Their symptoms can be much more muted, said Dr. Catherine Liu
, director of antimicrobial stewardship
at Fred Hutch and SCCA. They may have just a little runny nose, a mild cough or shortness of breath. Because their immune system is suppressed, they may not actually present with more severe symptoms like fever and body aches until the disease has progressed substantially.
This may sound counterintuitive, but it makes sense when you realize that flu symptoms are not caused by the virus itself but by the immune systems response to the virus. A weakened immune system simply mounts a milder response. But the flu itself is still deadly serious.
So in addition to taking steps to protect yourself, patients with weakened immune systems need to have what Liu calls a low index of suspicion. Dont be embarrassed to ask your doctor about a runny nose. And dont try to tough it out.
If you are immunosuppressed, be cognizant of any changes in your body, and get yourself evaluated if theres a change that might be suggestive of respiratory symptoms, she said. Be aware any time you think youre coming down with something. There are things we can do to try to prevent it from being worse.
6. Note to patients and providers alike: Antiviral therapy will help. Antibiotics wont.
What health care providers can do for the flu is prescribe the antiviral drug Tamiflu, or oseltamivir, especially for people with chronic health conditions or cancer or for transplant patients at risk for complications. The benefit is greatest when started as soon as possible after the onset of symptoms another reason to be extra vigilant about even a runny nose.
Treatment isnt perfect, said Pergam. But theres no question it can help mitigate the symptoms and potentially prevent you from getting worse. We encourage everyone whos immune-compromised who develops anything that could be early flu to get tested and treated.
While an antiviral therapy such as oseltamivir will help, antibiotics which treat bacterial infections will not.
We really try to discourage overuse of antibiotics, said Liu. Flu is a viral illness, and antibiotics are not effective against viral illnesses.
Yet because patients may be more familiar with antibiotics than antivirals, they often ask for antibiotics and their doctors often feel pressured to prescribe them. Any use of antibiotic raises the risk that bacteria will develop resistance
, meaning that antibiotics wont work when they truly are needed.
Antibiotics also can upset the balance among the trillions of microorganisms that make up your gut microbiome, killing off good bacteria and allowing bad bugs to take over. And researchers are learning that the microbiome itself affects immune response
So, get tested, and if no bacterial infection is present, ask for antiviral therapy, not an antibiotic.
Beyond that, the prescription for flu is the same whether your immune system is at full strength or not, Pergam said.
Stay home. Rest. Drink plenty of liquids. Elevating your head or upper body may help
7. Even if you are not immune-suppressed, protect those who are: Get the flu vaccine. Clean your hands. Stay home if youre sick.
So your immune system is healthy? You still can get the flu. And you can spread it to those who are more vulnerable to its complications.
Not only should those with weakened immune systems get flu shots, their families and caregivers should too.
The more you can do to prevent disease to people who are close to the patient, the lower the chance of exposure, said Liu. Thats really key.
But more people are immune-compromised than you realize. The broadest spectrum includes everyone under age 1, whose immune systems have not fully developed, and everyone over age 65, whose immune systems are starting to wear out.
Now add those with kidney, heart and lung disease and asthma. At higher risk still are people who have had organ transplants and are on lifelong immune-suppressing drugs to keep their bodies from rejecting their new heart, kidney or liver. Cancer patients on chemotherapy
may be more susceptible to infections even months after treatment has ended. At highest risk
are bone marrow transplant patients whose immune systems have been deliberately wiped out to make room for a new one to take hold.
Because many of these lifesaving but immune-dampening therapies are delivered in outpatient clinics, vulnerable people are walking around the community and getting exposed to flu and other infections, said Pergam. Even if you are not one of them even if you dont know who they are getting a flu shot helps reduce transmission routes that put them at risk.
The more you can protect the entire population, the more likely youre going to reduce the chance of transmission to those who are immune-compromised and more vulnerable, said Liu.
In summary, what can you do if you have a healthy immune system?
Get a flu shot. Thats number one, said Liu. Number two, if youre sick, visit your loved one another time. Stay home when youre sick. Clean your hands. Try to minimize that exposure."