also why your doctor or pharmacist recommends waiting on-site for 15 minutes after vaccination for monitoring. </p>
<p>If you’ve had a severe reaction to any vaccine in the past, it’s important to tell your doctor or pharmacist.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/as-flu-cases-surge-vaccination-may-offer-some-bonus-protection-from-covid-as-well-183613">As flu cases surge, vaccination may offer some bonus protection from COVID as well</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/184325/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tin Fei Sim is affiliated with Curtin University and the Pharmaceutical Society of Australia. </span></em></p>If you’re over 65, you’ll likely get an immune-boosting flu shot. And there are options for those who don’t want a vaccine made with eggs – though the standard shots are safe for those with allergies.Tin Fei Sim, Senior Lecturer, Curtin Medical School, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1793092022-04-10T20:08:17Z2022-04-10T20:08:17ZShould I get the 2022 flu vaccine? And how effective is it?<figure><img src="https://images.theconversation.com/files/456790/original/file-20220407-24494-8zi1or.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-adult-africanamerican-man-looking-away-1891456996">Shutterstock</a></span></figcaption></figure><p>Free influenza (flu) vaccines are now available for <a href="https://www.health.gov.au/news/2022-nip-influenza-vaccination-program">eligible groups</a>, subject to local supply arrangements, with health authorities encouraging booking in from mid April. </p>
<p>For those who aren’t eligible for a free vaccine, flu shots are available now for a small fee (around A$25) from pharmacies and GPs (though you might also have to pay a consultation fee). </p>
<p>This year, you can get your flu shot on the <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/is-it-true/is-it-true-do-i-have-to-wait-between-getting-the-influenza-flu-and-covid-19-vaccine">same day</a> as your COVID booster.</p>
<h2>Not ‘just the flu’</h2>
<p>Influenza is a disease of the respiratory tract. It <a href="https://www.health.gov.au/health-topics/flu-influenza">can cause</a> a runny nose, coughing, sneezing, sore throat, fever and chills, headache and body aches. It can cause vomiting and diarrhoea, which is more common in children. </p>
<p>Influenza affects people of all ages and can cause severe illness and lead to hospitalisation and death, particularly in young children, the elderly and those with underlying health conditions. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1504214887316471808"}"></div></p>
<p>The number of cases and deaths in Australia each year fluctuates. In 2019, before the pandemic, <a href="https://www.abc.net.au/news/2021-09-16/queensland-what-happened-to-the-flu-in-2021/100456616">313,000 lab-confirmed cases and 953 deaths</a> were reported. The 2019 case numbers were 2.7 times higher than the five-year average. </p>
<p>In the first two years of the pandemic, flu numbers plummeted due to prevention measures used to content COVID spread. </p>
<h2>When do they start working? How long do they last?</h2>
<p>Vaccines don’t cause disease in the person. Rather, they prompt the body’s immune system to respond, much as it would have on its first reaction to the <a href="https://www.immunology.org/celebrate-vaccines/public-engagement/guide-childhood-vaccinations/how-vaccines-work#How%20do%20vaccines%20work?">actual virus</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/you-cant-get-influenza-from-a-flu-shot-heres-how-it-works-118916">You can't get influenza from a flu shot – here's how it works</a>
</strong>
</em>
</p>
<hr>
<p>Flu vaccines stimulate antibodies to develop in the body usually within two weeks following vaccination. </p>
<p>While flu vaccines offer the highest level of protection <a href="https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/influenza-flu">three for four months after vaccination</a>, research suggests antibodies continue to <a href="https://www.cdc.gov/flu/prevent/different-flu-vaccines.htm">protect against</a> infection <a href="https://pubmed.ncbi.nlm.nih.gov/22633868/">8.5 months after vaccination and 11.8 months</a> after natural infection.</p>
<p>So while <a href="https://pubmed.ncbi.nlm.nih.gov/30722022/">antibodies decrease over time</a>, they generally last longer than a typical influenza season. </p>
<p><a href="https://www.health.gov.au/news/2022-influenza-vaccination-early-advice-for-vaccination-providers">Current recommendations</a> are to get vaccinated from April, before the flu season, which generally occurs from June to September. </p>
<h2>Why do we need a flu vax each year?</h2>
<p>There are four types (or strains) of influenza viruses: A, B, C or D. Types A and B cause severe disease in humans, and each year the seasonal flu vaccine protects against two A and two B strains. </p>
<p>The four types are related to the presence of specific proteins on the surface of the virus. These surface proteins aren’t stable and often mutate, or change. </p>
<p>When the body encounters these changes, the immune system cannot be activated. </p>
<p>So although the person may have been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928832/#:%7E:text=Influenza%20viruses%20are%20members%20of,sense%20single%2Dstrand%20RNA%20segments.">vaccinated</a> against or infected by a “old” version of the viral strain, the body won’t easily recognise and neutralise the new strain. </p>
<figure class="align-center ">
<img alt="Nisha Yunus, a 64-year old residential care aide in the Vancouver Coastal Health region, receiving her immunisation" src="https://images.theconversation.com/files/456746/original/file-20220407-24494-8egfwl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456746/original/file-20220407-24494-8egfwl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456746/original/file-20220407-24494-8egfwl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456746/original/file-20220407-24494-8egfwl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456746/original/file-20220407-24494-8egfwl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456746/original/file-20220407-24494-8egfwl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456746/original/file-20220407-24494-8egfwl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Our bodies can’t recognise and respond to new flu strains.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/bcgovphotos/50724854306/in/photolist-2kho8Xy-FKtNPY-dQRQag-nCG2HS-dQXoqh-dQRPDx-dQXoS9-kY51nv-2k3zWxL-2k3vqoX-2k3zgmi-2ktmqrq-2jxkwUS-2jxkwL5-2jxpXHv-2jx5xby-2jxpXFG-2jx8Uuc-2jx5xaG-2m6itfE-xgHefX-2kUw37T-2k3vqrT-2k3zghf-25nyRxU-2jHtaQb-2jHxyHm-2jHwL3b-2mX7P3J-2jHxyPo-2jHtaWt-2jy4Xsq-2jy4Xtn-2jxpXrt-2jy8dpS-2jxpXiN-2jxkwBc-pFPdB8-8KoAyi-9UhabY-9V9SLH-kY5QBs-2kGf5jF-dEWhu-kY5S2S-GaAjce-DHCPeb-FFgdMw-LwWYiq-FZbvHV">Province of British Columbia/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>Due to these continuous changes, the <a href="https://www.euro.who.int/en/health-topics/communicable-diseases/influenza/vaccination#:%7E:text=WHO%20recommends%20that%20health%20care,months%20with%20certain%20chronic%20diseases">World Health Organization</a> reviews and updates its recommendations for the composition of the vaccine annually. It selects the viruses (mutated versions of the virus) most likely to circulate in the coming season. </p>
<p><a href="https://www.tga.gov.au/committee/australian-influenza-vaccine-committee-aivc">The Australian Influenza Vaccine Committee</a> uses this recommendation to determine the composition of influenza vaccines for use in Australia. </p>
<p>Our 2022 seasonal flu vaccine <a href="https://www.tga.gov.au/media-release/2022-seasonal-influenza-vaccines">protects against</a>: </p>
<ul>
<li>an A/Victoria/2570/2019 (H1N1)pdm09-like virus</li>
<li>an A/Darwin/9/2021 (H3N2)-like virus</li>
<li>a B/Austria/1359417/2021-like (B/Victoria lineage) virus </li>
<li>a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.</li>
</ul>
<p>However, some vaccines protect against three strains (trivalent, covering one B strain) rather than four (quadrivalent, covering two B strains). </p>
<p>While it’s generally better to get the four-strain vaccine, the success of the vaccine depends on whether it matches (and therefore protects against) the strain or strains dominating that season. </p>
<h2>Who should get vaccinated?</h2>
<p>Annual vaccination is the most important measure to prevent influenza and its complications. </p>
<p>Vaccination does more than just protect an individual: sufficient vaccination levels across the community can protect members of the community who would otherwise be left vulnerable.</p>
<p>The seasonal flu vaccine is recommended for all Australians aged six months and over. </p>
<p>It’s <a href="https://www.health.gov.au/health-topics/immunisation/vaccines/influenza-flu-vaccine">available for free</a> to the population groups most as risk of severe disease from influenza: </p>
<ul>
<li>people aged 65 years or over</li>
<li>children aged six months to under five years</li>
<li>pregnant women at any stage of pregnancy</li>
<li>Aboriginal and Torres Strait Islander people aged six months and over</li>
<li>people aged six months or over who have <a href="https://www.health.gov.au/health-topics/immunisation/vaccines/influenza-flu-vaccine">medical conditions</a> that mean they have a higher risk of getting serious disease.</li>
</ul>
<p>For over-65s, adjuvanted influenza vaccines – which include an immune-stimulant to encourage a stronger immune response – <a href="https://www.health.gov.au/news/2022-influenza-vaccination-early-advice-for-vaccination-providers">are recommended</a> over standard influenza vaccine. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/high-dose-immune-boosting-or-four-strain-a-guide-to-flu-vaccines-for-over-65s-112224">High-dose, immune-boosting or four-strain? A guide to flu vaccines for over-65s</a>
</strong>
</em>
</p>
<hr>
<h2>How effective are vaccines?</h2>
<p>Vaccine effectiveness varies depending on the outcome being measured, the age group affected (as vaccine effectiveness is generally lower in older people), and the match between vaccine and circulating influenza strains. </p>
<p>Estimates of flu vaccine effectiveness is 40-60% <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm">in the United States</a> and 30-60% in <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/$File/Vacc-efficacy-effect-impact-Oct18.pdf">Australia</a>. This means 30-60% of those vaccinated are less likely to become seriously ill or die from influenza. </p>
<figure class="align-center ">
<img alt="Elderly woman gets vaccinated." src="https://images.theconversation.com/files/456798/original/file-20220407-20-2d0hsw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456798/original/file-20220407-20-2d0hsw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456798/original/file-20220407-20-2d0hsw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456798/original/file-20220407-20-2d0hsw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456798/original/file-20220407-20-2d0hsw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456798/original/file-20220407-20-2d0hsw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456798/original/file-20220407-20-2d0hsw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Older Australians should receive a vaccine with an added immune-booster.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/general-practitioner-vaccinating-old-patient-clinic-1850607544">Shutterstock</a></span>
</figcaption>
</figure>
<h2>What about side effects?</h2>
<p>Most influenza vaccines are <a href="https://ausvaxsafety.org.au/safety-data/influenza-vaccine">safe</a> in adults and children. </p>
<p>However, they can sometimes cause side effects. These include fever, muscle pain, vomiting, nausea, headache, irritability, injection site reaction and rash. </p>
<p><a href="https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/influenza-flu">Serious side effects are rare</a> and include anaphylaxis, an allergic reaction to the nonactive ingredients. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-the-flu-shot-if-im-pregnant-96408">Should I get the flu shot if I'm pregnant?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/179309/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Far from a mild disease, the flu can cause serious illness and death, particularly among children and older age groups. The flu vaccine isn’t perfect, but it’s the best way to protect yourself.Maja Husaric, Senior Lecturer; MD, Victoria UniversityVasso Apostolopoulos, Professor of Immunology and Pro Vice-Chancellor, Research Partnerships, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1793022022-03-28T03:04:06Z2022-03-28T03:04:06ZWhy do I (and my kids) get so many colds? And with all this COVID around, should we be isolating too?<figure><img src="https://images.theconversation.com/files/454071/original/file-20220324-15-1542vx2.jpg?ixlib=rb-1.1.0&rect=53%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/-CDN2nTKfrA">Brittany Colette</a></span></figcaption></figure><p>As we head towards winter, the likelihood of picking up a pesky cold increases. But COVID changes how we approach sore throats and runny noses. </p>
<p>If you have cold symptoms and return negative rapid antigen tests, isolating isn’t mandatory – but it’s a good idea. But how long should you stay away from others when you have a cold? </p>
<p>Generally, you’re infectious until your symptoms clear, and should stay away until you’re well again. Passing your cold onto others can mean unnecessary COVID testing for them. </p>
<p>Some people may have a lingering cough or other symptoms when they’re past the normal infectious period. If your RAT is clear for COVID and your symptoms linger, it’s a good idea to consult your GP to rule out other infections or complications. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-i-feel-a-bit-sick-should-i-stay-home-or-go-to-work-42759">Health Check: I feel a bit sick, should I stay home or go to work?</a>
</strong>
</em>
</p>
<hr>
<h2>What causes ‘the common cold’?</h2>
<p>Unlike other infectious diseases with one specific cause – such as COVID, which is caused by SARS-CoV-2 – the “common cold” is a viral upper respiratory tract infection with a set of classic signs and symptoms, but which is not caused by one specific virus. </p>
<figure class="align-center ">
<img alt="Upper respiratory tract graphic." src="https://images.theconversation.com/files/454065/original/file-20220324-17-1oozs5o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454065/original/file-20220324-17-1oozs5o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=462&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454065/original/file-20220324-17-1oozs5o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=462&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454065/original/file-20220324-17-1oozs5o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=462&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454065/original/file-20220324-17-1oozs5o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=581&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454065/original/file-20220324-17-1oozs5o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=581&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454065/original/file-20220324-17-1oozs5o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=581&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Common colds affect the upper respiratory tract.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/respiratory-tract-subdivision-system-involved-process-1798390387">Shutterstock</a></span>
</figcaption>
</figure>
<p>The common cold is most frequently caused by more than 100 different <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553670/">human rhinovirus</a> serotypes (viruses within one species with the same number and type of surface proteins).</p>
<p>Colds can also be caused by multiple other viruses including <a href="https://journals.lww.com/pidj/Fulltext/2022/03000/Proving_Etiologic_Relationships_to_Disease_.18.aspx">common cold human coronaviruses</a>, <a href="https://onlinelibrary.wiley.com/doi/10.1111/1348-0421.12865">parainfluenza viruses</a>, adenoviruses and others. </p>
<p>We repeatedly get colds because when we develop immunity to one type of virus that can cause colds, another comes along to which we don’t have immunity. Some of these <a href="https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1009453">mutate</a> over time and “escape” from the antibodies we have produced to a previous infection. </p>
<p>While we tend to think of colds as harmless, in the <a href="https://pubmed.ncbi.nlm.nih.gov/17299706/">very young</a>, the elderly or others with less robust immune systems they can cause serious illness. This can result in <a href="https://academic.oup.com/jid/article/185/9/1338/938156">hospitalisation</a> and can trigger <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2972660/#:%7E:text=Viral%20respiratory%20tract%20infections%20were,also%20been%20recorded%20in%20adults.">asthma</a> in susceptible people. </p>
<h2>How are colds transmitted?</h2>
<p>Cold viruses are transmitted through touching your eyes, mouth, nose or food with hands contaminated by viruses, by direct contact with others, or by inhaling contaminated aerosols. </p>
<p><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140673603121629/fulltext">Pre-school children</a> have six to eight (or more) colds per year. </p>
<p><a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30502-6/fulltext">Children</a> appear to be key drivers of community transmission and bring the infection home from pre-school or school. </p>
<figure class="align-center ">
<img alt="Man washes hands with soap." src="https://images.theconversation.com/files/454069/original/file-20220324-19-1tg2ecq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454069/original/file-20220324-19-1tg2ecq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454069/original/file-20220324-19-1tg2ecq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454069/original/file-20220324-19-1tg2ecq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454069/original/file-20220324-19-1tg2ecq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454069/original/file-20220324-19-1tg2ecq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454069/original/file-20220324-19-1tg2ecq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Good hand hygiene reduces the chance of catching a cold.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/coronavirus-pandemic-prevention-wash-hands-soap-1661809675">Shutterstock</a></span>
</figcaption>
</figure>
<p>Adults then take the infections into their workplaces. <a href="https://www.proquest.com/docview/199579881?parentSessionId=xjWwejqtrp8J0ZRdaGuCnrJXCa7Fu2ApCii5oxQKg3U%3D&pq-origsite=360link&accountid=14543">Poor ventilation in workplaces</a> may increase the risk of exposure to cold viruses. </p>
<p>Colds are <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140673603121629/fulltext">more common</a> in autumn, winter and spring, or in the rainy season if you live in the tropics. </p>
<h2>Common cold life cycle</h2>
<p>The median incubation period (the most common time it takes to develop symptoms) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327893/">can vary greatly</a> from about half a day to five and half days, depending on which virus is involved. </p>
<p>In a rhinovirus infection it’s roughly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327893/">two days</a>, although symptoms can occur in as little as half a day. </p>
<p>Generally, you’re likely to be <a href="https://emedicine.medscape.com/article/227820-overview#a3">infectious one to two days before developing symptoms</a> and while you have symptoms. </p>
<p>Adults and adolescents usually recover from their symptoms in around <a href="https://www.cdc.gov/features/rhinoviruses/index.html">seven to ten days</a>. Coughs may <a href="https://emedicine.medscape.com/article/227820-overview#a6">last longer</a> for some people, particularly <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Cough/#:%7E:text=If%20your%20child%20is%20unwell,from%20school%20for%20that%20long.">younger children</a>. </p>
<h2>What symptoms do you get and why?</h2>
<p><a href="https://emedicine.medscape.com/article/227820-overview#a3">Inflammation</a> from the infection can cause a number of symptoms, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140673603121629/fulltext">including</a> a sore throat, runny nose, nasal congestion, sneezing and cough. </p>
<p>The runny nose occurs because a chemical called histamine makes your blood vessels more leaky. Your snot starts out clear and runny. Over time it will tend to thicken. </p>
<p>As your immune cells fight off the infection, some white blood cells will die, changing snot colour. As the immune response kicks into high gear, white blood cells called neutrophils produce an infection-fighting chemical (myeloperoxidase) that has a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545676/">green colour</a>. </p>
<p>When lots of neutrophils die in the process of fighting the virus, the myeloperoxidase causes green snot. </p>
<p>If your runny nose persists for an extended period, or you develop facial pain, you may have acquired a <a href="https://www.cdc.gov/antibiotic-use/sinus-infection.html">sinus infection</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-does-my-snot-turn-green-when-i-have-a-cold-98379">Curious Kids: Why does my snot turn green when I have a cold?</a>
</strong>
</em>
</p>
<hr>
<h2>How to prevent catching and transmitting colds</h2>
<p>The US Centers for Disease Control and Prevention <a href="https://www.cdc.gov/features/rhinoviruses/index.html">recommend the following precautions</a> to reduce the risk to others:</p>
<ul>
<li><p>stay home while symptomatic (and keep sick kids home from school or daycare). For most people, this will be about <a href="https://www.cdc.gov/features/rhinoviruses/index.html">seven to ten days</a> </p></li>
<li><p>if you need to cough or sneeze, do so into your elbow. If using tissues, dispose of contaminated tissues and wash your hands afterwards</p></li>
</ul>
<figure class="align-center ">
<img alt="Child coughs into her arm" src="https://images.theconversation.com/files/454067/original/file-20220324-15-1t3613b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454067/original/file-20220324-15-1t3613b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454067/original/file-20220324-15-1t3613b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454067/original/file-20220324-15-1t3613b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454067/original/file-20220324-15-1t3613b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454067/original/file-20220324-15-1t3613b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454067/original/file-20220324-15-1t3613b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cough into your elbow.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-girl-demonstrates-coughing-sneezing-into-38010103">Shutterstock</a></span>
</figcaption>
</figure>
<ul>
<li><p>wash or sanitise your hands frequently because rhinoviruses can linger on fingers <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-6-130">and objects</a> for <a href="https://pubmed.ncbi.nlm.nih.gov/25614158/#:%7E:text=Rhinovirus%2DB14%20was%20deposited%20on,had%20no%20influence%20on%20survival.">several hours</a></p></li>
<li><p>transmission occurs when you’re in close proximity to others. So you may choose to work from home, if possible. If you can’t, keep your distance from your co-workers</p></li>
<li><p>given <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140673603121629/fulltext">aerosol transmission is possible</a>, depending on the virus involved, you could also wear a mask at work for a week or two after your symptoms have cleared or if you have returned to work with a lingering cough</p></li>
<li><p>disinfect frequently touched surfaces.</p></li>
</ul>
<p>Finally, train yourself to avoid touching your face. <a href="https://ieeexplore.ieee.org/document/9176589">One study</a> compared upper respiratory tract infections in two groups – one that handwashed only, and one that handwashed and used a Smartwatch with a sensor to track hand movements and give reminders about not touching the face. </p>
<p>The group with the hand-tracking and reminders touched their faces less frequently and had a 53% reduction in upper respiratory tract infections.</p><img src="https://counter.theconversation.com/content/179302/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thea van de Mortel teaches into the Graduate Infection Prevention and Control programs at Griffith University. </span></em></p>Your rapid antigen tests say you’re COVID-negative but you still have cold symptoms. Generally, you should stay away from others until you’re well again.Thea van de Mortel, Professor, Nursing and Deputy Head (Learning & Teaching), School of Nursing and Midwifery, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1407272020-06-24T20:17:14Z2020-06-24T20:17:14ZCoronavirus or just a common cold? What to do when your child gets sick this winter<figure><img src="https://images.theconversation.com/files/342880/original/file-20200619-41242-1xomyrq.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6794%2C4525&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>It’s Sunday night, around 8pm, when your ten-year-old tells you she has a sore throat. She doesn’t have any other symptoms, and feels OK. You tell her “let’s see how you feel in the morning” and she happily goes off to sleep. </p>
<p>But you’re left wondering what you’ll do if her throat is still sore the next day — or if she’s developed other symptoms by then. Should you get her swabbed for COVID-19?</p>
<p>Like most Australians, you haven’t recently travelled overseas or been in contact with anyone with COVID-19. And like most kids, your children often get coughs and colds during winter.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/worried-about-your-child-getting-coronavirus-heres-what-you-need-to-know-131909">Worried about your child getting coronavirus? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>COVID-19 symptoms in kids resemble other respiratory infections</h2>
<p>Generally, in their first 12 years, children can experience up to <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1399-3038.2007.00688.x?casa_token=nneK-1mapJsAAAAA%3A-5kcukD-IZDBZtTAahXa_0A4Gmja2TLPf2jZythl9vXwvDsGXkAklt7FjS-LaIMRFBdz8wCYwmeRKOTu">four to eight</a> respiratory tract infections, or “colds”, per year. This number is highest among the youngest children.</p>
<p>One-quarter of all <a href="https://www.mja.com.au/system/files/issues/202_05/bie00090.pdf">GP visits</a> in children under five in Australia are for respiratory tract infections.</p>
<p>A recent <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/apa.15270">review</a> showed COVID-19 symptoms in children were typical of most acute respiratory infections and included fever, cough, sore throat, sneezing, muscle aches and fatigue.</p>
<p>In general, COVID-19 in children is <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/apa.15270">less severe</a> than in adults.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/342896/original/file-20200619-41213-noca8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/342896/original/file-20200619-41213-noca8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/342896/original/file-20200619-41213-noca8e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/342896/original/file-20200619-41213-noca8e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/342896/original/file-20200619-41213-noca8e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/342896/original/file-20200619-41213-noca8e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/342896/original/file-20200619-41213-noca8e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In children, the symptoms of COVID-19 might appear like the symptoms of any cold or flu.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>So how do I know if I should get my child tested?</h2>
<p>If your child is unwell you can check their symptoms using healthdirect’s <a href="https://www.healthdirect.gov.au/symptom-checker/tool/basic-details">coronavirus symptom checker</a>.</p>
<p>It will ask you questions based on what we know to be common symptoms of COVID-19, including whether you or the person you’re caring for have: </p>
<ul>
<li><p>a fever of 37.5°C or more; or</p></li>
<li><p>symptoms suggesting fever (such as night sweats or chills); or </p></li>
<li><p>an acute respiratory infection (for example, cough, shortness of breath, sore throat); or</p></li>
<li><p>loss of smell or taste.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-and-kawasaki-disease-in-children-its-an-intriguing-but-unproven-link-137415">Coronavirus and Kawasaki disease in children: it's an intriguing but unproven link</a>
</strong>
</em>
</p>
<hr>
<p>It’s possible these could also be symptoms of a different respiratory infection. But if your child is displaying any of these symptoms, the current <a href="https://www.health.gov.au/resources/videos/coronavirus-video-stay-covid-free-do-the-3">federal government guidelines</a> recommend they stay at home and get tested. </p>
<p>You can also ask your GP if you’re not sure whether your child needs a test.</p>
<h2>How likely is it my child will test positive to COVID-19?</h2>
<p>Although Victoria is currently experiencing a spike, Australia has largely “flattened the curve”. In the past month there have been <a href="https://www.covid19data.com.au/">less than 40 new cases</a> nationally each day.</p>
<p>Around the country, since the pandemic began, we’ve performed <a href="https://www.covid19data.com.au/">more than two million tests</a> and identified 7,521 cases.</p>
<p>This means fewer than 0.5% of tests have been positive. And only a small proportion of confirmed cases have been in children.</p>
<p>So in our current situation it’s much more likely your child’s fever or runny nose is caused by one of the common respiratory viruses, such as rhinovirus, that we see each winter.</p>
<h2>How sustainable is all this testing?</h2>
<p>We’re now performing more tests each day than we were at the height of the pandemic in late March.</p>
<p><iframe id="tc-infographic-496" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/496/0598668018a5666e15da133b092ce9a6dc3b6534/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Australia’s high level of testing has undoubtedly played a significant role in our successful response to the COVID-19 pandemic.</p>
<p>But we now must ask ourselves whether, with potentially diminishing returns, it’s sustainable to keep testing every child with a cold for the foreseeable future. </p>
<p>Let’s remember there are <a href="https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Dec%202019?OpenDocument">4.7 million children</a> in Australia under 15 and each of them, particularly the younger ones, are likely to get multiple respiratory infections each year.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/stupid-coronavirus-in-uncertain-times-we-can-help-children-through-mindfulness-and-play-135317">'Stupid coronavirus!' In uncertain times, we can help children through mindfulness and play</a>
</strong>
</em>
</p>
<hr>
<p>One of the risks of a continued emphasis on COVID-19 testing is that when a child returns a negative result, the parent thinks “all good, my child doesn’t have coronavirus, they can go back to school”.</p>
<p>This risks spreading non-COVID-19 viruses to others, who then develop respiratory symptoms and need to be tested. Many of these viruses spread easily among children, especially where they’re in close contact, such as in childcare centres.</p>
<p>This may lead to an upward spiral of respiratory infections, particularly during winter when colds and the flu are traditional foes.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/342900/original/file-20200619-41242-lnh0fc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/342900/original/file-20200619-41242-lnh0fc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/342900/original/file-20200619-41242-lnh0fc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/342900/original/file-20200619-41242-lnh0fc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/342900/original/file-20200619-41242-lnh0fc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/342900/original/file-20200619-41242-lnh0fc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/342900/original/file-20200619-41242-lnh0fc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Viral infections can spread easily among children.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Keep sick kids at home</h2>
<p>While testing is important, physical distancing and hygiene measures have been instrumental in flattening the curve.</p>
<p>And as a bonus, these measures may have led to decreased incidence of other viral infections in the community.</p>
<p>In our hospital in Sydney, we’ve seen fewer hospitalisations for <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Respiratory_syncytial_virus_RSV/">respiratory syncytial virus</a> this year, a common cause of infant hospitalisations.</p>
<p>Nationally, in the first five months of 2020 there were <a href="http://www9.health.gov.au/cda/source/rpt_3.cfm">20,569 influenza notifications</a>, compared to more than 74,000 at the same point last year.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kids-are-more-vulnerable-to-the-flu-heres-what-to-look-out-for-this-winter-117748">Kids are more vulnerable to the flu – here's what to look out for this winter</a>
</strong>
</em>
</p>
<hr>
<p>Although restrictions are easing, Australians should continue to focus on physical distancing and hygiene throughout winter. </p>
<p>We need to see this pandemic as an opportunity to shift to a new normal: that is, staying at home when you’re sick, and keeping your child at home if they’re unwell (until their symptoms resolve).</p>
<p>We know it’s not always practical, but hopefully this “new normal” will see more flexibility from employers in these circumstances. </p>
<p>Finally, yes, follow public health advice around getting tested for COVID-19. But let’s not view this as the only thing that matters.</p><img src="https://counter.theconversation.com/content/140727/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Wood receives funding from National Health and Medical Research Council for a Career Development Fellowship</span></em></p><p class="fine-print"><em><span>Philip Britton receives funding from the National Health and Medical Research Council for an Early Career Fellowship</span></em></p>It’s much more likely your child’s symptoms are caused by a common respiratory virus than COVID-19. But it’s important to follow testing guidelines and keep them home if they’re unwell.Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyPhilip Britton, Senior lecturer, Child and Adolescent Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1316392020-03-15T11:41:06Z2020-03-15T11:41:06ZKeeping kids active despite the weather: Promoting outdoor activity all year round<figure><img src="https://images.theconversation.com/files/319956/original/file-20200311-116232-nysm05.jpg?ixlib=rb-1.1.0&rect=71%2C0%2C2923%2C2034&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Although colder weather is linked to lower levels of physical activity, changing seasons provide unique opportunities to be active.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span></figcaption></figure><p>Given the climate in much of Canada, cold, wet or snowy conditions are inescapable for many months of the year. And like it or not, <a href="https://doi.org/10.1123/pes.22.1.81">weather and seasonality</a> are a barrier to Canadian children engaging in physical activity. Consequently, we need to find a way to help children (as well as parents and educators) embrace the outdoors and stay active all year round. </p>
<p>This is particularly important as kids are more active outdoors than indoor. Since children’s activity levels <a href="https://doi.org/10.1016/j.puhe.2007.04.009">vary with the seasons</a>, getting kids outside year-round is important for meeting movement guidelines.</p>
<h2>Physical activity in cold, wet months</h2>
<p><a href="https://dx.doi.org/10.3390%2Fijerph6102639">Snow and cold temperatures</a> are tied to low levels of physical activity. Parents have identified warmer seasons as more conducive to physical activity for their children and colder seasons as posing <a href="https://dx.doi.org/10.1007%2FBF03405170">greater challenges</a>. </p>
<p>What’s more, children’s social and built environments are not very accommodating of active living in the winter. When temperatures are low, social norms among Canadians encourage staying indoors participating in more sedentary behaviours, like watching movies, streaming shows, playing video games, reading books or doing crafts. Likewise, extremely hot and humid days also have the tendency to drive kids indoors. </p>
<p>Many of the environments in which children spend the majority of their waking hours during the week (schools and childcare) often have strict <a href="https://globalnews.ca/news/5027337/indoor-recess-canada-winter/">policies prohibiting outdoor play when temperatures drop below a particular level</a>. Even when kids can get outside, there are <a href="https://dx.doi.org/10.2105%2FAJPH.2013.301319">many safety regulations</a> these settings must abide by (such as prohibiting some outdoor equipment, splashing in puddles, and making snow hills off limits), which hamper children’s innate desire to move their bodies outdoors.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/319437/original/file-20200309-118956-ncmtj6.jpg?ixlib=rb-1.1.0&rect=57%2C50%2C4718%2C3128&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319437/original/file-20200309-118956-ncmtj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319437/original/file-20200309-118956-ncmtj6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319437/original/file-20200309-118956-ncmtj6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319437/original/file-20200309-118956-ncmtj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319437/original/file-20200309-118956-ncmtj6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319437/original/file-20200309-118956-ncmtj6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Physical activity is an important part of children’s healthy development.</span>
<span class="attribution"><span class="source">AP Photo/Knoxville News Sentinel, Saul Young</span></span>
</figcaption>
</figure>
<p>Fortunately, changing seasons also present unique opportunities to be active, try different activities and improve healthy behaviours. Different settings — including water, ice, and snow — provide opportunities to develop or enhance new skills, like balance, co-ordination, agility, lifting and lowering, running, crawling, throwing and hopping. </p>
<h2>How to help kids stay active all year long</h2>
<p>Based on current research, there are numerous <a href="https://www.cps.ca/en/documents/position/physical-activity-guidelines#TABLE%202">evidence-informed recommendations</a> that can be drawn upon to help <a href="https://csepguidelines.ca/children-and-youth-5-17/">support, encourage, and promote increased activity levels</a> among children.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/319996/original/file-20200311-116270-8f75yl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319996/original/file-20200311-116270-8f75yl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319996/original/file-20200311-116270-8f75yl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319996/original/file-20200311-116270-8f75yl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319996/original/file-20200311-116270-8f75yl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319996/original/file-20200311-116270-8f75yl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319996/original/file-20200311-116270-8f75yl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children enjoy themselves on a playground at Wasaho Cree Nation School in Fort Severn, Ontario’s most northerly community, in this April 2018 photo.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Colin Perkel</span></span>
</figcaption>
</figure>
<p><strong>Keep it fun and positive</strong>. Children have different interests and enthusiasms, so it is important to suggest and enable activities that your child will enjoy. This may involve some trial and error: you might make mistakes and you might find different children in your home enjoy different activities. </p>
<p><strong>Stick to a routine</strong>. Find the times for activity that work best for your family and stick with them. In certain cases, you may need to get creative and consider new ways to get active if it’s not possible to play outside (heat or cold weather advisories). Also be mindful that it gets dark early during the winter months. </p>
<p><strong>Make it a family affair</strong>. Physical activity should be valued by the whole family and maintained as a priority. Getting everyone involved (including the family dog!) provides key opportunities to model healthy behaviours and provide positive behavioural prompts. Bonus: physical activities are a great way to spend time and bond as a family.</p>
<p><strong>Break it up</strong>. Kids do not need to accumulate the <a href="https://csepguidelines.ca/children-and-youth-5-17/">recommended 60 minutes of daily moderate-to-vigorous physical activity</a> in a single bout. It is OK to break it up and still reap the health benefits. Every little bit helps! </p>
<p><strong>Dress to impress</strong>. Wear layers (this will help children regulate their body temperature) made of breathable materials that repel water, and wear gloves, hats and warm boots when frostbite is a risk. From a health and safety perspective, wear reflective gear (to be seen at night), wear sunscreen and sunglasses (UVA/UVB rays are present, and water and snow-covered surfaces reflect the sun), and remember that helmets are as essential for tobogganing, skiing, and skating as they are for cycling, skateboarding, and rollerblading.</p>
<h2>Need some ideas to get your kids moving?</h2>
<p>There are plenty of options to keep children moving in any season, many of which can be done in groups, with the family, or even solo. </p>
<p>When the opportunity arises to get kids outdoors, consider some of the following activities: play tag, go for walks, rake leaves, swim in a pool or lake, go cycling or wheeling with friends. </p>
<p>In colder weather, build a snowman/snow angel, go tobogganing, have a snowball fight, go skiing (cross-country or downhill), try snowshoeing, go skating, help with snow shovelling, build a snow fort or try snow painting.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/319441/original/file-20200309-167285-1uierrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319441/original/file-20200309-167285-1uierrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319441/original/file-20200309-167285-1uierrb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319441/original/file-20200309-167285-1uierrb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319441/original/file-20200309-167285-1uierrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319441/original/file-20200309-167285-1uierrb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319441/original/file-20200309-167285-1uierrb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Keep sunscreen and helmets handy for tobogganing, skiing or skating, as well as for biking, skateboarding and rollerblading.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang</span></span>
</figcaption>
</figure>
<p>And in those instances when it’s not safe to be outdoors, don’t let this deter children from moving their bodies. Either take the fun indoors or just venture outside for a short time — <a href="https://dx.doi.org/10.3390%2Fijerph120606475">kids need the fresh air for a brain break and to expend energy</a>. </p>
<p>Some indoor activities include: have a dance party, play hide and seek, help with household chores, do yoga, participate in an indoor scavenger hunt or obstacle course. If you don’t have a ton of space indoors, venture to a community recreation centre or sports facility. </p>
<p>Check your local recreation centre for classes and activities, or your YMCA, indoor pool, ice rink or gym. Try ice skating or roller skating, go bowling or take a long walk inside the local mall.</p>
<p>Physical activity is an important part of children’s healthy development — ensuring this need is met in every season is equally important!</p><img src="https://counter.theconversation.com/content/131639/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leigh Vanderloo is affiliated with ParticipACTION. </span></em></p><p class="fine-print"><em><span>Trish Tucker receives funding from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council. </span></em></p>Keeping kids active in winter can be a challenge, as cold temperatures and icy conditions often mean more time indoors. Here’s how to maintain a healthy activity level throughout Canadian winters.Leigh Vanderloo, Adjunct Professor, Child Health and Physical Activity Lab, School of Occupational Therapy, Western UniversityTrish Tucker, Associate Professor and Director of the Child Health and Physical Activity Lab, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1291832020-01-29T20:23:31Z2020-01-29T20:23:31ZSnow shovelling: Healthy exercise or deadly activity?<figure><img src="https://images.theconversation.com/files/312101/original/file-20200127-81416-lqm9z8.jpg?ixlib=rb-1.1.0&rect=305%2C395%2C1639%2C1787&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Residents of St. John's, NL dig out after a major storm in January 2020.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Andrew Vaughan</span></span></figcaption></figure><p>Winter’s just over a month old and already from coast to coast, major storms have hit. While the snow can provide great opportunities for different outdoor activities such as skiing, snowshoeing, skating and tobogganing, for many people, it means getting a shovel out to clear the sidewalk or dig out the car.</p>
<p>As an exercise and health researcher, I can confirm that snow shovelling is an excellent physical activity. It works both your upper and lower body, and these sorts of activities done regularly can <a href="https://doi.org/10.1016/S0140-6736(17)31634-3">reduce your risk for heart disease and premature death</a>. In lab testing, snow shovelling was <a href="https://doi.org/10.1001/jama.1995.03520350062030">equivalent to vigorous physical activity, like running on a treadmill</a>. For many people, this would be at, or close to, their maximal fitness capacity.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/312615/original/file-20200129-92977-e2dbus.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/312615/original/file-20200129-92977-e2dbus.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=439&fit=crop&dpr=1 600w, https://images.theconversation.com/files/312615/original/file-20200129-92977-e2dbus.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=439&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/312615/original/file-20200129-92977-e2dbus.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=439&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/312615/original/file-20200129-92977-e2dbus.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=551&fit=crop&dpr=1 754w, https://images.theconversation.com/files/312615/original/file-20200129-92977-e2dbus.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=551&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/312615/original/file-20200129-92977-e2dbus.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=551&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A soldier from the 4th Artillery Regiment based at CFB Gagetown clears snow at a residence in St. John’s, NL in January 2020, after a state of emergency was declared following a major storm.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Andrew Vaughan</span></span>
</figcaption>
</figure>
<p>Every winter, hospital admissions of people experiencing chest pain or heart attacks increase after snowfalls. One Canadian study reported a <a href="https://doi.org/10.1503/cmaj.161064">34 per cent increased risk for death in men</a> due to heart attack on days following 20 cm or more of snow. </p>
<p>Over a two-year period, <a href="https://doi.org/10.1007/s00392-011-0356-6">seven per cent of 500 acute heart events</a> during the winter were attributed to snow shovelling. In the United States, approximately <a href="https://doi.org/10.1016/j.ajem.2009.07.003">770 people report to the emergency department annually</a> for heart-related events as a result of shovelling snow, of which nearly 100 result in deaths. </p>
<p>With these findings, one would think that we should avoid snow shovelling at all costs. But with a few exceptions, it’s no different from any other vigorous physical activity. </p>
<p>When one is active, the working muscles demand more oxygen causing the heart to beat faster and stronger. This stress on the heart results in a small increase in risk of having a heart attack or sudden cardiac arrest. However, this risk is extremely small; about <a href="https://doi.org/10.1001/jama.295.12.1399">one death in 36.5 million hours of exercise</a> compared to one in 59.4 million hours of sitting. To put this into perspective, if you live to 80 years, that’s only 700,000 hours.</p>
<h2>Snow shovelling: A perfect storm for the heart</h2>
<p>What sets snow shovelling apart from other activities is it’s done in the cold weather. It takes our body longer to warm up. Being exposed to cold weather causes our arteries to constrict at a time when we want them to open to allow more blood flow to our heart and working muscles. This can lead to higher blood pressure and poor blood flow to resulting in greater work for the heart. Indeed, <a href="http://dx.doi.org/10.1136/heartjnl-2017-311821">colder weather puts us at greater risk for heart attacks and stroke</a>.</p>
<p>However, probably the most crucial factor is the condition of the people who have had a heart attack or sudden cardiac deaths as a result of snow shovelling. These people tend to either have, or be <a href="https://doi.org/10.1007/s00392-011-0356-6">at risk for, heart disease</a> and are <a href="https://dx.doi.org/10.1016%2Fj.amjcard.2010.03.075">generally inactive</a>. For many of these people, snow shovelling may be the most vigorous activity they do. And with a low fitness level, the <a href="http://dx.doi.org/10.1001/jama.1995.03520350062030">stress on the heart due to snow shovelling is higher</a> and the <a href="http://doi.org/10.1056/nejm200011093431902">risk of death is greater</a> as well.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/312120/original/file-20200127-81346-162bx4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/312120/original/file-20200127-81346-162bx4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=438&fit=crop&dpr=1 600w, https://images.theconversation.com/files/312120/original/file-20200127-81346-162bx4h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=438&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/312120/original/file-20200127-81346-162bx4h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=438&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/312120/original/file-20200127-81346-162bx4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=550&fit=crop&dpr=1 754w, https://images.theconversation.com/files/312120/original/file-20200127-81346-162bx4h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=550&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/312120/original/file-20200127-81346-162bx4h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=550&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Digging out after a heavy snowfall in St. John’s, NL in January 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Andrew Vaughan</span></span>
</figcaption>
</figure>
<p>Lastly, the context of snow shovelling is also different from other activities. It’s often done as chore to be completed as fast as possible. One may be in a hurry trying to get the car out to go to work or take the kids to school. This compounds the first point regarding exposure to cold weather in that we do not allow our bodies to warm up like we would when exercising. We often underestimate the effort required to do activities we view as chores, such as snow shovelling, and because of this we don’t prepare physically or mentally for them.</p>
<p>It’s not only heart conditions that send people to the emergency department due to snow shovelling. The overwhelming majority of the average 11,500 injuries in the U.S. per year are the result of <a href="https://doi.org/10.1016/j.ajem.2009.07.003">muscle strains and tears, and lower back injuries</a>. Considering a shovel of snow may weigh between 10 and 30 pounds, with repeated lifting this can take a toll on one’s body.</p>
<h2>Treat snow shovelling like any vigorous exercise</h2>
<p>But there are a number of ways in which you can minimize your risk of injury. The first is to be regularly active. People who are active have a higher fitness level and are better able to handle the stresses of vigorous activity. Meanwhile, people who don’t exercise regularly have <a href="http://doi.org/10.1056/nejm200011093431902">seven times greater risk of having sudden cardiac death</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/312124/original/file-20200127-81369-chyhr0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/312124/original/file-20200127-81369-chyhr0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/312124/original/file-20200127-81369-chyhr0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/312124/original/file-20200127-81369-chyhr0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/312124/original/file-20200127-81369-chyhr0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=488&fit=crop&dpr=1 754w, https://images.theconversation.com/files/312124/original/file-20200127-81369-chyhr0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=488&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/312124/original/file-20200127-81369-chyhr0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=488&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A woman with a snow shovel in Montréal, January 2018.</span>
<span class="attribution"><span class="source">CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<p>As with any activity, your body needs time to warm up to work efficiently. Start off slow, and don’t hurry. Using a smaller shovel will reduce the chances of muscle injury. Alternatively, during large snowfalls, start shovelling early before it accumulates and do smaller amounts throughout the day. </p>
<p>For people who have heart disease, be aware of your limitations for activity. Wearing a heart rate monitor while shovelling is a good way to check how much work you’re doing. And if you need help, ask a family member, friend or neighbour. Likewise, if you live near someone who has mobility issues that make shovelling hard, be a snow angel and dig in.</p>
<p>Shovelling snow is an activity that will have to get done at some point each winter and it’s important to recognize that it is more than just a chore: it’s a vigorous activity similar to running and a great way to be active.</p>
<p><em>Scott Lear writes the weekly blog <a href="https://drscottlear.com/">Feel Health with Dr. Scott Lear</a>.</em></p><img src="https://counter.theconversation.com/content/129183/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Scott Lear has received research funding from the Canadian Institutes of Health Research, the Heart and Stroke Foundation, Novo Nordisk, Hamilton Health Sciences and the Robert Wood Johnson Foundation.</span></em></p>Shovelling snow is excellent exercise that works the upper and lower body. However, it’s important to remember that digging out from a storm pushes many people to their maximal fitness capacity.Scott Lear, Professor of Health Sciences, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1200042019-07-21T20:01:43Z2019-07-21T20:01:43ZMedia hype and increased testing: this year’s flu numbers are high, but there’s more to the story<figure><img src="https://images.theconversation.com/files/284437/original/file-20190717-173342-72nf9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The media suggests we're in the midst of a horror flu season, but there are nuances to consider.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>Over recent months, the news has been saturated with headlines claiming we’re experiencing a “<a href="https://www.abc.net.au/news/2019-04-10/australian-flu-season-concerns-as-experts-urge-vaccinations/10987700">killer flu season</a>”. Researchers watching laboratory data are using the term “<a href="https://web.archive.org/web/20190712012442/https://stories.uq.edu.au/small-change/flunami/index.html">flunami</a>”.</p>
<p>Data suggests this is a serious year for the flu, with a <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm">higher number of cases, hospitalisations and deaths</a> recorded than at the same time point in previous years. But there’s more to the story.</p>
<p>Increased testing for influenza and a very early start to the flu season have driven these high figures. Meanwhile, we’ve seen heightened community awareness and concern as the media continue to report on the high numbers of flu cases.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-a-bad-year-for-flu-but-its-too-early-to-call-it-the-worst-ever-5-charts-on-the-2019-season-so-far-120093">It's a bad year for flu, but it's too early to call it the worst ever – 5 charts on the 2019 season so far</a>
</strong>
</em>
</p>
<hr>
<h2>Increased concern leads to increased testing</h2>
<p>Tragically, influenza causes deaths every year, including among infants and healthy young people. This still comes as a surprise to many. News coverage of these deaths presents human stories that make the risk feel real and threatening. </p>
<p>We can see the impact of this by looking at the trends in Google searches for “flu deaths” and “flu symptoms” in Australia this year. The steep rise is closely aligned with <a href="https://www.abc.net.au/news/2019-05-07/teenager-among-ten-influenza-deaths-reported-in-sa/11088168">media reporting of deaths</a> from early May. </p>
<p>The Google search interest in deaths in 2019 dwarfs the 2017 interest, when media reports of <a href="https://www.theage.com.au/national/victoria/girl-8-dies-of-flu-in-melbourne-hospital-20170918-gyjdml.html">influenza deaths</a> appeared more sporadically.</p>
<p><iframe id="8xJ70" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/8xJ70/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>The fear of a uniquely severe and dangerous flu season leads more people to go to <a href="https://ijhpr.biomedcentral.com/articles/10.1186/s13584-015-0028-5">their GP</a> or <a href="https://www.sciencedaily.com/releases/2010/05/100504074839.htm">emergency department</a> for an assessment if they’re experiencing flu-like symptoms. In turn, it may also lead more doctors to test for influenza, resulting in increased influenza counts. </p>
<p>Every Monday morning in winter our <a href="https://info.flutracking.net/">Flutracking survey</a> asks around 45,000 Australians about their influenza-like symptoms (fever and cough). We also ask ill Flutrackers if their doctor tested them for influenza. </p>
<p>Every year, more and more Flutrackers answer yes. Comparing the percentage of Flutrackers with cough and fever who reported being tested for influenza during April and May increased markedly from 2016, with a very significant increase in 2019.</p>
<p><iframe id="9haq3" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/9haq3/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>The season is earlier, but it’s not more severe</h2>
<p>Since at least 2011, there has been an <a href="https://www.health.nsw.gov.au/Infectious/Influenza/Pages/reports.aspx">increasing summer to autumn blip</a> in influenza activity. That trend has been particularly pronounced this year.</p>
<p>Systems like Flutracking are showing higher levels of influenza-like illness for this time of year, but the figures are not nearly as high as the typical August to September peak seen over the last five years.</p>
<p><iframe id="Q2e9u" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Q2e9u/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Flutracking is not perfect, tracking only “influenza-like” symptoms. Influenza surveillance relies on multiple imperfect streams of data; each contribute to our understanding of the whole picture. </p>
<p>Another system providing objective information on the severity of influenza is the New South Wales <a href="https://www.health.nsw.gov.au/Infectious/Influenza/Publications/2019/weekending-07072019.pdf">death registration data</a>. It showed a few unseasonal spikes in February and March, but is otherwise low and around half the rate we see in the middle of a typical influenza season.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-2019-flu-shot-isnt-perfect-but-its-still-our-best-defence-against-influenza-120088">The 2019 flu shot isn't perfect – but it's still our best defence against influenza</a>
</strong>
</em>
</p>
<hr>
<p>Hospitalisation rates for influenza <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm">are high</a> across many hospitals for this time of year, and some may approach peak winter rates seen in 2017. But looking at the proportion of patients admitted to hospital with the flu requiring intensive care, there’s no indication the early influenza season is deadlier than usual.</p>
<p>The simplest way to describe the season is early, but average so far. The rates of influenza are high for this time of year, but the illness is no more severe compared to the typical peak we see in the middle of winter.</p>
<p>Comparing 2019 to 2018, which was a very mild year, further exaggerates the difference.</p>
<h2>So when will it end?</h2>
<p>In describing the season as “early”, the question arises as to how long it will last. No one knows. The dynamics of an influenza season are a mix of the particular strains circulating, underlying population immunity to the circulating strains from past infection or immunisation, levels of population density and interactions, and weather – all highly unpredictable factors.</p>
<p>If there is no change in the circulating strains then it’s possible the number of susceptible people in the community could be exhausted and the influenza season could “burn out”. If not, it could be a big year for influenza.</p>
<p>Note that this is a broad brush overview of a large country. Western Australia appears to be having a different experience this year with <a href="https://ww2.health.wa.gov.au/%7E/media/Files/Corporate/general%20documents/Infectious%20diseases/PDF/VWAtch/2019/20190630_virus_watch.pdf">very high rates of laboratory notifications and influenza related hospitalisations</a>. After experiencing a series of mild influenza seasons it may now have a much larger pool of people susceptible to influenza infection.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kids-are-more-vulnerable-to-the-flu-heres-what-to-look-out-for-this-winter-117748">Kids are more vulnerable to the flu – here's what to look out for this winter</a>
</strong>
</em>
</p>
<hr>
<h2>How worried should you be?</h2>
<p>So far, the season is early but average. It’s not the worst flu season on record and not a “flunami”. </p>
<p>Is there any harm in the media being hyperbolic about the nature of each flu season? Some see no downside in using media interest as an opportunity to educate the public about influenza or promote research.</p>
<p>At the same time, there is a danger in tying reasonable public health advice to unreliable interpretations of what is actually happening. Crying wolf may undermine trust in public health messaging.</p>
<p>Hopefully, the messages around flu remain clear. You don’t want to get influenza, and if you do get it, you don’t want to spread it to other people. Immunisation, hand hygiene, anti-viral treatment and staying home if ill can all help.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/have-you-noticed-australias-flu-seasons-seem-to-be-getting-worse-heres-why-43837">Have you noticed Australia's flu seasons seem to be getting worse? Here's why</a>
</strong>
</em>
</p>
<hr>
<p><em>If you would like to help Flutracking track the flu near you, you can join at <a href="https://info.flutracking.net/">Flutracking.net</a>.</em></p>
<p><em>Sandra Carlson, the Flutracking senior analyst, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/120004/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Craig Dalton receives funding from the Commonwealth Department of Health to support the Flutracking program. </span></em></p>The headlines paint a picture of a frightening flu season. While this season set in earlier than usual, it’s not necessarily more severe than previous years.Craig Dalton, Conjoint Senior Lecturer School of Medicine and Public Health, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1202282019-07-15T19:43:05Z2019-07-15T19:43:05ZHand sanitisers in public won’t wipe out the flu but they might help reduce its spread<figure><img src="https://images.theconversation.com/files/284038/original/file-20190715-173351-1oww2xq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's quicker to use hand sanitiser than soap and water, which means people might be more likely to use it. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/488408785?src=EFYBbKwcQuQdWXEZuqNcPA-1-43&studio=1&size=huge_jpg">Shutterstock</a></span></figcaption></figure><p>This year’s flu season is off to an early start, with 144,000 confirmed cases so far in 2019. That’s <a href="http://www9.health.gov.au/cda/source/rpt_3.cfm">more than twice as many confirmed cases</a> of the flu than for all of 2018 (58,000), and almost as many as the 2017 horror flu season (251,000). </p>
<p>The number of cases so far this year, including <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/$File/flu-05-2019.pdf">more than 231 deaths</a> nationwide, led the NSW opposition <a href="https://www.canberratimes.com.au/story/6260141/calls-for-hand-sanitisers-to-fight-nsw-flu/digital-subscription/">health spokesperson to call</a> for hand sanitisers in public spaces to help slow the spread.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-a-bad-year-for-flu-but-its-too-early-to-call-it-the-worst-ever-5-charts-on-the-2019-season-so-far-120093">It's a bad year for flu, but it's too early to call it the worst ever – 5 charts on the 2019 season so far</a>
</strong>
</em>
</p>
<hr>
<p>Influenza spreads via droplets from coughing and sneezing, which is why it’s a good idea to catch your cough. But coughing into your hand can leave flu virus on your hands, which is why <a href="https://theconversation.com/cough-and-sneeze-into-elbows-not-hands-13152">we recommend</a> coughing into your <a href="https://www.cdc.gov/healthywater/hygiene/etiquette/coughing_sneezing.html">elbow or sleeve</a> and washing your hands afterwards.</p>
<p>Along with <a href="https://theconversation.com/the-2019-flu-shot-isnt-perfect-but-its-still-our-best-defence-against-influenza-120088">getting vaccinated</a> and staying home if you’re sick, washing your hands is the best defence against getting the flu. </p>
<p>If the government can make this easier by providing hand sanitisers in public places, it may be worth the investment. It won’t solve our flu problem but it might be an important tool in the toolbox of measures to reduce its spread. </p>
<h2>What does the research say?</h2>
<p>The scientific literature on hand sanitisers isn’t so clear-cut. </p>
<p>A 2019 study in <a href="https://doi.org/10.1086/650396">university colleges</a> showed the use of hand hygiene and face masks didn’t protect against flu any better than mask use alone. But unlike some other countries, Australia doesn’t have a strong habit of mask use when people are unwell, so this may not be very helpful to us.</p>
<p>A <a href="https://doi.org/10.1371/journal.pmed.1001700">2014 study in New Zealand schools</a> showed that providing sanitiser didn’t reduce the rate of absenteeism from school either. </p>
<p>While these studies make it sound like hand sanitiser is not very effective, that’s not the end of the story. </p>
<p>Other studies show a positive effect – a <a href="https://doi.org/10.1111/j.1365-3156.2006.01568.x">16% reduction</a> in respiratory illness in one and a <a href="https://doi.org/10.2105/AJPH.2007.124610">21% reduction</a> in another. For some infections, the <a href="https://doi.org/10.1111/j.1365-3156.2006.01568.x">evidence</a> is even stronger – for example, gastroenteritis, most of which is also viral. </p>
<p>However, <a href="https://doi.org/10.1111/j.1365-3156.2006.01568.x">few of these studies</a> showing the benefits of hand sanitisers were done during a large disease outbreak, which means the potential benefit may be even greater. </p>
<p>Not all influenza-like illness is caused by the flu – it can be other viruses as well, so the estimates are a bit rubbery at best. Hand sanitiser trials which look at influenza-like illness or respiratory infections generally are more likely to show benefits than those that just look for influenza – meaning good hand hygiene prevents other infections as well.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/284039/original/file-20190715-173342-133ztej.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284039/original/file-20190715-173342-133ztej.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284039/original/file-20190715-173342-133ztej.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284039/original/file-20190715-173342-133ztej.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284039/original/file-20190715-173342-133ztej.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284039/original/file-20190715-173342-133ztej.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284039/original/file-20190715-173342-133ztej.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If you have the flu, the best place to be is at home.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/650188465?src=DQxn5m0Iyy6jykQO2hC3vg-1-6&studio=1&size=huge_jpg">Tero Vesalainen/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Lessons from hospitals</h2>
<p>Although preventing infection in hospitals is not the same as doing it in the community, there are two important lessons from hospital infection control. </p>
<p>First, in hospital hand-hygiene programs, hand sanitiser is <a href="https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf">more effective</a> than soap-and-water hand-washing, provided your hands aren’t visibly dirty. </p>
<p>This is partly because of the rapid effect of the alcohol, but mostly because it’s much quicker and therefore <a href="https://doi.org/10.1001/archinte.160.7.1017">more likely</a> that staff will use it. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-should-i-use-antibacterial-hand-sanitisers-21384">Health Check: should I use antibacterial hand sanitisers? </a>
</strong>
</em>
</p>
<hr>
<p>The second important point from <a href="https://dx.doi.org/10.3201/eid0702.700234">hand hygiene</a> and <a href="https://doi.org/10.1371/journal.pone.0015452">other areas</a> of hospital infection control is that introducing a “bundle” of strategies usually reduces healthcare-associated infection rates – even when the individual parts of these bundles don’t show benefits alone. </p>
<p>This could be because the individual effect sizes are too small, or that change in practice highlights a “safety culture”.</p>
<h2>Sanitisers can be one of many strategies</h2>
<p>Installing hand rub in public areas won’t solve this year’s flu outbreak by itself. But it can be part of a bundle of strategies – as long as the dispensers are kept topped up. </p>
<p>And it’s certainly a safe intervention – despite some <a href="https://www.change.org/p/all-schools-ban-alcohol-hand-sanitizers-in-schools">desperate hysteria</a> about the safety of hand gels, or the risk of people drinking them, there is little evidence this actually occurs in reality.</p>
<p>Hand sanitiser is also likely to be easier to implement than fixing the much larger social problem of Australians <a href="https://www.msn.com/en-au/news/other/australians-know-working-sick-is-bad-for-them-but-they-do-it-anyway/ar-AAE60oJ">going to work</a> when they’re sick. This may be because of inadequate sick leave, concerns about “letting the team down”, or other logistical problems such as child-care.</p>
<p>Get your flu vaccine – even now it’s still not too late – and get it for your kids as well, for <a href="https://www.immunisationcoalition.org.au/immunisation/influenza-and-children/">their sake</a> as well as <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-015-1007-8">your own</a>. </p>
<p>Remember to stay home if you’re unwell, and always to cough into your sleeve. And don’t forget to clean your hands – even if the government doesn’t end up making it easier for you.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-2019-flu-shot-isnt-perfect-but-its-still-our-best-defence-against-influenza-120088">The 2019 flu shot isn't perfect – but it's still our best defence against influenza</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/120228/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Trent Yarwood is affiliated with the Queensland Statewide Antimicrobial Stewardship Program and Cairns and Hinterland Hospital and Health Service. He is also a member of Future Wise - a not-for-profit research and advocacy organisation.
These are his personal opinions and not those of his employers or of Future Wise.</span></em></p>Washing your hands helps protect against the flu. So it makes sense for governments to make hand sanitisers available in public places.Trent Yarwood, Infectious Diseases Physician, Senior Lecturer, James Cook University and, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1200932019-07-14T18:47:07Z2019-07-14T18:47:07ZIt’s a bad year for flu, but it’s too early to call it the worst ever – 5 charts on the 2019 season so far<figure><img src="https://images.theconversation.com/files/283792/original/file-20190712-173342-1jh53ox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The impact of the flu on a population can be measured by looking at figures including cases, hospitalisations and deaths.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>From early this year it’s been apparent the 2019 Australian influenza “season” was going to be different. Normally, the flu season coincides with the winter months of July and August, sometimes stretching to September and October. </p>
<p>But this year, things have happened much earlier, with <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm">a record number of influenza cases</a> reported in summer and autumn. </p>
<p>So what’s been happening, and is it really as bad as the media have been reporting? Here we look at some of the latest data on cases and their outcomes to see if it is indeed “<a href="https://thewest.com.au/news/public-health/wa-flu-deaths-spike-800-per-cent-in-horror-season-ng-b881240641z">a horror flu season</a>”.</p>
<hr>
<p><iframe id="cNDw1" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/cNDw1/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<hr>
<p>The impact of influenza on the community is measured in several ways. The most basic measure is to simply count the number of cases of people presenting to their GP with influenza-like illness. </p>
<p>Sometimes the doctor will take a swab, and these are tested in the laboratory to confirm that influenza virus is present (it’s possible another respiratory virus or bacteria might be causing the flu-like symptoms).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-2019-flu-shot-isnt-perfect-but-its-still-our-best-defence-against-influenza-120088">The 2019 flu shot isn't perfect – but it's still our best defence against influenza</a>
</strong>
</em>
</p>
<hr>
<p>Cases of <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-ozflu-2019.htm">influenza-like illness</a> were increasing in early March, peaked in early June, and are now decreasing. Laboratory confirmed cases (the results of which we see in the above chart) show a similar trend. We haven’t included July in this chart because it’s not finished yet, but we’re still seeing a high number of cases into July.</p>
<p>Compared to previous years, 2019 looks like a big year with more than 120,000 cases of lab confirmed influenza <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/ozflu-surveil-no05-19.htm">up to the end of June</a>. But it’s not nearly as bad as <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-ozflu-2017.htm">2017</a>, which had more than 250,000 cases reported to the National Notifiable Diseases Surveillance System (NNDSS) by the end of the year. As this season occurred much later than 2019’s, 2017 had only 24,000 cases reported up to July 7. </p>
<p>The good news is that as the 2019 season started earlier, it’s also likely to finish earlier than usual. This is because once the main influenza season starts, it usually ends around 12-16 weeks later, when the number of susceptible people <a href="https://europepmc.org/abstract/med/29324895">drops below the level required</a> to maintain efficient circulation.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/283809/original/file-20190712-173370-yh2vwo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/283809/original/file-20190712-173370-yh2vwo.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=519&fit=crop&dpr=1 600w, https://images.theconversation.com/files/283809/original/file-20190712-173370-yh2vwo.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=519&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/283809/original/file-20190712-173370-yh2vwo.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=519&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/283809/original/file-20190712-173370-yh2vwo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=652&fit=crop&dpr=1 754w, https://images.theconversation.com/files/283809/original/file-20190712-173370-yh2vwo.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=652&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/283809/original/file-20190712-173370-yh2vwo.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=652&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/$File/flu-05-2019.pdf">FluCAN (via Department of Health Influenza Surveillance Report)</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<hr>
<p>Another measure of how severe the influenza season is can be gauged by the number of hospitalisations, including admissions to ICU (intensive care units).</p>
<p>Hospital admissions show from <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/ozflu-surveil-no05-19.htm">April 1 to June 30 this year</a>, there have been 1,309 admissions to the Australian sentinel surveillance hospitals (a number of hospitals where flu admissions are tracked each year). </p>
<p>This figure is much higher than previous years at the same time point. In 2018, there were <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/ozflu-surveil-no03-18.htm">90 admissions</a>, and in 2017, <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/ozflu-surveil-no04-17.htm">311</a>. But in 2017 the season arrived much later and more seriously and ultimately resulted in <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/ozflu-surveil-no12-17.htm">3,969 admissions</a> for that year.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kids-are-more-vulnerable-to-the-flu-heres-what-to-look-out-for-this-winter-117748">Kids are more vulnerable to the flu – here's what to look out for this winter</a>
</strong>
</em>
</p>
<hr>
<p>It’s also useful to look at the proportion of people attending hospital with influenza infections who are admitted directly to ICU. In 2019 it’s been <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/ozflu-surveil-no05-19.htm">6.7% of admissions</a> compared to 2018 (a mild influenza year) with <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/ozflu-surveil-2018-final.htm">8.1% of admissions</a>, and 2017 (a very severe year) with <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/ozflu-surveil-2017-final.htm">8.9% of admissions</a>. </p>
<p>The 2019 ICU rate is at the lower end of historical figures which range from <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/097F15A91C05FBE7CA2581E20017F09E/$File/2017-season-summary-22112017.pdf">8.7% in 2015 to 14.2% in 2013</a>. By this measure, the 2019 season is of a similar severity to that seen in previous seasons and is therefore not exceptional.</p>
<p><iframe id="0J9aJ" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/0J9aJ/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>While hospital admissions can be measured relatively easily, measuring deaths due to influenza is more complicated for a few reasons. The flu often paves the way for secondary bacterial infections, like pneumonia, which can lead to hospitalisation and death, particularly in the elderly. When this happens, it can be difficult to link death directly to an earlier influenza infection.</p>
<p>And, death data is often very delayed. So readily available death data collected by the NNDSS is considered a significant underestimate of the actual number.</p>
<p>To the end of June 2019, there were <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/ozflu-surveil-no05-19.htm">231 influenza-related deaths</a> reported to the NNDSS. Virtually all of these were due to the influenza A strain. They spanned all ages, but most deaths were in the elderly (80 years and older).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sick-with-the-flu-heres-why-you-feel-so-bad-118395">Sick with the flu? Here's why you feel so bad</a>
</strong>
</em>
</p>
<hr>
<p>This compares to 24 and 21 deaths over the same period in <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-ozflu-2018.htm">2018</a> and <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-ozflu-2017.htm">2017</a> respectively. But these figures grew to 55 deaths and 598 deaths reported by the end of 2018 and 2017 respectively. </p>
<p>Clearly 2019 is more severe than 2018, based on the measures detailed above, but at this stage it looks like it will be less severe than 2017. However, we’ll need to wait for a number of weeks yet to be sure. </p>
<p><iframe id="tc-infographic-420" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/420/2f50f6a0ce8f78fc867171c0c8fb345eb9e83658/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>When we look at what’s happened in each state of Australia so far this year, we see some interesting differences in how the season has played out. Most states began to see significant rises in cases in April, while South Australia had already peaked in April and this number of cases was maintained into May. This means that most other states still have a number of weeks of influenza circulation to endure.</p>
<hr>
<p><iframe id="vyLwG" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/vyLwG/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<hr>
<p>People of all ages are susceptible to influenza, and this is reflected in the wide range of ages at which people are infected. Young children (especially those under 10 years of age) and the elderly (especially those over 80 years of age) are more susceptible, and are often more severely affected by influenza infections – as are pregnant women. </p>
<p>Interestingly, different types of influenza affect different age groups, with influenza B and influenza A(H1N1) more common in the young and influenza A(H3N2) more common in the elderly.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-why-the-2017-flu-season-was-so-bad-86605">Here's why the 2017 flu season was so bad</a>
</strong>
</em>
</p>
<hr>
<p>At this stage we can conclude that the 2019 influenza season is quite different to our usual seasons and overall, is likely to be one of the more severe seasons seen in the last 20 years. </p>
<p>So while 2019 doesn’t appear to be the worst season we’ve ever seen – that’s likely to remain with 2017 – it may well run a close second place. But we’ll have to wait another month or two before we can be sure.</p><img src="https://counter.theconversation.com/content/120093/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Barr and the Melbourne WHO Collaborating Centre for Reference and Research on Influenza is
supported by the Australian Government Department of Health.</span></em></p>Headlines about this year’s flu season have been alarming. It’s true, we are having a serious season – but the data doesn’t indicate it’s the worst one we’ve ever had.Ian Barr, Deputy Director, WHO Collaborating Centre for Reference and Research on InfluenzaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1200882019-07-10T20:15:50Z2019-07-10T20:15:50ZThe 2019 flu shot isn’t perfect – but it’s still our best defence against influenza<figure><img src="https://images.theconversation.com/files/283461/original/file-20190710-44457-9xdauw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Early indications are that the vaccine has been a reasonably good match in the 2019 season.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sick-woman-drinking-tea-holding-thermometer-228879439?src=Kw0c2Q9bR90xE9_okYJDgw-1-69&studio=1">Shutterstock</a></span></figcaption></figure><p>Over recent months, reports of “<a href="https://thewest.com.au/news/public-health/wa-flu-deaths-spike-800-per-cent-in-horror-season-ng-b881240641z">a horror flu season</a>” causing <a href="https://www.news.com.au/lifestyle/health/health-problems/perth-girl-ravaged-by-flu-must-learn-to-walk-and-talk-again/news-story/d6dcfb95040d2f5384772258dcd635af">serious illness</a> and <a href="https://www.news.com.au/lifestyle/health/health-problems/flu-season-has-turned-deadly-with-sharp-rise-in-national-death-toll/news-story/5b19cd0a5ffd1c70aeeb9217f7664f81">death</a> have dominated the headlines.</p>
<p>The high number of cases has led some people to question the effectiveness of the flu vaccine, and whether it’s worth getting if it doesn’t guarantee you won’t get the flu.</p>
<p>The flu vaccine is designed to cover the strains of the flu anticipated to circulate during the season. But even with the most sophisticated scientific processes, determining the right strains to include in the vaccine isn’t 100% foolproof.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whens-the-best-time-to-get-your-flu-shot-114978">When's the best time to get your flu shot?</a>
</strong>
</em>
</p>
<hr>
<p>Sometimes the virus undergoes major genetic changes or “mutations” in a relatively short space of time. Reports of a “<a href="https://www.skynews.com.au/details/_6055975664001">mutant strain</a>” this year means there’s concern some people might catch a strain the vaccine hasn’t protected against. </p>
<p>It’s too soon to tell the full extent of the effects of this mutation on how well the vaccine has worked. But the 2019 vaccine is showing early signs of being a good match for the common strains of the flu circulating this season.</p>
<h2>What’s in a name?</h2>
<p>Influenza or “flu” isn’t just one virus; different strains circulate each season. </p>
<p>Flu viruses that cause seasonal epidemics in humans fit under one of two major groups: <a href="https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)">influenza A or B</a>. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/283462/original/file-20190710-44441-19zsu4j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/283462/original/file-20190710-44441-19zsu4j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=885&fit=crop&dpr=1 600w, https://images.theconversation.com/files/283462/original/file-20190710-44441-19zsu4j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=885&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/283462/original/file-20190710-44441-19zsu4j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=885&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/283462/original/file-20190710-44441-19zsu4j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1113&fit=crop&dpr=1 754w, https://images.theconversation.com/files/283462/original/file-20190710-44441-19zsu4j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1113&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/283462/original/file-20190710-44441-19zsu4j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1113&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Most flu vaccines protect against four strains of influenza.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaccinating-woman-181676732?src=uTnp1dB7SC_4gPxGHqvxcg-1-29&studio=1">Image Point Fr/Shutterstock</a></span>
</figcaption>
</figure>
<p>Influenza A is further broken down into strains or subtypes based on surface proteins called hemagglutinin (H) and neuraminidase (N). </p>
<p>We’re currently concerned about two subtypes which cause outbreaks in humans: A/H1N1pdm09 and A/H3N2. </p>
<p>Influenza B viruses are similarly categorised into strains based on two distinct lineages: B/Yamagata and B/Victoria.</p>
<p>Understanding the circulating strains is important because it gives us clues as to which age groups will likely be worst affected. Influenza A/H3, for example, has historically been associated with <a href="https://www.mja.com.au/system/files/issues/209_03/10.5694mja18.00334.pdf">higher rates of disease</a> in people aged 65 and over. </p>
<p>But the circulating strains are also important because they inform how the vaccine will be developed. A good match between the vaccine strains and what is circulating will mean the vaccine offers the best possible protection.</p>
<h2>So how do we decide which flu strains are covered by the vaccine?</h2>
<p>Every year, a new vaccine is produced to cover the strains that are predicted to be circulating in the northern and southern hemispheres. The World Health Organisation (WHO) uses <a href="https://www.who.int/influenza/vaccines/virus/recommendations/201809_qanda_recommendation.pdf">a range of measures</a> to determine which strains should be included in the vaccine.</p>
<p>Many of us who were vaccinated this year would have received a quadrivalent vaccine. This means it covered four strains in total: two strains of influenza A, and two strains of influenza B. </p>
<p>People aged 65 and over are offered a “high-dose” trivalent vaccine, which covers both A strains, and one B strain.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/high-dose-immune-boosting-or-four-strain-a-guide-to-flu-vaccines-for-over-65s-112224">High-dose, immune-boosting or four-strain? A guide to flu vaccines for over-65s</a>
</strong>
</em>
</p>
<hr>
<p>The Australian Influenza Vaccine Committee (AIVC) reviews the results and makes <a href="https://www.tga.gov.au/aivc-recommendations-composition-influenza-vaccine-australia-2019">recommendations</a> for the Australian vaccine, which in 2019 covered the following strains:</p>
<ul>
<li>an A/Michigan/45/2015 (H1N1)pdm09-like virus</li>
<li>an A/Switzerland/8060/2017 (H3N2)-like virus</li>
<li>a B/Colorado/06/2017-like virus (Victoria lineage) – not included in the trivalent vaccine recommendation</li>
<li>a B/Phuket/3073/2013-like virus (Yamagata lineage).</li>
</ul>
<h2>Do we always get it right?</h2>
<p>The basic premise of forecasting is that it’s a “best guess”. It’s a highly educated guess, based on analysis and evaluation, but it’s not a guarantee. </p>
<p>The effectiveness of a vaccine depends on a number of factors, only some of which are within our control. While the choice for the vaccine is made on the best evidence available at the time, the viruses circulating in the population undergo <a href="https://www.cdc.gov/flu/about/viruses/change.htm">changes</a> as they replicate, known as antigenic “drift” and “shift”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/283463/original/file-20190710-44453-1a14p3k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/283463/original/file-20190710-44453-1a14p3k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/283463/original/file-20190710-44453-1a14p3k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/283463/original/file-20190710-44453-1a14p3k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/283463/original/file-20190710-44453-1a14p3k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/283463/original/file-20190710-44453-1a14p3k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/283463/original/file-20190710-44453-1a14p3k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Flu viruses change every year so researchers have to make an educated guess about which ones might circulate.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/171525560?studio=1&size=huge_jpg">Image Point Fr/Shutterstock</a></span>
</figcaption>
</figure>
<p>If the changes are only small, we can still get good cross-protection. </p>
<p>Less frequently, a big genetic “shift” happens. If this occurs after vaccine development has started and the strains have been chosen, we are dealing with a so-called “mutant flu” and the vaccine will likely not be a good match.</p>
<h2>So is this year’s vaccine is working?</h2>
<p>Data available for this year are showing <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/$File/flu-05-2019.pdf">the majority</a> of influenza cases in Australia have been influenza A – with some states reporting more H3N2 than H1N1, and others reporting a more even mix of both.</p>
<p>The WHO Collaborating Centre in Victoria is also reporting that the majority of specimens of all four strains they’ve tested this year appear to be <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/$File/flu-05-2019.pdf">similar</a> to the vaccine strains.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-cant-predict-how-bad-this-years-flu-season-will-be-but-heres-what-we-know-so-far-115303">We can't predict how bad this year's flu season will be but here's what we know so far</a>
</strong>
</em>
</p>
<hr>
<p>While early indications are that the vaccine has been a good match in the 2019 season, the WHO Collaborating Centre has also recently confirmed there has been <a href="https://www.dailytelegraph.com.au/lifestyle/health/flu-jab-may-not-protect-from-mutant-virus/news-story/096234516d20f1693dd2ee29d308ce2c">a mutation</a> in the A/H3N2 strain this season. </p>
<p>It’s not clear yet if this mutation will have a significant impact on vaccine effectiveness, but it may at least partially explain the high case numbers we’ve seen so far. </p>
<p>Large vaccine effectiveness studies done at the end of the flu season will help assess the impact of this mutation. In the meantime, a mismatch on only one strain means the vaccine will still provide reasonable protection against other circulating strains.</p>
<h2>It’s still worth being vaccinated</h2>
<p>In the same way wearing a seat belt is no guarantee we won’t be injured in a car accident, a flu vaccine is no guarantee we won’t develop influenza this season. </p>
<p>A person’s underlying susceptibility, due to factors such as their age and health, will also influence how well a vaccine works.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kids-are-more-vulnerable-to-the-flu-heres-what-to-look-out-for-this-winter-117748">Kids are more vulnerable to the flu – here's what to look out for this winter</a>
</strong>
</em>
</p>
<hr>
<p>But the flu shot remains a <a href="http://www.ausvaxsafety.org.au/influenza-vaccine/2019-influenza-data">safe</a> and <a href="https://www.cdc.gov/flu/vaccines-work/effectiveness-studies.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fflu%2Fprofessionals%2Fvaccination%2Feffectiveness-studies.htm">reasonably effective</a> strategy to reduce your risk of serious illness. </p>
<p>While flu epidemics remain complex, advice to prevent flu transmission remains simple. Regularly washing our hands, covering our mouth when we cough or sneeze, and staying home when we’re unwell are things we can all do to help stop the spread.</p><img src="https://counter.theconversation.com/content/120088/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Bloomfield works for the WA Department of Health; the views expressed in this article may not necessarily reflect those of this organisation.</span></em></p>The flu vaccine is built on the strains expected to circulate in a given year. While the majority of strains circulating this year are matched in the vaccine, there’s one strain we didn’t predict.Lauren Bloomfield, Lecturer, School of Medical and Health Sciences, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1187762019-07-01T02:48:47Z2019-07-01T02:48:47ZHealth Check: why do we crave comfort food in winter?<figure><img src="https://images.theconversation.com/files/281506/original/file-20190627-76717-h3un1a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You're not imagining it. Our bodies really do crave macaroni cheese and other comfort foods as the temperature drops. Here's why.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/174655184?src=MX6D1PvJewj4gLIAnijq3g-1-1&studio=1&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>It’s winter and many of us find ourselves drawn to bowls of cheesy pasta, oozing puddings, warming soups, and hot chocolate with marshmallows. </p>
<p>These and other <a href="https://www.nature.com/articles/1602346">comfort foods</a> can make us feel good. But why? And why do we crave them in winter and not in summer?</p>
<p>Research tells us there are three good reasons.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-food-affects-mood-and-mood-affects-food-24834">Health Check: how food affects mood and mood affects food</a>
</strong>
</em>
</p>
<hr>
<h2>1. The gut ‘speaks’ to the brain</h2>
<p>We know from <a href="https://www.ncbi.nlm.nih.gov/pubmed/28242200">the relatively new field of nutritional psychiatry</a> that our stomachs produce the “happiness chemicals” dopamine and serotonin. When we eat, a complex process involving the brain means these neurochemicals <a href="https://www.karger.com/Article/FullText/492834">trigger feelings of happiness and well-being</a>. </p>
<p>These happiness chemicals are also produced when we <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737893/">exercise and are exposed to sunlight</a>, which decline in winter.</p>
<p>This results in a change in the fine balance between the good and bad bacteria that live in our stomachs, and consequently, the relationship between the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/j.1550-8528.1995.tb00215.x">gut and the brain</a>.</p>
<p>So, in winter when we eat our favourite comfort foods, we get a <a href="https://www.sciencedirect.com/science/article/pii/S0261561401800224">rush of happiness chemicals</a> sent from the gut to our brain and this make us feel happy and content. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/essays-on-health-microbes-arent-the-enemy-theyre-a-big-part-of-who-we-are-79116">Essays on health: microbes aren't the enemy, they're a big part of who we are</a>
</strong>
</em>
</p>
<hr>
<h2>2. Evolution may have a hand</h2>
<p>The second reason we crave more comfort foods during the winter months could be evolutionary. Before we enjoyed technological advances such as housing, heating, supermarkets and clothing, humans who increased their body weight during winter to keep warm were more likely to survive their <a href="https://theconversation.com/how-the-diets-of-early-humans-explain-our-eating-habits-46481">environmental conditions</a>. Craving carbohydrate and sugar rich foods was therefore a protective mechanism. </p>
<p>Although we are not still living in shelters or foraging for food today, food cravings in winter may still be <a href="https://royalsocietypublishing.org/doi/full/10.1098/rspb.2015.2443">programmed into our biology</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/caveman-cravings-rating-the-paleo-diet-14995">Caveman cravings? Rating the paleo diet</a>
</strong>
</em>
</p>
<hr>
<h2>3. Psychology, craving and mood</h2>
<p><a href="https://journals.sagepub.com/doi/abs/10.1177/109019818801500203">Social learning theory</a> says people learn from each other through observing, imitating and modelling. In the context of food cravings this suggests that what our caregivers gave to us in winter as children has a striking impact on what we choose to eat in winter as adults.</p>
<p>A <a href="https://www.sciencedirect.com/science/article/pii/S1878450X16300786">review of studies</a> on the psychological reasons behind eating comfort food says this food may play a role in alleviating loneliness and boosting positive thoughts of childhood social interaction. </p>
<p>We may also naturally experience <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0447.1994.tb05800.x">lower mood in winter</a> and low mood has been linked to <a href="https://www.sciencedirect.com/science/article/pii/S0195666313000743">emotional eating</a>. </p>
<p>In winter due to it being darker and colder, we tend to stay indoors longer and <a href="https://www.sciencedirect.com/science/article/pii/S0889159104001527">self-medicate</a> with foods that are <a href="https://www.sciencedirect.com/science/article/pii/S0195666301903903">carbohydrate and sugar rich</a>. These types of foods release <a href="https://neuro.hms.harvard.edu/harvard-mahoney-neuroscience-institute/brain-newsletter/and-brain-series/sugar-and-brain">glucose straight to our brain</a> which gives us an instant feeling of happiness when we are feeling cold, sad, tired or bored. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/here-comes-the-sun-how-the-weather-affects-our-mood-19183">Here comes the sun: how the weather affects our mood</a>
</strong>
</em>
</p>
<hr>
<h2>Comfort food can be healthy</h2>
<p>For all the comfort they provide, comfort foods generally receive a bad rap because they are usually energy and calorie dense; they can be high in sugar, fat and refined carbohydrates. </p>
<p>These types of foods are usually linked to <a href="https://www.nature.com/articles/1602346">weight gain in winter</a> and if you eat too much over the longer term, can <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2473679">increase the risk of heart disease and diabetes</a>. </p>
<p>However, not all comfort foods are created equally, nor are they all bad for our health.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/281507/original/file-20190627-76738-7xp47o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/281507/original/file-20190627-76738-7xp47o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/281507/original/file-20190627-76738-7xp47o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281507/original/file-20190627-76738-7xp47o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281507/original/file-20190627-76738-7xp47o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281507/original/file-20190627-76738-7xp47o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281507/original/file-20190627-76738-7xp47o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281507/original/file-20190627-76738-7xp47o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You still get a comforting feeling with a hearty bowl of soup, but without the extra calories.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/695227096?src=OJTcM9YSuSpBzOUnzU7sJg-1-1&studio=1&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>You can get the same comforting feelings from winter foods containing ingredients that are good for you. For example, a hearty bowl of soup with a slice of wholegrain bread can give you all the components you need for optimal physical and <a href="https://theconversation.com/five-types-of-food-to-increase-your-psychological-well-being-101818">psychological health</a>. Steaming bowls of chilli and curries can provide <a href="https://www.ncbi.nlm.nih.gov/pubmed/17569207">immunity boosting properties</a> with the use of their warming spices. So too are all the wonderful <a href="http://www.fao.org/3/x2650T/x2650t03.htm">citrus fruits</a> that become available in the winter. </p>
<p>If you are craving something that is carbohydrate rich, try swapping white varieties for <a href="https://theconversation.com/five-types-of-food-to-increase-your-psychological-well-being-101818">wholegrain versions</a> that will dampen carbohydrate cravings. If you crave a <a href="https://theconversation.com/want-to-improve-your-mood-its-time-to-ditch-the-junk-food-107358">hot chocolate</a> try swapping the cocoa powder for cacao which has a higher concentration of vitamins and minerals. </p>
<h2>More good news</h2>
<p>The good news for all of us who crave comfort foods in winter is <a href="https://www.tandfonline.com/doi/abs/10.1080/02646838.2019.1607968?journalCode=cjri20">studies</a> that assess intuitive eating — eating when you are hungry, stopping when you are full and listening to what your body is telling you to eat — suggest people who eat this way <a href="https://theconversation.com/thinking-youre-on-a-diet-is-half-the-problem-heres-how-to-be-a-mindful-eater-99207">are happier with their body image</a>, feel better psychologically and are less likely to have disordered eating.</p>
<p>So, embrace this wonderful chilly weather. Rug up in your favourite woolly jumper, sit by the fire, cuddle up with a loved one, make some <a href="https://theconversation.com/want-to-improve-your-mood-its-time-to-ditch-the-junk-food-107358">healthier swaps</a> to your classic comfort foods, remove the food guilt and listen to what your body is telling you it needs during these cold winter months.</p><img src="https://counter.theconversation.com/content/118776/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research into our brain, gut and childhood memories tells us why we reach for macaroni cheese rather than salad in winter.Megan Lee, Academic Tutor and PhD Candidate, Southern Cross UniversityJacqui Yoxall, Senior Lecturer in Allied Health, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1189162019-06-24T20:11:27Z2019-06-24T20:11:27ZYou can’t get influenza from a flu shot – here’s how it works<figure><img src="https://images.theconversation.com/files/280886/original/file-20190624-97772-1l6ud56.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You might feel a bit off after your flu shot but this doesn’t last long.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1052421314?studio=1&size=huge_jpg">Rawpixel.com/Shutterstock</a></span></figcaption></figure><p>Influenza is a moving target for vaccines. Each year, up to four different strains circulate, and they are constantly evolving to escape our immune system. </p>
<p>So rather than childhood jabs giving long lasting immunity, we need annual flu shots to provide optimal protection against influenza. </p>
<p>But while you might sometimes get sick after having a flu shot, it’s a myth that having a flu shot can give you the flu. </p>
<h2>A quick history of the flu vaccine</h2>
<p>Influenza vaccines were first developed in the 1930s and 1940s, starting with the isolation of the influenza virus. </p>
<p>Back then, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2554195/pdf/bullwho00626-0133.pdf">we learned</a> there were many different influenza strains. To be effective, early research showed the vaccine needed to be matched to the circulating strains, and to be able to stimulate a response from the immune system. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whens-the-best-time-to-get-your-flu-shot-114978">When's the best time to get your flu shot?</a>
</strong>
</em>
</p>
<hr>
<p>The process to produce modern influenza vaccines now occurs on a much more refined and industrial scale. Hundreds of thousands of influenza viruses are collected by hundreds of national influenza centres around the world. </p>
<p>From these, four strains are <a href="https://www.who.int/influenza/vaccines/en/">selected</a> for the annual flu vaccine, based on the viruses that are circulating at that time, how well the vaccines activate the immune system, how the strains are evolving, and the effectiveness of previous vaccines. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/280888/original/file-20190624-97762-1hxds8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/280888/original/file-20190624-97762-1hxds8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/280888/original/file-20190624-97762-1hxds8d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/280888/original/file-20190624-97762-1hxds8d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/280888/original/file-20190624-97762-1hxds8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/280888/original/file-20190624-97762-1hxds8d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/280888/original/file-20190624-97762-1hxds8d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Modern flu vaccine development is slow and labour-intensive process.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/601490906?src=B-ifjUHi_y36zB8dENWKiQ-1-11&studio=1&size=huge_jpg">hotsum/Shutterstock</a></span>
</figcaption>
</figure>
<p>Most modern vaccines are <a href="https://www.cdc.gov/flu/prevent/how-fluvaccine-made.htm">manufactured</a> by growing large quantities of live virus – mostly in chicken eggs or less commonly animal cells – which are then purified, deactivated and split into smaller components. These vaccines are inactive and cannot replicate. </p>
<p>There are also two new “enhanced” vaccines that are used in older people, who don’t tend to respond as strongly to vaccines: <a href="https://www.ncbi.nlm.nih.gov/pubmed/25119609">Fluzone High Dose</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447603/">Fluad</a>, which is designed to better stimulate immunity and draw immune cells to the site of vaccination. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/high-dose-immune-boosting-or-four-strain-a-guide-to-flu-vaccines-for-over-65s-112224">High-dose, immune-boosting or four-strain? A guide to flu vaccines for over-65s</a>
</strong>
</em>
</p>
<hr>
<h2>How the immune system fights the flu</h2>
<p>The human immune system has several strategies to protect against infection. For viral infections such as influenza, the key strategy is known as adaptive immunity. This part of the immune system can “remember” previous exposure to pathogens. </p>
<p>When you get an influenza infection, the virus enters and hijacks the machinery of the host cell to replicate itself, before releasing these copies to infect more cells. </p>
<p><a href="https://www.immunology.org/public-information/bitesized-immunology/c%C3%A9lulas/cd8-t-cells">T lymphocyte cells</a> of the immune system can recognise this viral incursion. T cells protect against further spread of the virus by activating pathways that cause infected cells to trigger a “suicide” process.</p>
<p>Another strategy the body uses is to produce antibodies, which are molecules produced by B cells that recognise components of the viral capsule. These <a href="https://www.immunology.org/public-information/bitesized-immunology/c%C3%A9lulas/b-cells">antibodies</a> work by sticking to the surface of the influenza virus to prevent it spreading and facilitating disposal. </p>
<h2>Flu shots help mount a quicker defence</h2>
<p>On a first exposure to a pathogen, our B cells take at least two weeks to ramp up production of antibodies. However, on subsequent challenges, antibody production occurs much more quickly. </p>
<p>Influenza vaccines harness this arm of the immune system, known as “humoral” immunity. By “practising” on viral components, vaccines allow the immune system to react more quickly and effectively when faced with the real virus.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/280887/original/file-20190624-97777-rg7k7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/280887/original/file-20190624-97777-rg7k7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/280887/original/file-20190624-97777-rg7k7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/280887/original/file-20190624-97777-rg7k7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/280887/original/file-20190624-97777-rg7k7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/280887/original/file-20190624-97777-rg7k7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/280887/original/file-20190624-97777-rg7k7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The flu shot takes about two weeks to start protecting you against influenza.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/556416004?src=s-y3-2RWOo59L4AnpkoE0w-1-2&studio=1&size=huge_jpg">DonyaHHI/Shutterstock</a></span>
</figcaption>
</figure>
<h2>So why do you sometimes get sick after a flu shot?</h2>
<p>There are several reasons why you might feel a bit off after getting your flu shot. </p>
<p>First, your flu shot only protects you against influenza and not other respiratory illness which might causes similar cold or flu symptoms. This includes RSV (<a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/respiratory-syncytial-virus.aspx">respiratory syncytial virus</a>), which is common in late autumn and early winter. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sick-with-the-flu-heres-why-you-feel-so-bad-118395">Sick with the flu? Here's why you feel so bad</a>
</strong>
</em>
</p>
<hr>
<p>Second, stimulating the immune system can result in <a href="https://beta.health.gov.au/services/flu-influenza-immunisation-service">symptoms</a> similar to that of influenza, although much milder and short-lived. These include local inflammation (redness, pain or swelling at the site of the vaccine) and more general symptoms (fever, aches and pains, tiredness).</p>
<p>Third, vaccine-induced protection isn’t complete. In some years, the vaccine is not well <a href="https://www.who.int/influenza/vaccines/virus/recommendations/201502_qanda_vaccineeffectiveness.pdf">matched</a> to circulating strains. Usually this is due to mutations that may develop in circulating strains after the vaccine strains are selected. </p>
<p>The flu vaccine also doesn’t “kick in” for two weeks after vaccine administration. In some people, particularly those who are older and those who have weakened immune systems, antibody production is not as strong, and the level of protection is lower. </p>
<p>Despite this, studies have consistently shown that vaccinated people are <a href="https://www.ncbi.nlm.nih.gov/pubmed/22032844">less likely to get influenza or complications from the flu</a> than those who aren’t vaccinated.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flu-vaccine-wont-definitely-stop-you-from-getting-the-flu-but-its-more-important-than-you-think-75778">Flu vaccine won't definitely stop you from getting the flu, but it's more important than you think</a>
</strong>
</em>
</p>
<hr>
<h2>A better way to protect against the flu</h2>
<p>A problem with current vaccines is the reliance on eggs, which results in a relatively slow and labour-intensive production process. </p>
<p>Current <a href="https://cmr.asm.org/content/26/3/476">work</a> is aiming to speed up this process by using different technologies so that vaccine manufacturers can react more quickly to changes in circulating viruses. </p>
<p>The “<a href="https://theconversation.com/a-universal-flu-vaccine-is-still-some-time-off-18525">holy grail</a>” for influenza vaccines is to stimulate an effective immune response to a component of influenza that doesn’t change each year, so annual vaccination is not required. </p>
<p>These efforts have proved <a href="https://www.fiercebiotech.com/biotech/gsk-dumps-universal-flu-vaccine-after-interim-data-readout">elusive</a> so far. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-holy-grail-of-influenza-research-a-universal-flu-vaccine-14046">The Holy Grail of influenza research: a universal flu vaccine</a>
</strong>
</em>
</p>
<hr>
<p>A better strategy might be to harness T cell immunity. Recent <a href="https://www.ncbi.nlm.nih.gov/pubmed/30778243">work</a> has shown that a type of T cell, known as “killer” T cells, can recognise other parts of the influenza virus, and therefore can provide broad protection against seasonal and pandemic strains.</p>
<p>But while we wait for a better alternative, getting an annual flu shot is the best way to avoid the flu.</p><img src="https://counter.theconversation.com/content/118916/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Allen Cheng receives funding from the Commonwealth Government and holds research grants with the National Health and Medical Research Council. He is the Chair of the Advisory Committee for Vaccines and the Co-Chair of the Australian Technical Advisory Group on Immunisation.</span></em></p><p class="fine-print"><em><span>Katherine Kedzierska receives funding from the National Health and Medical Research Council, and from the Australian Research Council.</span></em></p>The flu vaccine takes about two weeks to start working and only protects against influenza, so you can still get sick from other viruses after your flu shot.Allen Cheng, Professor in Infectious Diseases Epidemiology, Monash UniversityKatherine Kedzierska, Academic, Microbiology and Immunology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1122242019-04-15T20:17:28Z2019-04-15T20:17:28ZHigh-dose, immune-boosting or four-strain? A guide to flu vaccines for over-65s<figure><img src="https://images.theconversation.com/files/269238/original/file-20190415-147505-1i9tpjh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are three types of flu vaccine available in Australia.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/173815610?src=_nwGAZwzeqVDjPwbh7eb9g-1-1&size=huge_jpg">Image Point Fr/Shutterstock</a></span></figcaption></figure><p>Flu vaccines work by exposing the body to a component of the virus so it can “practise” fighting it off, without risking infection. The immune system can then mount a more rapid and effective response when faced with a “real” virus. </p>
<p>Three types of influenza vaccines are <a href="https://beta.health.gov.au/resources/publications/atagi-advice-on-seasonal-influenza-vaccines-in-2019">available</a> in Australia:</p>
<ul>
<li><p>“standard” vaccines that contains four different strains of influenza</p></li>
<li><p>a “high-dose” vaccine (<a href="http://www.sanofiflu.com/fluzone-high-dose-influenza-vaccine.html">Fluzone High Dose</a>) that contains three strains of influenza at a higher dose than standard vaccines</p></li>
<li><p>an “adjuvanted” vaccine (<a href="https://www.fluad.com/">Fluad</a>) that contains the standard dose of three strains of influenza, along with MF59, an immune stimulant designed to encourage a stronger immune response to the vaccine.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whens-the-best-time-to-get-your-flu-shot-114978">When's the best time to get your flu shot?</a>
</strong>
</em>
</p>
<hr>
<p>The high-dose and adjuvanted vaccines are designed for use only in people aged 65 and over because they can <a href="https://www.ncbi.nlm.nih.gov/pubmed/28431815">stimulate a better immune response</a> than the standard vaccine. Standard vaccines should be used those younger than 65 years.</p>
<p>This year, the Australian government is offering the adjuvanted vaccine for free for over-65s. The standard vaccine is available for free for some groups under 65 under <a href="https://beta.health.gov.au/news-and-events/news/2019-influenza-vaccines-your-best-shot-at-stopping-influenza">national and state programs</a>. The high-dose vaccine will only be available to buy through pharmacies and general practices on prescription.</p>
<h2>Is the high-dose vaccine better?</h2>
<p>Clinical trials have compared the high-dose vaccine with older forms of the standard vaccine that contained three strains. </p>
<p>One <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1315727">US study</a> in over-65s found 1.4% of recipients who were given the high-dose vaccine were diagnosed with influenza, compared with 1.9% of those who received the standard vaccine.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/269242/original/file-20190415-147522-18y1c71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/269242/original/file-20190415-147522-18y1c71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/269242/original/file-20190415-147522-18y1c71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/269242/original/file-20190415-147522-18y1c71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/269242/original/file-20190415-147522-18y1c71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/269242/original/file-20190415-147522-18y1c71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/269242/original/file-20190415-147522-18y1c71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A flu vaccination doesn’t completely eliminate the risk of getting the flu, but it’s likely to make the illness less severe.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>Subsequent studies also found people who got the high-dose vaccine were less likely to be <a href="https://www.ncbi.nlm.nih.gov/pubmed/26212007">hospitalised</a> with influenza-related complications. A similar <a href="https://www.ncbi.nlm.nih.gov/pubmed/28736045">trial</a> in nursing home residents also found a reduced risk of hospitalisation.</p>
<p>Although clinical trials are generally regarded as the gold standard when testing vaccines, it’s also important to consider data from other studies, where different flu strains circulate and where the vaccine may be used in groups that were excluded from clinical trials.</p>
<p>These studies have <a href="https://www.ncbi.nlm.nih.gov/pubmed/25672568">generally</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/28329311">found</a> that the high-dose vaccine is better than the standard vaccine. However, <a href="https://www.ncbi.nlm.nih.gov/pubmed/28329311">some</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/25829001">studies</a> have shown a lesser degree of benefit.</p>
<h2>What about the adjuvanted vaccine?</h2>
<p>Clinical trials have not been designed to show the different rates of flu infection after taking the adjuvanted vaccine compared with the standard vaccine. But studies have examined the effectiveness of this vaccine in preventing hospitalisations with influenza.</p>
<p>One <a href="https://www.ncbi.nlm.nih.gov/pubmed/25045825">trial</a> found a small decrease in influenza infection in people who had been given adjuvanted vaccine, compared with standard vaccine, but this difference was not statistically significant. </p>
<p>Another recent trial has been performed in nursing home residents. Preliminary <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253508/">results</a> suggest a very small reduction in hospitalisations compared with those who took the standard vaccine.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/269243/original/file-20190415-147502-grakbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/269243/original/file-20190415-147502-grakbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/269243/original/file-20190415-147502-grakbm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/269243/original/file-20190415-147502-grakbm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/269243/original/file-20190415-147502-grakbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/269243/original/file-20190415-147502-grakbm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/269243/original/file-20190415-147502-grakbm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">With different vaccination options available, it can be hard to work out which is likely to provide the most protection.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>Despite a lack of clinical trial data, several observational <a href="https://www.sciencedirect.com/science/article/pii/S0264410X1631218X?via%3Dihub">studies</a> have found getting the adjuvanated vaccine means you’re less likely to be hospitalised with influenza than if you receive the standard vaccine.</p>
<p>As with the studies of the high-dose vaccine, the estimated degree of protection varies between studies, reflecting differences in circulating strains, study types, and populations.</p>
<h2>Which is better?</h2>
<p>There is not yet sufficient data to know whether one enhanced vaccine is better than the other. </p>
<p>One observational <a href="https://www.ncbi.nlm.nih.gov/pubmed/30561688">study</a> suggests the high-dose vaccine is more effective than the adjuvanted vaccine at preventing hospital admissions with influenza. But this study was not designed to address this question specifically, and the differences observed were small. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-strong-immune-system-helps-ward-off-colds-and-flus-but-its-not-the-only-factor-99512">A strong immune system helps ward off colds and flus, but it's not the only factor</a>
</strong>
</em>
</p>
<hr>
<p>Both enhanced vaccines are safe. Although a higher proportion of patients who receive enhanced vaccines report a sore arm, compared to those who receive the standard vaccine, this is generally mild and <a href="http://www.ncirs.org.au/ausvaxsafety/current-ausvaxsafety-surveillance-data">rarely requires</a> medical attention.</p>
<p>Immunisation expert groups in <a href="https://beta.health.gov.au/resources/publications/atagi-advice-on-seasonal-influenza-vaccines-in-2019">Australia</a>, the <a href="https://www.cdc.gov/mmwr/volumes/67/rr/rr6703a1.htm">United States</a>, <a href="https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2018-44/issue-6-june-7-2018/article-1-summary-influenza-2018-2019.html">Canada</a> and the <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/757784/Vaccines_for_2019_20_seasonal_flu_vaccination_programme.pdf">United Kingdom</a> have not recommended either enhanced vaccine over the other.</p>
<h2>Can you get two for better coverage?</h2>
<p>The currently available enhanced vaccines protect against three flu strains, whereas the standard vaccine protects against four. </p>
<p>But for most people, there is no evidence that receiving multiple doses of different vaccines in any one year is any better than getting a single dose of vaccine. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/269244/original/file-20190415-147525-ukfyfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/269244/original/file-20190415-147525-ukfyfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/269244/original/file-20190415-147525-ukfyfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/269244/original/file-20190415-147525-ukfyfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/269244/original/file-20190415-147525-ukfyfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/269244/original/file-20190415-147525-ukfyfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/269244/original/file-20190415-147525-ukfyfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There’s no evidence that two shots are better than one.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/84110590?src=hhbgDfwkVT2M2epgrHMtgw-1-15&size=huge_jpg">By Nyvlt-art</a></span>
</figcaption>
</figure>
<p>In theory, the four-strain vaccines protect against one more strain than the enhanced three-strain vaccines. But in most seasons, few infections are caused by the fourth strain.</p>
<p>There are some specific groups of people for whom two doses may be recommended, including young children receiving the vaccine for the first time, and some people with bone marrow or organ transplants. Seek advice from your doctor if this describes you or your children’s situation.</p>
<p>It’s important to note that none of the standard or enhanced flu vaccines are completely protective; they reduce, but don’t completely eliminate, the risk of getting influenza. </p>
<p>A single dose of any influenza vaccine in each season is the most effective strategy to reduce your chance of getting influenza.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-long-should-you-stay-away-when-you-have-a-cold-or-the-flu-98702">Health Check: how long should you stay away when you have a cold or the flu?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/112224/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Allen Cheng receives funding from the Australian government and from the Australian National Health and Medical Research Council. He is the Co-Chair of the Australian Technical Advisory Group on Immunisation and the Advisory Committee for Vaccines; the views expressed in this article may not necessarily reflect those of these committees. </span></em></p><p class="fine-print"><em><span>Chris Blyth has received funding from the Australian National Health and Medical Research Council, Commonwealth and State Governments to conduct influenza surveillance and evaluate the performance of the current influenza vaccination programs. He is the Co-Chair of the Australian Technical Advisory Group on Immunisation; the views expressed in this article may not necessarily reflect those of the Commonwealth Government</span></em></p>The adjuvanted flu vaccine is free for over-65s and offers better protection than the standard vaccine. Here’s what the research says.Allen Cheng, Professor in Infectious Diseases Epidemiology, Monash UniversityChristopher Blyth, Paediatrician, Infectious Diseases Physician and Clinical Microbiologist, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1149782019-04-14T19:15:14Z2019-04-14T19:15:14ZWhen’s the best time to get your flu shot?<figure><img src="https://images.theconversation.com/files/268928/original/file-20190412-76831-1xcigq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What goes up must come down, and that includes the protection the flu vaccine offers against influenza.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/572712955?src=mkoHzl84N53nCSYxPSMa6w-1-5&size=huge_jpg">Irina Bg/Shutterstock</a></span></figcaption></figure><p>When most of us get the flu, we spend three or four days on the couch feeling miserable, then we bounce back pretty quickly. But others have more severe symptoms and need to be hospitalised because they’re at risk of life-threatening complications. Some people even die from the flu.</p>
<p>The size and impact of influenza seasons varies from year to year. In 2017, Australia had its worst flu season for 20 years, with <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2017%7EMain%20Features%7EDeaths%20due%20to%20influenza%7E5">at least 1,255 lives lost</a>. The 2018 season was relatively mild, but it doesn’t seem to have ever ended – cases have been reported throughout summer and into autumn 2019.</p>
<p>The best way to protect against influenza is to <a href="https://www.mja.com.au/journal/2016/204/2/influenza-vaccine-effectiveness-general-practice-and-hospital-patients-victoria">get a flu vaccine</a> each year. It’s not as effective as some other vaccines, but it <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70295-X/fulltext">reduces your risk of getting the flu</a> by around 60%. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-to-tell-the-difference-between-hay-fever-and-the-common-cold-104755">Health Check: how to tell the difference between hay fever and the common cold</a>
</strong>
</em>
</p>
<hr>
<p>Protection often will have begun to wane four or five months later, so getting vaccinated in mid to late May, or even early June, will give you better protection at the height of the flu season. But there are number of factors to consider before deciding when to get your flu shot.</p>
<h2>Remind me, why get a flu shot each year?</h2>
<p>Influenza viruses change each year and the vaccine is updated to keep up with these changes. This year, for example, the vaccine protects against two different strains than the 2018 vaccine.</p>
<p>Our body’s immune response to the vaccine also wanes over time. So even if you were vaccinated last winter, you may no longer be fully protected 18 months later, depending on your age and your response to the last vaccination.</p>
<h2>When does the flu vax become available?</h2>
<p>Influenza vaccines are usually available in early April, or even in March; though you’ll generally have to pay full price for early access, even if you’re eligible for a free flu vaccine later.</p>
<p>In mid-April, stock starts arriving at GP clinics and pharmacies for the <a href="https://beta.health.gov.au/news-and-events/news/2019-influenza-vaccines-your-best-shot-at-stopping-influenza">government’s immunisation program</a>, which offers free flu vaccines for those most at risk of complications from influenza. This includes:</p>
<ul>
<li>all Aboriginal and Torres Strait Islander people aged six months and over</li>
<li>pregnant women (during any stage of pregnancy)</li>
<li>all people aged 65 years and over</li>
<li>people aged six months and over with medical conditions which increase the risk of complications following influenza infections.</li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-the-flu-shot-if-im-pregnant-96408">Should I get the flu shot if I'm pregnant?</a>
</strong>
</em>
</p>
<hr>
<p>In addition, most states in Australia offer free vaccination to all other children from six months of age to five years of age.</p>
<p>For those not eligible for the free vaccine, influenza vaccines are available through pharmacies and GPs for <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/immunisation/vaccines/flu+vaccine/flu+vaccine+frequently+asked+questions#How%20much%20will%20the%20vaccine%20cost?">between A$10 and A$25</a> (plus the cost of a consultation if your GP doesn’t bulk bill), or via workplace programs.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/268931/original/file-20190412-76846-10yrwh3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/268931/original/file-20190412-76846-10yrwh3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/268931/original/file-20190412-76846-10yrwh3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/268931/original/file-20190412-76846-10yrwh3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/268931/original/file-20190412-76846-10yrwh3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/268931/original/file-20190412-76846-10yrwh3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/268931/original/file-20190412-76846-10yrwh3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The 2018 flu season was mild but there have been more cases of influenza over summer than usual.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/496461661?src=yCnCSvEUTXpMzuTXYeSX7A-1-13&size=huge_jpg">kurhan/Shuttestock</a></span>
</figcaption>
</figure>
<h2>Is it good to get in early?</h2>
<p>Getting a vaccine immediately after it becomes available will ensure you don’t miss out if there’s a vaccine shortage. And it will protect against the “<a href="https://www.theage.com.au/national/victoria/flu-shot-orders-at-record-levels-as-summer-outbreak-claims-13-lives-20190411-p51d5p.html">summer flus</a>” we’ve been seeing over the last few months, which are circulating earlier than normal.</p>
<p>But there is a potential downside. Protection against influenza peaks one to two months after you have your vaccine, and then declines. This rate of decline varies from person to person, by age, and by influenza strain.</p>
<p>The flu season usually <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm">reaches its peak</a> in August or sometimes even September. So if you’re vaccinated in early April, four to five months will have passed by the time you reach the peak virus months, and you will have lower levels of protection.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flu-vaccine-wont-definitely-stop-you-from-getting-the-flu-but-its-more-important-than-you-think-75778">Flu vaccine won't definitely stop you from getting the flu, but it's more important than you think</a>
</strong>
</em>
</p>
<hr>
<p>There are few good quality studies across all ages to measure this rate of decline accurately, although <a href="https://www.ncbi.nlm.nih.gov/pubmed/26014800">a study from 2015</a> showed that the measurable antibody responses to the influenza vaccine components reduced slowly.</p>
<p>Another <a href="https://www.ncbi.nlm.nih.gov/pubmed/24395730">study from 2014</a> showed the vaccine was less effective in people vaccinated three or more months earlier, adding to the evidence that protection wanes over time.</p>
<h2>When is too late for the flu shot?</h2>
<p>If you delay your decision to be vaccinated until July or August, when the flu season is well underway, your chance of becoming infected will significantly increase.</p>
<p>Mid to late May or early in June is the sweet spot between trying to maximise your protective levels of antibodies generated by vaccination and getting vaccinated before there are significant levels of influenza virus circulating.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/268932/original/file-20190412-76837-1bshs57.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/268932/original/file-20190412-76837-1bshs57.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/268932/original/file-20190412-76837-1bshs57.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/268932/original/file-20190412-76837-1bshs57.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/268932/original/file-20190412-76837-1bshs57.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/268932/original/file-20190412-76837-1bshs57.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/268932/original/file-20190412-76837-1bshs57.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s better to be vaccinated early than not at all.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/556416004?src=ZySbmlSuSpPSVAaVglm7fQ-1-4&size=huge_jpg">DonyaHHI/Shutterstock</a></span>
</figcaption>
</figure>
<p>Remember, it takes seven to ten days from the time of your flu shot for the vaccine to begin to be fully effective.</p>
<p>Getting vaccinated in late May or early June should provide good levels of protection during the peak of the influenza season and may even last through to November, by which time the influenza season has usually finished. </p>
<h2>Vaccinate kids a month earlier</h2>
<p>Vaccination timing is a little different for children. Those aged six months to nine years who haven’t been vaccinated against influenza before need <a href="https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/influenza-flu">two doses of vaccine</a>, four weeks apart. So they will need to start their vaccination program a month earlier than adults and the elderly.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-about-getting-your-child-the-flu-vaccine-heres-what-you-need-to-know-94393">Thinking about getting your child the flu vaccine? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<p>So if you want to get vaccinated in 2019, there’s no need to rush, and in fact May or even early June might be a better time to be vaccinated. But it’s better to be vaccinated early than not at all.</p>
<p>Your GP or pharmacist will advise you on the most appropriate vaccine and the best timing for you.</p><img src="https://counter.theconversation.com/content/114978/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The WHO Collaborating Centre for Reference and Research on Influenza receives funding support for its early stage vaccine seed work from Seqirus Ltd. and the IFPMA and the author (Ian Barr) has shares in an influenza vaccine producing company.
</span></em></p>Protection wanes after four or five months, so for most people, it makes sense to get a flu shot in mid to late May or early June so you’re protected when the flu season peaks in August or September.Ian Barr, Deputy Director, WHO Collaborating Centre for Reference and Research on InfluenzaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1088162019-01-22T11:48:12Z2019-01-22T11:48:12ZIt’s cold! A physiologist explains how to keep your body feeling warm<figure><img src="https://images.theconversation.com/files/254534/original/file-20190118-100273-owm1dg.jpg?ixlib=rb-1.1.0&rect=675%2C23%2C4501%2C3406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's all about holding on to the heat you have.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/O99hgJe2CU8">Jason Rosewel/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Whether waiting for a bus, playing outside or walking the dog – during the colder winter season, everyone is looking for ways to stay warm. Luckily, the process your body uses to break down foods serves as an internal heater.</p>
<p>But when the weather is cold, some defensive strategies are also necessary to prevent your body from losing its heat to the surrounding environment. As the temperature difference between your warm body and its frigid surroundings increases, heat is lost more quickly. It becomes more of a challenge to maintain a normal body temperature.</p>
<p>And two people with the same exact body temperature in the same exact environment <a href="http://theconversation.com/health-check-why-do-some-people-feel-the-cold-more-than-others-37805">may have very different perceptions</a>. One may feel frozen while the other is completely comfortable. </p>
<p>But beyond the subjective experience of coldness, researchers do know that natural physiological responses to cold as well as behavioral adaptations – like bundling up! – can help keep your body around 98.6 degrees Fahrenheit and make sure you feel warm.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/254541/original/file-20190118-100282-1yu1k33.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/254541/original/file-20190118-100282-1yu1k33.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/254541/original/file-20190118-100282-1yu1k33.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/254541/original/file-20190118-100282-1yu1k33.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/254541/original/file-20190118-100282-1yu1k33.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/254541/original/file-20190118-100282-1yu1k33.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/254541/original/file-20190118-100282-1yu1k33.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/254541/original/file-20190118-100282-1yu1k33.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some jobs necessitate being out in inclement weather, and your physiology has some defenses against cold conditions.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/marine_corps/38936922645">U.S. Marine Corps/Lance Cpl. Cody Rowe</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<h2>What your body does</h2>
<p>Your blood courses through your body carrying nutrients, oxygen and other biological important substances. And this delivery system also brings heat produced in the muscles to the skin, where it’s released.</p>
<p>When you enter a cold environment, your body redistributes blood to the torso, protecting and maintaining the warmth of the vital organs there. At the same time, your body constricts blood flow to the skin. Narrowing the roads to the skin means less heat can make the journey, and so less is lost to the environment. And minimizing how much blood goes to the skin – which is in closest proximity to the cold – means you can hold onto more of your internal heat longer. </p>
<p>Another defensive strategy the body uses to stay warm is cranking up muscle activity. This in turn increases your metabolism and creates more heat. Think of a brisk winter walk when the mercury has really plunged – your teeth may chatter and your arms and legs may shake uncontrollably <a href="https://www.livescience.com/32475-why-do-we-shiver-when-cold.html">in shivers</a>. This seemingly nonproductive use of the muscles is actually an effort to increase body temperature by breaking down more nutrients to stoke your internal furnace. </p>
<p>Differences in <a href="https://doi.org/10.1016/j.jtherbio.2017.10.017">body size, body fatness and metabolic activity</a> influence how different individuals experience cold. Smaller people with lower levels of body fat lose more heat to the environment than larger people with more body fat. A bigger individual may have increased muscle mass, which is a producer of heat, or elevated body fatness, which functions as an insulator to reduce heat loss. These differences are not easy to change.</p>
<h2>Things you can do</h2>
<p>In order to maintain a feeling of warmth, you can manipulate your clothing, your activity and your food.</p>
<p>The most common thing people do to stay warm is wear a coat, hat and gloves. Obviously increasing clothing thickness or piling on the layers helps. Winter clothes serve not to warm you up, but more as a means to keep the heat you are producing from dispersing to the surrounding environment.</p>
<p><a href="https://www.livescience.com/34411-body-heat-loss-head.html">Contrary to popular belief</a>, <a href="https://doi.org/10.1152/japplphysiol.01241.2005">the head is not</a> <a href="https://www.nytimes.com/2004/10/26/health/the-claim-you-lose-most-of-your-body-heat-through-your-head.html">a greater source of heat loss</a> than any other adequately covered body part. If you were to wear a warm hat and no coat, your torso would contribute the most to heat loss, thanks to how your body redistributes its blood in cold conditions. <a href="https://www.webmd.com/a-to-z-guides/features/do-we-really-lose-most-of-our-heat-through-our-heads">If you can keep your torso warm</a>, you’ll maintain blood flow to your limbs and can often keep the arms, legs, hands and feet warm.</p>
<p>Secondly, being physically active causes your muscles to contract, breaking down more nutrients, which generates additional heat. This additional heat production can help maintain body temperature and the feeling of warmth. Maybe you’ve noticed this in your own life if you’ve run in place for a bit or done a quick set of jumping jacks when you’re out in the cold. </p>
<p>Unfortunately, physical activity or layers of clothing can tip the balance past what you need to offset heat losses. In that case, you’ll experience an increase in body temperature – and your body will start sweating in an effort to cool down. This is a bad outcome, because the <a href="https://www.mottchildren.org/health-library/tw9037">evaporation of sweat</a> will lead to greater rates of heat loss.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/254535/original/file-20190118-100273-1shj2p1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/254535/original/file-20190118-100273-1shj2p1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/254535/original/file-20190118-100273-1shj2p1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/254535/original/file-20190118-100273-1shj2p1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/254535/original/file-20190118-100273-1shj2p1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/254535/original/file-20190118-100273-1shj2p1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/254535/original/file-20190118-100273-1shj2p1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/254535/original/file-20190118-100273-1shj2p1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Take some tips from those who enjoy the great outdoors even when the mercury falls.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/951YFKbvS3A">Serhii Danevych/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Finally, eating increases the body’s production of heat. The process of breaking down food is going to slightly increase body temperature. Sometimes campers will have a snack before bed in an effort to stay warmer through the night. While the <a href="https://www.active.com/nutrition/articles/winter-and-nutrition-fueling-for-cold-weather-exercise">metabolic impact of a small snack</a> may not be huge, the tipping point between heat balance and heat loss is pretty small.</p>
<p>You may also notice the urge to urinate – what physicians call <a href="http://www.arkansasurology.com/blog/what-is-cold-diuresis">cold diuresis</a>. It’s a side effect of constricting blood vessels and the resulting increase in blood pressure as the same amount of blood has a smaller space available to travel through your body.</p>
<p>And if you’re the type who tends to feel cold and leave your coat on even inside, you might want to rethink the habit. Your skin will be flush with blood as your body tries to dissipate excess heat inside. Worst of all, you may start to sweat. Once you head back out the door, you might feel even colder initially than you would have as the cold air saps the heat from your skin and your sweat evaporates. To stay comfortable, your best bet is dressing appropriately, whether inside or outdoors this winter.</p><img src="https://counter.theconversation.com/content/108816/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>JohnEric Smith has received research funding from multiple sports nutrition companies. He is a member of Dymatize Nutrition’s Advisory Board. </span></em></p>Winter comes with colder temperatures. You and your body can work together to stay comfortable.JohnEric W. Smith, Assistant Professor of Exercise Physiology, Mississippi State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/995122018-08-10T02:07:43Z2018-08-10T02:07:43ZA strong immune system helps ward off colds and flus, but it’s not the only factor<figure><img src="https://images.theconversation.com/files/231212/original/file-20180809-30446-72yohm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Winter bugs are impossible to escape.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-holding-handle-on-train-taiwan-1135859891?src=uZJW9VVKeaZjAFi8ngnyoQ-2-53">Shutterstock</a></span></figcaption></figure><p>It’s peak flu season. You’re cold, rugged up and squashed on public transport or in the lift at work. You hear a hacking cough, or feel the droplets of a sneeze land on your neck. Will this turn into your third cold this year?</p>
<p>No matter how much we try to minimise our exposure to respiratory viruses, it’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5187459/">far more difficult</a> in winter when we spend so much time in close proximity to other people. </p>
<p>On top of this, viruses tend to be more stable in colder and drier conditions, which means they <a href="https://www.nih.gov/news-events/nih-research-matters/flu-virus-fortified-colder-weather">stick around longer</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-long-should-you-stay-away-when-you-have-a-cold-or-the-flu-98702">Health Check: how long should you stay away when you have a cold or the flu?</a>
</strong>
</em>
</p>
<hr>
<p>The common cold is caused by more than <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/colds">200 different viruses</a>, the most common of which are rhinoviruses (rhino meaning nose). Rhinovirus infections tend to be mild; you might get a sore throat and a head cold lasting just a few days. </p>
<p>Influenza, or the flu, is generally caused by type A or B <a href="https://www.webmd.com/cold-and-flu/advanced-reading-types-of-flu-viruses">influenza viruses</a>. The flu is far more aggressive and often includes a fever, fatigue and body aches, in addition to all the classic cold symptoms. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/231207/original/file-20180809-30476-1pivwfn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/231207/original/file-20180809-30476-1pivwfn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=379&fit=crop&dpr=1 600w, https://images.theconversation.com/files/231207/original/file-20180809-30476-1pivwfn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=379&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/231207/original/file-20180809-30476-1pivwfn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=379&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/231207/original/file-20180809-30476-1pivwfn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=477&fit=crop&dpr=1 754w, https://images.theconversation.com/files/231207/original/file-20180809-30476-1pivwfn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=477&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/231207/original/file-20180809-30476-1pivwfn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=477&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The flu tends to be more severe than the common cold.</span>
<span class="attribution"><a class="source" href="https://www.healthdirect.gov.au/cold-or-flu-infographic">healthdirect</a></span>
</figcaption>
</figure>
<p>When it comes to getting sick, there’s always an element of bad luck involved. And some people, particularly those with young children or public transport commuters, are likely to come into contact with more viruses. </p>
<p>But you may have noticed that illness often strikes when you’re stressed at work, not sleeping properly, or you’ve been out partying a little too much. The health of our immune system plays an important role in determining how we can defend against invading cold and flu viruses.</p>
<h2>How the immune system fights viruses</h2>
<p>Your skin and saliva are key barriers to infection and form part of your immune system, along with cells in every tissue of your body, including your blood and your brain. </p>
<p>Some of these cells migrate around to fight infection at specific sites, such as a wound graze. Other cells reside in one tissue and regulate your body’s natural state of health by monitoring and helping with the healing process.</p>
<p>The cells that make up your immune system need energy too, and when you’re low on juice, they’ll be on low-battery mode. This is when our natural immune defences are weakened and normally innocuous bugs can begin to cause strife. </p>
<p>Our immune system requires a lot of energy to defend our bodies. Feeling tired and achy, overheating, and glands swelling are all signs that our immune system is busy fighting something.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-how-does-the-immune-system-work-27163">Explainer: how does the immune system work?</a>
</strong>
</em>
</p>
<hr>
<h2>Boosting our natural defence system</h2>
<p>Our immune system has evolved to naturally detect and eliminate viral infections. And we can actively <a href="https://www.health.harvard.edu/staying-healthy/how-to-boost-your-immune-system">strengthen our immunity and natural defences</a> by looking after ourselves. This means:</p>
<ul>
<li><p>getting adequate sleep. Sleep deprivation <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132857/">increases the hormone cortisol</a>, which suppresses immune function when its levels are elevated</p></li>
<li><p>exercising, which <a href="https://medlineplus.gov/ency/article/007165.htm">helps the lymphatic system</a>, where our immune cells circulate, and lowers levels of stress hormones </p></li>
<li><p>eating well and drinking enough water. Your immune system needs energy and nutrients obtainable from food. And staying well hydrated helps the body to flush out toxins</p></li>
</ul>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/231242/original/file-20180809-30458-qhpcs4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/231242/original/file-20180809-30458-qhpcs4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/231242/original/file-20180809-30458-qhpcs4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/231242/original/file-20180809-30458-qhpcs4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/231242/original/file-20180809-30458-qhpcs4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/231242/original/file-20180809-30458-qhpcs4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/231242/original/file-20180809-30458-qhpcs4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Good food feeds your immune system.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/IGfIGP5ONV0">Anna Pelzer</a></span>
</figcaption>
</figure>
<ul>
<li>not smoking. Smoking, or even secondary smoke, damages our lungs and increases the vulnerability of our respiratory system to infection.</li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-should-i-take-vitamin-c-or-other-supplements-for-my-cold-98309">Health Check: should I take vitamin C or other supplements for my cold?</a>
</strong>
</em>
</p>
<hr>
<h2>Educating our immune system</h2>
<p>Natural defences aren’t always enough to keep us safe and we need the help of flu vaccinations.</p>
<p>Vaccines are designed to educate an army of B and T cells which make up your adaptive immune system. This arm of your immune system learns by exposure and provides long-term immunity. </p>
<p>These T and B cells need a bit of time from the initial influenza exposure before they can be activated. This activation lag time is when you feel the brunt of the flu infection: lethargy, body aches, extreme fatigue and unable to get off the couch for a day or two. </p>
<p>To overcome this delay and protect people before they are exposed to potentially harmful flu strains, flu vaccination introduces fragments of the influenza virus into the body, which acts like prior exposure to the bug (without actual infection).</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/231241/original/file-20180809-30458-wgcdo7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/231241/original/file-20180809-30458-wgcdo7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/231241/original/file-20180809-30458-wgcdo7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/231241/original/file-20180809-30458-wgcdo7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/231241/original/file-20180809-30458-wgcdo7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/231241/original/file-20180809-30458-wgcdo7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/231241/original/file-20180809-30458-wgcdo7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">You can still get the flu if you’ve been vaccinated but you might not get as sick.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/caring-man-made-tea-cute-sick-1151493122?src=T6GHODDflT-C25W6avSXHA-1-99">VGstockstudio/Shutterstock</a></span>
</figcaption>
</figure>
<p>Seasonal vaccines are designed to match currently circulating strains and target those strains before you’re infected. </p>
<p>You can still catch the influenza virus if you are vaccinated. But because of this pre-education, the symptoms will likely be milder. The immune system has been trained and the army of B and T cells can move into action quicker. </p>
<h2>Already have a cold or the flu?</h2>
<p>If you’ve been sniffling and sneezing your way through winter, be comforted by the fact that these bugs are strengthening your immune system. Our body remembers the particular strain of rhinovirus or influenza we get, so it can recognise and mount a stronger defence if we encounter it again. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-whats-new-about-the-2018-flu-vaccines-and-who-should-get-one-94514">Explainer: what's new about the 2018 flu vaccines, and who should get one?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/99512/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Illness often strikes when you’re stressed at work, not sleeping properly, or you’ve been out partying a little too much. Here’s why.Hui-Fern Koay, Research Fellow in Immunology, The University of MelbourneJesseka Chadderton, PhD Candidate, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.