Getting High & Preventing Flu

Thursday, January 3, 2013
By Axel E. Thieke G.P.

At this very moment I am a little bit low, suffering from mountain-home-sickness, as there is an apparently endless blue stretching south and west and my next mountain will be on arrival in Saint Lucia. Treatment is not instantly available because sailing back against the prevailing trade winds would take weeks and the flight back will not be until shortly before Christmas. Not a medical problem anyhow.

But acute mountain sickness is. And one may suffer it when climbing Mulhacen for example.

There are preventative treatments, but they may have some serious side effects and therefore alternatives have been sought.

Researchers randomized 90 healthy non-acclimated adults to receive 600mg of oral Ibuprofen or placebo every 6 hours, beginning 6 hours before rapidly ascending from an altitude of 1.000 to 4.000 meters. It was measured how often symptoms of acute mountain sickness such as headaches, dizziness, disorientation occurred and how severe they were.

Significantly fewer participants in the Ibuprofen group than in the placebo group developed acute mountain sickness: 43% vs. 69%. And if they still got it, symptom severity was lower.

This translates into the nowadays notorious and nevertheless very illustrative NNT – number needed to treat. In this particular case 4 people will have to take Ibuprofen to avoid one ‘case’ of mountain sickness (Ann Emerg Med 2012 Jun; 59:484 ).

The efficacy of prophylactic Ibuprofen is similar to traditional remedies such as Dexamethasone, but the safety profile is much more favourable and it therefore seems to be the obvious choice.

So do consider to tie up your visit to the dentist with a little walk up Mulhacen – Ibuprofen will cover you for both.

Composition of the seasonal flu vaccine is always a bit of a guessing game and sometimes the mismatch between vaccine and circulating flu strains is cited to explain suboptimal vaccine performance – or in other words: why one still gets the flu, even though one had been vaccinated. Last years flu-vaccine formulation was well matched and researchers have studied how well it performed.

Amongst 5.000 infants, children and adults the vaccine status was ascertained as they presented to the hospital with flu-like symptoms. Standard laboratory tests were performed to diagnose if it was influenza or not.

Overall 30 % of diagnosed influenza occurred in previously vaccinated people, which indicates an efficacy of 60%. All age groups showed similar efficacy except for older people above the age of 65, in whom the vaccine essentially was ineffective (Clin Infect Dis 2012 Oct 1; 55:951).

The researchers describe the overall level of benefit as “modest” and point out the concerning poor efficacy among older adults. In other years, and this can only be determined in retrospect, the matching of vaccine and flu viruses was much poorer and efficacy was estimated to be less than 30%!

These are certainly challenging figures and need corroboration by other non-industry-sponsored researchers. Doctors should not vaccinate indiscriminately, but only people with chronic conditions at elevated risk when getting flu.

Apart from that there is the still valid and may be even more valid recommendation to avoid big crowds such as in bars, planes, buses & supermarkets. And the ones with flu-like symptoms should stay away from infants and the elderly or cover up as the Japanese do – nothing wrong with a little bit of social responsibility.

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