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Q&A with Dr. Cameron Wolfe

The beginning of autumn ushers in leaves changing colors, the start of the holidays and the flu. The Chronicle’s Jack Mercola spoke with influenza expert Dr. Cameron Wolfe, a physician in the medicine and infectious diseases department of Duke Medicine, to find out ways the Duke community can prepare for the flu season.

The Chronicle: What exactly is “the flu?”

Dr. Cameron Wolfe: Influenza is a RNA virus, well suited to flourish in human respiratory tissues, but it can also affect other mammals and birds. Broadly speaking, there are three groups of flu—flu A, flu B and flu C. A and B are the most common ones for humans, with A being the one more likely to cause human illness. Influenza A is not more likely to cause human illness, but if one person gets flu A and one gets flu B, flu A is likely to make the person more severely sick with a greater propensity for pneumonia, whereas influenza B is often a milder illness.

TC: What about influenza is so dangerous, and when does it reoccur every year?

CW: For the majority of people, it’s not dangerous but causes a three to five day illness that self-resolves. There are some people, however, who will develop a severe and life-threatening bilateral viral pneumonia. The flu also makes people more susceptible to bacterial pneumonia co-infection. It recurs each year typically in winter months.

TC: What are the symptoms of influenza?

CW: Classic influenza causes high fevers, sweats, muscle and joint aches—less commonly a runny nose, sore throat and sometimes a little diarrhea. Severe disease is characterized often by progressive breathlessness and chest pain.

TC: At what time in the year is influenza most prevalent and why?

CW: It is most prevalent in January, February and March in the Northern Hemisphere and opposite in the Southern Hemisphere. We don’t exactly know why, but likely a combination of one, humans have closer huddled contact in winter; two, we probably make more nasal and throat secretions anyway for influenza to stick to; three, we touch our hands to our mouth and nose more, therefore increasing transmission risk; and four, the virus likes cooler temperatures. It’s probably a mix of viral factors, human factors and social factors.

TC: How contagious is influenza, and how is it spread?

CW: Influenza is very contagious through respiratory droplets—via sneezing or coughing—and less so, but still transmissible, via contact on a surface that flu exists on—hence hand washing.

TC: What is the best way to prevent catching influenza?

CW: Vaccination—it not only protects you, but even if you get a case, it is less severe; you shed less virus; and therefore you’re less likely to spread it on to others.

TC: What are some alternative methods of prevention?

CW: You should avoid close contact with sick people, especially when flu circulates. Wash your hands frequently and avoid putting hands in mouth and nose, etc. Out of courtesy to others, if you’re sick, sneeze into your sleeve and not out into the open.

TC: What is the history of influenza medication? How is it treated differently now than when treatment was first introduced?

CW: Influenza is often not treated at all, if mild. There are probably more treatment options these days, ranging from inhalational medications to tablets to intravenous agents. Not all work for all strains, so the choice is based on how sick someone is and what strain they might have.

TC: What is the next direction of influenza medication?

CW: Hopefully, like vaccines, the goal is to find one medication that is strain independent, and one in which the virus has less chance of mutating in order to become resistant. This has been a problem in recent years as we perhaps overuse influenza medication, hence the desire to reserve it for the sick or high risk.

TC: What kind of problems does influenza pose to this species? Are there any serious dangers?

CW: Humans get anxious, as a community, about the fact that influenza has a “drift” and “shift” phenomena. Drifting is when there is slight variation year to year with the surface proteins influenza produces, thereby escaping perfect immune control. As a community, we have some collective immune memory to previous influenza strains, but not enough to stop getting sick each year, thus causing mild disease. If it’s a highly pathogenic influenza, like Spanish Flu or H5N1 Avian Flu, more people catching influenza can translate into more people getting critically sick. Fortunately for most people, H1N1 was not so serious. But, it’s why we worry about H5N1, which seems to have a much higher death rate.

TC: What kinds of problems does influenza pose to a college campus, specifically Duke?

CW: College campuses are great flu breeding grounds. Think about how close all the students are on a daily basis, and you can begin to understand how it can spread. Alternatively though, you can also say that a college campus is typically more proactive about preventative health measures and typically does a great job at doing the simple things well—like getting students vaccinated and being courteous to colleagues with hand hygiene techniques. I personally believe colleges can be great examples of how to run flu prevention programs, which is why we make such a deal of it through places like [Duke] Student Health.

TC: Do humans have any hope of ever eradicating influenza?

CW: I wish I knew the answer to that question. Personally, I suspect influenza will always be around. But, we’ll become much better at detecting people who are about to become sick before they feel symptoms and getting them isolated and away from others. Many of the actual symptoms of influenza, like any febrile illness, are late results of a chain of immune reactions. If we could work out some of the early pre-clinical symptoms, it would be terrific. Some of that work is going on here at Duke. I also suspect we’ll get much better at treating the illness. The Holy Grail would be to find a single vaccine that could provide long term, multi-strain immune protection. If we can do that, then there’s no reason this illness may not go the way of polio or small pox. It is a difficult challenge, but many smart people are working hard to figure it out.

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