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Colds and the fluInfluenza; Strep throat; Bird flu; Avian influenza
An in-depth report on the diagnosis, treatment, and prevention of colds and flu.
- Upper respiratory tract infections affect the air passages in the nose, ears, and throat.
- Organisms that cause these upper respiratory tract infections are generally spread by direct contact (such as hand-to-mouth) with germs or by someone coughing or sneezing.
- The common cold is the most common upper respiratory tract infection.
Influenza (flu)
- The two major flu strains are referred to as A and B:
- Influenza A is the cause of the major pandemics of influenza that have occurred so far.
- Influenza B infects only humans.
Flu Vaccine
- The Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of 6 months receive the flu vaccine every year. The only exceptions are for those allergic to the vaccine. Two types of flu vaccine are available: a killed vaccine that comes in 3 injectable forms, and a live vaccine given as a nasal spray.
- Newer vaccines contain very little egg protein, but an allergic reaction still may occur in people with strong allergies to eggs. A new vaccine made in animal cell culture, not in eggs, was approved by the Food and Drug Administration (FDA) in November 2012, for people aged 18 years and older.
- In December 2012, the FDA approved a new type of influenza vaccine, which will be used for the first time in the 2013 - 2014 season. This vaccine will match the 2 current strains of both influenza A and B, to provide wider protection. The vaccine is approved for ages 3 years and older.
Cold and Flu Treatments
- Antibiotics are often prescribed inappropriately for colds, flu, and for sore throats that are not caused by strep bacteria. Studies indicate that fewer than half of adults and far fewer of the children with even strong signs and symptoms for strep throat actually have strep infections.
- Dozens of remedies are available that combine ingredients aimed at more than one cold or flu symptom. In most cases these preparations are safe, but they can cause problems and their effectiveness is open to question
Upper respiratory tract infections affect the air passages in the nose, ears, and throat.
Structures of the throat include the esophagus, trachea, epiglottis, and tonsils.
The infections can be caused by viruses, bacteria, or other microscopic organisms. In most cases, these infections lead to colds or mild influenza (flu) and are temporary and harmless. In rare cases, flu can be severe, or the infections may turn into pneumonia.
Organisms that cause these upper respiratory tract infections are generally spread by:
- Direct contact (such as hand-to-mouth)
- Coughing or sneezing
The Common Cold
The common cold (medically known as infectious nasopharyngitis) is the most common upper respiratory tract infection. More than 200 different viruses can cause colds. The most common cause is the rhinovirus, which is responsible for about half of all colds. The adenovirus family also causes upper respiratory infections (it is one of the many viruses that cause the common cold). It also causes pneumonia, conjunctivitis, and several other diseases. A newer strain of adenovirus has causedseveral deaths.
Symptoms usually develop 1to 3 days after being exposed to the cold virus.
A cold usually progresses in the following manner:
- It nearly always starts rapidly with throat irritation and stuffiness in the nose.
- Within hours, full-blown cold symptoms usually develop, which can include sneezing, mild sore throat, fever, minor headaches, muscle aches, and coughing.
- Fever is low-grade or absent. In small children, however, fever may be as high as 103 °F for 1 or 2 days. The fever should go down after that time, and be back to normal by the 5th day.
- Nasal discharge is usually clear and runny the first 1to 3 days. It then thickens and becomes yellow to greenish.
- The sore throat is usually mild and lasts only about a day. A runny nose usually lasts 2 to7 days, although coughing and nasal discharge can persist for more than 2 weeks.
Influenza ("The Flu")
Every year, influenza strikes millions of people worldwide. Influenza epidemics are most serious when they involve a new strain, against which most people around the world are not immune. Such global epidemics (pandemics) can rapidly infect more than one fourth of the world's population. For example, the Spanish flu in 1918 and 1919 killed an estimated 20 million people in the U.S. and Europe and 17 million people in India. With modern society's dependence on air travel, an influenza pandemic could potentially inflict catastrophic damage on human lives, and disrupt the global economy.
More recently, the new H1N1 ("Swine Flu") that emerged in Mexico in the spring of 2009 quickly became a pandemic, though it was far less severe or deadly than the Spanish flu of 1918. As of February 24 2010,the World Health Organization estimated the total deaths from the H1N1 pandemic at over 16,000 people. It is likely the actual total is somewhat larger, because not all victims are tested for H1N1 influenza. The H1N1 pandemic was declared over by the World Health Organization in August 2010. This particular influenza strain became one of the seasonal influenza viruses circulating world-wide during the 2010 - 2011 flu season, and to a lesser extent during the 2011 - 2012 flu season. It is still a part of the 2012 - 2013 seasonal flu vaccine.
Symptoms of influenza. Patients usually feel sick 1to 2 days after exposure to the influenza (flu) virus. The flu usually involves:
- Abrupt onset of severe symptoms, which include headache, muscle aches, fatigue, and high fever (up to 104 °F).
- Cough (which is usually dry but is often severe) and sometimes a runny nose and sore throat.
- Children may experience vomiting, diarrhea, and ear infections, as well as other flu symptoms.
- The symptoms usually resolve in 4to 5 days, although some people can experience coughing and feelings of illness for more than 2 weeks. In some cases, flu can become more severe or make other conditions worse.
Transmitting the Virus. The flu virus is spread primarily when a person with the flu coughs or sneezes near someone else. Adults with flu typically spread it to someone else from 1 day before symptoms start to about 5 days after symptoms develop. Children can spread the infection for more than 10 days after symptoms begin, and young children can transmit the virus 6 days or even earlier before the onset of symptoms. People with severely compromised immune systems can transmit the virus for weeks or months.
Flu Strains. A virus is a cluster of genes wrapped in a protein membrane, which is coated with a fatty substance that contains molecules called glycoproteins. Strains of the flu are identified according to the number of membranes and type of glycoproteins present.
The two major flu strains are referred to as A and B:
- Influenza A is the most widespread and can infect animals and humans. Influenza A is the cause of the major pandemics of influenza that have occurred so far. It is usually further categorized by two subtypes based on two substances that occur on the surface of the viruses: hemagglutinin (H) and neuraminidase (N).
- Influenza B infects only humans. It is less common and less severe than type A, but is often associated with specific outbreaks, such as in nursing homes.
The vast majority of flu cases are type A. Influenza A usually causes more serious disease than type B. There is some concern, however, that since influenza B has been less common in the past few years, some people, particularly small children, may have fewer antibodies to it and so may be at higher risk for severe infection.
Avian Influenza (Bird Flu)
The influenza virus mutates (changes) rapidly as it moves from species to species. While most avian influenza (bird flu) virus strains are relatively harmless, a few develop into "highly pathogenic avian influenza," which can be very deadly for domesticated poultry. As recent events have shown, these strains can also be deadly to humans. People can become infected by these bird flu strains through contact with contaminated chickens and other birds. The medical community is concerned about the H5N1 bird flu virus, which has infected and killed people in several countries.
Since 1997, the H5N1 virus has triggered deadly outbreaks in poultry across Southeast Asia. As ofDecember 17, 2012,610 people had been infected with the bird flu in 15 countries. Of these people, 360 have died, according to the World Health Organization. No cases have been reported in the United States.
So far, the virus has spread only from birds to humans. The virus does not seem to be easily spread from person to person. However, scientists and public health officials are monitoring the spread of H5N1 and working to contain it. Efforts include slaughtering infected birds, developing new vaccines, and stockpiling antiviral drugs such as oseltamivir (Tamiflu). Many poor nations have limited resources and already contend with other serious health problems, including HIV-AIDS. If H5N1 does mutate and spread, the consequences could be especially severe for these countries.
In April 2007, the Food and Drug Administration (FDA) approved a vaccine to protect humans from avian influenza. Currently this vaccine is not being used for routine immunization. However, if the avian flu develops the ability to spread fairly easily from human to human, this vaccine may be made available. A new avian influenza vaccine is currently in clinical trials and is showing
promising results. On November 14, 2012 the FDA Vaccines and Related Biological Products Advisory Committee unanimously decided that these clinical trials' results support the vaccine's licensure. The FDA's decision on whether to approve the vaccine is pending.
Differentiating between a cold and flu may be difficult. Cold symptoms are nearly always less severe than those of the flu.
Comparing Colds and Flus
None or low grade
Common and high (102 - 104 °F); lasts 3to 4 days
None or mild
Almost always present
General aches and pains
Mild, if they occur at all
Often severe
Fatigue, exhaustion, and weakness
Mild, it they occur at all
Extreme exhaustion is early and severe; can last 2to 3 weeks
Stuffy nose
Nearly always
Very common
Sore throat
Chest discomfort and cough
Mild-to-moderate, hacking cough
Common, can be severe
Source: National Institute of Allergy and Infectious Disease
Diagnosing the Flu
Several available tests can isolate and identify the viruses responsible for some respiratory infections. They are generally not needed, since most cases of the flu are self-evident. Decisions about treatment are almost always made based on how sick an individual is, and whether the person is at risk for more severe complications. If a doctor believes a diagnosis would help, samples using a swab should be taken from the nasal passages or throat within 4 days of the first symptoms.
Several rapid tests for the flu can produce results in less than 30 minutes, but vary on the specific strain or strains that they can detect. They are not as accurate as a viral culture, however, in which the virus is reproduced in the laboratory. Culture results can take 3to 10 days. Blood tests can also document the infection several weeks after symptoms appear.
Diagnosing Avian Influenza
In February 2009, the FDA approved a faster test for diagnosing H5 strains of avian influenza in people suspected of having the virus. The test is called A/H5N1 Flu Test. The test gives preliminary results within 40minutes. Older tests required 3 to 4 hours. It checks for the presence of the protein NS1, which indicates an influenza H5N1 strain, the current strain of concern.
Other Causes of Congestion
Ruling out Allergic Rhinitis. Symptoms of allergic rhinitis include nasal obstruction and congestion, which are similar to the symptoms of a cold. People with allergies, however, are likely to have the following:
- Thin, clear, and runny nasal discharge
- An itchy nose, eyes, or throat
- Recurrent sneezing
There are two forms of allergic rhinitis:
- Symptoms that appear only during allergy season are called allergic rhinitis, commonly known as hay or rose fever. [For more information, see In-Depth Report #77: Allergic rhinitis.]
- Allergens in the house, such as house dust mites, molds, and pet dander, can cause year-long allergic rhinitis, referred to as perennial rhinitis.
Ruling out Sinusitis. The signs and symptoms suggestive of true acute sinusitis include the following:
- A return of congestion and discomfort after initial improvement in a cold (called double sickening)
- Purulent (pus-filled) nasal secretion
- A lack of response to decongestant or antihistamine
- Pain in the upper teeth or pain on one side of the head
- Pain above or below both eyes when leaning over
Children with sinusitis are less likely to have facial pain and headache and may only develop a high fever or prolonged upper respiratory symptoms (such as a daytime cough that does not improve for 11to 14 days). When the diagnosis is unclear or complications are suspected, further tests may be required. [For more information, see In-Depth Report #62: Sinusitis.]
Other Causes of Coughing
Acute Bronchitis. Acute bronchitis is usually caused by a virus and in most cases is self-limiting. The cough it causes typically lasts for about 7to 10 days, but in about half of patients, coughing can last for up to 3 weeks, and 25% of patients continue to cough for over 1 month.
Atypical Pneumonia. Pneumonia caused by atypical organisms (such as Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella) can cause symptoms similar to the flu. Only laboratory tests can diagnose the difference. [For more information, see In-Depth Report #64: Pneumonia.]
Ruling out other Viral Infections. Respiratory syncytial virus (RSV), and possibly human parainfluenza viruses (HPV), are proving to be important causes of serious respiratory infections in infants, the elderly, and people with damaged immune systems. (Both also cause mild conditions.) RSV may be a much more common cause of flu-like symptoms than previously thought.
Pertussis. Pertussis (whooping cough) was a very common childhood illness throughout the first half of the century. Although immunizations caused a decline in cases to only 1,730 in the U.S. in 1980, the incidence has risen recently, with 18,719 cases in 201According to the Centers for Disease Control and Prevention (CDC), many additional
cases in the United States go undiagnosed. Many more cases are reported worldwide.
Nearly half of pertussis cases now occur in people 10 years of age or older, perhaps due to waning immunity in adolescents and adults. Up to 25% of adults who see a doctor for persistent cough may actually have pertussis. It may go undiagnosed, however, because their symptoms are usually mild, and adults are unlikely to have the classic "whooping" cough. This is of some concern because such adults may unknowingly infect unvaccinated children. The younger the patient with pertussis, the higher the risk for severe complications, including pneumonia, seizures, and even death. Children younger than 6 months are at particular risk because protection is incomplete, even with vaccination.
Pertussis vaccines safe for older children and adults are now available.
Other Causes of Sore Throat
In addition to common cold viruses, other, less frequent causes of sore throat include the following:
- Strep throat
- Foodborne and waterborne infections (Streptococcus C and G)
- An uncommon organism called Arcanobacterium haemolyticum (infection with this bacterium can mimic strep throat and may even cause a rash)
- Infectious mononucleosis ("mono")
- Herpesvirus 1
What is Strep Throat?
Group A Streptococcal bacteria is the most common bacterial cause of the severe sore throat known commonly as "strep throat." It occurs mostly in school age children, but people of all ages are susceptible. (Strep throat constitutes about 12% of all sore throat cases seen by doctors.)
The symptoms of strep throat include the following:
- A sudden onset of severe sore throat
- Difficulty in swallowing
- Fever
- Headache
- Stomach pain
- Vomiting
Only about half of patients with strep throat have such clear-cut symptoms. Furthermore, half of people who have these symptoms do not actually have strep throat.
How Is Strep Throat Diagnosed? Most cold-related sore throats are caused by viruses and require no treatment. They usually do not last more than a day. When the sore throat persists and is very painful the doctor will want to rule out or confirm the presence of the Streptococcus bacteria.
- The doctor will look for redness and pus-filled patches on the tonsils and back of the throat.
- The doctor will feel the sides of the neck for swollen lymph nodes. If the lymph nodes are not swollen, it is less likely to be a strep throat.
- A cotton swab is used to take a sample of pus in the throat for a throat culture.
A throat culture is the most effective and least expensive test for confirming the presence of strep throat. It takes 24to 48 hours to obtain a result.
Rapid Antigen-Detection Test for Strep Throat. A faster test, called the Rapid Strep Antigen Test, uses chemicals to detect the presence of bacteria in a few minutes. A positive result nearly always means that streptococcal bacteria are present in the throat. The test, however, fails to detect 5to 10% of cases, so a culture may still be necessary to catch any missed infections, particularly in children.
How Serious is Strep Throat? The use of antibiotics has removed the threat of most complications from streptococcus infection in the throat. However, untreated strep throat could lead to the following complications:
- Abscess in the tonsils
- Scarlet fever
- Rheumatic fever (rare in the U.S.)
Colds rarely cause serious complications. In about 1% of cases, a cold can lead to other complications, such as sinus or ear infections. It can also aggravate asthma and, in uncommon situations, increase the risk for lower respiratory tract infections.
Ear Infections. The rhinovirus, a major cause of colds, also commonly predisposes children to ear infections, possibly by blocking the Eustachian tube, which leads to the middle ear. Viruses may even attack the ear directly.
Sinusitis. Between 0.5to 3% of people with colds develop sinusitis, an infection in the sinus cavities (air-filled spaces in the skull). Sinusitis is usually mild, but if it becomes severe, antibiotics generally eliminate further problems.
Lower Respiratory Tract Infections. The common cold poses a risk for bronchitis and pneumonia in nursing home patients, and in other people who may be vulnerable to infection.
Aggravation of Asthma. Rhinovirus infections can aggravate asthma in both children and adults. In fact, rhinovirus has been reported to be the most common infectious organism associated with asthma attacks. Problems with wheezing may persist for weeks after a cold.
Complications of Influenza
The flu is usually self-limited. However, each flu season is unpredictable and can make varying numbers of people dangerously sick. According to the CDC, between 1976 and 2006, flu-associated deaths ranged from about 3,000 to 49,000. People at highest risk for serious complications from seasonal flu are those over 65 years old and those with chronic medical conditions. Influenza A is the most severe strain. Influenza B tends to be milder.
Unlike the seasonal flu, children younger than 5 years old, especially those younger than age 2, with H1N1 (swine) flu are also at risk for more serious complications. Pregnant women with H1N1 influenza are also at increased risk for complications.
Pneumonia. Pneumonia is the major serious complication of influenza and can be very serious. It can develop about 5 days after the flu. More than 90% of the deaths caused by influenza and pneumonia occur among older adults.
Flu-related pneumonia nearly always occurs in high-risk individuals. It should be noted that pneumonia is an uncommon outcome of influenza in healthy adults.
Complications in the Central Nervous System in Children. Influenza increases the risk for complications in the central nervous system of small children. Febrile seizures are the most common neurologic complication in children. The risks decline after a child turns 1 year old, but are still high in children aged 3to 5 years old.
Risk Factors
The very young and the very old are at higher risk for upper respiratory tract infections and their associated complications.
Children. Young children are prone to colds and may have as many as 12 colds every year. Millions of cases of influenza develop in American children and adolescents each year.
Before the immune system matures, all infants are susceptible to upper respiratory infections, with a possible frequency of one cold every 1to 2 months. Smaller nasal and sinus passages also make younger children more vulnerable to colds than older children and adults. Upper respiratory infections gradually diminish as children grow, until at school age their rate of such infections is about the same as an adult's. There is almost never cause for concern when a child has frequent colds, unless the colds become unusually severe or more frequent than usual.
The Elderly. The elderly have diminished cough and gag reflexes, and their immune systems are often weaker. They are therefore at greater risk for serious respiratory infections than the young and middle-aged adults.
Exposure to Smoke and Environmental Pollutants
The risk of respiratory infections is increased by exposure to cigarette smoke, which can injure airways and damage the cilia (tiny hair-like structures that help keep the airways clear). Toxic fumes, industrial smoke, and other air pollutants are also risk factors. Parental smoking increases the risk of respiratory infections in their children.
Medical Conditions
People with AIDS and other medical conditions that damage the immune system are extremely susceptible to serious infections.
Cancers, especially leukemia and Hodgkin's disease, put patients at risk. Patients who are on corticosteroid (steroid) treatments, chemotherapy, or other medications that suppress the immune system are also prone to infection.
People with diabetes are at a higher risk for the flu.
Certain genetic disorders predispose people to respiratory infections. They include sickle-cell disease, cystic fibrosis, and Kartagener syndrome (which results in malfunctioning cilia).
People under Stress
A number of studies suggest that stress increases one's susceptibility to a cold. Stress appears to increase the risk for a cold regardless of lifestyle or other health habits. And once a person catches a cold or flu, stress can make symptoms worse.
It is not clear why these events occur. Some experts believe that stress alters specific immune factors, which cause inflammation in the airways.
Seasonal Incidence
Colds and the flu occur predominantly in the winter. Flu season typically starts in October and lasts into mid March.
The reasons for this seasonal bias are not due to the cold itself, but to other factors. Certainly, the flu and colds are more likely to be transmitted in winter because people spend more time indoors and are exposed to higher concentrations of airborne viruses. Dry winter weather also dries up nasal passages, making them more susceptible to viruses. Some experts theorize that the high rates of viral infections in winter may be due to certain immune factors, which react to light and dark and affect a person's susceptibility to viruses.
Traveling in Trains, Buses, and Planes
Traveling in close contact with people, whether on trains, planes, or buses, can increase the risk for respiratory infections.
Day Care Centers
Children who attend day care may have an increased risk of colds. However, they may have lower cold rates in their first years of regular school. The colds they catch in day care, then, may bestow some immunity to future colds for a few years. By age 13, such protection has worn off. There is also some evidence that frequent colds in young children may help protect against future allergies and asthma.
Because colds and the flu are easily spread, everyone should always wash their hands before eating and after going outside. Ordinary soap is sufficient. Waterless hand cleaners that contain an alcohol-based gel are also effective for everyday use and may even kill cold viruses.
Antibacterial Products
Antibacterial soaps add little protection, particularly against viruses. In fact, one study suggests that common liquid dish washing soaps are up to 100 times more effective than antibacterial soaps in killing respiratory syncytial virus (RSV), which is known to cause pneumonia. Wiping surfaces with a solution that contains one part bleach to 10 parts water is very effective in killing viruses. Alcohol-based hand cleaners are very effective, as mentioned above, and are recommended by the CDC.
Colds are not caused by insufficiently warm clothes or by going outside with wet hair.
The following are some food and fluid recommendations.They will not cure a cold, but they may help a person deal better with the symptoms:
- Drinking plenty of fluids and getting lots of rest when needed is still the best bit of advice to ease the discomforts of the common cold. Water is the best fluid and helps lubricate the mucous membranes. (There is no evidence that drinking milk will increase or worsen mucus.)
- Chicken soup does indeed help congestion and body aches. The hot steam from the soup may be its chief advantage, although laboratory studies have actually reported that ingredients in the soup may have anti-inflammatory effects. In fact, any hot beverage may have similar soothing effects from steam. Ginger tea, fruit juice, and hot tea with honey and lemon may all be helpful.
- Spicy foods that contain hot peppers or horseradish may help clear sinuses.
Despite a few studies that suggest that large doses of vitamin C may reduce the duration of a cold, most of the scientific evidence finds no benefit. Taking high doses of vitamin C is not recommended, for the following reasons:
- High doses of vitamin C may cause headaches, intestinal and urinary problems, and even kidney stones.
- Because vitamin C increases iron absorption, people with certain blood disorders, such as hemochromatosis, thalassemia, or sideroblastic anemia, should avoid high doses of this vitamin.
- Large doses of vitamin C can also interfere with anticoagulant medications ("blood thinners"), blood tests used in diabetes, and stool tests.
In addition, a review of evidence suggests that taking large doses of vitamin C after the onset of cold symptoms does not improve the symptoms or shortens the duration of the cold.
Zinc appears to influence the immune system and it may have a direct effect on viruses. Zinc preparations in lozenge or nasal gel form are marketed as cold treatments. Studies are very mixed on the effects of zinc on colds. A review of available studies comparing zinc treatment to placebo ("sugar pill") found only one high-quality study, which showed that zinc nasal gels might provide a benefit. Another review of 14 studies showed that oral zinc may shorten the duration of colds, but cautioned that large high-quality studies are needed before any treatment recommendations can be made. The overall benefit of zinc in the prevention of colds remains unclear. In any case, no one with an adequate diet and a healthy immune system should take zinc for prolonged periods, for the purpose of preventing colds.
Side Effects. Side effects, particularly of the lozenges form, include the following:
- Dry mouth
- Constipation
- Nausea
- Bad taste (possibly only with zinc gluconate lozenges)
- Severe vomiting, dehydration, and restlessness (signs of overdose, seek medical help)
- Allergic response (rare)
In 2009, the FDA issued a warning regarding Zicam nasal gel swabs containing zinc. The FDA has received reports of cases of anosmia (loss of the sense of smell) following use of these products. These reports are corroborated by several studies connecting nasal zinc applications with anosmia. The reports concerned only nasal gel containing zinc, not oral preparations of zinc.
Food and Drug Interactions. Zinc may also interact with drugs or other elements:
- It may reduce absorption of certain antibiotics.
- Foods high in calcium or phosphorus may reduce zinc absorption.
- In high doses and for long periods of time, zinc can cause copper deficiencies.
Medications for Mild Pain and Fever Reduction
Many people take medications to reduce mild pain and fever. Adults most often choose aspirin, ibuprofen (Advil), or acetaminophen (Tylenol).
The following are recommendations for children:
- Acetaminophen (Tylenol) or ibuprofen (usually Advil or Motrin) are the typical pain-relievers parents give their children. Most pediatricians advise such medications for children who run fevers over 101 °F. Some suggest alternating the two agents, although there is no evidence that this regimen offers any benefits, and it might be harmful.
- Aspirin and aspirin-containing products should never be used in children or adolescents. Reye syndrome, a very serious condition that can be life threatening, has been associated with aspirin use in children who have flu symptoms or chicken pox.
Nasal Strips
Nasal strips (such as Breathe Right) are placed across the lower part of the nose and pull the nostrils open. These strips may open the nasal passages and claim to ease congestion due to a cold, sinusitis, or hay fever. As of yet, there is no scientific evidence that they offer such benefits.
Nasal Wash
A nasal wash can be helpful for removing mucus from the nose. A saline solution can be purchased at a drug store or made at home. If you make a salt solution at home, you should first boil tap water and carefully clean and dry any device that was used to store the water. Although nasal washes have long been recommended, one study reported that neither a homemade solution (using one teaspoon of salt and one pinch of baking soda in a pint of warm water) nor a commercial hypertonic saline nasal wash had any effect on symptoms. Further, one preliminary study found that over-the-counter saline nasal sprays that contain benzalkonium chloride as a preservative may actually worsen symptoms and infection.
Some physicians, however, advocate a traditional nasal wash that has been used for centuries and is different from that used in most studies. It contains no baking soda and uses more fluid for each dose and less salt. The nasal wash should be performed several times a day.
A simple method for administering a nasal wash:
- Lean over the sink head down.
- Pour some solution into the palm of the hand and inhale it through the nose, one nostril at a time.
- Spit the remaining solution out.
- Gently blow the nose.
The solution may also be inserted into the nose using a large rubber ear syringe, available at a pharmacy. In this case, the process is the following:
- Lean over the sink head down.
- Insert only the tip of the syringe into one nostril.
- Gently squeeze the bulb several times to wash the nasal passage.
- Then press the bulb firmly enough so that the solution passes into the mouth.
- The process should be repeated in the other nostril.
Nasal-Delivery Decongestants
Nasal-delivery decongestants are applied directly into the nasal passages with a spray, gel, drops, or vapors. Nasal forms work faster than oral decongestants and have fewer side effects. They often require frequent administration, although long-acting forms are now available. Ingredients and brands of nasal decongestants include the following:
Long Acting Nasal-Delivery Decongestants. They are effective in a few minutes and remain so for 6 - 12 hours. The primary ingredient in long-acting decongestant is:
- Oxymetazoline: Brands include Vicks Sinex (12-hour brands), Afrin (12-hour brands), Dristan 12-Hour, Good Sense, Nostrilla, Neo-Synephrine 12-Hour
- Xylometazoline: Inspire, Otrivin, Natru-vent
Short-Acting Nasal-Delivery Decongestants. The effects usually last about 4 hours. The primary ingredients in short-acting decongestants are:
- Phenylephrine: Neo-Synephrine (mild, regular, high-potency), 4-Way, Dristan Mist Spray, Vicks Sinex
- Naphazoline (Naphcon Forte, Privine)
Dependency and Rebound. The major hazard with nasal-delivery decongestants, particularly long-acting forms, is a cycle of dependency and rebound effects. The 12-hour brands pose a particular risk for this effect. This effect works in the following way:
- With prolonged use (more than 3 - 5 days), nasal decongestants lose effectiveness and even cause swelling in the nasal passages.
- The patient then increases the frequency of their dose. The congestion worsens, and the patient responds with even more frequent doses, in some cases as often as every hour.
- Individuals then become dependent on them.
Tips for Use. The following precautions are important for people taking nasal decongestants:
- When using a nasal spray, spray each nostril once. Wait a minute to allow absorption into the mucosal tissues, and then spray again.
- Keep the nasal passages moist. All forms of nasal decongestants can cause irritation and stinging. They also may dry out the affected areas and damage tissues.
- Do not share droppers and inhalators with other people.
- Use decongestants only for conditions requiring short-term use, such as before air travel or for a single-allergy attack. Do not take them more than 3 days in a row.
- Discard sprayers, inhalators, or other decongestant delivery devices when the medication is no longer needed. Over time, these devices can become reservoirs for bacteria.
- Discard the medicine if it becomes cloudy or unclear.
Oral Decongestants
Oral decongestants also come in many brands, which mainly differ in their ingredients. The most common active ingredients are pseudoephedrine (Sudafed, Actifed, Drixoral) or phenylephrine (Sudafed PE and many other cold products). Note that pseudoephedrine sales are restricted in many communities because of potential use in the manufacturing of meth.
Side Effects of Decongestants. Decongestants have certain adverse effects, which are more apt to occur in oral than nasal decongestants and include the following:
- Agitation and nervousness
- Drowsiness (particularly with oral decongestants and in combination with alcohol)
- Changes in heart rate and blood pressure
Avoid combinations of oral decongestants with alcohol or certain drugs, including monoamine oxidase inhibitors (MAOI) and sedatives.
Individuals at Risk for Complications from Decongestants. People who may be at higher risk for complications are those with certain medical conditions, including disorders that make blood vessels highly susceptible to contraction. Such conditions include the following:
- Heart disease
- High blood pressure
- Thyroid disease
- Diabetes
- Prostate problems that cause urinary difficulties
- Migraines
- Raynaud's phenomenon
- High sensitivity to cold
- Emphysema or chronic bronchitis
Anyone with the above conditions should not use either oral or nasal decongestants without a doctor's guidance. In addition, people taking medications that increase serotonin levels, such as certain antidepressants, anti-migraine agents, diet pills, St. John's wort, and methamphetamine, should avoid decongestants. The combinations can cause blood vessels in the brain to narrow suddenly, causing severe headaches and even stroke.
Others who should use these drugs with caution are the following (consult your health care provider):
- Anyone who is pregnant.
- Children: Children appear to metabolize decongestants differently than adults. Decongestants should not be used at all in infants and small children under the age of 4. Young children are at particular risk for side effects that depress the central nervous system. Such symptoms cause changes in blood pressure, drowsiness, deep sleep, and, rarely, coma. Studies have also shown that these cough and cold products generally are not effective in the treatment of children under 6 years of age.
In October 2007, drug manufacturers voluntarily withdrew from the market all oral cough and cold products, including decongestants, aimed at children under 2, due to potential harm from misuse. In late 2008, the Consumer Healthcare Products Association, which represents most of the US makers of nonprescription over-the-counter cough and cold medicines in children, began voluntarily modifying its products' labels to read "Do Not Use in Children Under 4." This action is supported by the FDA.
Under no circumstances should children be given adult medicines, including over-the-counter medications.
Cough Remedies
Major studies have indicated that over-the-counter cough medicines are not very effective, but they are also not harmful.
- For thick phlegm, patients may try cough medications that contain guaifenesin (Robitussin, Scot-Tussin Expectorant), which loosens mucus. Patients should not suppress coughs that produce mucus and phlegm. It is important to expel this substance. To loosen phlegm, patients should drink plenty of fluids and use a humidifier or steamer.
- For patients with a dry cough, a suppressant may be useful, such as one that contains dextromethorphan (Drixoral Cough, Robitussin Maximum Strength Cough Suppressant).
Medications that contain both a cough suppressant and an expectorant are not useful and should be avoided. Medicated cough drops that contain dextromethorphan are not very useful. A patient is just as likely to find relief from hard candy or lozenges.
Prescription cough medications with small doses of narcotics are available. They are usually reserved for lower respiratory infections with significant coughs.
Remedies for Sore Throat Associated with Colds
Sore throats that are associated with colds are generally mild. The following may be helpful:
- Cough drops, throat sprays, or gargling warm salt water may help relieve sore throat and reduce coughing.
- Throat sprays that contain phenol (such as Vicks Chloraseptic) may be helpful for some.
- Cough drops that contain menthol and mild anesthetics, such as benzocaine, hexylresorcinol, phenol, and dyclonine (the most potent), may soothe a mild sore throat.
- People with sore throats from postnasal drip might try taking a teaspoon of liquid antacid. They shouldn't drink anything afterward, since the intention is to coat the throat and help neutralize the acid in the mucus that might be causing pain.
If soreness in the throat is very severe and does not respond to mild treatments, the patient or parent should check with the physician to see if a strep throat is present, which would require antibiotics. [See "What is Strep Throat?" in the Diagnosis section of this report.]
Combination Cold and Flu Remedies and Antihistamines
Dozens of remedies are available that combine ingredients aimed at more than one cold or flu symptom. In general, they do no harm, but they have the following problems:
- Some ingredients may produce side effects without even helping a cold.
- In some cases, the ingredients conflict (such as a cough expectorant and a cough suppressant).
- In other cases, a patient may wish to increase the dosage to improve one symptom, which serves to increase other ingredients that do no good and, in higher doses, may cause side effects.
Acetaminophen. Many cold and flu remedies contain acetaminophen, the active ingredient in Tylenol. Acetaminophen in high dosages can cause serious liver injury. When taking combination medicines, always check the ingredients for the presence of acetaminophen, and be sure never to take more than the recommended daily dose of 4g acetaminophen.
Note on Antihistamines. Many combination remedies contain antihistamines. Antihistamines are used principally for allergies and the common cold. First-generation antihistamines may reduce cold symptoms by drying out nasal passages; this may help with a running nose caused by colds (but it also interferes with treatments of sinusitis). Their benefits for the cold are likely to be due to the drowsiness they cause. Such antihistamines include Benadryl, Tavist, and Chlor-Trimeton. The newer, second-generation antihistamines (Claritin, Allegra, Zyrtec) do not have these effects and also appear to have no benefits against colds.
Herbs and Supplements
Herbal remedies and dietary supplements are not regulated by the FDA. This means that manufacturers and distributors do not need FDA approval to sell their products. However, any substance that affects the body's chemistry can, like any drug, produce side effects that may be harmful. There have been numerous reported cases of serious and even deadly side effects from herbal products.
The following are special concerns for people taking natural remedies for colds or influenza:
- Echinacea is commonly taken to prevent onset and ease symptoms of colds or flu. High quality studies have failed to show that this herb helps prevent or treat colds. In addition, some people are allergic to echinacea. People who have autoimmune diseases or plant allergies should avoid it. There have been a few reports of people experiencing a skin reaction to this herb. This particular reaction, called erythema nodosum, is characterized by tender, red nodules under the skin.
- Chinese herbal cold and allergy products can contain trace amounts of aristolochic acid, a chemical that causes kidney damage and cancer. Many herbal remedies imported from Asia may contain potent pharmaceuticals, such as phenacetin and steroids, as well as toxic metals.
- The use of elderberry extract has been shown in laboratory studies to inhibit the activity of certain viruses, including flu viruses. A small randomized controlled study in humans has shown elderberry extract shortened the duration of flu symptoms in participantsHowever, larger studies are needed to confirm these observations.
Vaccines are available to prevent influenza (See Viral Influenza Vaccines section in this report).
For mild influenza, symptom relief is similar to that for colds.
Who Needs Antiviral Drugs
Two classes of antiviral agents have been developed to treat influenza: neuraminidase inhibitors and M2 inhibitors. These drugs can shorten symptoms but there is no indication that they can prevent or reduce complications such as pneumonia. They do not help if they are started after the first 36 hours of illness. Because of emerging drug resistance, some experts suggest these drugs be reserved for severely ill patients or those at high risk.
Most people who get seasonal or H1N1 flu will likely recover without needing medical care. Doctors, however, can prescribe antiviral drugs to treat people who become very sick with the flu or are at high risk for flu complications.
If you need treatment for the flu, the CDC recommends that your doctor give you zanamivir (Relenza) or osteltamivir (Tamiflu). These drugs work best if you receive them within 2 days of becoming ill. You may get them later if you are very sick or if you have a high risk for complications.
Those at high risk for complications and are more likely to need treatment include:
- People with weakened immune systems, such patients patients being treated for AIDor cancer
- Elderly patients, particularly patients in nursing home
- Very young children (it may be difficult to tell whether pneumonia is related to influenza or caused by respiratory syncytial virus [RSV])
- Hospitalized patients and anyone with serious medical conditions, such as diabetes, heart, circulation, or lung disorders, particularly chronic lung disease
- Drug abusers who use needles
- Pregnant woman, especially those suspected of having H1N1 flu
To prevent infection with H1N1 flu, people who are atrisk for complicationsand living in the same house as someone diagnosed with the virus should ask their doctor if they also need a prescription for these medicines.
Anti-Viral Drugs: Neuraminidase Inhibitors
Brands and Benefits. Zanamivir (Relenza) and oseltamivir (Tamiflu) are neuraminidase inhibitors. They are newer agents that have been designed to block a key viral enzyme, neuraminidase, which is involved with viral replication. While effective, their overall benefit is modest.
Important points about the use of these drugs:
- The main benefit of these drugs is a reduction in the length of symptoms by about one day, and only when started within 48 hours after symptoms become evident. They may be used for treating both A and B strains of influenza.
- They may help reduce transmission of the virus.
- Both show some benefits for preventing influenza. Only oseltamivir has been approved for this purpose, however, in people over the age of 1 year.
- They reduce complications of influenza, and decrease mortality when given within the first 4 days of onset of symptoms.
- Oseltamivir is the only drug studied in avian flu cases. Although it is active in lab experiments, it has not been successful clinically. Experience is very limited, however, and it is not clear whether people infected with avian flu received the drug in time for it to be useful.
Limitations and Side Effects. Although they have many advantages compared to the M2 inhibitors, neuraminidase inhibitors are much more expensive. They also need to be taken within 2 days of the start of symptoms to be effective. Neither neuraminidase inhibitor is effective against influenza-like illness (one that is not caused by an influenza virus). There are also some differences between the two drugs that could be significant for some individuals:
- Zanamivir is administered through an inhaler. People with asthma or other lung disorders may experience airway spasms and should use this drug with caution. Side effects are generally minor in most patients. It is important to make sure that elderly patients are able to properly use the zanamivir inhaler device. Zanamivir should ONLY be used in its original inhaler device.
- Oseltamivir comes in capsule and liquid form. Side effects are also minor, but about 10to 15% of patients experience nausea and vomiting. Patients with kidney dysfunction should take lower doses.
The current use of neuraminidase inhibitors in different age and patient groups is as follows:
- Adults: Both drugs are approved for treatment in adult patients.
- Children: Oseltamivir is approved for use in children 2 weeks and older for treatment. Studies report significant reduction in symptoms and in the incidence of ear infections in this population. The American Academy of Pediatrics recommends the following: Therapy should be provided to children with influenza infection who are at high risk of severe infection, and to children with moderate-to-severe influenza infection who may benefit from a decrease in the duration of symptoms. Prophylaxis should be provided (1) to high-risk children who have not yet received immunization and during the 2 weeks after immunization, (2) to unimmunized family members and health care professionals with close contact with high-risk unimmunized children or infants who are younger than 6 months, and (3) for control of influenza outbreaks in unimmunized staff and children in an institutional setting. Children aged 3to 11 months who were born at full term may receive oseltamivir for prevention. The use of this medication for prevention of influenza in full term infants younger than 3 months of age is not recommended unless the situation is judged critical, such as a critically ill family member is hospitalized with the flu. Oseltamivir should not be given to preterm infants.
- High-risk Patients. Recent studies indicate neuraminidase inhibitors are safe and effective in patients with serious medical problems or other conditions that put them at risk for complications of flu.
A third neuroaminidase product, peramivir, is now in clinical trials. However, it was authorized as emergency treatment for severely ill, hospitalized patients with H1N1 "swine" flu. This authorization was terminated in June 2010. Peramivir is given intravenously.
Anti-Viral Drugs: M2 Inhibitors
Brands and Benefits. Amantadine (Symmetrel) and rimantadine (Flumadine) are M2 inhibitors. The following benefits may apply to the minority of strains of influenza A that remain sensitive to the drugs:
- Both offer some protection against influenza A and prevent severe illness if a person contracts the infection. (To be effective, it must be administered within 2 days of onset.)
- They may shorten the duration and lessen the severity of the flu if given within 48 hours of onset of symptoms.
Limitations. Drawbacks of M2 inhibitors include:
- They are not effective against the 2012 - 2013 flu strains.
- Viral resistance to these agents is rapidly increasing.
- M2 inhibitors are not effective against influenza B.
- Neither drug has proven to reduce the risk for complications of the flu, including pneumonia and bronchitis.
Side Effects. Both M2 inhibitors occasionally cause nausea, vomiting, indigestion
,insomnia, and hallucinations. Amantadine affects the nervous system and about 10% of people experience nervousness, depression, anxiety, difficulty concentrating, and lightheadedness. Rimantadine is less likely to do so. Rarely, amantadine can cause seizures.
Note: Amantadine is a standard treatment for Parkinson's disease and should be continued for that condition.
Influenza Vaccines
"Flu Shots." These vaccines use inactivated (not live) viruses. They are designed to provoke the immune system to attack antigens found on the surface of the virus. (Antigens are foreign molecules that the immune system specifically recognizes as alien and targets for attack.)
Unfortunately, the antigens in these influenza viruses undergo genetic changes (called antigenic drift) over time, so they are likely to become resistant to a vaccine that worked in the previous year. Vaccines are then redesigned annually to match the current strain.
- Influenza A. The influenza A virus is further categorized by primary molecular antigens (hemagglutinin and neuraminidase), which serve as the targets for the vaccines. Influenza A is a particular problem, because it can infect other species, such as pigs or chicken, and undergo major genetic changes.
- Influenza B viruses tend to be more stable than influenza A viruses, but they too vary. Although influenza B has been far less common than A, a vaccine for type B is important because experts are concerned that small children will not have developed any immunity to the virus, and will experience severe flu if they are exposed to type B viruses.
- Existing influenza vaccines match 2 current influenza A strains and 1 current influenza B strain. In December 2012, the FDA approved a new type of influenza vaccine, which will be used for the first time in the 2013-2014 season. This vaccine will match the 2 current strains of both influenza A and B, to provide wider protection. The vaccine is approved for ages 3 years and older.
Injectable vaccines. There are 3 types of influenza injectable vaccines:
- The regular killed vaccine is licensed for use in everyone 6 months and older.
- The intradermal injection uses a much smaller needle, and a smaller dose of the same killed vaccine. It is injected into the skin instead of the muscle.
- The high-dose injection is for people 65 and older, whose immune system is possibly weaker as a result of normal aging. This killed vaccine is identical to the other two in the strains it carries, but delivers a much higher dose of the antigens, to create a strong immune response in the recipients.
Intranasal (inside the nose) vaccine. A live but weakened intranasal vaccine (FluMist) is effective and safe in healthy, non-pregnant people aged 2to 49 years. It is known as a live, attenuated, intranasal influenza vaccine (LAIV). The vaccine is engineered to grow only in the cooler temperatures of the nasal passages, not in the warmer lungs and lower airways. It boosts the specific immune factors in the mucous membranes of the nose that fight off the actual viral infections. FluMist is given using a nasal spray. It should NOT be used in those who have asthma or in children under age 5 who have repeated wheezing episodes.
Timing and Effectiveness of the Vaccine. Ideally, everyone should be vaccinated every October or November. However, it may take longer for a full supply of the vaccine to reach certain locations. In such cases, the high-risk groups should be served first.
Antibodies to the flu virus usually develop within 2 weeks of vaccination, and immunity peaks within 4to 6 weeks, then gradually wanes.
- Children younger than 9 years of age, who have not been previously vaccinated or received only 1 doseprior to July 2010should be given 2 vaccine doses, spaced 4 weeks apart.
- It should be noted that if an individual develops flu symptoms and is accurately diagnosed in time, vaccination of the other members of the household within 36to 48 hours affords effective protection to those individuals, according to an analysis of multiple studies.
In healthy adults, immunization typically reduces the chance of getting the seasonal flu by about 70to 90%. The current flu vaccines may be slightly less effective in certain patients, such as the elderly and those with certain chronic diseases. Some evidence suggests, however, that even in people with a weaker response, the vaccine is usually protective against serious flu complications, particularly pneumonia. Some evidence also suggests that among the elderly, a flu shot may help protect against stroke, adverse heart events, and death from all causes.
Everyone aged 6 months and over should get a flu vaccine; the only exception is for those who are allergic to the vaccine. Vaccination is especially important in the following groups, who are at a high risk for complications from the flu:
- People who are 50 or more years of age
- People who are 6 to 49 months of age
- People who have chronic lung disease, including asthma and COPD, or heart disease
- People who are 18 years old or younger AND taking long-term aspirin therapy
- People who have sickle cell anemia or other hemoglobin-related disorders
- People who have kidney disease, anemia, diabetes, or chronic liver disease
- People who have a weakened immune system (including those with cancer or HIV/AIDS)
- People who receive long-term treatment with steroids for any condition
- Women who are pregnant or plan to become pregnant during the flu season. Women who are pregnant should receive only the inactivated flu vaccine. (Vaccinations should usually be given after the first trimester. Exceptions may be women who are in their first trimester during flu season, because their risk from complications of the flu is higher than any theoretical risk to the baby from the vaccine)
Negative Effects
Possible side effects of the flu vaccine include:
- Allergic Reaction. Newer vaccines contain very little egg protein, but an allergic reaction still may occur in people with strong allergies to eggs. A new vaccine (Flucelvax) made in animal cell culture, not in eggs, was approved by the FDA in November 2012 for people aged 18 years and older.
- Soreness at the Injection Site. Up to two-thirds of people who receive the influenza vaccine develop redness or soreness at the injection site for 1 or 2 days afterward.
- Flu-like Symptoms. Some people actually experience flu-like symptoms, called oculorespiratory syndrome, which include conjunctivitis, cough, wheeze, tightness in the chest, sore throat, or a combination. Such symptoms tend to occur 2 to 24 hours after the vaccination and generally last for up to 2 days. It should be noted that these symptoms are not the flu itself but an immune response to the virus proteins in the vaccine. (Anyone with a fever at the time the vaccination is scheduled, however, should wait to be immunized until the ailment has subsided.)
- Guillain-Barre Syndrome. Isolated cases of a paralytic illness known as Guillain-Barre syndrome have occurred, but if there is any higher risk following the flu vaccine, it is very small (one additional case per 1 million people), and does not outweigh the benefits of the vaccine. Guillain-Barre syndrome resolves in most cases, but recovery is slow.
There has been some question concerning influenza vaccinations because of reports that these vaccines may worsen asthma. Recent and major studies have been reporting, however, that the vaccination is safe for children with asthma. It is also very important for these patients to reduce their risk for respiratory diseases.
Avian Influenza Vaccine
The FDA approved the first vaccine for humans against H5NI influenza virus in April 2007. The vaccine, which is made from a human strain of the virus, could be used in people ages 18to 64 to prevent the spread of the virus from human to human. The vaccine requires two doses, given about a month apart. It will not be sold commercially, but instead is being purchased by the U.S. government to be stockpiled and distributed to public health officials in the event of an outbreak of avian flu. The vaccine led to the development of antibodies in 45% of those who received the higher dose studied. The most common side effects reported were pain at the injection site, headache, and muscle pain. Research on the vaccine is continuing.
A new vaccine, currently in clinical trials, is made from artificial virus-like particles -- a collection of proteins that look like the outside of the virus but are made in the lab and cannot reproduce.
Who Needs Antibiotic
How Is Strep Throat Treated? Strep throat infections require antibiotics. Antibiotics prevent a serious complication called rheumatic fever, which can result in permanent damage to the heart. Fortunately, this complication rarely occurs in United States anymore. Antibiotic treatment of strep throat will almost always prevent this complication. In addition, antibiotics shorten the recovery time from strep throat.
The following antibiotics are generally used to treat strep throat:
- Penicillin is usually the antibiotic of choice unless the patient is allergic to it. A full 10 days of treatment may be necessary to clear the infection. Amoxicillin, a form of penicillin, is proving to be effective when taken in a single daily dose for 10 days.
- Macrolide antibiotics. Erythromycin is known as a macrolide antibiotic and is an appropriate choice for patients with penicillin allergies. A 10-day regimen is needed to clear the infection. The drug often causes gastrointestinal distress. Another macrolide, azithromycin, can be given as a single daily dose and is effective in 5 days. It has fewer side effects than erythromycin but is more expensive. Bacterial resistance to macrolides is increasing.
- Cephalosporins are also very effective in eradicating the bacteria. but they may cause reactions in people with severe penicillin allergies.
Antibiotics are often prescribed inappropriately for non-strep sore throats. Studies indicate that fewer than half of adults and far fewer of the children with even strong signs and symptoms for strep throat actually have strep infections.
Parents should be comforted that a delay in antibiotic treatment while waiting for lab results does not increase the risk that the child will develop serious long-term complications, including acute rheumatic fever. If a patient is severely ill, however, it is reasonable to begin administering antibiotics before the results are back. If the culture is negative (there is no evidence of bacteria), the doctor should call the family to make certain the patient stops taking the antibiotics and any remaining pills are discarded.
Children who have a sore throat and who have had rheumatic fever in the past should receive antibiotics immediately, even before culture results are back. Children with a sore throat who have a family member with strep throat or rheumatic fever should also receive immediate antibiotic treatment.
Antibiotic Resistance
The intense and widespread use of antibiotics is leading to a serious global problem of antibiotic resistance. The inappropriate use of powerful newer antibiotics for conditions such as colds or sore throats poses a particular risk for the development of resistant strains of bacteria. For example, the number of cases of methicillin-resistant Staphylococcus aureus (MRSA) is increasing in people who have no known risk factors. (MRSA can cause severe skininfections.) In 2006, rates of Neisseria gonorrhoeae resistance to the fluoroquinolone antibiotics family exceeded 10%. The CDC no longer recommends treating gonorrhea infections with fluoroquinolone first.
When Antibiotics Are Needed for Upper Respiratory Infections.
Antibiotics do not affect viruses and, in healthy individuals, these drugs are not necessary or helpful for influenza or colds, even with persistent cough and thick, green mucus. In one disturbing study, antibiotics were prescribed for nearly half of children who went to the doctor for a common cold.
Antibiotics may be required for upper respiratory tract infections only under certain situations, such as the following:
- Patients, particularly small children or elderly people, who have medical conditions that put them at high risk for complications from any respiratory tract infections, may sometimes be given antibiotics.
- Patients with severe sinusitis that does not clear up within 7 days (some experts say 10 days) and whose symptoms include one or more of the following: green and thick nasal discharge, facial pain, or tooth pain or tenderness. [For more information, see In-Depth Report # 62: Sinusitis.]
- Some children with middle ear infections, although experts differ on who will benefit. Some experts recommend that only children under the age of 2 years should be treated with antibiotics, and children over 2 should be treated on a case-by-case basis. [For more information, see In-Depth Report # 78: Ear Infections.]
- Patients with strep throat or severe sore throat that involves fever, swollen lymph nodes, and absence of cough. (Strep throat makes up only 10to 15% of all sore throat cases.)
Patients at Highest Risk for Infection with Resistant Bacteria Strains. Some patients are at greater risk for developing an infection resistant to common antibiotics. At this time, the average person is not endangered by this problem. Risk factors include:
- Very old or very young age
- Exposure to patients with drug-resistant infection
- Hospitalization in intensive care units
- History of an invasive surgical procedure
- Staying in the hospital
- Prolonged course of antibiotics, particularly within the past 4to 6 weeks
- Serious wounds
- Tubes down the throat, catheters, or intravenous (I.V.) lines
- Immunosuppression
Children at higher risk for antibiotic resistance are those who attend day care, who are exposed to cigarette smoke, who were bottle-fed, and who had siblings with recurrent ear infections.
What the Health Care Community Is Doing. Prescribing antibiotics only when necessary is the most important step in restoring bacterial strains that are susceptible to antibiotics. Encouraging studies are reporting that inappropriate antibiotic prescriptions are on the decline. Prescriptions for other common respiratory infections, such as otitis media, sore throat, acute bronchitis, and colds and flus have been decreasing.
What Patients and Parents Can Do. Patients and parents can also help with the following tips:
- Use home or over-the-counter remedies to relieve symptoms of mild upper respiratory tract infections.
- Realize that antibiotics will not shorten the course of a viral infection. It is important for patients and parents to understand that although antibiotics may bring a sense of security, they provide no significant benefit for a person with viral infection, and overuse can contribute to the growing problem of resistant bacteria.
- Don't pressure a doctor into prescribing an antibiotic if it is clearly inappropriate. The doctor very often will give in.
- If a child needs an antibiotic, ask the doctor whether it is appropriate to use high-dose short-term antibiotics, which may lower the risk for developing resistant strains.
- If an antibiotic is prescribed, take the full course, even if you feel better before finishing it.
- www.cdc.gov/flu -- U.S. Centers for Disease Control and Prevention
- www.niaid.nih.gov -- National Institute for Allergy and Infectious Diseases
- www.who.int/csr/disease/influenza/en -- World Health Organization
- www.cdc.gov/vaccines -- National Immunization Program
- www.immunize.org -- Immunization Action Coalition
- www.entnet.org -- American Academy of Otolaryngology -- Head and Neck Surgery
- www.cdc.gov/flu/avianflu -- Avian Influenza Information
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Advanced Studyec
Related Informationec
Review Date: 1/31/2013�
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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Headquartered in Cincinnati, Kroger is one of the nation's largest grocery retailers, with fiscal 2009 sales of $76.7 billion.
The Kroger Company spans many states with store formats that include grocery and multi-department stores, convenience stores and mall jewelry stores. We operate under nearly two dozen banners, all of which share the same belief in building strong local ties and brand loyalty with our customers.
You need the best quality products. That's why we have higher standards, and when it comes to higher standards, we mean the highest standards possible; we even offer our own label that not only meets but exceeds the quality of national brands. Many supercenters have their own brands, but our brand goes above and beyond by offering specialty labels such as Meijer Gold, Organics, and Naturals, which gives you more options for your specific needs!
Morris Home Furnishings
Morris Furniture Co., Inc. is one of the largest privately owned furniture stores in Ohio. The company, which is headquartered in Fairborn, Ohio, owns and operates Morris Home Furnishings stores in Centerville and Dayton and Ashley Furniture HomeStores in Dayton, Springfield, Cincinnati, Columbus and Northern Kentucky. Morris also operates the Dayton area's only Thomasville showroom in Centerville and the Midwest Clearance Outlet in Fairborn. Morris Home Furnishing stores feature the area's largest selection of home furnishings, mattresses and home theater products all under one roof.
Premier Health
Our mission is to improve your quality of health at every stage of life by enhancing your access to top-tier health services, expertise and information. Our family of 14,000 employees provides leading health care to Southwestern Ohio through member hospitals and affiliate organizations in seven counties. Our mission, vision & values guide everything we do.
Speedway LLC is a gasoline-convenience store company operating primarily under the Speedway brand name in seven states throughout the Midwest. Speedway LLC is a wholly owned subsidiary of Marathon Petroleum Corporation and is headquartered in Enon, Ohio, near Dayton.
WDTN is the NBC-affiliated television station for the Miami Valley area of Ohio that is licensed to Dayton. It broadcasts a high definition digital signal on UHF channel 50 from a transmitter in the Frytown section of the city. Owned by the LIN TV Corporation, the station has studios on South Dixie Drive in Moraine.
Wright-Patt Credit Union
Wright-Patt is your partner through life. We do not simply sell checking accounts, mortgages, car loans, and IRAs. No, we do something much more fundamental: we help you and your family live happier, more financially secure lives, no matter what important stage of life you're in. The accounts and services we offer are simply the tools we use to help make you happier, more secure, and more productive than if you had gone anywhere else.
Wright State Alumni Association
We are an independent organization which cultivates lifelong relationships with current and future alumni. As a committed partner and supporter of the University, we strive to promote pride in and recognition of Wright State University and its graduates.http://www.wright.edu/alumni
WSP Orthopaedics
The Orthopaedic Surgery, Sports Medicine and Rehabilitation practice of Wright State Physicians provides complete orthopaedic care, from joint reconstruction and replacement to sports medicine and much more. The focus of our service is to provide individualized, comprehensive care to people with orthopaedic concerns. We specialize in careful diagnosis and "state of the art" treatment plans.

subset: commoncrawl


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More than ever, it's important to understand what's involved, in order to strive to deliver a clean signal when you're DJing or producing music. That's what these 7 Rules For Great DJ Sound Quality are designed to help you with.
7 Rules For Great DJ Sound Quality
December 17, 2012 by 24 Comments


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NACA FAX Cover link NOT working. Anyone else?
Discussion in 'NACA' started by Mercury213, Dec 11, 2009.
Discussion in 'NACA' started by Mercury213, Dec 11, 2009.
"Hello Moe, I just wanted to tell you, your website has saved my life (literally), I stumbled on your site in the middle of losing my home, I was able to network with people going through the same thing as I am. I didn't feel alone anymore, I have tried to give back and counsel those that haven't walked in my shoes yet. We hear so much about what is wrong with America, I just wanted you to know, you are whats "right" with America."Nina Mitchell


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SIT153 - Introduction to Game Programming
Unit details
|2017 unit information
|Enrolment modes:
|Trimester 2: Burwood (Melbourne), Waurn Ponds (Geelong), Cloud (online)
|Credit point(s):
|EFTSL value:
|Unit chair:
Alexander Baldwin
|Incompatible with:
|Contact hours:
Campus: 2 x 1 hour class per week, 1 x 2 hour practical per week.
Cloud (online): Learning experiences are via CloudDeakin. Students will have the opportunity to participate in online consultation sessions.
This unit introduces students to the development of games software using the C++ programming language; the principle programming language used in the development of computer and video games. Core language knowledge and programming skills are developed in the context of games software development tasks. Students will learn to read, analyse, modify and develop code that produces components for interactive games using both procedural programming and object-oriented programming techniques. Additionally, students will apply software architectures and patterns to the design of computer games. Topics covered in this unit include: the stack model, conceptual models of code execution, features of the C++ language, code analysis, program flow control, object-oriented design, game software architecture, robust programming practices. Upon completion of this unit students will be able to design, develop and analyse software applications written in C++ to implement simple computer games.
Programming portfolio 40%, project 30%, examination 30%
Unit Fee Information
Click on the fee link below which describes you:


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Dressed in a T-shirt and sweatpants, Utah women's basketball coach Anthony Levrets headed to practice earlier this week with an air of confidence he's rarely had in the last three years.
If his team stays healthy and that's been a challenge in the past the Utes likely possess the talent and finally the experience to make noise and possibly make their first NCAA Tournament in two years. There is more depth than previous seasons. A touted recruiting class is in place to complement the veterans.
"We have been so young in the last few years," Levrets said. "We think that we have a nice balance now, and it's welcome. We have depth and we have the ability to mix and match. That's something we haven't had in quite a while."
Utah returns four starters. Michelle Plouffe is fresh off her summer Olympic experience of playing for Canada. The 6-foot-4 junior projects as one of the best power forwards in the Pac-12. In the paint, Taryn Wicijowski is finally fully healthy from the ACL she tore two years ago. She's 30 pounds lighter, more nimble in the post and poised to make a big impact.
Rachel Messer offers shooting and intangibles on the perimeter, while Iwalani Rodrigues is a three-year starter at shooting guard, a fifth-year senior and is the single most experienced player on the roster.
Those four all do different things, which Levrets hopes will make his offense more versatile and dynamic. As a group, they've been through almost every situation imaginable, and that breeds chemistry on the court.
"We gained a lot from playing in the Pac-12 last season," Plouffe said. "We realized that we were no longer playing in the Mountain West Conference, where some games we would win no matter how we're playing.
"We realize that teams are good in the Pac-12 every night. So we have to adjust and play that way."
Even with the depth and the experience, Utah's biggest question comes at its most important position. Danielle Rodriguez, a 5-foot-10 freshman, takes over at point guard for Janita Badon, who was a four-year starter.
Her maturation and ability to handle the position will be a key to the season. She was highly recruited and Levrets feels she has the mentality to step in right away.
"She comes from a great high school program," Levrets said. "She also is stepping into a veteran lineup. It's not like she's passing to other freshmen. She has people who will help her along the way."
Twitter: @tjonessltrib
Utah schedule
Saturday • At Denver, 4 p.m.
Nov. 13 • vs. Southern Utah, 7 p.m.
Nov. 16 • vs. Michigan, 4:30 p.m.
Nov. 20 • vs. Northern Colorado, 7 p.m.
Nov. 24 • At Weber State, 2 p.m.
Nov. 27 • vs. Utah State, 7 p.m.
Dec. 1 • At Hawaii, 2 p.m.
Dec. 8 • vs. BYU, 3 p.m.
Dec. 15 • vs. Houston Baptist, 7 p.m.
Dec. 20 • vs. UC Irvine, 7 p.m.
Dec. 29 • vs. North Dakota, 3 p.m.
Jan. 4 • vs. California, 6 p.m.
Jan. 6 • vs. Stanford, 2 p.m.
Jan. 8 • at Colorado, 6 p.m.
Jan. 13 • vs. Colorado, 3 p.m.
Jan. 18 • vs. Arizona, 7 p.m.
Jan. 20 • vs. Arizona St., 3 p.m.
Jan. 25 • at Stanford, 7 p.m.
Jan. 27 • at California, 2 p.m.
Feb. 1 • at USC, 7 p.m.
Feb. 3 • at UCLA, 2 p.m.
Feb. 8 • vs. Oregon, 7 p.m.
Feb. 10 • vs. Oregon St., 1 p.m.
Feb. 15 • at Arizona St., 5 p.m.
Feb. 17 • at Arizona, 5 p.m.
Feb. 22 • vs. Washington, 7 p.m.
Feb. 24 • vs. Washington State, 3 p.m.
March 1 • at Oregon St., 7 p.m.
March 3 • at Oregon, 12 p.m.
March 7 • Pac-12 Tournament


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She's always been a total cutie, Kristen Bell's growing baby bump was extremely evident at the 70th Golden Globe Awards in Beverly Hills last night (January 13).
Before, during, and after the 2013 Golden Globe Awards celebrities hit up their social network accounts to share their favorite moments from the night.
Everyone from Heidi Klum to Miranda Kerr snapped away on their Instagrams while the coveted awards were handed out to the biggest names in Hollywood.
Celebrating the victorious evening at the 70th Golden Globe Awards, the cast of "Les Miserables" turned up at NBC Universal's post-party last night (January 13).
Amanda Seyfried, Anne Hathaway, Hugh Jackman, and Eddie Redmayne all gathered together for some group photos while fans and shutterbugs looked on.
She's always up for a good time, and last night (January 13) Lana Del Rey paid a visit to the Weinstein Company's Post-Golden Globe Awards soiree.
The "Video Games" gal posed with fellow hottie Jaime King at the Beverly Hilton Hotel following the 70th Golden Globes goodness.
His film "Django Unchained" score the Best Original Screenplay trophy at the 70th Golden Globe Awards last night (January 13) and Quentin Tarantino was up to his old tricks of creating controversy.
During his backstage interview, the "Pulp Fiction" mastermind addressed the objections to his use of the word "ni**er" during the flick.
Making her rounds on Golden Globe night, Jessica Alba showed up at the InStyle/Warner Bros shindig at the Oasis Courtyard in the Beverly Hilton Hotel.
Joined by guy pal Brad Goreski, the "Good Luck Chuck" starlet changed into a black and white party dress as she posed for the shutterbugs.
She made the trip across the pond to attend the 70th Golden Globe Awards last night (January 13) and Adele's transatlantic travel ended up paying off in a big way.
The "Rolling in the Deep" songstress took home the Globe for Best Original Song thanks to her James Bond theme "Skyfall," and couldn't have been happier.
The Beverly Hilton was overflowing with gorgeous gals as the Weinstein Company held its after-party for the 70th Golden Globe Awards last night (January 13).
"On The Floor" songstress Jennifer Lopez showed up at the exclusive affair in a stunning black halter-style dress as she posed with her boyfriend Casper Smart.


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If E.L. James' Fifty Shades of Grey opened the door for fan-fiction novels in the publishing world, Christina Lauren's Beautiful Bastard may well nail that same door to the wall.
Like Fifty Shades of Grey, Beautiful Bastard recasts Bella Swan and Edward Cullen of Stephenie Meyer's Twilight series from chaste teens into libido-charged young adults. Unlike Grey, Bastard sidesteps James' erotic scenes of dominance and submission. Instead, it charges full steam ahead and we do mean steam to forge a catty relationship between an intern, Chloe Mills, and her demanding, hard-driving boss, Bennett Ryan. While not exactly smitten at the emotional level, they're positively magnetic at the physical end, perpetually consummating their attraction in the fog of carnal pleasure despite nagging reservations each holds for the other.
Salt Lake City native Christina Hobbs conceived the characters as part of her online novel The Office in 2009. Then, after she met writer and California neuroscientist Lauren Billings at San Diego's annual Comic-Con, the two took up a mutual pen to supercharge Mills and Ryan for the publishing world.
The pair inked a two-book deal with Simon & Schuster's Gallery imprint late last year, proving that fan fiction's practice of crafting new characters and scenes from older, original cloth is nothing to sneeze at. Hobbs, who guards details of her personal life given Beautiful Bastard's subject matter, took time out from a book launch for a phone interview from Anaheim, Calif. She says she also has plenty of non-erotic young-adult novels of her own in the works.
Are the characters Chloe Mills and Bennett Ryan based on people you know, have met or even your own experiences?
They're over the top. They say things that most people would never say. That's what was so fun about writing this book to make characters do and say things I would never in my wildest dreams think of doing or saying. Part of the fun of writing is that you get to write outside of your own experiences. Chloe is a little like Lo [Lauren Billings] and I, however, in that she's strong-willed. It's fair to say I don't know anyone like Bennett.
'Beautiful Bastard' is almost a fantasy book, then, even if it's a different kind of fantasy from imaginary worlds of elves and orcs.
It all comes down to the fact that things that make a story authentic aren't the things we want to live in real life. Waking up next to someone you respect in the morning doesn't really make for a compelling read. That's why this book is fiction. I'm about the polar opposite of Chloe in that I'd never want to date or marry a jerk. This isn't my fantasy it was just fun to write and collaborate with back and forth with Lauren.
How big is your debt to Stephenie Meyer and her "Twlight" series?
[Billings and I] never would have found each other if it hadn't been for that. It's brought so many people together. I'm meeting a friend today who lives in Nashville. I didn't know I had a voice, or had a story to tell, until I met this community of women who were writing and reading each other's stories. When we say "fandom" we don't necessarily mean Twilight, though. It's also Harry Potter or Sherlock fandom, "Doctor Who" or The Vampire Diaries that also brought writers together in the world of fan fiction.
One online review described the book as "detailed without being obscene" and "sexy but still has a high level of romance." How do you pull off a trick like that?
It's not just physical actions taking place that are important, but also the reactions between characters. It's not just how "a" slipped into "b" it's everything going on. That's always been really important to us. A lot of it is also in the language that's used. Sometimes the sexiest thing isn't what you say, but the scene you paint for the readers.
What are some of the biggest misconceptions people have about fan fiction?
That there's a specific type of people who read and write fan fiction scientists, business professionals, teachers and people who are well-educated to people who haven't gone to college are all part of it. It's not just women. It's not just men. It's not a certain age group. You have this huge group of people who want to write and read for others, and that's what's so amazing about it.
The words "hot" and "sex" invariably show up in reviews of this book, and there's a lot of debate about what women and men readers are drawn toward in books. The standard line is that men prefer the visual of pornography, while women overwhelmingly prefer romance novels. What's wrong with those assumptions?
Fan fiction has taught me to never assume, never to generalize. Because the people I thought would never like the book like it, and people I thought would take to it often did not. You think you're writing for women, but then I've met men who loved it. That's something we never anticipated, and we were thrilled.
What's the best feedback you've received from fans regarding the book?
One reader said she could tell how much fun we had writing this book, that it really came through on the page. That's exactly what we want to hear. We don't take ourselves seriously. If someone can escape for two hours to read our work, we're high-fiving each other. … The fact that I wrote this [book] surprises no one more than me. Lo always tells me my Utah is showing whenever I say "Oh, my word!" or "Oh, my gosh!"
Christina Lauren launches 'Beautiful Bastard'
When • Friday, Feb. 22, 7 p.m.
Where • The King's English Bookshop, 1511 S. 1500 East, Salt Lake City
Info • Free. Call 801-484-9100 or visit www.kingsenglish.com or Beautiful-Bastard.com for more information.
'Beautiful Bastard'
Christina Lauren
Pages • 320
Price • $15


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Hilary Duff Teases New Song With Mega Songwriter
Photo: Getty Images
By Kathleen Perricone
Hilary Duff just dropped her comeback single, "Chasing the Sun," but she's already prepping her next release.
She gave fans a big hint at it when she tweeted songwriter extraordinaire Savan Kotecha:
"Can't wait for everyone to hear our little secret…@savan_kotecha @carlfalkmusic @kristian_lundin" — Hilary Duff (@HilaryDuff) August 7, 2014
For those who don't know, Savan is not only a vocal coach on The X Factor, but she also has written a ton of hit songs, including Ariana Grande's "Problem," which have sold 100 million copies globally.
Until we get to hear it, "Chasing the Sun" is available on iTunes now!


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Craigslist seems weirder around a military town. Fort Bragg and the greater Fayetteville area have provided several hilarious weirdos. There was the man with 5 felonies demanding that we all stop being absconding interlopers. And there was the 50 foot dresser that was also specifically advertised as 'not haunted' This week's entry into my series on [Read More…]
Fort Bragg Craigslist ad: Tree climber looking for work
February 7, 2012 by 9 Comments


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John Thomas serves on the boards of the Historical Society of Long Beach, Long Beach Heritage, the Bluff Heights Neighborhood Association and others. He is the historic resource adviser and preservation consultant for the Queen Mary. The co-author of "Long Beach Art Deco," Thomas will lead, in association with the Art Deco Society of Los Angeles, for the eighth time, the Art Deco Festival, Aug. 31-Sept. 2, aboard the ship.
Question: Your condo is filled with Art Deco items. What's your favorite piece?
Answer: That's like asking someone who their favorite child is.
Q: My favorite child is my (inaudible). By far. Now, tell me yours.
A: I guess I'd have to say my cobalt blue sleigh radio designed by Walter Teague.
Q: Your favorite building in Long Beach?
A: The Lafayette on Linden Avenue.
Q: Building you wish hadn't been destroyed?
A: The three public buildings that made up the old civic center after the 1933 quake: The old city hall, the Public Utilities Building and the Veterans Memorial Building. Those three in a line were great edifices of Art Deco. The architecture signaled to the public a sense of style and sophistication. I'm so sorry they weren't kept and adapted and re-used.
Q: Favorite Art Deco ship in Long Beach?
A: The Queen Mary.
Q: Second-favorite Art Deco ship in Long Beach?
A: I don't think there is one.
Q: Why does the Queen Mary need a preservationist or historical resources adviser now after going without for so many decades? No one's threatening to tear the ship down or build a Wal-Mart in it, are they?
A: There's a lot that's involved. There's paintings, etched glass, bronze. Each piece of art has its own unique level of conservancy and maintenance that needs to be done. The historic veneers have to be preserved and maintained: There are more than 50 species of wood used on the ship. There's a lot of decorative metal - our elevators, stairways, handrails. There are the teak decks, the lifeboats. Each area will have a very specific evaluation and treatment protocol on how to stabilize, preserve and, most importantly, maintain it.
Q: In fewer than a billion words, what is Art Deco?
A: In its purest form, it's the geometry. When King Tut's tomb was discovered in 1922, the artwork - the zigzags, chevrons, leaping animals - was embraced in the 1925 Paris Exposition, and that became Art Deco, which later turned into Streamline Moderne: Designers started smoothing things out, cutting the corners, incorporating speed-lines. Think of the old Model A Fords, and later the more rounded, aerodynamic bodies that Detroit started using.
Q: Was the streamlining a matter of form or function?
A: Yes.
Q: So it was function that looked nice, plus something that looked nice that happened to have function.
A: Exactly.
Q: Are you planning on another Long Beach Art Deco book?
A: My partner, photographer Christopher Launi, who took the pictures in the book, has done a lot of work of close-up shots of Art Deco. We'd call it "Deco in the Details," and I'd like us to do a book in color.
Q: You conduct an Art Deco walking tour of Long Beach. Where do you find the best examples in Long Beach?
A: A great example is the Acres of Books building on Long Beach Boulevard. And there's some beautiful art, murals, architecture at the schools in Long Beach that were built or rebuilt after the earthquake and we had all these great architects in town incorporating Art Deco and Streamline Moderne into their design. Washington, Rogers, Poly. There's a lot of them. Lindbergh has a beautiful frieze over the entryway of airplanes flying over the continents.
Q: What do you have planned for the Art Deco Festival over Labor Day weekend?
A: There's so much we're doing. The event has really grown over the years. The signature events are the lectures, which we try to make both educational and entertaining. There's a 1930s-theme ball on Saturday night, which is wonderful. On Sunday we have a 1920s-era tea dance. There's entertainment throughout the weekend in the Observation Bar and Sir Winston's. We'll have a vintage car display from the 1930s. If you go to the Queen Mary website (www.queenmary.com) you can download the entire schedule. There will also be a lot of things for sale.
Q: You gonna buy more stuff?
A: I will if you don't tell Chris.
Q: Will you always have the festival on the Queen Mary?
A: I hope so. It's exactly the right venue for an Art Deco festival. And it's exactly why the ship was built: to bring people together from all over the world to celebrate style and a sense of wonder, and you can't do that any better than on the Queen Mary.
firstname.lastname@example.com, 562-714-2116 or http://twitter.com/grobaty


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Things are never as bad as they seem – Part 1
Our Central Governor When we're faced with a seemingly insurmountable task, challenge or problem, what is it that makes us say "enough, I give up!"? And how often, shortly afterwards, do we think that maybe we just gave up too early and that we should have persevered and continued on. Tim Noakes, a South African… Read more


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Miami, October 22, 2012 – Ken Simpson from Arlington, Illinois is the grand prize winner of Regent Seven Seas Cruises' (RSSC) "Cover Your Cruise" Facebook Photo Contest. Fans were asked to submit travel photos captured on any Regent Seven Seas' cruise, and Simpson's entry was voted the best by RSSC Facebook fans from a selection of five finalist's photos.
Simpson's snapshot of a quiet, picturesque, cobbled-stone street in Warnemünde, Germany was taken while he sailed the Baltic aboard the 700-guest, all-suite, all-balcony, Seven Seas Voyager. As grand prize winner, Simpson's photograph graces the cover of RSSC's Scandinavia, Russia & Northern Europe mailer, and is also featured in the October 2012 Voyages to Explore catalogue in the introduction to the Northern Europe section.
"We were overwhelmed by the response from our loyal guests as there were so many notable, travel-inspiring images" said Kari Tarnowski, the line's senior vice president of marketing. "The winning image chosen by our Facebook fans certainly hits the right note of exploration…it almost feels as if one is about to take a step down that street and into a wonderful adventure."
In July and August, travelers submitted their best travel photographs to the ultra-luxury line's Facebook page at www.facebook.com/RegentSevenSeasCruises where five finalists were chosen by the company and public voting determined the grand prize winner. Submissions captured iconic landmarks, colorful cultures, landscapes and architecture from around the world.
"When planning our trip to the Baltic, Regent Seven Seas Cruises came highly recommended from my sister and we loved it, the service and tours were amazing," said Ken Simpson. "I'm not a professional photographer but I have always had a love for photography. I must have taken nearly a thousand photos on that trip, so I knew one had to be contest worthy. I'm happy to see my picture will be enjoyed by other fellow travelers."
Recognized as The Most Inclusive Luxury Cruise Experience™, all Regent Seven Seas Cruises sailings include all-suite accommodations, 97 percent with private balconies, gourmet cuisine, premium spirits and fine wines, free shore excursions, gratuities, and a pre-cruise luxury hotel stay, at no additional cost.
Regent Seven Seas Cruises
Regent Seven Seas Cruises is the world's most inclusive luxury cruise line. Fares include all-suite accommodations, round-trip air, highly personalized service, acclaimed cuisine, fine wines and spirits, sightseeing excursions in every port, a pre-cruise luxury hotel package and gratuities. Three award-winning, all-suite vessels, Seven Seas Navigator, Seven Seas Mariner, and Seven Seas Voyager, are among the most spacious at sea and visit more than 300 destinations around the globe.
About Prestige Cruise Holdings
Prestige Cruise Holdings (PCH) is the parent company of Oceania Cruises and Regent Seven Seas Cruises. PCH manages select assets in Apollo Management's cruise investment portfolio and is led by Chairman and CEO Frank J. Del Rio and President and COO Kunal S. Kamlani. PCH is the market leader in the upper-premium and luxury segments of the cruise industry with over 6,400 berths between the Oceania Cruises and Regent Seven Seas Cruises brands.
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