When is the flu not the flu?

Sick stomach? Don't blame the flu

Canadian Press
Wednesday, January 15, 2003

TORONTO (CP) -- When is the flu not the flu? When you are vomiting.

That's right. If you are nauseated, throwing up or chained to your bathroom with a bad case of the trots, you do not have the flu. (Young children are an exception to the rule, but more on that later.)

You may have food poisoning. You may have Norwalk virus or one of any number of other nasty gastrointestinal bugs. But you don't have the flu. And you don't even have "a stomach flu" -- a nonsense phrase that makes infectious disease specialists see red.

Flu is influenza. Influenza is a virus that attacks the respiratory system. Flu works on your lungs, not your stomach.

"Influenza is sudden, it's quite severe and there's an absence of gastrointestinal symptoms, whereas if you have a stomach virus, it's definite that you have gastrointestinal symptoms," explains Nicole Le Saux, an infectious disease doctor at the Children's Hospital of Eastern Ontario in Ottawa.

Flu typically kills somewhere between 500 and 1,500 Canadians annually. But about three or four times a century, influenza mutates into virulent strains that kill millions around the globe. The Spanish flu of 1918 claimed an estimated 20 million lives, more than the First World War.

Vicious stomach bugs like Norwalk virus are a short-term trip to hell to be sure. But they generally don't kill people.

Despite these differences, people -- including some doctors -- routinely and erroneously use the term flu to describe stomach ailments that have nothing to do with influenza. The common public misconception incenses infectious disease types.

"If you really believe in the seriousness of influenza, it makes your skin crawl when you hear people refer to 'flu' in sort of colloquial terms," says influenza expert Dr. Danuta Skowronski.

"In my mind, that word, flu, should be banished from the English language."

Skowronski is a physician epidemiologist at the University of British Columbia Centre for Disease Control, where she has earned the nickname Dr. Fluski. "I told them they have to change it to Dr. Influenski, but you know, give it time."

Despite the joke, Skowronski doesn't think influenza is any laughing matter. She's not alone.

Le Saux recently published some research that shows the confusion over the word flu is undermining public health efforts to persuade people to get an annual flu shot.

She and some colleagues conducted a study to see if parents were embracing Ontario's new universal free flu shot program, and if not, why not. During a three-month period in 2001, they interviewed parents of children who showed up at the hospital's emergency department. Only 27 per cent of the children had had a flu shot.

Many parents who chose not to have their children vaccinated thought flu shots didn't work because they or people they've known have suffered stomach ailments despite having had a flu shot.

Their logic: My flu shot didn't keep me from getting a gastrointestinal virus, so clearly it doesn't work.

The problem: That's like blaming the polio vaccine for not preventing measles.

"We've got to be able to get our minds clear about what influenza is and what the vaccine does so that we can get people to believe in it," says Dr. Allison McGeer, director of infectious diseases at Mount Sinai Hospital in Toronto.

Here goes:

Gastrointestinal viruses like Norwalk rip through the system like drain cleaner. For 24, 48 or 72 hours, you feel like death warmed over and you can't stray far from the safety of familiar plumbing.

Influenza, on the other hand, has symptoms like those of a bad cold: coughing, sneezing, runny nose, achy muscles, fatigue, lethargy and a fever.

High fever can trigger vomiting in young children, so occasionally children with influenza will vomit -- a fact that probably adds to the confusion over what influenza is and isn't.

"Little kids when they get sick barf. It's a fact of life," McGeer says, noting it's the fever, not the influenza, that is responsible for the vomiting.

Most of the parents -- those who vaccinated their children and those who didn't -- interviewed for Le Saux's study thought vomiting and diarrhea were symptoms of the flu. "I thought it was pretty frightening," Le Saux admits.

About 15 per cent of the population gets influenza each year. Most take to their beds and re-emerge days later feeling weaker but none the worse for the experience. But the elderly and others with weakened immune systems can die from influenza.

Influenza can also trigger pneumonia, which can kill as well. The Canadian Committee for Influenza Immunization estimates that if all influenza-triggered pneumonia deaths were worked into the equation, the virus's annual death toll in Canada would likely be 2,000 people.

In fact, now that major infectious threats of old -- polio, diphtheria, smallpox -- have largely been conquered in North America, influenza is the Number 1 infectious disease killer in this country.

"Absolutely -- by a wide margin," McGeer says.

Yet people -- including some doctors -- continue to view it as no big deal. Skowronski is convinced the nickname is part of the problem.

"Flu sounds silly and innocuous. But there is nothing silly or innocuous about influenza," she insists.

"It takes three more syllables to say than flu (but) those syllables are jam-packed -- in terms of complications, in terms of risk of death and also in terms of our ability to prevent because we have the vaccine. So it's worth it to add those three extra syllables, to get the meaning correct."

© Copyright 2003 The Leader-Post (Regina)