The flu (influenza virus infection) can be a very serious illness. The flu is not the sniffles, sore throat, or an upset stomach that goes away in a few days, even though some people think it is. The flu most often causes fever, body aches, tiredness, and a cough that can last for weeks. Up to 1 in 5 Americans gets the flu each year, and over 200,000 are put in the hospital because of it. About 36,000 people each year die from the problems caused by the flu.

Currently, there is another type of flu -- the swine flu. It is called novel H1N1 or just H1N1. It is a new flu (influenza) virus that was first found in people in the United States in April 2009. It is going around this winter, along with the better known seasonal flu strains.

It causes the same problems, with fever, cough, and the risk of more serious illness. But this type is caused by a different virus, one that the 2009 flu shot does not protect you from. This is why a new vaccine was made to prevent this new type of flu. So this year, there are 2 flu shots: the usual seasonal flu vaccine and the swine (H1N1) flu shot.

Any flu shots you've had in the past, including the swine flu vaccine used in 1976, will not protect you from this new H1N1 (swine flu) virus. People who need flu shots should take both shots this year.

These flu vaccines are the best way to prevent the flu. Talk to your doctor about whether or not you should get the flu shots.

What should adults with cancer know about the flu this season (2009-2010)?

The flu is spreading in most of the United States, and most states report widespread flu infections. This flu season, the Centers for Disease Control and Prevention (CDC) expects both swine flu (H1N1 flu) and seasonal flu to cause illness. Cancer patients and survivors are more likely to have serious problems from the flu. They are more likely to end up in the hospital or even to die from these problems.

I have had cancer in the past, but I have no signs of cancer now. Is this still true for me?

Yes. If you have had cancer in the past, you are at higher risk for having serious problems if you get the flu, even if you are free from cancer now.

Are cancer patients and survivors more likely to get the flu than others?

No one knows for sure if cancer patients and survivors are at greater risk for being infected with either H1N1 (swine) flu or seasonal flu. But they are at higher risk for having serious problems from both seasonal and H1N1 flu. Even if cancer patients are at the same risk of getting the flu, once they get either type of flu they are at higher risk of complications.

What can I do to protect myself from the flu?

The best way to prevent flu is to get the vaccines. A vaccine for swine flu was produced and tested in 2009, using the same methods as the seasonal flu vaccine. Its production was started later, so it was not available to the public until after the seasonal flu vaccine.

Swine flu and regular seasonal flu are spread in the same ways. Even if you haven't had the 2 vaccines, there are things you and others can do to try to prevent the spread of flu viruses and many other germs.

• Wash your hands often. Use soap and warm water or alcohol-based cleaners or wipes.

• Do not touch your eyes or nose. Keep your fingers away from your mouth.

• Cover your mouth and nose with a tissue when you cough or sneeze. Then throw the tissue in the trash and wash your hands.

• Try to stay away from sick people. At least 6 feet is thought to be a safe distance.

• Try to stay away from small children who spend their days in group settings like daycare or school -- germs spread easily in these places.

• If you have symptoms of the flu, stay home for at least 24 hours unless you need to see a doctor. Try to stay away from other people for about a week.

• Be ready just in case you do get sick. Have the things you may need at home (food, tissues, hand cleaners, medicines for cough and fever, and so on) so that you don't have to go out in public.

• Take care of yourself. Follow public health advice about things like school closings and avoiding crowds.

In some cases, prescription flu medicines and anti-viral drugs can be used to try to prevent the flu in someone who has just been near someone with it. They can also be used to treat people who have been infected. (See the sections, "Can the flu be treated if I already have symptoms?" and "When should cancer patients and survivors get anti-viral drugs to prevent the flu?")

What else can I do to prepare?

Make plans in advance with your doctor about what to do if you get sick. Talk with your doctor about:

• When you should call the doctor
• Whether or not you will need anti-viral medication
• How to get a prescription for anti-viral medication quickly if needed
• Making sure your vaccines are up to date

Keep a written record of these important facts in a place you can find them quickly:

• The type of cancer you have or have had
• Treatment you have received and when you received it
• The name and contact information for your doctor
• A complete list of medicines you are taking

What about patients who are getting cancer treatment?

People getting cancer treatment often have weak immune systems. For them, the flu can lead to serious, even life-threatening problems. The flu shot is recommended for most people with cancer.

Many people with cancer worry that the flu shot will make them sick or cause a reaction with other medicines they are taking. Talk to your doctor about this -- he or she knows your situation best and can tell you if you should get the shot and when is the best time to get it. Some people do get mild symptoms, such as a low-grade fever or achy muscles, after a flu shot. These symptoms are caused by the immune system's response to the flu shot and should go away in a day or so. The flu shot cannot cause the flu.

The CDC says that people with a high risk of having serious problems if they get the flu should get flu shots every year before flu season begins. It is best if they are vaccinated as soon as it is available, or before December. (Flu season is usually from November to April and peaks in January and February each year.) People who are at high risk for problems if they get the flu includes anyone with a weak immune system due to cancer treatment with x-rays (radiation) or drugs (chemotherapy). Those who are very sick should talk to their cancer doctor about getting a flu shot before they do it.

The CDC also recommends that people who live with or care for a person at high risk for flu-related problems get the vaccines, too. This means that if you are in cancer treatment, your family members, caregivers, and children at home should get the flu shots, too.

Remember that if you have an allergy to chicken eggs you might have an allergic reaction to flu shots. Talk with your doctor about this and any other allergies you have before you get seasonal or swine flu shots.

What types of flu vaccines are recommended for people with cancer?

Cancer patients do have to be careful about the type of flu vaccine they get. There come in 2 forms:

• Live vaccines are made up of weakened live virus and are given as a nasal spray.

• Inactivated vaccines are made up of killed virus and are given as actual shots or injections, most often in the arm.

People with cancer should get the inactivated flu shots, NOT the nasal spray. Family members can safely get the nasal spray unless the patient is being cared for in a germ-protected area (after a recent stem cell or bone marrow transplant, for example).

When should cancer patients and survivors get anti-viral drugs to prevent the flu?

If you have been within 6 feet of someone known or suspected to have the flu, and you:

• have had cancer treatment like chemotherapy or radiation treatment within the last month.

OR

• have a blood or lymphatic form of cancer (such as leukemia, lymphoma, or myeloma).

Call your doctor right away. Your doctor may give you anti-viral drugs to help prevent the flu.

Can the flu be treated if I already have symptoms?

Prescription flu medicines like Tamiflu^® and Relenza^® can be used to treat and prevent swine flu as well as seasonal flu.

Other anti-viral drugs can also be used. These drugs are also available only by prescription. They work by keeping the virus from reproducing in your body. They can make the flu symptoms milder and can help you feel better faster. They can also help keep the infection from causing severe problems. Anti-viral drugs work best if they are started within 2 days after getting sick.

If you are a cancer patient or survivor, and you think you have the flu, follow the steps below.

• Contact your health care provider and follow his or her instructions.

• Stay home and away from others as much as possible to keep from making them sick. Avoid public activities, including work, school, travel, shopping, social events, and public gatherings. Stay home for at least 24 hours after your fever is gone (without the use of fever-reducing drugs). Only go out to get medical care or other things you must have.

• If you need to go to the doctor, emergency room, or any other health care facility, cover your mouth and nose with a face mask if you can. If not, cover your mouth and nose with a tissue when you cough or sneeze. Let the facility's staff know you are there because you think you may have the flu.

What are the symptoms of seasonal and swine flu?

Common symptoms of the flu include:

• Fever
• Cough
• Sore throat
• Runny or stuffy nose
• Body aches
• Headache
• Chills
• Fatigue (tiredness)

Some people may have vomiting and diarrhea as well. But other people may have the flu, including swine flu, and only have a cough, sore throat, or stuffy head without a fever.

What else do I need to know?

Seasonal and swine flu vaccines work in the same way. They cause the body to make antibodies that protect it against influenza virus infection. It takes up to 2 weeks after the shot for the body to do this. This is why you should get the flu shots as soon as you can. That way your body can have more time to form the protection you need.

Keep in mind that any former immunizations, including last year's flu vaccine or the 1976 swine flu vaccine, will NOT protect against the current strain.

People with cancer should get both 2009 flu vaccines. People who care for people with cancer, including health care workers, should also get both vaccines.

In most people, both seasonal and swine flu are limited illnesses that are not life threatening. But the flu can be serious in the high-risk groups, and these people should get priority for vaccination.

Additional resources

More information from your American Cancer Society

We have selected some related information that may also be helpful to you. These materials may be ordered from our toll-free number.

• Infections in People With Cancer

• After Diagnosis: A Guide for Patients and Families (also available in Spanish)

• A Message of Hope: Coping With Cancer in Everyday Life (also available in Spanish)

National organizations and Web sites*

Centers for Disease Control and Prevention (CDC)
Toll-free number: 1-800-232-4636
Web site: www.cdc.gov/cancer/flu/#1
Has information on flu just for people with cancer.

Web site: www.cdc.gov/h1n1flu/
For more information on swine flu and weekly activity updates.

Web site: www.cdc.gov
Has information on influenza and flu vaccines, including side effects and which types can be used for people with serious illness.

*Inclusion on this list does not imply endorsement by the American Cancer Society.

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

References

Centers for Disease Control and Prevention. Inactivated Influenza Vaccine 2009-10: What You Need to Know. Accessed at: www.cdc.gov/vaccines/pubs/vis/downloads/vis-flu.pdf on August 28, 2009.

Centers for Disease Control and Prevention. Key Facts about Seasonal Influenza. Accessed at: www.cdc.gov/flu/keyfacts.htm on August 28, 2009.

Centers for Disease Control and Prevention. Questions and Answers: Novel H1N1 Influenza Vaccine. Accessed at: www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm on August 28, 2009.

Centers for Disease Control and Prevention. Seasonal Flu Vaccine. Accessed at: www.cdc.gov/flu/about/qa/fluvaccine.htm on August 28, 2009.

Centers for Disease Control and Prevention. The Nasal-Spray Flu Vaccine (Live Attenuated Influenza Vaccine [LAIV]). Accessed at: www.cdc.gov/FLU/about/qa/nasalspray.htm on November 24, 2009.

Centers for Disease Control and Prevention. What Cancer Patients and survivors should know about the flu. Accessed at: www.cdc.gov/cancer/flu/#1 on November 23, 2009.

Last Medical Review: 12/21/2009
Last Revised: 12/21/2009