In March 1918, the worst epidemic in our nation's history started at Fort Riley, Kansas. Young, healthy soldiers who had just returned from the European front began dying, sometimes more than sixty per day, from a mysterious illness.

By September, the unnamed disease had spread to the civilian population throughout the country. Hospitals quickly filled to capacity. The symptoms progressed rapidly. Many people were healthy by day and were dead by nightfall. Fortunately, many others recovered. But when the epidemic was over, 600,000 had died, a figure higher than the total American casualties due to all the combat in the twentieth century. The cause of death was later identified as an unusual strain of influenza. Could such an outbreak happen again? Yes, indeed.

Influenza, also known as the flu, is a highly contagious disease that is caused by the influenza virus. In the Midwest, it usually occurs between December and March and attacks the respiratory tract (nose, throat, and lungs) not the gastrointestinal tract. The term stomach flu is a misnomer.

Transmission occurs when a person who has the flu sends flu virus into the air (usually from coughing, sneezing, or speaking) and is inhaled by other people. Once in the body, the virus begins to multiply, causing symptoms of influenza.

A person can spread the flu one day before he or she feels sick. Adults can continue to pass the flu virus to others for another three to seven days after symptoms start. Children can pass the virus for longer than seven days. Symptoms start one to four days after the virus enters the body. Some persons can be infected with the flu virus, displaying no symptoms, yet still spread the virus to others.

The flu is different from a cold in that it usually comes on suddenly with the following symptoms:

• Fever
• Headache
• Fatigue (sometimes extreme)
• Dry cough
• Sore throat
• Nasal congestion
• Body aches

Influenza is probably the most numerically significant acute respiratory illness to cause people to miss work and to see a physician. Each person infected with the flu will miss an average of 3.5 days of work. Seven percent of all doctor visits are attributed to influenza. Each year, over 36,000 people die in the United States from the flu while over 110,000 are hospitalized.

Influenza is caused by a virus, so antibiotics such as penicillin, don’t work to cure it. In fact, they may even prolong the duration of illness. The best way to prevent the flu is to get an influenza vaccine (flu shot) each fall, before flu season. The ideal time for vaccination is late October to early November.

Cost savings to companies who offer the flu vaccine are impressive. Physician visits for the flu can be reduced by up to forty-four percent and lost workdays can be decreased by up to forty-five percent. Flu shots have been shown to save .4 working days per vaccine recipient. A company with 100 employees will have an average of 40 fewer employee lost workdays annually if the entire work force is vaccinated.

A flu shot, which is made from inactivated viruses (the viruses are killed), can be given to anyone who wants to avoid the flu. The shot can be administered to children as young as 6 months. Persons who provide essential community services (policemen, firemen, etc.) should consider getting a flu shot to minimize disruption of essential activities during flu outbreaks. Students or others in institutional settings (those who reside in dormitories) and people who travel should also be encouraged to get a flu shot.

The Center for Disease Control recommends that the following people be vaccinated:

• Persons aged 50 years and over
• Residents of nursing homes and other long-term care facilities that house persons of any age who have long-term illnesses
• Adults and children over 6 months of age who have chronic heart or lung conditions, including asthma
• Adults and children over 6 months of age who need regular medical care or who are hospitalized because of metabolic diseases (such as diabetes), chronic kidney disease, or weakened immune system (including immune system problems caused by medicine or by infection with human immunodeficiency virus [HIV/AIDS])
• Children and teenagers (aged 6 months to 18 years) who are on long-term aspirin therapy and therefore could develop Reye Syndrome after the flu
• Women who will be more than 3 months pregnant during the flu season

Since persons with the flu can transmit it to others, it is further recommended that the following people should also get flu shots:

• Doctors, nurses, and other employees in hospitals and doctors’ offices, including emergency response workers
• Employees of nursing homes and long-term care facilities who have contact with patients or residents
• Employees of assisted living facilities and other residences for people in high-risk groups
• People who provide home care to those in high-risk groups
• Household members (including children) of people in high-risk groups

People in the following groups should NOT get a flu shot before talking with their doctor:

• People who have a severe allergy to hens’ eggs
• People who have had a severe reaction to a flu shot in the past
• Women in their first trimester of pregnancy

Should you get a flu vaccine? Yes, unless you are allergic to eggs, are in your first trimester of pregnancy, or have had adverse reactions to previous vaccinations.