Can flu be treated?

Yes. There are prescription medications called “antiviral drugs” that can be used to treat flu illness. CDC recommends prompt treatment for people who have flu or suspected flu and who are at higher risk of serious flu complications, such as people with asthma, diabetes (including gestational diabetes), or heart disease.

What are flu antiviral drugs?

Flu antiviral drugs are prescription medicines (pills, liquid, an inhaled powder, or an intravenous solution) that fight against flu viruses in your body. Antiviral drugs are not sold over the counter. You can only get them if you have a prescription from a health care provider. Antiviral drugs are different from antibiotics, which fight against bacterial infections. Antiviral drugs for flu only work to treat flu. Flu antiviral drugs are different than antiviral drugs used to treat other infectious diseases such as COVID-19. Antiviral drugs prescribed to treat COVID-19 are not approved or authorized to treat flu.

What should I do if I think I am sick with flu?

If you get sick with flu, antiviral drugs are a treatment option. Check with your doctor promptly if you are at higher risk of serious flu complications (full list of higher risk factors) and you develop flu symptoms. Flu signs and symptoms can include feeling feverish or having a fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. However, not everyone with the flu has a fever. Your doctor may prescribe antiviral drugs to treat your flu illness.

Should I still get a flu vaccine?

Yes. Antiviral drugs are not a substitute for getting a flu vaccine. While flu vaccine can vary in how well it works, a flu vaccine is best way to help prevent seasonal flu and its potentially serious complications. Everyone 6 months and older should receive a flu vaccine every year. Antiviral drugs are a second line of defense that can be used to treat flu (including seasonal flu and variant flu viruses) if you get sick.

What are the benefits of antiviral drugs?

When treatment is started within two days of becoming sick with flu symptoms, antiviral drugs can lessen fever and flu symptoms and shorten the time you are sick by about one day. They also may reduce the risk of complications such as ear infections in children, respiratory complications requiring antibiotics, and hospitalization in adults. For people at higher risk of serious flu complications, early treatment with an antiviral drug can mean having milder illness instead of more severe illness that might require a hospital stay. For adults hospitalized with flu illness, some studies have reported that early antiviral treatment can reduce their risk of death.

When should antiviral drugs be taken for treatment?

Antiviral treatment provides the greatest benefit when started soon after flu illness begins. Studies show that flu antiviral drugs work best for treatment when they are started within two days of getting sick. However, starting them later can still be beneficial, especially if the sick person is at higher risk of serious flu complications or is in the hospital with more severe illness.  Follow instructions for taking these drugs. Follow your doctor’s instructions and the dose, frequency, and duration listed on the label instructions for taking these drugs.

What antiviral drugs are recommended this flu season?

There are four FDA-approved antiviral drugs recommended by CDC to treat flu this season.

• oseltamivir phosphate (available as a generic version or under the trade name Tamiflu®),
• zanamivir (trade name Relenza®)
• peramivir (trade name Rapivab®), and
• baloxavir marboxil (trade name Xofluza®).

Generic oseltamivir and Tamiflu® are available as a pill or liquid suspension and are FDA approved for early treatment of flu in people 14 days and older.

Zanamivir is a powdered medication that is inhaled and approved for early treatment of flu in people 7 years and older. (Note: Zanamivir (trade name Relenza®) is administered using an inhaler device and is not recommended for people with breathing problems like asthma or COPD.) Oseltamivir and zanamivir are given twice a day for five days.

Peramivir is given once intravenously by a health care provider and is approved for early treatment of flu in people 6 months and older.

Baloxavir is a pill given as a single dose by mouth and is approved for early treatment of flu in children aged 5 years to less than 12 years who do not have any chronic medical conditions, and for all people aged 12 years and older. (Note: Baloxavir (trade name Xofluza®) is not recommended for treatment of flu in pregnant people, lactating  people, or in outpatients with complicated or progressive illness because there is no information about use of baloxavir in these patients. Baloxavir is also not recommended for treatment of flu in hospitalized patients due to limited data.)

How long should antiviral drugs be taken?

To treat flu, oseltamivir or inhaled zanamivir are usually prescribed for five days, while one dose of intravenous peramivir or one dose of oral Baloxavir are usually prescribed.  Oseltamivir treatment is given to hospitalized patients, and some patients might be treated for more than five days.

What are the possible side effects of antiviral drugs?

Side effects vary for each medication. The most common side effects for oseltamivir are nausea and vomiting. Zanamivir can cause bronchospasm, and peramivir can cause diarrhea. Other less common side effects also have been reported. Your health care provider can give you more information about these drugs or you can check the Food and Drug Administration (FDA) website for specific information about antiviral drugs, including the manufacturer’s package insert.

Can pregnant people take antiviral drugs?

Yes. Oral oseltamivir is recommended for treatment of pregnant people with flu because compared to other recommended antiviral medications, it has the most studies available to suggest that it is safe and beneficial during pregnancy. Baloxavir is not recommended for pregnant people or while breastfeeding, as there are no available efficacy or safety data.

Who should take antiviral drugs?

It’s very important that flu antiviral drugs are started as soon as possible to treat patients who are hospitalized with flu, people who are very sick with flu but who do not need to be hospitalized, and people who are at higher risk of serious flu complications based on their age or health, if they develop flu symptoms. Although other people with mild illness who are not at higher risk of flu complications may also be treated early with antiviral drugs by their doctor, most people who are otherwise healthy and not at higher risk for flu complications do not need to be treated with antiviral drugs.

Following is a list of all the health and age factors that are known to increase a person’s risk of getting serious complications from the flu:

• Asthma
• Neurologic and neurodevelopment conditions
• Blood disorders (such as sickle cell disease)
• Chronic lung disease (such a chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
• Endocrine disorders (such as diabetes mellitus)
• Heart disease (such a congenital heart disease, congestive heart failure and coronary artery disease)
• Kidney disorders
• Liver disorders
• Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
• People who are obese with a body mass index [BMI] of 40 or higher
• People younger than 19 years of age on long-term aspirin- or salicylate-containing medications.
• People with a weakened immune system due to disease (such as people with HIV or AIDS, or some cancers such as leukemia) or medications (such as those receiving chemotherapy or radiation treatment for cancer, or persons with chronic conditions requiring chronic corticosteroids or other drugs that suppress the immune system)

Other people at higher risk from flu:

• Adults 65 years and older
• Children younger than 2 years old
• Pregnant women and women up to 2 weeks after the end of pregnancy
• People from certain racial and ethnic minority groups, including non-Hispanic Black, Hispanic or Latino, and American Indiana or Alaska Native persons
• People who live in nursing homes and other long-term care facilities.
• Although all children younger than 5 years old are considered at higher risk for serious flu complications, the highest risk is for those younger than 2 years old, with the highest hospitalization and death rates among infants younger than 6 months old.

To learn more, please visit https://www.cdc.gov/flu/treatment/whatyoushould.htm.

Person to Person

People with flu can spread it to others. Most experts think that flu viruses spread mainly by droplets made when people with flu cough, sneeze, or talk. These droplets can land in the mouths or noses of people who are nearby (usually within about 6 feet away) or possibly be inhaled into the lungs. Less often, a person might get flu by touching a surface or object that has flu virus on it and then touching their own mouth, nose, or possibly their eyes.

When Are People with Flu Contagious?

Flu viruses can be detected in most infected persons beginning one day before symptoms develop and up to five to seven days after becoming sick. People with flu are most contagious in the first three to four days after their illness begins. However, infants and people with weakened immune systems who are infected with flu viruses may be contagious for longer than seven days.

Symptoms typically begin about two days (but can range from one to four days) after flu viruses infect a person’s respiratory tract. It is theoretically possible that before symptoms begin, an infected person can spread flu viruses to their close contacts. Some people can be infected with flu viruses and have no symptoms but may still be able to spread the virus to their close contacts.

To learn more, please visit https://www.cdc.gov/flu/about/disease/spread.htm.

Getting an annual flu vaccine is the best way to protect yourself and your loved ones from flu.

If you are at higher risk of developing serious flu complications, flu vaccination is especially important. When you get vaccinated, you reduce your risk of getting sick with flu and possibly being hospitalized or dying from flu.

Following is a list of all the health and age factors that are known to increase a person’s risk of getting serious flu complications:

• Adults 65 years and older
• Children younger than 2 years old¹
• Asthma
• Neurologic and neurodevelopment conditions
• Blood disorders (such as sickle cell disease)
• Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
• Endocrine disorders (such as diabetes mellitus)
• Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
• Kidney diseases
• Liver disorders
• Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
• People who are obese with a body mass index [BMI] of 40 or higher
• People younger than 19 years old on long-term aspirin- or salicylate-containing medications.
• People with a weakened immune system due to disease (such as people with HIV or AIDS, or some cancers such as leukemia) or medications (such as those receiving chemotherapy or radiation treatment for cancer, or persons with chronic conditions requiring chronic corticosteroids or other drugs that suppress the immune system)
• People who have had a stroke

Other people at higher risk from flu:

• Pregnant people and people up to 2 weeks after the end of pregnancy
• People who live in nursing homes and other long-term care facilities
• People from certain racial and ethnic minority groups are at increased risk for hospitalization with flu, including non-Hispanic Black persons, Hispanic or Latino persons, and American Indian or Alaska Native persons
• ¹ Although all children younger than 5 years old are considered at higher risk of serious flu complications, the highest risk is for those younger than 2 years old, with the highest hospitalization and death rates among infants younger than 6 months old.

Information on groups at higher risk from COVID-19 is available.

To learn more information, please visit https://www.cdc.gov/flu/highrisk/index.htm.

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Martha came to Boyd Nursing and Rehab for Physical and Occupational Therapy services following a knee replacement. With her happy and sociable personality, she set herself apart from typical orthopedic recoveries, resilient to the intense rehab that she received during her short stay. Mrs. Rice was able to meet her rehabilitation goals and discharge home with family prior to the holidays requiring only supervision assistance! Congratulations to Martha and her Care Team on their success!

Misconceptions about Flu Vaccines

Can a flu vaccine give you flu?

No, flu vaccines cannot cause flu illness. Flu vaccines given with a needle (i.e., flu shots) are made with either inactivated (killed) viruses, or with only a single protein from the flu virus.  The nasal spray vaccine contains live viruses that are attenuated (weakened) so that they will not cause illness.

Are any of the available flu vaccines recommended over the others?

Yes, for some people. For the 2022-2023 flu season, there are three flu vaccines that are preferentially recommended for people 65 years and older. These are Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant  flu vaccine and Fluad Quadrivalent adjuvanted flu vaccine. This recommendation was based on a review of available studies which suggests that, in this age group, these vaccines are potentially more effective than standard dose unadjuvanted flu vaccines. There is no preferential recommendation for people younger than 65 years.

What if a preferentially recommended flu vaccine is not available?

If none of the three flu vaccines preferentially recommended for people 65 years and older is available at the time of administration, people in this age group should get any other age-appropriate flu vaccine instead.

Is it better to get sick with flu than to get a flu vaccine?

No. Flu can be a serious disease, particularly among young children, older adults, and people with certain chronic health conditions, such as asthma, heart disease or diabetes. Any flu infection can carry a risk of serious complications, hospitalization or death, even among otherwise healthy children and adults. Therefore, getting vaccinated is a safer choice than risking illness to obtain immune protection.

Do I really need a flu vaccine every year?

Yes. CDC recommends a yearly flu vaccine for everyone 6 months of age and older with rare exception. The reason for this is that a person’s immune protection from vaccination declines over time, so an annual vaccination is needed to get the “optimal” or best protection against the flu. Additionally, flu viruses are constantly changing, so the vaccine composition is reviewed each year and updated as needed.

Why do some people not feel well after getting a seasonal flu vaccine?

Some people report having mild side effects after flu vaccination. The most common side effects from flu shots are soreness, redness, tenderness or swelling where the shot was given. Low-grade fever, headache and muscle aches also may occur. If these reactions occur, they usually begin soon after vaccination and last 1-2 days.

Side effects from the nasal spray flu vaccine may include: runny nose, wheezing, headache, vomiting, muscle aches, fever, sore throat and cough. If these problems occur, they usually begin soon after vaccination and are mild and short-lived. The most common reactions people have to flu vaccines are considerably less severe than the symptoms caused by actual flu illness.

• Carolyn Bridges et al. (2000). Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A randomized controlled trial.

What about serious reactions to flu vaccine?

Serious allergic reactions to flu vaccines are very rare. If they do occur, it is usually within a few minutes to a few hours after vaccination. While these reactions can be life-threatening, effective treatments are available.

What about people who get a seasonal flu vaccine and still get sick with flu symptoms?

There are several reasons why someone might get flu symptoms even after they have been vaccinated against flu.

• Someone can get sick with another respiratory virus besides flu such as rhinoviruses or SARS-CoV-2 (the virus that causes COVID-19). Other respiratory viruses can cause symptoms similar to flu, and they can also spread and cause illness during flu season. Flu vaccines only protect against flu and its complications, not other illnesses.
• Someone can be exposed to flu viruses shortly before getting vaccinated or during the two-week period after vaccination that it takes the body to develop immune protection. This exposure may result in a person becoming sick with flu before protection from vaccination takes effect.
• Flu vaccines vary in how well they work, and someone can get vaccinated but still get sick with flu. There are many different flu viruses that spread and cause illness among people, so this can happen if someone is exposed to a flu virus that is very different from the viruses in the flu vaccine. The ability of a flu vaccine to protect a person depends partially on the similarity or “match” between the vaccine viruses chosen to make vaccine and those spreading and causing illness. Even when that happens though, flu vaccination can still reduce severity of illness.

Can vaccinating someone twice provide added immunity?

In adults, studies have not shown a benefit from getting more than one dose of vaccine during the same influenza season, even among elderly persons with weakened immune systems. Except for children getting vaccinated for the first time, only one dose of flu vaccine is recommended each season.

Is it true that getting a flu vaccine can make you more susceptible to other respiratory viruses?

Flu vaccines are not thought to make people more susceptible to other respiratory infections.

A 2012 study that suggested that flu vaccination might make people more susceptible to other respiratory infections. After that study was published, many experts looked into this issue further and conducted additional studies to see if the findings could be replicated. No other studies have found this effect. It’s not clear why this finding was detected in the one study, but the majority of evidence suggests that this is not a common or regular occurrence and that flu vaccination does not, in fact, make people more susceptible to other respiratory infections.

• Maria Sundaram et al. (2013). Influenza Vaccination Is Not Associated With Detection of Noninfluenza Respiratory Viruses in Seasonal Studies of Influenza Vaccine Effectiveness.

Does a flu vaccination increase your risk of getting COVID-19?

There is no evidence that getting a flu vaccination increases your risk of getting sick from a coronavirus, like the one that causes COVID-19.

You may have heard about a study published in January 2020 that reported an association between flu vaccination and risk of four commonly circulating seasonal coronaviruses, but not the one that causes COVID-19. This report was later found to be incorrect.

The results from that initial study led researchers in Canada to look at their data to see if they could find similar results in their population. The results from this study showed that flu vaccination did not increase risk for these seasonal coronaviruses. The Canadian findings highlighted the protective benefits of flu vaccination.

The Canadian researchers also identified a flaw in the methods of the first study, noting that it violated the part of study design that compares vaccination rates among patients with and without flu (test negative design). This flaw led to the incorrect association between flu vaccination and seasonal coronavirus risk. When these researchers reexamined data from the first study using correct methods, they found that flu vaccination did not increase risk for infection with other respiratory viruses, including seasonal coronaviruses.

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Misconceptions about Flu Vaccine Effectiveness

Influenza (flu) vaccine effectiveness (VE) can vary. The protection provided by a flu vaccine varies from season to season and depends in part on the age and health status of the person getting the vaccine and the similarity or “match” between the viruses in the vaccine and those in circulation. During years when the flu vaccine match is good, it is possible to measure substantial benefits from flu vaccination in terms of preventing flu illness and complications. However, the benefits of flu vaccination will still vary, depending on characteristics of the person being vaccinated (for example, their health and age), what flu viruses are circulating that season and, potentially, which type of flu vaccine was used. More information is available at Vaccine Effectiveness – How well does the Flu Vaccine Work.

Below is a summary of the benefits of flu vaccination and selected scientific studies that support these benefits.

• Flu vaccination can keep you from getting sick with flu.
  • Flu vaccine prevents millions of illnesses and flu-related doctor’s visits each year. For example, during 2019-2020, the last flu season prior to the COVID-19 pandemic, flu vaccination prevented an estimated 7.5 million influenza illnesses, 3.7 million influenza-associated medical visits, 105,000 influenza-associated hospitalizations, and 6,300 influenza-associated deaths.
  • During seasons when flu vaccine viruses are similar to circulating flu viruses, flu vaccine has been shown to reduce the risk of having to go to the doctor with flu by 40% to 60%.
• Flu vaccination has been shown in several studies to reduce severity of illness in people who get vaccinated but still get sick.
  • A 2021 study showed that among adults hospitalized with flu, vaccinated patients had a 26% lower risk of intensive care unit (ICU) admission and a 31% lower risk of death from flu compared with those who were unvaccinated.
  • A 2018 study showed that among adults hospitalized with flu, vaccinated patients were 59% less likely to be admitted to the ICU than those who had not been vaccinated. Among adults in the ICU with flu, vaccinated patients on average spent four fewer days in the hospital than those who were not vaccinated.
• Flu vaccination can reduce the risk of flu-associated hospitalization.
  • Flu vaccine prevents tens of thousands of hospitalizations each year. For example, during 2019-2020 flu vaccination prevented an estimated 105,000 flu-related hospitalizations.
  • A 2018 study showed that from 2012 to 2015, flu vaccination among adults reduced the risk of being admitted to an ICU with flu by 82%.
  • A 2017 study found that during 2009-2016, flu vaccines reduced the risk of flu-associated hospitalization among older adults by about 40% on average.
  • A 2014 study showed that flu vaccination reduced children’s risk of flu-related pediatric intensive care unit (PICU) admission by 74% during flu seasons from 2010-2012.
• Flu vaccination is an important preventive tool for people with certain chronic health conditions.
  • Flu vaccination has been associated with lower rates of some cardiac events among people with heart disease, especially among those who have had a cardiac event in the past year.
  • Flu vaccination can reduce the risk of a flu-related worsening of chronic lung disease (for example, chronic obstructive pulmonary disease (COPD) requiring hospitalization).
  • Among people with diabetes and chronic lung disease,flu vaccination has been shown in separate studies to be associated with reduced hospitalizations from a worsening of their chronic condition.
• Flu vaccination during pregnancy helps protect pregnant people from flu during and after pregnancy and helps protect their infants from flu in their first few months of life.
  • A 2013 study showed that during the 2010–2011 and 2011–2012 flu seasons vaccination reduced the risk of flu-associated acute respiratory infection in pregnant people by about one-half.
  • A 2018 study showed that getting a flu shot reduced a pregnant person’s risk of being hospitalized with flu by an average of 40% from 2010-2016.
  • A number of studies have shown that in addition to helping to protect pregnant people from flu, a flu vaccine given during pregnancy helps protect the baby from flu for several months after birth, when babies are too young to be vaccinated.
• Flu vaccine can be lifesaving in children.
  • A 2022 study showed that flu vaccination reduced children’s risk of severe life-threatening influenza by 75%.
  • A 2020 study found that during the 2018-2019 flu season, flu vaccination reduced flu-related hospitalization by 41% and flu-related emergency department visits by half among children (aged 6 months to 17 years old).
  • A 2017 study was the first of its kind to show that flu vaccination can significantly reduce children’s risk of dying from flu.
• Getting vaccinated yourself may also protect people around you, including those who are more vulnerable to serious flu illness, like babies and young children, older people, and people with certain chronic health conditions.

Despite the many benefits offered by flu vaccination, only about half of Americans get an annual flu vaccine. During an average flu season, flu can cause millions of illnesses, hundreds of thousands of hospitalizations and tens of thousands of deaths. Many more people could be protected from flu if more people got vaccinated.

*References for the studies listed above can be found at Publications on Influenza Vaccine Benefits.

Misconceptions about the Timing of Seasonal Influenza Vaccination

Should I wait to get vaccinated so that my immunity lasts through the end of the season?

How long you are immune or your “duration of immunity” is discussed in the ACIP recommendations. While delaying getting of vaccine until later in the fall may lead to higher levels of immunity during winter months, this should be balanced against possible risks, such as missed opportunities to receive vaccine and difficulties associated with vaccinating a large number of people within a shorter time period.

Is it too late to get vaccinated after Thanksgiving (or the end of November)?

No. Vaccination can still be beneficial as long as flu viruses are circulating. If you have not been vaccinated by Thanksgiving (or the end of November), it can still be protective to get vaccinated in December or later. Flu is unpredictable and seasons can vary. Seasonal flu disease usually peaks between December and March most years, but disease can occur as late as May.

Misconceptions about Physician Consent for Vaccination

Do pregnant people or people with pre-existing medical conditions need special permission or written consent from their doctor to get a flu vaccine?

No. There is no recommendation for pregnant people or people with pre-existing medical conditions to seek special permission or secure written consent from their doctor for vaccination if they get vaccinated at a worksite clinic, pharmacy or other location outside of their physician’s office. With rare exception, CDC recommends an annual flu vaccine for everyone 6 months of age and older, including pregnant people and people with medical conditions.

A variety of flu vaccines are available (Table 1). Vaccine providers should be aware of the approved age indications of the vaccine they are using and of any contraindications or precautions. Providers also should appropriately screen all people getting vaccinated for allergies to vaccine components or other contraindications. People who have previously had a severe allergic reaction to influenza vaccine or any of its ingredients should generally not be vaccinated.

There are some people who should not get a flu vaccine without first speaking with their doctor. These include:

• People who have a moderate-to-severe illness with or without a fever (they should wait until they recover to get vaccinated), and
• People with a history of Guillain-Barré Syndrome (a severe paralytic illness, also called GBS) that occurred after receiving influenza vaccine and who are not at risk for severe illness from influenza should generally not receive vaccine. Tell your doctor if you ever had Guillain-Barré Syndrome. Your doctor will help you decide whether the vaccine is recommended for you.

Pregnant people or people with pre-existing medical conditions who get vaccinated should get a flu shot.

If a person is vaccinated by someone other than their primary health care provider, the vaccinating provider should ensure that the patient and, if possible, the patient’s medical provider have documentation of vaccination.

For a complete list of people who should not get a flu vaccine before speaking with their doctor, please review the influenza Vaccine Information Statement for the inactivated or recombinant flu vaccine or live, intranasal influenza vaccine.

Misconceptions about “Stomach Flu”

Is the “stomach flu” really flu?

No. Many people use the term “stomach flu” to describe illnesses with nausea, vomiting or diarrhea. These symptoms can be caused by many different viruses, bacteria or even parasites. While vomiting, diarrhea, and being nauseous or “sick to your stomach” can sometimes be related to flu — more commonly in children than adults — these problems are rarely the main symptoms of influenza. Flu is a respiratory disease and not a stomach or intestinal disease.

To learn more, please visit https://www.cdc.gov/flu/prevent/misconceptions.htm.

What should I do if I get sick?

Most people with flu have mild illness and do not need medical care or antiviral drugs. If you get sick with flu symptoms, in most cases, you should stay home and avoid contact with other people except to get medical care.

If, however, you have symptoms of flu and are in a higher-risk group, or are very sick or worried about your illness, contact your health care provider (doctor, physician assistant, etc.).

Certain people are at increased risk of serious flu-related complications (including young children, people 65 and older, pregnant people, and people with certain medical conditions). For a full list of people at increased risk of flu-related complications, see People at Higher Risk of Developing Flu–Related Complications. If you are in a higher-risk group and develop flu symptoms, it’s best for you to contact your doctor early in your illness. Remind them about your higher-risk status for flu. CDC recommends that people at higher risk for complications should get antiviral treatment as early as possible, because benefit is greatest if treatment is started within 2 days after illness onset.

Do I need to go to the emergency room if I am only a little sick?

No. The emergency room should be used for people who are very sick. You should not go to the emergency room if you are only mildly ill.

If you have emergency warning signs of flu sickness, you should go to the emergency room. If you get sick with flu symptoms and are at higher risk of flu complications or you are concerned about your illness, call your health care provider for advice.

What are emergency warning signs of flu?

People experiencing any of these warning signs should obtain medical care right away.

In children

• Fast breathing or trouble breathing
• Bluish lips or face
• Ribs pulling in with each breath
• Chest pain
• Severe muscle pain (child refuses to walk)
• Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
• Not alert or interacting when awake
• Seizures
• Fever above 104°F
• In children less than 12 weeks, any fever
• Fever or cough that improve but then return or worsen
• Worsening of chronic medical conditions

In adults

• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest or abdomen
• Persistent dizziness, confusion, inability to arouse
• Seizures
• Not urinating
• Severe muscle pain
• Severe weakness or unsteadiness
• Fever or cough that improve but then return or worsen
• Worsening of chronic medical conditions

These lists are not all inclusive. Please consult your medical provider for any other symptom that is severe or concerning.

Are there medicines to treat flu?

Yes. There are drugs your doctor may prescribe for treating flu called “antivirals.” These drugs can make you better faster and may also prevent serious complications. See Treatment – Antiviral Drugs for more information.

How long should I stay home if I’m sick?

CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or other necessities. Your fever should be gone without the need to use a fever-reducing medicine, such as Tylenol®. Until then, you should stay home from work, school, travel, shopping, social events, and public gatherings.

CDC also recommends that children and teenagers (anyone aged 18 years and younger) who have flu or are suspected to have flu should not be given Aspirin (acetylsalicylic acid) or any salicylate containing products (e.g. Pepto Bismol); this can cause a rare, very serious complication called Reye’s syndrome. More information about Reye’s syndrome can be found here.

What should I do while I’m sick?

Stay away from others as much as possible to keep from infecting them. If you must leave home, for example to get medical care, wear a facemask if you have one, or cover coughs and sneezes with a tissue. Wash your hands often to keep from spreading flu to others.

To learn more, please visit https://www.cdc.gov/flu/treatment/takingcare.htm.

CDC Director Rochelle P. Walensky, M.D., M.P.H., adopted the Advisory Committee on Immunization Practices’ (ACIP) recommendation to preferentially recommend the use of specific flu vaccines for adults 65 years and older, including higher dose and adjuvanted flu vaccines. The preference applies to Fluzone High-Dose Quadrivalent, Flublok Quadrivalent and Fluad Quadrivalent flu vaccines.

While flu seasons vary in severity, during most seasons, people 65 years and older bear the greatest burden of severe flu disease, accounting for the majority of flu-related hospitalizations and deaths. Additionally, changes in the immune system with age mean that older adults often do not have as strong an immune response to vaccination as younger, healthy people. “Given their increased risk of flu-associated severe illness, hospitalization, and death, it’s important to use these potentially more effective vaccines in people 65 years and older,” said José R. Romero, M.D., Director of CDC’s National Center for Immunization and Respiratory Diseases. Additionally, data has shown that racial and ethnic health disparities exist in populations that receive a high-dose flu vaccine compared with standard-dose flu vaccines. “This recommendation could help reduce health disparities by making these vaccines more available to racial and ethnic minority groups,” said Dr. Romero.

ACIP voted to preferentially recommend the use of higher dose flu or adjuvanted flu vaccines over standard-dose unadjuvanted flu vaccines for people 65 years and older. This recommendation was based on a review of available studies which suggests that, in this age group, these vaccines are potentially more effective than standard dose unadjuvanted flu vaccines. Dr. Walensky’s adoption of the ACIP recommendation makes this recommendation official CDC policy, which will be further detailed in an upcoming Morbidity and Mortality Weekly Recommendation Report later this summer.

In recent years, CDC has not recommended any one flu vaccine over another for any age group, and there is still no preferential recommendation for people younger than 65. People 65 and older should try to get one of the three preferentially recommended vaccines, however, if one of these vaccines is not available at the time of administration, people in this age group should get a standard-dose flu vaccine instead.

To learn more, please visit https://www.cdc.gov/media/releases/2022/s0630-seniors-flu.html.

Flu Symptoms

Influenza (flu) can cause mild to severe illness, and at times can lead to death. Flu symptoms usually come on suddenly. People who have flu often feel some or all of these symptoms:

• fever* or feeling feverish/chills
• cough
• sore throat
• runny or stuffy nose
• muscle or body aches
• headaches
• fatigue (tiredness)
• some people may have vomiting and diarrhea, though this is more common in children than adults.

*It’s important to note that not everyone with flu will have a fever.

More information is available at  Flu and COVID-19 symptoms.

Flu Complications

Most people who get flu will recover in a few days to less than two weeks, but some people will develop complications (such as pneumonia) as a result of flu, some of which can be life-threatening and result in death.

Sinus and ear infections are examples of moderate complications from flu, while pneumonia is a serious flu complication that can result from either flu virus infection alone or from co-infection of flu virus and bacteria. Other possible serious complications triggered by flu can include inflammation of the heart (myocarditis), brain (encephalitis) or muscle tissues (myositis, rhabdomyolysis), and multi-organ failure (for example, respiratory and kidney failure). Flu virus infection of the respiratory tract can trigger an extreme inflammatory response in the body and can lead to sepsis, the body’s life-threatening response to infection. Flu also can make chronic medical problems worse. For example, people with asthma may experience asthma attacks while they have flu, and people with chronic heart disease may experience a worsening of this condition triggered by flu.

People at Higher Risk from Flu

Anyone can get sick with flu, even healthy people, and serious problems related to flu can happen to anyone at any age, but some people are at higher risk of developing serious flu-related complications if they get sick. This includes people 65 years and older, people of any age with certain chronic medical conditions (such as asthma, diabetes, or heart disease), pregnant people and children younger than 5 years, but especially those younger than 2 years old.

Cold Vs. Flu

Signs and Symptoms	Cold	Influenza (Flu)
Symptom onset	Gradual	Abrupt
Fever	Rare	Common; lasts 3-4 days
Aches	Slight	Common; often severe
Chills	Uncommon	Fairly common
Fatigue, weakness	Sometimes	Usual
Sneezing	Common	Sometimes
Chest discomfort, cough	Mild to moderate; hacking cough	Common; can be severe
Stuffy nose	Common	Sometimes
Sore throat	Common	Sometimes
Headache	Rare	Common

Emergency Warning Signs of Flu Complications

People experiencing these warning signs should obtain medical care right away.

In Children

• Fast breathing or trouble breathing
• Bluish lips or face
• Ribs pulling in with each breath
• Chest pain
• Severe muscle pain (child refuses to walk)
• Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
• Not alert of interacting when awake
• Seizures
• Fever above 104 degrees Fahrenheit that is not controlled by fever-reducing medicine
• Worsening of chronic medical conditions

In Adults

• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest or abdomen
• Persistent dizziness, confusion, inability to arouse
• Seizures
• Not urinating
• Severe muscle pain
• Severe weakness or unsteadiness
• Fever or cough that improve but then return or worsen
• Worsening of chronic medical conditions

These lists are not all inclusive. Please consult your medical provider for any other symptom that is severe or concerning.

To learn more, please visit https://www.cdc.gov/flu/symptoms/symptoms.htm.

People 65 years and older are at higher risk of developing serious flu complications compared with young, healthy adults. This increased risk is due in part to changes in immune defenses with increasing age. While flu seasons vary in severity, during most seasons, people 65 years and older bear the greatest burden of severe flu disease. In recent years, for example, it’s estimated that between 70 percent and 85 percent of seasonal flu-related deaths have occurred in people 65 years and older, and between 50 percent and 70 percent of seasonal flu-related hospitalizations have occurred among people in this age group.

A Flu Vaccine is the Best Protection Against Flu

Flu vaccination has many benefits. It has been shown to reduce the risk of getting sick with flu and also to reduce the risk of more serious flu outcomes that can result in hospitalization or even death. Although immune responses to vaccination may lower in older people, studies have consistently found that flu vaccination has been effective in reducing the risk of medical visits and hospitalizations in older people. Higher dose and adjuvanted flu vaccines are potentially more effective than standard dose of unadjuvanted flu vaccines for people in this age group and are therefore recommended preferentially over a regular dose flu vaccine.

The best way to protect against flu and its potentially serious complications is with a flu vaccine.  Flu vaccines are updated each season because flu viruses are constantly changing. Also, immunity wanes over time. Annual vaccination helps to ensure the best possible protection against flu. A flu vaccine protects against the flu viruses that research indicates will be most common during the upcoming season. (More information about this season’s exact vaccine composition is available at Vaccine Virus Selection.) Flu vaccines for the 2022-2023 flu season have been updated from last season’s vaccine to better match circulating viruses. Immunity from vaccination fully sets in after about two weeks.

Flu vaccination is especially important for people 65 years and older because they are at higher risk of developing serious flu complications. Three specific flu vaccines are preferentially recommended for people 65 years and older over other flu vaccines. People 65 and older should get a higher dose or adjuvanted flu vaccine, including: Fluzone High-Dose Quadrivalent, Flublok Quadrivalent, or Fluad Quadrivalent vaccine. These vaccines are preferred for people 65 years and older because a review of existing studies suggested that, in this age group, these vaccines are potentially more effective than standard dose unadjuvanted flu vaccines.

When should I get vaccinated?

For most people who need only one dose of flu vaccine for the season, September and October are generally good times to be vaccinated against flu. Ideally, everyone should be vaccinated by the end of October. Additional considerations concerning the timing of vaccination for certain groups of people include:

• Most adults, especially those 65 years and older, and pregnant people in the first or second trimester should generally not get vaccinated early (in July or August) because protection may decrease over time. However, early vaccination can be considered for any person who is unable to return at a later time to be vaccinated.
• Some children need two doses of flu vaccine. For those children it is recommended to get the first dose as soon as vaccine is available, because the second dose needs to be given at least four weeks after the first. Vaccination during July and August also can be considered for children who need only one dose.
• Vaccination during July and August also can be considered for people who are in the third trimester of pregnancy during those months, because this can help protect their infants for the first few months after birth (when they are too young to be vaccinated).

Specific Flu Shots for People 65 and Older

For the 2022-2023 season, CDC and ACIP preferentially recommend the use of higher-dose flu vaccines (Fluzone High-Dose Quadrivalent inactivated influenza vaccine and Flublok Quadrivalent flu vaccine) or adjuvanted flu vaccine (Fluad Quadrivalent vaccine) over standard-dose unadjuvanted flu vaccines for people 65 years and older. This recommendation is based on a review of available studies which suggests that, in this age group, these vaccines are potentially more effective than standard dose unadjuvanted flu vaccines. More information is available at Flu Vaccines Worked Better than Initially Estimated this Past Season & CDC’s Advisory Council Recommends Specific Flu Vaccines for Seniors. If one of these vaccines is not available at the time of administration, people in this age group should get a standard-dose unadjuvanted inactivated flu vaccine instead. There are other flu vaccines approved for use in people 65 years and older. People 65 years and older should not get a nasal spray vaccine. More information about preferentially recommended flu vaccines is below:

Symptoms and Treatment

Because you are at higher risk of developing serious flu complications, if you get flu symptoms, call your health care provider right away. There are antiviral drugs that can treat flu illness and prevent serious flu complications. CDC recommends prompt treatment with a flu antiviral medication for people who have flu or suspected flu infection and who are at higher risk of serious flu complications.

Symptoms:
Flu symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people may also have vomiting and diarrhea, though this is more common in children than in adults. People may be infected with flu and have respiratory symptoms without a fever.

Treatment:

• Influenza antiviral drugs are medicines that fight against flu by keeping flu viruses from making more viruses in your body.
• Antiviral drugs can make your flu illness milder and make you feel better faster. They may also prevent serious health problems that can result from flu illness.
• Treatment with an influenza antiviral drug should begin as soon as possible because these medications work best when started early (within 48 hours after symptoms start).
• You need a prescription from a health care provider for an influenza antiviral medication.
• There are four FDA-approved flu antiviral drugs recommended by CDC this season that can be used to treat the flu.

Other Preventive Actions

In addition to getting a flu shot, people 65 years and older should take the same everyday preventive actions CDC recommends for everyone, including avoiding people who are sick, covering coughs, and washing hands often.

To learn more, please visit https://www.cdc.gov/flu/highrisk/65over.htm.

CDC’s first full FluView report of the 2022-2023 flu season shows that while flu activity is relatively low overall, there are early increases happening in most of the country. Flu activity is highest and increasing the most in the southeast and south-central parts of the United States. This increased activity could signal an early start to flu season. CDC recommends that everyone 6 months and older get vaccinated each year, ideally by the end of October, but vaccination should continue as long as flu viruses may circulate. For people who live in a community where flu activity has already begun, there’s still time to be vaccinated. Most of the time flu activity peaks between December and February, although significant activity can last as late as May.

This week’s FluView report shows that the percentage of respiratory specimens testing positive for flu nationally has reach 3.3%. The percent positive ranges from about 10% in HHS Region 4 (the southeast of the country) to 0.2% in the northwestern part of the country. In Region 6 (the south-central part of the country) 5% of specimens tested positive for flu, followed by Region 9 (the south-west of the country and Hawaii and Guam) at 4%.

The report also shows data from the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) which tracks the percentage of people visiting outpatient health care providers or emergency departments for respiratory illness. Respiratory illness, also referred to as influenza-like illness (ILI), is defined as fever or couth or sore throat. ILI is already slightly above the national baseline of 2.5%. National and regional baselines indicate a statistically significant increase above the average percent of patient visits for ILI during weeks of low flu activity in previous seasons. This is a high level of ILI for this time of year and the first time that ILI has been above baseline at this time of year since the 2009 H1N1 flu pandemic.

It’s important to note that ILINet monitors symptoms of respiratory disease, not laboratory-confirmed flu, and will therefore capture respiratory illness visits due to infection with pathogens that can present with similar symptoms, including flu, the virus that causes COVID-19, and RSV. Other respiratory viruses are circulating at elevated levels in the United States at this time; therefore, it is important to evaluate data from ILINet and other symptom-based data in the context of other sources of surveillance data to obtain a complete and accurate picture of flu and other respiratory virus activity.

While the timing and severity of the upcoming flu season cannot be predicted, the United States has experienced little flu for the past two seasons. Reduced population immunity, particularly among young children who may never have had flu exposure or been vaccinated, could bring about a robust return of flu. CDC is particularly concerned about drops in flu vaccine coverage in the past two years among higher risk groups, including children and pregnant people. ILI visits at this time are highest among children 0-4 years, followed by people 5-24 years. Often flu activity first increases in children and then spreads to older age groups.

This week, CDC also reported three new pediatric deaths for the prior (2021-2022) flu season, bringing the season total to 43 pediatric deaths. This report further underscores the importance of vaccination among children. During most years, about 80% of pediatric flu deaths happen in children who have not been fully vaccinated.

More than 105 million doses of flu vaccine have been distributed in the United States at this time. You can find a flu vaccine by visiting vaccines.gov and entering your zip code.

To learn more, please visit https://www.cdc.gov/flu/spotlights/2022-2023/early-flu-activity.htm