Influenza is a highly infectious viral illness. It can cause mild to severe illness, and at times can lead to death.1
Most experts think that influenza viruses are spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in people’s mouths or noses, or can be inhaled into the lungs. Less often, a person might get influenza by touching a surface or object that has the virus on it and then touching his or her own mouth or nose.2,3
Most healthy adults may be able to infect other people with flu beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick. Children may pass the virus for longer than 7 days.2
Symptoms start 1 to 4 days after the virus enters the body, though some people can be infected with the flu virus and show no symptoms. Despite not showing symptoms, people may still spread the flu virus to others.2
While there are several types of influenza viruses, two are predominantly associated with human infection: type A and type B.4 These viruses can severely impact more vulnerable populations, such as adults age 65 and older, as well as young children and babies.5
Type A viruses specifically have different subtypes based on the two different proteins they express on their surface: hemagglutinin (H) and neuraminidase (N).4 For example, influenza A (H3N2) is a type A virus that has H3 and N2 on its surface. Over time as the virus replicates, small changes in the genes of influenza can accumulate, resulting in viruses that are antigenically different.4 As a result of this antigenic drift we have to change our flu vaccines every season in accordance with the predicted new strain. Of note, occasionally more abrupt changes in the influenza virus can occur as well, known as antigenic shift, resulting in new hemagglutinin and/or new hemagglutinin and neuraminidase proteins.4 Antigenic shifts can result in influenza pandemics.4
The clinical presentation of influenza ranges from asymptomatic infection or a self-limiting upper respiratory tract infection, to a severe illness with potentially fatal complications.1
In older adults, influenza sometimes presents differently than it does in other age groups:
Older adults may experience malaise, instead of the sudden onset of high fever typical in children and younger adults.6
Stomach pain, diarrhea, and nausea are more frequent symptoms in older adults than in other age groups.6
Runny nose, sore throat, and nasal congestion are all less frequent symptoms in older adults than in other age groups.6,7
SERIOUS COMPLICATIONS
Complications from influenza can lead to life-threatening conditions in older adults. Serious complications include1:
EVIDENCE-BASED RESOURCES
From the Centers for Disease Control and Prevention
- Influenza ACIP Vaccine Recommendations (web page)
- Influenza (Flu) Information for Health Professionals (web section)
- Flu & People 65 Years and Older (web page)
- Influenza (Flu) Communication Resource Center (web section)
- Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book): Influenza Chapter (PDF)
- Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022–23 Influenza Season
From Immunize.org
- Communicating the Benefits of Influenza Vaccine during COVID-19 (PDF)
- Influenza: Questions and Answers – Information about the Disease and Vaccines (PDF)
From the Literature
- JAMA: Respiratory and Nonrespiratory Diagnoses Associated With Influenza in Hospitalized Adults
- American Journal of Infection Control: Hospital-onset influenza hospitalizations-United States, 2010-2011.
- Clinical Infectious Diseases: Hospitalization Associated With Influenza and Respiratory Syncytial Virus in the United States, 1993-2008.
- Annals of Internal Medicine: Respiratory and Nonrespiratory Diagnoses Associated With Influenza in Hospitalized Adults
1. Flu Symptoms & Complications. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/consumer/symptoms.htm. Accessed October 2022. 2. How Flu Spreads. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/about/disease/spread.htm. Accessed October 2022. 3. Centers for Disease Control and Prevention. Prevention Strategies for Seasonal Influenza in Healthcare Settings. https://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm. Accessed October 2022. 4. Centers for Disease Control and Prevention. Understanding Influenza Viruses. https://www.cdc.gov/flu/about/viruses/index.htm. Accessed October 2022. 5. Centers for Disease Control and Prevention. People at High Risk for Flu Complications. https://www.cdc.gov/flu/highrisk/index.htm. Accessed October 2022. 6. Call to Action: Reinvigorating Influenza Prevention in U.S. Adults Age 65 Years and Older. National Foundation for Infectious Diseases. http://www.nfid.org/flu-older-adults. Accessed October 2022. 7. Cox NJ, Subbarao K. Influenza. Lancet. 1999;354(9186):1277-1282. doi:10.1016/S0140-6736(99)01241-6 8. Centers for Disease Control and Prevention. FluView Weekly U.S. Influenza Surveillance Report. https://gis.cdc.gov/grasp/fluview/flu_by_age_virus.html. Accessed September 2022. 9. Centers for Disease Control and Prevention. Flu Season. https://www.cdc.gov/flu/about/season/flu-season.htm. Accessed October 2022.