Influenza Influenza

Influenza Influenza (flu) is a common contagious viral infection that spreads quickly and can cause serious illness and sometimes death. Older people, young children, pregnant women and people with certain medical conditions (such as heart disease, asthma, or an autoimmune disease) are at a higher risk of developing serious complications from influenza. Influenza can be spread through the air – coughing and sneezing releases tiny droplets – or by direct contact with an infected person. People are infectious usually one day before the symptoms start and up to five days after they become sick. Flu season in New Zealand is usually from May to September, although can start earlier or last longer. Each year, the majority of influenza cases are caused by three to four major viruses. Our flu season tends to reflect that experienced in the Northern hemisphere. The seasonal influenza vaccine for 2017 includes a different H1N1-like strain to last year (see Immunisation box opposite). Symptoms usually come on suddenly and commonly include high fever (38.8– 40°C), body chills, headache, dry cough, sore throat, runny or stuffy nose, chest discomfort, muscle and joint aches and pains, tiredness and weakness. Stomach symptoms, such as nausea, vomiting and diarrhoea, are more common in children than in adults. Secondary infections (eg, bronchitis, pneumonia) are common. Medicines are available over the counter to help improve flu symptoms, such as fever, body aches, headaches, coughs and joint pains. Oseltamivir is an antiviral which is available as a pharmacist–only medicine year round. Oseltamivir can shorten the time to flu resolution and reduce the risk of hospitalisation and complications from influenza; however, the occurrence of nausea and vomiting is increased (see Treatment options next page). masks readily available should you need to don one when talking with customers who are actively coughing. Run through the Refer to Pharmacist questions to help you decide which customers are amenable to self-treatment and who needs to be referred to the pharmacist. Advice for customers • Consider yearly influenza vaccinations, which are free for some people from their doctor (see text box Immunisation, next page for specific recommendations). • Recommend bedrest, increased fluid intake and symptom control using analgesics and other treatment options for people who have already contracted the flu. • Warn sufferers the flu is contagious and they should refrain from going to work and avoid public places where possible for up to five days. • Refer patients to the doctor if symptoms worsen or persist for longer than a week. • Many cold and flu remedies contain paracetamol, a decongestant and/or a cough suppressant. Watch for double-dosing with these products. • Turn to page 98 to see Treatment options. Initial assessment During the flu season, you will be exposed on a daily basis to people with the flu. However, determining whether a customer has the flu or a cold can be challenging. Colds generally do not present with fever, joint pains, or body chills, and can occur at any time throughout the year (see also Colds). Sneezing is common with colds, and coughs associated with colds are more likely to be productive. The symptoms of a cold usually take a few days to develop, compared with flu symptoms that usually come on within three to four hours. Always take precautions to protect your own health during flu season. Yearly vaccination is the best form of protection, and you should always wash your hands before and after direct contact with customers. Consider having face Important note: Cough, cold and flu medicines in children Parents or caregivers should not give cough, cold or flu medicines to children aged less than six years, and should seek pharmacist advice before using these preparations in children aged less than 12 years. Instead, paracetamol may be used to relieve any pain or discomfort, and natural remedies containing ingredients such as glycerol, honey, or lemon can be suggested to help soothe irritated throats or coughs in children older than one year. MANAGING PAIN FREE PROFESSIONAL DEVELOPMENT FOR Pharmacy assistants, technicians and students 4 Page 96 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Immunisation The New Zealand Ministry of Health recommends annual vaccination against influenza. The following groups are eligible for free influenza vaccination (through a doctor) in 2017 with Influvac: •• anyone aged 65 years or over •• anyone aged less than 65 years with: »» cardiovascular disease (ischaemic heart disease, congestive heart failure, rheumatic heart disease, congenital heart disease and cerebrovascular disease) »» chronic respiratory disease (asthma if on regular preventive therapy; other chronic respiratory disease with impaired lung function) »» diabetes »» chronic renal disease »» any type of cancer, excluding basal and squamous skin cancers if not invasive »» other conditions (autoimmune disease, haemaglo binopathies, immune suppression, HIV, neuromuscular and central nervous system disease, transplant recipients, children on longterm aspirin) •• pregnant women •• children aged four or less who have been hospitalised for a respiratory illness or have a history of significant respiratory illness. The 2017 influenza vaccine varies from the 2016 vaccine and provides protection against the following three virus strains: •• A/Michigan/45/2015 (H1N1)-like virus (new strain) •• A/Hong Kong/4801/2014 (H3N2)-like virus •• B/Brisbane/60/2008-like virus. Quadrivalent vaccines contain an additional B virus (B/Phuket/3073/2013-like strain). Pharmacists who have qualified as an authorised vaccinator are able to give privately purchased influenza immunisations within a community pharmacy setting to individuals aged 13 and older. Some pharmacists may also be able to vaccinate adults who meet specified eligibility criteria for funded influenza vaccination. Useful websites •• Immunisation Advisory Centre (IMAC) – www.immune.org.nz »» Provides independent, factual information about vaccine-preventable diseases and the benefits and risks of immunisation. •• National Influenza Specialists Group (NISG) – influenza.org.nz »» Not-for-profit group of expert New Zealand doctors, nurses, and pharmacists whose aim is to promote the benefits of immunisation for those most at risk. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, heart or lung problems, immunosuppression, diabetes, is pregnant or breastfeeding)? • Does the person take any other medication, either prescribed by a doctor or bought from a shop or supermarket (including herbal/ complementary medications)? • Is the person under 12 years or elderly? • Does the person have a fever, rash or a stiff or sore neck (see Childhood Diseases and Immunisation: Meningococcal disease). • Does the person have a high fever that doesn’t reduce? • Does the person have chills or severe shaking, or a purple or bluish discolouration of their lips, skin, fingers or toes? • Does the person have difficulty breathing? • Does the person appear confused or is their mental functioning impaired? • Does the person also have vomiting or diarrhoea? • Is the person having trouble eating or drinking? • Have the symptoms continued to get worse or persisted for longer than a week? • Does the person have a productive cough? • Has the person recently travelled overseas? • Is the person particularly unwell, eg, unable to get out of bed? • Does the person have any allergies to medicines? To complete the work book assessment visit pharmacytoday.co.nz WIN ONE OF SEVEN $500 CASH PRIZES Page 97