Don't go viral
Get the shot, not the flu
BY BOB ARMSTRONG
Winnipeg Health Region
Wave, September / October 2010
It's a familiar scenario for many.
You wake up one morning feeling a bit
out of sorts. Your throat is scratchy, your
muscles are sore and your head aches.
Naturally, your first instinct is to stay
home and rest. After all, it's not as though
you're going to get much work done in this
condition. But then the guilt sets in: Can
you really afford a sick day after just two
months on the job? What would your boss
think? After thinking about it for a few moments,
you decide to tough it out and head
It's a decision hundreds, if not thousands,
of Manitobans are faced with
making every year, especially during the
influenza season in the late fall and winter
months. One study, for example, suggests
that as many as one in four people 18 years
of age and over is infected by influenza in
a given year. And in some cases, people
with influenza are choosing to go to work.
A story published by working.com last
spring illustrates the point. It noted that
61 per cent of Canadian respondents to a
survey of visitors at monster.com admitted
to going to work when sick. Only 26 per
cent of respondents said they would stay at
home when sick. Some of these individuals
go to work sick because they fear taking
time off could cost them their job or a possible
promotion; others may feel the need
to soldier on, disregarding their aches and
pains, in order to ensure their team is not
Whatever the reason, the fact is that
some individuals may actually be doing
more harm than they realize, especially if
they have "the flu." That's because a person
with influenza could infect as many as a
dozen people during the course of a day
without even knowing it.
It's a problem that public health officials
like Dr. Michael Routledge understand
well. "Most people are sensitive to the risk
of spreading influenza," says Routledge,
Medical Director of Population and Public
Health with the Winnipeg Health Region.
"But people often go to work sick because
they feel they have to."
The problem is that when infected individuals
go to work or attend a gathering
where they come into contact with people,
they run the risk of infecting others, including
those who may be more susceptible to
complications associated with the virus.
So how should someone prepare for the
upcoming flu season?
Well, the first thing is to think about reducing
your risk of becoming infected with
the influenza virus in the first place. Health
officials say the best way to do that is to
get vaccinated every fall before the start of
influenza season. Not only does a vaccination
reduce your risk of getting sick, it
limits the possibility that you will transmit
the virus to someone else.
That's partly why Manitoba Health has
decided to make flu vaccinations available
at no charge to anyone who wants one this
year. Previously, the seasonal vaccine was
free only to people deemed to be most at
risk of becoming infected with influenza
and their care providers. And it's also why
the Winnipeg Health Region is staging 12
immunization clinics throughout the city
from Oct. 19 to 23.
Routledge welcomes the move to make
the influenza vaccine more readily available,
and hopes people will take advantage
of the offer - especially those in the priority
categories. "We need to continue to get out
the message that there are certain populations
who are at more risk of complications from seasonal influenza, and those are the
people in particular we want to protect."
Canada's National Advisory Committee
on Immunization encourages all Canadians
over the age of six months to get a flu shot.
Key target groups for immunization include
care providers, and those with conditions
that put them at high risk of complications
from influenza such as people over
65, young children, pregnant women, and
people with chronic health conditions.
Three additional new target groups were
identified this year by the advisory committee
- persons with morbid obesity, Aboriginal
peoples and children two to four
years of age. The rationale for the target
groups is that health-care workers and others
in contact with those at high risk have
the potential to infect the most vulnerable
people, while the other priority groups are
most likely to have serious consequences
Brenda Dyck, Director of Infection,
Prevention and Control for the Region, says
she's worried that some people may become
blasé about "seasonal" influenza this
year. She explains that last year's H1N1 influenza
pandemic raised concerns because
it came on suddenly, killed a significant
number of younger people and left many
others sick. Seasonal influenza also kills
a significant number of people - as many
as 4,000 a year - but many of these cases
involve those who are elderly and frail, so
there is less media attention.
"During a pandemic, everyone gets a little
uptight. But when it is normal seasonal
influenza, people become complacent,"
says Dyck. The result is people sometimes
forget that when they pass on a virus, it
may have significant consequences.
"Who knows who you will infect or
whether they may have any underlying
illnesses that might make them more susceptible
to complications? It's not just you
having the infection. It's who you might
infect," she says.
As for those who do not get the shot and
become sick with influenza, the message is
clear. "Whether it is influenza or some other
kind of infection, we don't want people
coming out into the community, into the
workplace or schools . . . and transmitting
infection. The message is, stay home when
you are sick."
Of course, some people can be contagious
and not even know it. In fact, some
studies have suggested that as many as one
in five may have an influenza virus and not
have any symptoms.
Generally speaking, the influenza
virus is spread among humans through
tiny droplets in the air, usually when an
infected person sneezes or coughs close
to someone else. The virus can also spread
when the droplets are transmitted from
one person to another by physical contact
- like shaking hands - or via a surface
touched by the infected person, such as
bus railings, door handles, and coffee pots.
When the infected person covers a cough
with his or her hand, that hand gets covered
with influenza virus droplets. Those
droplets are then left on everything that
hand touches, and can survive 24 to 48
hours on a hard surface, says Routledge.
People infected with the influenza
virus, which is an infection of the respiratory
tract, are most contagious just before
they have symptoms and then for several
days after symptoms have first appeared.
When the non-infected person picks up
the droplets and touches his or her mouth,
the disease can find a new host. And if that new infected person has a chronic health
condition, the infection can progress to viral
pneumonia. Likewise, if the newly infected
person visits somebody in the hospital, the
virus can spread to more vulnerable people.
The bottom line, Routledge says is everyone
needs to take influenza seriously.
"If you wake up in the morning and you're
not feeling well, consider staying home," says
Routledge. "I'd say to a work supervisor, 'If
that person stays home, they aren't infecting
other people at work.'"
Routledge also underscores the importance
of taking precautions in the first days of sickness.
"People who are sick are particularly
infectious in the first couple of days, and the
more we can get people to stay home and
take care of themselves, the better for everybody."
There are signs that the message is being
received. Mark Hollingsworth, Executive
Director of the Human Resources Association
of Manitoba, says that when it came time to
updating the office computer system, he opted
to have everyone outfitted with a laptop.
The idea was to provide for increased opportunities
for people to work from home, which meant that anyone who felt under
the weather did not feel like they had to
make a choice between missing work or
infecting colleagues at the office.
"We talked about the idea that we are
in an enclosed environment, where we are
interacting with each other, (and) could
be spreading contagious diseases. Being
that we are with the HR association,
we thought if we have the opportunity to
showcase what can be done, we should.
At a small level, we're just thinking through
creating a culture that is effective, efficient,
but looks after people."
The Region, meanwhile, continues to develop
new strategies to contain the spread
of influenza. This year, for example, the
Region decided to hold its influenza immunization
clinics from Oct. 19 - 23 in a
bid to reach as many people as possible at
the beginning of influenza season, which
usually runs from November to March.
Each year, the seasonal influenza vaccine
includes three strains, or types, of
influenza virus. This year, the vaccine
includes the 2009 pandemic influenza A/
H1N1 component, as well as influenza A/
H3N2 and B components.
The Region is also making an effort to
promote respiratory etiquette as a means of
helping prevent the spread of influenza.
For example, the Region and other
health organizations have been urging
people to cover their coughs by sneezing
into a tissue or the crook of your elbow,
says Dyck. After coughing or sneezing,
clean hands with soap and water or use
an alcohol-based hand rub (sanitizer). This
will prevent influenza droplets from ending
up on your hand.
Infection Prevention and Control is also
promoting "hand hygiene," an approach
that goes beyond keeping hands clean.
Training programs for Region staff focus on
when to wash the hands and when to use
an alcohol-based hand rub (sanitizer).
The Region has placed dispensers of
alcohol-based hand rub at the entrance of
every facility so that everybody coming in
to work or to visit can clean their hands
before they enter. "There's lots of research
to show that alcohol-based products in
health-care settings are the first line of
defence," Dyck says.
Promoting good hand hygiene and
respiratory etiquette has value beyond
preventing influenza. "It could be any type
of infection that's carried on the hands. We
want to prevent these kind of infections."
Of course, preventing the spread of
influenza is a tall order. "The reality is, it's
such a ubiquitous virus, it's very hard to
contain," says Routledge. "But that doesn't
mean we shouldn't be doing things to try
and prevent its spread."
Bob Armstrong is a Winnipeg writer.
Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.
Read the September / October 2010 issue of Wave