The Five: HCV Myth Busters —Alan Franciscus, Editor-in-Chief

Ever since I’ve been working in hepatitis C there have been many, many myths about hepatitis C.  Thankfully, some of the myths have disappeared, but unfortunately, many still linger.  I have included the most common myths I still hear, but these are by no means all of the myths circulating out there! 

 

1. Myth: Hepatitis C is a death sentence! 
Fact: When someone is newly diagnosed with hepatitis C, one of the first questions he or she asks themselves is this question.  Yes, too many people die from hepatitis C but it is not necessarily hepatitis C that is killing people—the lack of diagnosis, medical care and treatment are responsible for all the deaths.  No one should die from hepatitis C!  If everyone with hepatitis C was diagnosed early on, received regular monitoring and was treated with HCV medications we would not see these many deaths that we see.   But of course, that is not reality so people are needlessly dying. 

2. Myth:  Genotype 1 is the ‘worst’ genotype!
Fact: Wrong!  As it turns out genotype 3 turns out to be the genotype that has the lower treatment response, and that seems to increase the chances of developing fatty liver. While the direct link between genotype 3 and fatty liver is not completely understood, it is known that when people with genotype 3 are cured the fatty liver is reduced and sometimes completely resolved.  It is well-known that fatty liver increases the rate of HCV disease progression that can lead to cirrhosis.  People with genotype 3 also have faster rates of disease progression. 

There may also be a link between genotype 3, insulin resistance and viral load, but more studies are needed. 

People with genotype 3 and cirrhosis have a much lower response rate with the two currently approved HCV medications—Sovaldi plus ribavirin and Daklinza plus Sovaldi.  More HCV medications are under development to meet this unmet medical need.

3. Myth: HCV has no symptoms!
Fact: Come on! Anyone who is living with hepatitis C can tell you that there are many symptoms from hepatitis C.  They may come on so gradually that some people with hepatitis C may not even notice that the symptoms are from hepatitis C.  When cured, however, the symptoms for the most part fade away.  The most common symptoms are fatigue.  The type of fatigue can be mild, moderate or severe.  It is difficult to measure some of the symptoms and that is the reason that they are many times dismissed.  There are many other symptoms such as muscle and joint pain, brain fog, skin problems, insomnia, and of course there can be some very severe symptoms and problems associated with hepatitis C.

4. Myth: There is a hepatitis C vaccine!
Fact: BIG FALSE! This myth is because people get hepatitis A, B, C confused and lump them all together.  There is a vaccine to protect against hepatitis A and hepatitis B.  But, don’t we wish there was a vaccine for hepatitis C?  There are also other confusing myths out there like:  “Isn’t that the one you get from eating bad food?”; “Isn’t hepatitis C that one when hepatitis A gets worse, turns into hepatitis B, gets even worse and turns into hepatitis C—all of these are myths.

Note:  It is important to remember, however, that people with hepatitis C should be vaccinated against hepatitis A and hepatitis B if they are not immune.  You don’t want to get another hepatitis virus on top of hepatitis C.

 
5. Myth: Hepatitis C is a sexually transmitted disease!
Fact: Hepatitis C is not classified as a sexually transmitted disease. It can be transmitted sexually, but it is uncommon among people who are in a stable long-term monogamous relationship.  In people who are not in a stable long-term monogamous relationship the risk of sexual transmission is higher.  If you fall within this group safer sex practices should be followed. 


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The Five: HCV Genotypes —Alan Franciscus, Editor-in-Chief

Originally Published June 15, 2015

This month’s column is about hepatitis C (HCV) genotypes.  I will discuss genotypes 1, 2, 3, 4, and 6.  You will notice that I am not discussing genotype 5 since it is discussed elsewhere in this issue. Genotype 7 is also not being discussed because only three people with genotype 7 have been identified—all found to be from the Democratic Republic of Congo.

According to the World Health Organization 130 – 150 million people worldwide have chronic hepatitis C and 350,000 – 500,000 die every year from complications of hepatitis C. 

As mentioned above there have been seven genotypes identified but there are likely more that have not yet been found or classified.  There is a 30 to 35% viral diversity or difference in the genetic make-up of the nucleotide sites of the virus that are used to classify them as different genotypes.  This viral diversity is what makes it so difficult to develop one drug to treat all of the genotypes.  There are new drugs called pan-genotypic that work on all of the genotypes that are being developed that might just produce high cure rates across all of the genotypes.  The viral diversity i.e. genotype is another reason why it is going to be difficult to develop a therapeutic or a protective vaccine.  There has been some early research that is encouraging.

All evidence points to that the hepatitis C virus originated in Africa and spread throughout Africa by various routes including the European colonization of Africa, unsafe medical practices to treat tropical diseases and various cultural practices.  HCV spread out of Africa occurred by way of the slave trade throughout the World, needle reuse, organ transplantation, unsafe medical practices, unscreened blood, and injection drug use, etc. 

Genotype 1
Genotype 1 is the most common genotype worldwide and accounts for approximately 46% of the total number of people with hepatitis C worldwide —83 million people.  The prevalence of genotype 1 expanded greatly during the 20th century due to unsafe blood product/organ transplantation, unsafe medical practices and injection drug use.

Countries with the highest prevalence include East Asia (32,082,000), South Asia (12,889,000), Southeast Asia (4,910,000), Western sub-Sahara Africa (4,427,000), Eastern Europe (4,023,000), Central Latin America (2,796,000), Central Asia (2,100,000)
 

Genotype 1 has two main subtypes 1a and 1b. Genotype 1a accounts for about 55% of those with genotype 1 in the U.S. and 45% of those with genotype 1b. HCV 1a is more difficult to treat than HCV genotype 1b.  The current standard of care for treating HCV genotype 1 can cure up to 90% to 100% of people who take the medications.  The current standard of care treatment is HARVONI and VIEKIRA PAK. 

Genotype 1 subtypes c through l have been identified but are uncommon

Genotype 2 
Genotype 2 is the 3rd most common genotype worldwide and is also the 3rd most common one in the United States.  The areas of highest prevalence of genotype 2 worldwide include central Latin America (754,000), high-income Asia Pacific (629,000), Southeast Asia (1,572,000), East Asia (8,444,000), Western sub-Saharan African (1,550,000) and western Europe (583,000). Genotype 2 accounts for more than 16.5 million people worldwide with hepatitis C. 

Genotype 2 spread through the slave trade from Africa to the Americas and through trade routes from the Africa, the America and Asia. 

The most common subtypes of genotype 2 are 2a, 2b, and 2c, so far there have been another 15 subtypes identified.

The standard of care for treating HCV genotype 2 is the combination of Sovaldi (sofosbuvir) plus ribavirin for a treatment duration of 12 weeks.  The cure rates are 88% to 97%. 

Genotype 3
Genotype 3 is the 2nd most common genotype in the United States and worldwide.  The areas with the highest prevalence of genotype 3 include Australasia (280,000), Central Asia (906,000), East Asia (5,762,000), Eastern Europe (1,881,000), High Income North America (492,000), and South Asia (39,706,000). The total number of people worldwide with genotype 3 is 54 million.

Genotype 3 has been found to exist for 200 years. Genotype 3 causes steatosis (fatty liver), insulin resistance (precursor of type 2 diabetes), and increases the risk of HCV disease progression and liver cancer.

So far there have been 10 genotype 3 subtypes identified—subtype 3a is the most common.

The current standard of care to treat genotype 3 is the combination of Sovaldi and ribavirin for a treatment period of 24 weeks.  The cure rates are up to 83%.   However, Sovaldi plus ribavirin doesn’t work as well in genotype 3 people with cirrhosis who are treatment experienced.  There are, however, very good treatment options (see article in this issue on Sovaldi, pegylated interferon and ribavirin) and many new drugs are being developed to treat genotype 3. 

Genotype 4
Genotype 4 is the 4th most common genotype worldwide and accounts for 90% (6,030,000) of the hepatitis C population in Egypt—The HCV population of Egypt is estimated at 6.7 million.  Africa and the Middle East account for the majority of genotype 4 infections.  Approximately 1% of the U.S. population has genotype 4.  Genotype 4 has many subtypes – a through o.

In Egypt the spread of hepatitis C genotype 4 was the result of a mass campaign in the 1960’s through the 1980’s to control schistosomiasis infection—a parasitic disease transferred by snails to humans wading in water while working in rice fields.  During the 1960’s through the 1980’s people infected with schistosomiasis were treated with drugs using unsterilized and re-used syringes.

The current standard of care for treating HCV genotype 4 is the combination of Sovaldi (sofosbuvir), pegylated interferon and ribavirin.  The treatment duration is 12 weeks and cure rates are up to 96%.  There are many drugs that have been developed to treat genotype 4—by AbbVie and Merck—that are likely to be approved in the near future.

Genotype 6
Genotype 6 is mostly seen in Southeast Asia.  The estimated number of people who are infected with genotype 6 is about 10,000,000—mostly in Asia. It is the most prevalent genotype in Laos and one of the most common genotypes in Vietnam.  Genotype 6 is seen in countries outside of Asia, but mainly in populations that have emigrated from Asian countries.

Genotype 6a is the most common, but there been 26 subtypes identified so far.

There is no standard of care to treat genotype 6.  In a study of 25 people who took Harvoni (sofosbuvir plus ledipasvir) for a treatment period of 12 weeks to treat genotype 6 resulted in a cure rate of 82%.   The study included people who had never been treated and people who had been treated but had not been cured.  There are many other drugs in development to treat genotype 6 including Merck’s combination of grazoprevir/elbasvir.

The future is bright for the treatment of hepatitis C with more awareness of all of the HCV genotypes worldwide.  There are many drugs under development to treat hepatitis C that are even more effective.  Many of the newer drugs in development are pan-genotypic—that is they work against all genotypes and have the potential to cure all genotypes—these drugs could provide cures worldwide if we could only identify and treat everyone.

http://hcvadvocate.org/news/newsLetter/2015/advocate0615_mid.html#1

The Five: Coffee —Alan Franciscus, Editor-in-Chief

For some people that morning cup of Joe is the perfect way to start the day.   Surprisingly, there are many published studies that show that caffeinated coffee can improve the health of the liver and provide other health benefits.  There are some caveats to these health claims that I will discuss at the end of this article.  First let’s talk about the good news—the possible health benefits:

1. Liver Fibrosis / HCV Disease Progression: 
In a review of 177 patients—121 patients with HCV who drank about 2 ¼ cups of coffee a day were found to have reduced levels of liver fibrosis.  The results were only found in those who drank caffeinated coffee.  

In another review, 766 participants in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial found more good news.  Those who had hepatitis C-related bridging fibrosis or cirrhosis on a liver biopsy and who failed to achieve a cure after being treated with pegylated interferon and ribavirin therapy also yielded some surprising results.  Those with advanced liver disease who regularly consumed coffee were found to have lower rates of HCV disease progression.

2. Liver Cancer:
A small study found that people who drank one to three cups of coffee a day had a 29% lower risk of developing liver cancer compared to those who drank 6 cups or less a week. 

Another study which reviewed 16 different studies involving over 3,200 patients found that drinking more than 3 cups of coffee a day might cut the risk of liver cancer by up to 50%. 

3. Other Conditions: 
There are many studies that show a link between the reduction or prevention of certain types of cancers and drinking caffeinated coffee (skin, breast, colon, prostate, uterine, oral).  There are also studies that show that caffeinated coffee can lower the risk of diabetes and death. 

4. The Downside:
Now, I am going to burst the bubble!  Coffee, specifically caffeine, is a drug (a stimulant).  Moreover, with any drug you can have withdrawal: It can take more than eight weeks to withdraw entirely from caffeine—although, caffeine withdrawal is usually just an annoying headache and some light fatigue. 

Drinking or consuming caffeine can raise blood pressure, lead to heart arrhythmia (irregular heartbeats), can cause cramps, diarrhea and other gastrointestinal health issues.  If you drink it too close to bedtime, it can cause insomnia.  Too much caffeine can cause depression, anxiety and other types of nervous behaviors.    Although rare there have been serious health consequences from people drinking energy drinks and shots. 

Examples of the typical amount of caffeine:*

• Coffee – 100 mg per cup
• Tea – 14 mg to 60 mg per cup
• Chocolate – 45 mg in 1.5 oz bar
• Most colas (unless they are labeled “caffeine-free”) – 45 mg in 12 oz. drink
• Candies, energy drinks, snacks, gum – 40-100 mg per serving

*http://www.nlm.nih.gov/medlineplus/ ency/article/002445.htm

There are many other side effects of caffeine, but I will stop here.  However, for most people caffeine in moderation is safe and well-tolerated!

5. Final Thoughts: 
What does all of this mean?   It is hard to draw concrete conclusions from these studies because you cannot measure what people drink, how it is made and what chemicals are in the coffee.  However, there must be something in caffeinated coffee that is contributing to all of these positive outcomes.  There are over 1,000 natural chemicals in coffee, and some of these chemicals may be contributing to the caffeine and providing these benefits.  Scientists are studying the various chemicals, and we may soon have more concrete information that may lead the way to more potent medications to treat many conditions.  In the meantime, it could not hurt to have a cup of Joe—that is if your health allows it. 

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Overview – Preparing for Treatment: Part 1 – Alan Franciscus, Editor-in-Chief

Treatment of hepatitis C has made great advances from the early days.  Back when interferon was first approved, the cure rates were about 10%.  The list of just the most common side effects could take up an entire page.  Now, we have medications that can cure 90 to 100% of patients who undergo therapy.  Even better, the side effects of the newer treatments are much easier to tolerate.  This article will discuss what it takes to prepare for treatment. 

Support and Resources
Start by gathering resources.  Trusted resources such as your medical provider, a support group, and a reliable internet site are safe places to start.  An important issue for people thinking about treatment is to learn as much as possible about treatment.  Talk to others who have been on treatment—they are some of the best experts.  Facebook is another resource where you can learn about treatment and receive support.  There are various Facebook accounts for the brand name drugs—HARVONI and VIEKIRA PAK—that provide a wealth of information about what people are experiencing while on treatment.  A caveat: Sometimes the sickest patients may use these sites more than those who feel well, and may have more side effects and complaints.

The pharmaceutical companies also have many resources that can be useful for investigating treatment issues and receiving support.  

Financial Preparations 
Whether you are dealing with your pharmacy, insurance company, medical provider or a patient assistance program—be prepared to provide the following information:

• Patient’s name
• Patient’s address
• Patient’s phone number (home and cell)
• Patient’s date of birth
• Identifying number—social security account number or a membership number.

Note:  Every time you call your insurance company or medical office, keep comprehensive notes—include the date, name and any issues that you discussed.  If it was over email, print it out and keep it with your other records.  If your medical office has an online record keeping system, print it off and keep it in a secure place. 

Insurance
HCV treatment is very expensive; some insurance companies have exclusivity agreements for individual HCV medications.  Check with your insurance carrier if there is a preferred HCV drug.  This could limit the choice of drugs.  Find out how much your share of expenses will be.  Additionally there are costs associated with medical appointments and lab tests.  Factor all these costs into what you have to pay.

Try to get answers to the following questions:

• Do you have prescription coverage?
• If so, what will your out-of-pocket expenses be?
• Do you have any reason to think your medical insurance will stop during treatment, such as a probable job lay off or a reduction in work hours?
• If you do not have prescription coverage, what is the cost of HCV treatment?
• How often will you have lab tests done and what is the co-pay?
• How often will you need to see your medical provider and what is the co-pay?  Remember, HCV treatment is typically 12 weeks but for some people it can range from 8 to 24 weeks.
• Insurance or not, can you afford the costs associated with HCV treatment?

Patient Assistance Programs:
The pharmaceutical companies that make the drugs to treat hepatitis C have programs that can provide the medications if you qualify.  Additionally, there are other programs that help with the co-pays.  A list of the Patient Assistance Programs can be found below and on our website.  There are also programs that can help people through the entire process of physician visits, insurance issues, and specialty doctors. 

The Workplace
In the past, some patients were unable to work while on interferon-based therapies.  Now that we have interferon-free therapies with fewer side effects, this is mostly an issue for people with more advanced liver disease.  In fact for most people, the workplace issue will mainly involve scheduling medical appointments and lab work. 

Remember you do not have to tell your employer you have hepatitis C or that you are taking hepatitis C medications.  Everyone has the right to time off for medical reasons.  However, it is not always that easy, so you should check in with your employer about your rights and responsibilities.  Also check in with your state health department about your rights.  It is also important to think through the worst-case scenario.  Some people are worried that they may feel sick especially at the beginning of therapy.  This is normal.  It might help to schedule a couple of days off at the beginning of treatment.  Talk with your employer about your sick leave policy, how much you have available and what your employer’s policies are.  You may also be able to use your vacation.  There is also the Family and Medical Leave Act (FMLA)—see if you qualify for this benefit. 

The most important issue is likely to be the time that you will need to take off for doctor appointments and lab tests. 

Part 2 of this article will discuss Medical Tests, Medications and Side Effect Management, among other things.

Resources:

Help with Medicines

Patient Assistance Programs

The Five: Diabetes —Alan Franciscus, Editor-in-Chief

If you notice, I did not title this article HCV and diabetes.  That is because new studies have not found a direct link between hepatitis C and diabetes—that is type 2 Diabetes mellitus.  However, it is still being studied, and it keeps coming up so the complete story may not be over.   Regardless, it is an important health issue facing people living with hepatitis C especially those who are considered part of the ‘Baby Boomer’ generation.  This month’s Five is about diabetes and how it relates to people with hepatitis C and why it is important to be tested for it, how to treat it and how it may improve the chances of being approved for HCV treatment. 

Diabetes affects approximately 40 million Americans. 

1. At-Risk Populations:  People who are more likely to develop diabetes include people 45 years old or older, being overweight or obese, having a parent, brother or sister with diabetes, having a genetic disposition to developing diabetes.  Certain races and ethnicities such as African Americans, Hispanics, Alaskan Natives, American Indians, Asian Americans, Native Hawaiians or Pacific Islanders are more prone to having diabetes.

2. Symptoms:  The most common symptoms of diabetes include increased thirst and hunger or appetite, dry mouth, frequent urination (peeing), fatigue (feeling tired), unexplained weight loss—even when eating more food.  In extreme cases, people may experience loss of consciousness.

3. Complications:  Over time, left untreated or uncontrolled diabetes can lead to very serious complications including mental confusion, blurred vision, sores or wounds that are slow to heal or don’t heal, sexual problems, heart and kidney disease, blindness, peripheral neuropathy, amputation, and death.

4. Treatment:  Diabetes can be treated and controlled with diet, exercise, and medications.  It is important to be monitored regularly.

5. HCV Treatment:  Many insurance companies and state Medicaid programs are restricting HCV treatment to those with severe fibrosis and cirrhosis.   There are other conditions that may increase the chances of being approved for HCV treatment—Type 2 Diabetes mellitus is one of the conditions that may increase the likelihood of being approved for treatment.  (See: AASLD-ISDA Recommendations for Testing, Managing, and Treating Hepatitis C 2014: When and in Whom to Initiate Treatment).  Talk to your medical provider to find out if you should be tested for diabetes.  If you have diabetes—check with you medical provider about HCV treatment.

The Bottom Line:  Diabetes is a serious disease that has many consequences.  The United States Preventive Services Task Force (USPSTF) now recommends testing adults for diabetes who have high blood pressure (greater than 135/80 mm Hg).  The USPSTF is currently in the process of updating their guidelines to include screening adults:

“Having factors that increase the chances of developing high blood sugar or diabetes, such as being 45 or older, being overweight or obese, or having a close relative with diabetes.”

The updated guidelines should be released in the coming months.


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The Five: Sleep and Insomnia —Alan Franciscus, Editor-in-Chief

A good night’s sleep is a critical component of living healthy especially with hepatitis C.  As any insomiac will tell you, getting a restful night’s sleep may be one of the most difficult goals to achieve, but man when you get one it’s like achieving nirvana! 

Recently, the National Sleep Foundation released new recommendations for Americans of every age.  While these are recommendations, there are always reasons why people may require more sleep than recommended.  For instance, if you have an illness or are being treated for hepatitis C your body needs more sleep than recommended to heal and recover. 

1. The National Sleep Foundation recommends the following hours of sleep every day: 

• Newborns (0-3 months): 14-17 hours
• Infants (4-11 months): 12-15 hours
• Toddlers (1-2 years): 11-14 hours
• Preschoolers (3-5 years): 10-13 hours
• School-age children (6-13): 9-11 hours
• Teenagers (14-17):  8-10 hours
• Young  Adults & Adults (18-64): 7-9 hours
• Older Adults (65+): 7-8 hours

2. Causes of insomnia: There are many causes of insomnia or sleeplessness including:  

• Living with hepatitis C and the uncertainty of life with a potentially deadly illness
• People who are on HCV treatment may worry about being cured
• Sleep Apnea (a medical condition that interferes with people’s breathing while they sleep)
• Certain prescribed and over-the-counter medications
• A sleeping partner who snores or is restless (including pets)
• Too much alcohol, nicotine, caffeine,  too little or too much food before bedtime
• Change in work schedule
• Traveling long distances, travel across time zones, and many, many  more reasons 

3. Complications of Insomnia:

• Anxiety and depression
• Slow reaction times and poor work performance
• Irritability
• Increased risk for high blood pressure, heart disease, and diabetes
• Substance use
• Overeating and obesity that could lead to fatty liver

4. Self-Help Tips:

• Limit caffeine, soda, tea, chocolate
• Avoid or cut back on alcohol and tobacco especially too close to bedtime
• Go to bed the same time every night.  Have a consistent routine when preparing for bed—brush teeth, read a book—this tells your mind and body you are ready for bed
• Make sure your bed/pillow  is comfortable
• Don’t go to bed hungry, but don’t eat a large meal too close to bedtime
• Use earplugs and eye masks to block noise and light if needed. 
• Turn off your mind when going to sleep—try  relaxation techniques and tapes
• If you cannot sleep, get up do something boring and go back to bed. 

5. Medical care:  There are many over-the-counter and prescription medications that can treat chronic insomnia.  People who suffer from chronic insomnia can benefit from a sleep study to determine if they have sleep apnea or another sleep disorder.  A symptom of sleep apnea is being tired during the day—the same symptom that is the most common symptom of hepatitis C.  Treating sleep apnea can improve everyone’s quality of life especially those with hepatitis C.

Don’t live your life full of sleepless nights—practice self-help strategies and get medical help as needed to live life to the fullest.  No one should live a life full of sleepless nights and days full of being tired.  Get tested. Get treated. Get Cured. 

Check Out These Sleep and Insomnia
Fact Sheets

• Easy C Facts: Sleep
• Easy C Facts: Side Effects – Insomnia
• HCSP Fact Series: Sleep

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The Five: Fatigue —Alan Franciscus, Editor-in-Chief

1. Fatigue or feeling tired is the most common symptom of hepatitis C.  It is also the most common extrahepatic (occurring outside of the liver) condition of hepatitis C.  It is also one of the most common side effects of HCV therapy.  It can range from mild to moderate to so severe that it can affect almost every area of life.
   
   
2. Causes:  Fatigue can be caused by many factors besides hepatitis C.  Be sure to talk with your medical provider before jumping to a conclusion that the cause is hepatitis C.  Other factors that could be causing fatigue could be other extrahepatic manifestations of hepatitis C (thyroid problems, anemia, HCV treatment, depression, sleep problems, poor diet, lack of exercise, medications, alcohol use and so on). 
   
   
3. Self-help strategies:  After you have ruled out any other causes with your medical providers there are many strategies to help improve your energy levels.  We have an excellent Guide to Understanding and Managing Fatigue that can walk you through many self-help tips such as information on improving sleep, nutrition, exercise, meditation, complementary medicines and much more.
   
   
4. HCV Treatment:  Severe fatigue is one of the extrahepatic manifestations that can qualify someone for treatment.  Curing hepatitis C can also cure fatigue, though fatigue can worsen temporarily during treatment.  Be sure to talk with your medical provider about the fatigue you are experiencing and other symptoms.  Make sure to document all symptoms in your medical records.  For some people, it is hard to complain or even talk about their symptoms.  It is critical, however, to make sure that you document your complaints.  Medical records are important for treatment and disability records.
   
   One of the best ways to gauge your level of energy or any other factor is to use a scale of 1 to 10 and keep a journal.  Let’s say you have a wonderful day, full of energy, and you feel like your old self.  That would be a fatigue scale of 1.  Now let’s say you have a day where you are feeling sluggish but can still work.  Maybe that is a fatigue day of 4.  Then there are days when you can hardly get out of bed.  Let’s say that is a 10 on the scale of fatigue.  I think you get the idea.  Log it into a journal every day.  Take a copy with you to your medical provider and have them put it in your medical records.
    
   
5. Support: One way to fight fatigue is to join a support group (either on-line or in-person) and talk with others who are experiencing fatigue.   Try to remember to take care of yourself and to practice self-care tips to keep you well and healthy. 
   

http://hcvadvocate.org/news/newsLetter/2015/advocate0215.html#3

The Five: The Flu —Alan Franciscus, Editor-in-Chief

This year’s strains of influenza are particularly virulent, and unfortunately the vaccine developed this year does not provide protection against all of the strains.  The flu is a nasty virus that causes 36,000 deaths and 200,000 hospitalizations each year in the United States. The largest and deadliest flu outbreak was the Spanish flu pandemic of 1918-1919 that caused 20 to 40 million deaths.  Now we are lucky to have a healthcare system that prevents most deaths, and vaccines that provide protection against most strains of the flu. 

1. Symptoms:  Many people confuse the symptoms of flu with the cold, but the flu has definite symptoms, such as: 

• A fever of 100 degrees or higher (but not everyone gets a fever)
• A cough and/or sore throat
• A runny or stuffy throat
• Headache and/or body aches
• Chills
• Fatigue or feeling tired
• Nausea (feeling sick to your stomach), vomiting, and/or diarrhea

2. People who are at risk for severe complications:

• Children younger than 5, especially those younger than 2 years old
• Adults 65 years and older
• People who have medical conditions including liver disease (such as hepatitis B and C)

3. Prevention:

• The best prevention is the flu vaccination.  It is safe and is usually effective; but this year’s flu has mutated so the vaccine is not protective against this year’s most virulent flu strain.  Even so, it is protective against 50% of the strains infecting people this year.
• Basic hand washing can help to protect people from the cold, flu and other infections—wash the hands for at least 20 seconds with soap and water. 
• Watch what you touch, especially other people’s items—phones, iPads, remote controls, etc.

4. The Flu:

• If you get the flu, the best advice is to get bed rest, and monitor your temperature and drink lots of fluids.
• There are many over-the-counter medicines that can help lessen some of the symptoms
• Your medical provider can prescribe antiviral medications to reduce the symptoms and shorten the duration of the flu
• Seek medical attention if you experience any of the following:
• Difficulty breathing or shortness of breath
• Purple or blue discoloration of the lips
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Seizures
• Flu-like symptoms that improve but then return with fever and worse cough

5. The Bottom Line:

• There is still time to get the flu vaccine, but if you don’t get vaccinated, be prepared to take precautions to protect yourself against getting the flu. 

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