Even somewhat late in the season, ‘winter’ does linger on until April, hence a reminder for our readers.

Although there is no apparent scientific reason why this, flu-like illnesses with subsequent chest complications is more common in winter and unless carefully managed can kill many frail, older people.

The National Foundation of Infectious Diseases meets regularly to draw up appropriate plans of action each winter. Needless to say flu-vaccination is perhaps the most important and low cost preventive measure. Because of the changing nature of the influenza viruses, each year the WHO determines the correct strain of virus for that year and effective vaccines are manufactured for clinical usage.

It is almost compulsory for all general practices to advise and invite certain groups of older and frail people for the vaccination before the winter sets in. Unfortunately another common condition causing similar symptoms as influenza - Respiratory Syncytial Virus - does not yet have any available vaccination. More about that later.

Whether Influenza A or B, it is an acute disease with fever, cough and sneezing with aches and pains, headache and extreme tiredness. It develops fully within a few days and in some subjects gets into the chest pretty quickly. For uncomplicated influenza, antibiotics are totally useless and there are no ‘effective’ anti-viral remedy for general use. Most ‘fitter’ individuals recover within a week without any after effects. The vulnerable, however, are at risk of other complications eg chest infections and only at that stage need antibiotics.

Sadly it is this latter group that tend to end up in hospital. Whether a busy general ward full of many other ‘bugs’ is an ideal place for them is open to question. Nursing at home, where feasible, away from other patients is the most safe and better alternative.

In many the flu-like symptoms are due to a different respiratory syncytial virus; antibiotics are not effective for this virus either. As mentioned already, in an older frail subject their symptoms are identical and it responds to supportive care – fluids, pain killers and tackling fever. In serious complicated cases more intensive treatment in hospital may be necessary.

Winter illnesses eg flu with or without chest or other serious complications are a main hazard which face the health service each year. Preventive flu vaccination, although not an absolute guarantee, does or can minimise symptoms. Care at home is always preferable for avoiding cross infection in busy hospitals. Most of the time it is a self limiting disorder, and no complex therapy is needed. Recently an association with vitamin D status of the body has been established; accordingly over the winter months intake of vitamin D supplements may be justified.

All older people, especially the frail or those with other co-existent diseases eg diabetes, heart conditions, kidney disorders or body immunity compromised in any other way, must get their flu jab when advised. There is absolutely no chance of acquiring flu from the vaccination – the virus in the vaccine is either dead or weak.

Hopefully there will be a vaccination for syncytial virus fairly soon.

Arup K Banerjee