Colds and Flu

Colds  

Also known as nasopharyngitis or upper respiratory tract infection, the cold is the most common cause of human illness. An adolescent on average has a cold about four to five times each year, and it is the most frequent reason for absenteeism from school or work in the adolescent age group.

The cold is caused by a viral infection, and there are over two hundred types of viruses capable of causing a cold. These viruses are most often transmitted from a sick to a well teen by coughing sneezing or kissing. If a teen is exposed to these viruses, he or she could develop cold symptoms within one to five days. The teen is then capable of transmitting the cold virus to others over the next seven to ten days.

Anyone can catch a cold. Teenagers who smoke or have medical conditions that weaken their immune system—such as HIV/AIDS or certain cancers—can be at higher risk for catching a cold.

An adolescent can have a cold at any time of the year, but there is a sharp rise in infection rates during the colder months. This is not because colder temperatures weaken the immune system. In fact, neither cold temperatures nor loss of sleep nor a poor diet has been shown to increase one’s susceptibility to a cold. More likely, teens have more colds during the winter months since they spend more time indoors in close contact with one another. Also, cold viruses may survive outside the body for longer periods during the winter. There is also some evidence that psychological stress, especially chronic life stresses and poor social supports can increase the risk for infection.

Most people with a cold experience a runny nose, congestion and a scratchy or sore throat. The nasal secretions are usually clear; but may become white or yellow/green. The teen’s voice may sound nasal, and he or she will have sneezing and some hoarseness. Cough and phlegm are often mistakenly thought to indicate bronchitis, but the common cold is the most frequent cause of cough in adolescents. Fever greater than 100.5 degrees F (38 degrees C) is unusual with a cold, and its presence suggests either a bacterial infection or the flu.

Most often, symptoms of a cold abate in five to seven days. In one fourth of patients, however, the symptoms may persist for two weeks or longer. Sometimes a cold can lead to other infections, particularly in the sinuses or the middle ear. Rarely, a cold may progress to a serious infection such as pneumonia. If a teen’s symptoms do not improve within two weeks, or if the symptoms appear more severe, it is advisable to consult a clinician.

Self-diagnosis of a cold is usually accurate. The clinician’s primary role is to exclude other causes of cold-like symptoms. These include ear infections, sinusitis, streptococcal sore throats, the flu and environmental allergies. The clinician may use diagnostic tests to rule out these conditions, but it is neither practical nor important to order tests specific for a cold.

Although many remedies have been proposed, there is no proven cure for a cold. Treatment is instead aimed at reducing symptoms and preventing complications. Almost all forms of reliable treatment can be purchased over the counter or found in the home. The best treatments may be the most basic: obtain plenty of rest and drink lots of fluids. Hot beverages including chicken soup and tea may help to relieve congestion and muscle aches.

Decongestants can be helpful both for providing symptomatic relief as well as preventing sinusitis or an ear infection. Nasal spray decongestants may be effect for short-term use, but can be counterproductive if used for more than three or four days. If a decongestant is needed for more than a few days, then an oral decongestant may be a better choice. Inhaled steam, saline nasal spray and warm fluids may be more effective at loosening secretions than decongestants. Sedating antihistamines may be helpful in promoting rest, but like nasal spray decongestants, these can sometimes exacerbate symptoms. Prescription non-sedating antihistamines are expensive and ineffective for treating colds. Nasal sprays containing ipratropium may relieve sneezing and runny noise in some teens, and these are usually well tolerated when used for fewer than five days. Acetaminophen, ibuprofen and naproxen are helpful in treating the headache, fever and muscle aches that often accompany a cold. Cough suppressants, such as dextromethorphan, usually help to reduce cough that is especially important at night when cold sufferers are attempting to sleep. Clinicians disagree about the usefulness of zinc lozenges, but some studies have shown that they can reduce many cold symptoms. Side effects include nausea and a bad taste in the mouth. To date, the verdict seems to rule against the effectiveness of Echinacea.

Antibiotics should not be prescribed for a cold since these medications are not effective in treating the viruses that cause a cold. Like all medications, antibiotics carry the risk of side effects, which range from mild to severe. The indiscriminate use of antibiotics may promote bacterial resistance, so that the effectiveness of the medication may be compromised over time.

The best way to prevent a cold is to avoid the secretions from a person infected with a cold. Because this may not be practical, frequent hand washing and minimizing hand to face contact may be helpful. Hand washing has been shown to decrease the chance of contracting a cold. Neither gargling with antiseptic mouthwash nor the use of zinc lozenges has been shown to be beneficial. Most experiments with Vitamin C have failed to demonstrate a protective effect.

The flu  

The flu, also known as influenza, is an infection of the respiratory tract. It is caused by the influenza virus of which there are many strains. Although a teen may be immune to some strains, new strains arise every year posing a challenge for the healthiest immune system. In 2006, there were warnings of a possible “bird flu” pandemic.

The flu is a highly contagious disease that is spread from person to person by the inhalation of aerosolized virus or by secretions from the nose and mouth of the infected person. The incubation period, the time between exposure and onset of the symptoms is one to three days. People with the flu are most infectious during the twenty-four hours before the onset of symptoms and when their symptoms are most severe. They usually cease to be infectious within seven days after the onset of symptoms.

During an outbreak of the flu, infection rates are highest among school-age children and adolescents. Each year, ten to forty percent of healthy children become infected with the flu and about one percent require hospitalization. Infection rates are higher for teens with weakened immune systems. Infected adolescents may spread the virus to other members of their families. Influenza outbreaks occur during the winter months and typically last from four to twelve weeks.

The flu can be heralded by the sudden onset of fever, chills, headache and muscle soreness. This may be followed by fatigue, dry cough, sore throat and nasal congestion. Other symptoms may include red eyes, abdominal pain, nausea and vomiting.

Healthy teens usually begin to improve from two to five days after the onset of flu symptoms. Occasionally the illness may last for more than a week, and some symptoms including fatigue may persist for several weeks.

Some teens with the flu develop a secondary infection such as pneumonia. If this occurs, then the adolescent may develop higher fevers and a more persistent productive cough. Rarely will the flu cause damage to the nervous system, heart or muscles.

If a teen is suspected of having the flu, the clinician may order confirmatory tests. These include cultures for the influenza virus or a rapid test for the presence of Influenza A or B. In fact, these tests may be time consuming and expensive, so a working diagnosis is usually made based on the teen’s symptoms and the clinician’s clinical acumen.

For most healthy adolescents, the flu resolves within a week. Fluids, rest, fever and pain relievers may be helpful. Aspirin should be avoided because of the association between influenza, aspirin and Reye’s syndrome.

There are specific medical treatments for the flu that should be considered when symptoms are severe or when the teen has another illness that could worsen the flu. Amantidine and rimantadine are two M2 inhibitor medications that diminish the severity of the flu if given within forty-eight hours of the onset of illness. They offer protection only against influenza A, not B. Rimantadine is labeled only for the treatment of influenza in adults.

Two newer drugs, called neuraminidase inhibitors, are proving to be effective for treating both Influenza A and B. Zanamivir is approved for persons twelve years of age and older; it is administered as a nasal spray or inhaler. Oseltamivir works in a similar fashion to zanamivir, and it comes in capsule form. It is approved for persons eighteen years of age and older. Both of these drugs shorten the duration of the flu by one to three days, but they also need to be taken within forty-eight hours of the onset of the illness. For the vast majority of flu cases, these medications are not necessary.

How is the flu prevented?

The influenza vaccine is an excellent means of protecting against the flu because it decreases the rate of infection by about eighty percent. It is important that some teens receive the vaccine annually including those with certain chronic diseases such as diabetes, recurrent asthma, sickle cell disease, cystic fibrosis and others. The influenza vaccine should also be considered for teens in boarding school and college since viral spread may be facilitated in close living quarters.

The vaccine provides protection for about a year but because of antigenic drift, the influenza virus undergoes changes over time. Accordingly, a new influenza vaccine is prepared for administration each fall between October and December. For adolescents who received the vaccine after the flu has begun to circulate in their community, amantadine or rimantadine may be given to provide protection in the two weeks before the vaccine takes effect. At present, the vaccine can be delivered as an intramuscular injection or by nasal spray. The vaccines are considered safe. The most frequent side effect, seen in about a third of the people receiving the injection, is redness or soreness at the injection site. This mild reaction lasts no more than one or two days. The vaccine should not be given to teens who have a severe allergic reaction to chicken or eggs. The intranasal vaccine can produce headache, nasal congestion, runny nose or other side effects.

Related topics:

Antibiotics, boarding school, chronic illness, cystic fibrosis, immunizations, kissing, Reye’s syndrome, sickle cell anemia, stress