It’s that time of the year again. Winter is around the corner and flu season—which can stretch from October to May—is already well under way. As Benjamin Franklin once stated, “ An ounce of prevention is worth a pound of cure.” The key to avoiding the flu is prevention. The cornerstones of flu management are based on a three-pronged approach: getting vaccinated, washing hands well and often, and protecting others by staying at home if infected. Once you’ve contracted the influenza virus, the best cure is time. The virus will typically last from 7 to 10 days. It’s important to manage a fever with acetaminophen or ibuprofen and to keep well-hydrated. Antiviral therapy (for example, Tamiflu) started within two days of symptom onset has been reported to decrease the length of the flu by one or two days. However, there is much debate within the medical community as to whether or not antivirals play any role at all. Consult your healthcare provider to determine the appropriate plan of action in your scenario. But first things first…

Who should get vaccinated?

If you are reading this, the answer is almost certainly You. The exceptions would be babies under 6 months, people with allergies and active asthma—need to discuss their options with their physician to determine an appropriate plan of action (i.e., those with an egg allergy)—and those with weakened immune systems, who might be best served to receive the Inactivated Influenza Vaccine (IAV) as opposed to the Live Attenuated Influenza Vaccine (LAIV).

So there are more than one kind of flu shot available?

Yes. You will need to discuss the most appropriate option for yourself with your physician, taking your age and medical history into account. The most common options are:

  1. Standard Dose Trivalent Shot (Contains Killed Viruses). This shot is approved for people ages 6 months and older.
  2. High-Dose Trivalent Shot (Contains Killed Viruses). This shot is approved for people ages 65 and older. As we age, our immune system becomes less robust. The aging immune system can lack the necessary immune response to combat the flu. The high dose flu-shot contains three times the exposure (antigen) to the virus resulting in a more immunogenic response to the flu.
  3. Trivalent Shot (Standard) contains 2 Influenza A strains and 1 Influenza B strain
  4. Quadrivalent Shot contains 2 Influenza A strains and Influenza B strains
  5. Nasal Spray Flu Vaccine (Contains Live Viruses). The CDC recommends this as an option for healthy children from ages 2 through 8 years old, as studies have shown that nasal sprays are more efficacious than the flu shot in children in this age group.

Do I need to get vaccinated every year?

Yes, you do. Researchers isolate the top three flu viruses that will be most prevalent each season and create one flu vaccine. Therefore, you need to get a new flu shot every year to make sure that you are protected. Ninety percent of deaths related to the flu occur in people 65 years of age or older, so it is especially important for this group to get annual vaccinations.

How does the flu actually spread?

The flu virus is contained in droplets. The flu is spread when an infected person with the flu sneezes, coughs or talks. As with most viruses, it spreads from our hands to our nasal and oral cavities.

What’s the best way to avoid getting the flu?

If you are sick, stay home from work, school or daycare. It is imperative to practice excellent hand-washing hygiene in order to prevent the spread of the flu. A helpful tip is to wash your hands with soap and water for approximately 15 seconds—the same time it takes to sing the Happy Birthday song. You can also use an alcohol-based hand rub.

What are the common symptoms that tell me I’ve got the flu?

Cough, runny nose, stuffy nose, sore throat, fever, fatigue, muscle aches, vomiting and diarrhea.

How do I know when to seek medical attention?

If you are at the extremes of age, pregnant or have multiple co-morbid conditions such as diabetes, COPD, asthma—or if you are immuno-compromised—get to the doctor the instant you suspect you have the flu.

Editor’s Note: John D’Angelo, DO, is the Chairman of Emergency Medicine at Trinitas Regional Medical Center. He has been instrumental in introducing key emergency medical protocols at Trinitas, including the life-saving Code STemi, which significantly reduces the amount of time it takes for cardiac patients to move from the emergency setting to the cardiac catheterization lab for treatment.


Enterovirus-D68 was first detected in California in 1962. It occurs less frequently than other types of Enteroviruses (EV), which can be difficult to distinguish from any of the viruses that cause the common cold.

The viruses are called “Entero” because they enter the body through the stomach or intestinal tract. There are over 100 types of EV, which affect 10-15 million people each year in the U.S. The strain in question was identified as D68 in August by the CDC. More than 40 states have confirmed respiratory cases caused by EV-D68. In the state of NJ, there are a total of nine laboratory-confirmed cases as of October 3. The counties affected included are: Sussex, Essex. Passaic, Middlesex, Mercer, Morris, Camden and Burlington counties. EV-D68 was detected in specimens from four patients who have died and had samples submitted.

What are symptoms of EV-D68 infection and how is it spread?

Symptoms are nearly indistinguishable from the common cold—cough runny nose, sneezing, body aches and sometimes fever. Severe symptoms include difficulty breathing, wheezing and worsening of asthma. Enteroviruses can be found in secretions from the nose, mouth and through the entire gastrointestinal tract. The virus spreads from person to person via fecal oral contamination, coughing, sneezing or by touching your hands to your face after touching infected surfaces.

Are children at particular risk?

They are. Little ones get their hands in everything. Children are in close contact with one another. Whereas most adults have been exposed to the many types of Enterovirus—and over time, our immunity strengthens and we are able to combat the assailant—infants, children and adolescents lack the immunity necessary to fight the virus. Children with reactive airway disease are particularly susceptible to EV-D68. Parents of children with asthma should use particular vigilance. If their child becomes ill or has increase in his/her work of breathing they should consult their healthcare provider. Adults can contract the virus, of course, but are less likely to become very ill. Even so, EV-D68 can masquerade as the flu or any other “cold-like” illness. Medical professionals view EV-D68 as a possible cause of severe respiratory illness. If you, a member of your family or community experience a new onset of difficulty breathing or shortness of breath, please seek medical attention.

Can it be treated with antibiotics?

No. Antibiotics treat bacteria, not viruses. A patient will be treated by supportive care—namely medications for breathing, fever control and hydration. Practicing proper hand hygiene is paramount to protecting yourself and others. Wash with soap and water for 20 seconds, especially after changing diapers. Hand sanitizers are not effective against Enterovirus. Avoid contacting your eyes, nose, and mouth with unwashed hands. Cough or sneeze into a tissue or an elbow as opposed to an uncovered space. Keep your children or yourself at home if you are not feeling well. Disinfect high-traffic household items such as bathroom surfaces, countertops and toys with bleach-based household cleaners. EV is resistant to alcohol disinfectants. Look for products that list “Alkyl dimethyl benzyl ammonium chloride” as the active ingredient on the label. The product should state that it kills norovirus and rhinovirus.

Should my child stay home from school if I suspect EV?

Parents should never send a sick child to school. And they should not return to school until they are symptom-free and fever-free, meaning a temperature less than 100 degrees for 24 hours without fever-reducing medications.