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Cold and flu guide

It’s that time again — cold and flu season. Dr. Barry Wolcott made a house call to answer our cold and flu questions.
/ Source: WebMD

Yes, it’s cold and flu season again, and no, there’s still no cure for the common cold. But there are precautions and treatments to help you snuff out the sniffles. WebMD senior physician Dr. Barry Wolcott made a house call to answer our cold and flu questions.

The opinions expressed herein are the guest’s alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: So many of us lump colds and flu into one nebulous illness. Please tell us the difference, and why it’s important to make that distinction.

Wolcott: Colds and flu have a lot in common:

Both are viral illnesses.

There are scores of viruses that cause the common cold, and a single family of viruses — the influenza viruses — that cause influenza.

Both the common cold and influenza are illnesses of the upper respiratory system.

But there are differences too:

Influenza is generally a more severe illness. By that I mean influenza generally has fever, even high fever, while fever is unusual in a common cold.

Severe headache, severe muscle aches, and severe fatigue are characteristic of infections caused by influenza viruses and are far less common in illnesses caused by the viruses of the common cold.

Influenza can be severe enough that people require hospitalization and some people even die from influenza. Neither of these bad outcomes is common with a “cold.”

There are immunizations that protect against influenza viruses and medications that can shorten the course of influenza. Neither immunizations nor specific treatment exist yet for the common cold.

Member question:

I’m always told that the flu shot will not cause any flu-like symptoms, but I always feel like I have the flu after the shot. Is this just coincidence?

Wolcott: In a word, yes. The vaccine used in the injectable form of influenza immunization does not contain any live virus. The virus in the vaccine has been killed; therefore, you cannot get the flu from a flu shot.

That doesn’t mean that you can’t get a cold right after you get a flu shot and confuse the cold with influenza from the flu shot. It also does not mean that everyone who gets a flu shot is protected. The protection from the flu shot is approximately 80 percent in otherwise healthy people. But, no, you can’t get the flu from the flu shot.

Member question: I understand the active ingredients in the flu shot are based on predictions of which viruses might be prevalent in the coming year. Is this correct? If so, just how many different kinds of flu viruses are out there?

Wolcott: Basically that is true. There are many different forms of influenza virus that cause similar illnesses but are immunologically different. The CDC conducts worldwide influenza surveillance in an attempt to identify the most likely type of influenza for the next year. Based on that prediction, the influenza vaccine is made to protect against the three to five immunologic types of influenza felt most likely to spread to the United States the next fall and winter.

Fortunately for us, the CDC is very good in their predictions. That is why each year’s vaccine is different. It is one of the reasons why having a flu shot last year does not protect you this year.

Member question: My husband has asthma and is considered high-risk. Should I get a flu shot because of his asthma?

Wolcott: The most important thing would be for him to get a flu shot. Of secondary importance would be for you to get a flu shot. Your getting a flu shot not only protects you from becoming ill, but it protects him from you getting ill and your passing the virus on to him. That is important because the flu shot is not 100 percent protective, so even if he received a shot it would still be possible for you to pass an infection to him if he were one of the unlucky for whom the flu shot was not protective.

Moderator: Who are the high-risk groups?

Wolcott: Actually, the high-risk groups were defined to help ration flu vaccine when it was in short supply to ensure that the people who needed it the most got it. Those recommendations have been misinterpreted by some that only high-risk individuals need a flu shot or will benefit from a flu shot. That’s not true. Above the age of 6 months, unless there’s a specific reason not to get a flu shot, anyone can benefit from a flu shot because they won’t become ill.

Additionally, immunization lowers the chances of passing influenza to someone more likely to develop a complication from influenza. This year there’s plenty of vaccine and there’s no reason to ration it to just those in high-risk groups.

Member question: Who should not get a flu shot?

Wolcott: Anyone who has previously had a life threatening allergic reaction to eggs; anyone with a history of Guillian-Barre syndrome should not receive the influenza vaccine by injection.

Member question: I’ve been seeing commercials for the new FluMist vaccine. What can you tell me about it?


The FluMist vaccine has been approved by the FDA for human use within the United States within the last year. This provides a brand new tool for immunizing the population against influenza. Many people in the past have avoided being immunized against influenza because they did not want to get a shot. This inhaled vaccine avoids that necessity for an injection, which will make it more attractive to many people.

This vaccine differs from the vaccine that is injected in several significant ways, most related to its use of an attenuated live virus rather than the killed virus used in the injectable vaccine. The live virus that is used is an influenza virus modified in the laboratory to not cause clinical influenza infection (meaning you don’t get a severe flu disease from it).

Additionally, each year this virus is altered in a way to give it the same immune characteristics as in the CDC-predicted influenza strains for the upcoming year. The body responds to this viral infection by producing antibodies that are protective against influenza.

This form of immunization against influenza is new, and therefore comes with a large number of cautions from the manufacturer too long to list in their entirety here, but which are easily found on WebMD Health.

Member question: Is the FluMist vaccine as effective as the shot?

Wolcott: The reason that the FDA approved FluMist was that it was as effective as traditional immunizations and had the advantage of not requiring an injection. So yes, the indications are that it will be as protective as traditional injection methods of immunization. However, because it is a live virus vaccine and because it has been newly improved, it does come with a large number of exclusions and warnings.

Member question: Should I get the flu shot if I’m trying to conceive, but haven’t gotten a positive pregnancy test yet?

Wolcott: The standard recommendations for the injected flu program recommend against immunization of women in the first trimester of their pregnancy. This is primarily because of a lack of hard scientific information proving the safety of immunization during this period, rather than hard scientific data showing a danger.

The issue would be, is there a danger during the few days to few weeks between conception and a positive pregnancy test, and I don’t believe there is enough scientific information for me to provide an accurate answer to that question. For women in the second and third trimesters, influenza immunization is considered reasonable and safe.

Member question: My son and daughter have a problem with nosebleeds, which seem to be much worse when they have a cold. There have been some scary moments recently when I thought I might need to take them to the emergency room. Should I consider cauterizing or is there anything less traumatic we can try?

Wolcott: I am fond of saying that appropriate therapy follows accurate diagnosis. There really is no way to know the proper therapy for a recurrent nosebleed without the opportunity to conduct a detailed history with the patient and their family and to examine the patient. That requires a visit to the physician. I would never recommend “home cautery” in the absence of a clear diagnosis and a physician’s clear recommendation for that treatment.

Member question:

What is the best way to protect infants and toddlers from the flu?

Wolcott: The American Academy of Pediatrics recommends influenza vaccination for children between the ages of 6 months and two years. So that certainly is one way to protect that age group. Another is to make certain that the people caring for them have had flu immunization, and that hand washing precautions, especially when taking care of many children simultaneously, are followed.

Member question: I hear that you can tell if a cold is bacterial by the color of the drainage. Is that true?

Wolcott: Well, first of all, no “cold” is “bacterial.” By definition, colds are viral illnesses. Probably what you mean by this question is, can you differentiate between viral illnesses causing a cold and bacterial illnesses affecting the nose and sinuses. The answer is a physician really cannot make that distinction based on the color of the nasal drainage. Many physicians believe that they can, but when put to scientific test, that has not been shown to be the case.

Member question: If you cannot tell the difference due to color of discharge, is there ever a good time to resort to an antibiotic?

Wolcott: Antibiotics are ineffective in the treatment of viral infections. Antiviral agents are ineffective in the treatment of infections caused by bacteria. The physician faces a difficult clinical decision when trying to separate viral from bacterial in a single patient. How to make that distinction is a far longer issue than can be discussed in this forum.

But I tell my patients that one should not “resort” to antibiotics; one should treat with antibiotics when that is clearly the appropriate choice. In other words, I don’t personally recommend antibiotics to patients “because it might be a bacterial infection.” I only prescribe them when I know it is a bacterial infection.

Member question: Can both colds and flu cause occasional dizziness? Dizziness when you stand from a sitting position?

Wolcott: I always tell medical students that whenever a patient asks a question can “X lead to Y” their answer has to be, “Yes, but.” There are some viruses that cause true vertigo (meaning that the room seems to spin around). In general, those viruses are not the viruses that cause influenza and the common cold.

Almost any illness can make some people feel woozy and light-headed when they stand up, and some people will refer to that felling as “dizziness.” That dizziness is a different sensation than the vertigo I just described.

So yes, the flu or a cold can make you feel woozy when you stand up, but in general will not make you feel like you just got off the merry-go-round.

Member question: I have a real problem with over-the-counter cold/flu remedies - they all make me incredibly jumpy and unable to sleep. I don’t have high blood pressure or any other known medical issue but they all effect me this way — is there any over-the-counter treatment that won’t?

Wolcott: I’ve not seen those complications with chicken soup. Additionally, saline nose drops are, for many people, as effective as over-the-counter nose drops containing vasoconstrictors. For most people, the antihistamine family of active ingredients in over-the-counter medications is sedative rather than stimulating. However, for a small number of people, the opposite is true.

A good rule of thumb is, if something makes you sicker than you already are, don’t take it. But you might want to take an antihistamine if stuffiness is an issue in your particular case.

Member question: I know that washing hands helps keep colds from spreading, but what other steps can we impress upon our children?

Wolcott: You can impress them on your children, but also on your friends, neighbors, and people you meet on buses, airplanes, and trains.

Cover your mouth or nose with a tissue or handkerchief rather than just your hand when you cough or sneeze. Don’t rub your hands on your face or someone else’s face after sneezing or coughing, or cleaning up after a child who has just had a runny nose, without washing your hands. Those are the primary ways of trying to decrease the chances of having an infection spread.

Moderator: We tell our daughter to sneeze into the crook of her elbow when she doesn’t have a tissue handy!

Member question: When should you stop trying to treat your cold and flu symptoms at home and make an appointment to see the doctor?

Wolcott: This is what I tell my adult patients. They should make an appointment if they have:

Temperatures that exceed 104 to 104.5 degrees that do not respond to Tylenol or aspirin

Worrisome shortness of breath

Chest pain brought on by coughing or deep breathing that cuts off their ability to take a deep breath

A chronic illness that makes them susceptible to complications of chest infections, such as asthma, chronic obstructive pulmonary disease, or emphysema

Symptoms that are unabated for more than two weeks, or if their symptoms resolve and then return

There is an excellent summary of “when to see the doctor” at the Cold and Flu Center on WebMD Health (

Member question: I have a bad cold now; head stuffy, chest congested, and eyes runny. When I cough if makes my head hurt. My husband says I should cough it up to clear my chest. I’d just as soon take something to stop the coughing. Who is right?

Wolcott: Probably you’re both right. “Coughing stuff up” is a natural protective device of the body and so not coughing at all increases the chances of developing a lung infection.

However, coughing a lot interferes with sleep and normal activities. So I tell my patients, I certainly don’t want to make it so you don’t cough at all, but I do recommend cough medicines if they will help you sleep or help you adequately do the activities you need to do while you’re awake.

Moderator: Do you have any parting words on facing the cold and flu season, Dr. Wolcott?

Wolcott: Getting a flu shot — unless there’s a contraindication not to — is a good idea. If you choose to use the new inhaled immunization product, be prepared to read the material containing the contraindications and warnings before receiving it. And read about cold and flu at a place like WebMD Health before you’re sick so you know how to deal with an illness, should one occur.

Moderator: Thanks to Dr. Barry Wolcott, for sharing his expertise with us today. For more information, please visit Dr. Wolcott at our message boards, where you can find support, advice, and expert guidance on your health concerns.

WebMD content is provided to MSNBC by the editorial staff of WebMD. The MSNBC editorial staff does not participate in the creation of WebMD content and is not responsible for WebMD content. Remember that editorial content is never a substitute for a visit to a health care professional.