In a letter sent to doctors and pharmacists, the HSE said that approximately 1.3 million vaccines have been distributed to date, but only 700,000 of those have been recorded as administered vaccines on the claims system used by healthcare professionals to reimburse costs.
As a result, it is not clear whether or not the remaining 600,000 vaccines have been administered.
The HSE’s national clinical advisor, Dr Colm Henry however denied reports that there are any quantities of the flu vaccine missing. Responding to some media reports, Dr Henry said that the HSE had held back 50,000 doses of the vaccine so they could ascertain where there were gaps.
The plan was to get doses to the priority groups, the over 65s and those with vulnerable conditions, he told RTÉ radio’s Morning Ireland. “No doses have disappeared.”
To date (11th November) this winter 1.3 million doses of the vaccine have been given, which was 20% up on last year, he explained. In this article, we take a look at the commonly presenting symptoms of both cold and flu to pharmacies and how pharmacy teams can ensure they are adequately poised to deal with customer issues.
Complaints relating to the upper airways are arguably one of the most common reasons for presentation to community pharmacies, and contribute to a substantial loss of productivity and absence from work and school. The common cold and influenza affect a large proportion of the population every year. Infections of the upper respiratory tract (URTI) show a seasonal trend, with cases peaking in the winter months.
The Common Cold
The common cold is the most common infection of the upper respiratory tract, caused by over 200 virus strains, which are predominantly rhinoviruses, but also human coronaviruses and adenoviruses.
The common cold primarily affects the nose, pharynx, and sinuses, presenting symptoms often include a blocked or runny nose, fever, headaches, coughing, a sore throat, and sneezing. The common cold is usually mild and self-limiting in nature with an average duration of 7–10 days. The virus penetrates the tissues of the airways, resulting in local inflammation which presents as nasal discharge, sneezing, sore throat, and cough. Children experience between 5 and 7 colds each year, and adults have 2–4 infections each year. Infections may be more severe in the young or elderly or those who are immunocompromised.
Influenza
Unlike the common cold, influenza, colloquially referred to as “the flu,” is a more serious infection that tends to present with an abrupt onset of symptoms and may include systemic symptoms that are not restricted to the upper airways such as lethargy, diarrhoea, nausea, and muscular aches. There are a number of strains of the influenza virus, and
those known to infect humans are broadly divided into Type A, Type B, and Type C influenza. Individuals will often say that they are experiencing influenza when they are presenting with the common cold, it is important for pharmacists to differentiate between the two and educate patients on the difference.
Medicines Management
Pharmacological management of upper respiratory tract infections in the community pharmacy consists primarily of symptomatic relief for the presenting symptoms. Choice of product should be based on patient preference, presenting symptoms, and clinical considerations such as contraindications and potential drug–drug interactions.
Pain and Fever
Pain and fever are common symptoms during an infection with the common cold or flu as the body’s immune system responds to the invading virus. Simple analgesics such as paracetamol or ibuprofen can be used to
manage both pain and fever. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to be effective in improving pain symptoms associated with the common cold. Aspirin should not be used in children as there is an increased risk of Reye’s syndrome, and caution may be required with the use of the ibuprofen and other NSAIDs in patients
with asthma, hypertension, electrolyte disturbances, and renal impairment.
Cough
Coughs are classified as “acute” or “chronic”. An acute cough is most common and lasts up to three weeks. It’s usually caused by a cold or flu virus and most improve after one to two weeks.
Chronic cough lasts for eight or more weeks. The most common causes include acid reflux, asthma, TB, COPD, bronchitis and smoker’s cough. A dry cough is caused by inflamed
airways due to a viral infection such as a cold or flu. A chesty cough produces phlegm. This is caused by the lungs producing extra fluid due to an infection.
It is important to get a detailed overview of the patient’s symptoms. Is their cough productive? How long have they had the cough and what action has been taken? Pharmacists
should ask if a patient has any medical conditions that may affect any treatment or product you recommend.
The role of cough medicine is to ease symptoms while the body heals. There are many brands of OTC cough medicines. But there are only three basic types: Expectorants help thin mucus, making it easier to cough up. The ingredient is guaifenesin.
Suppressants help cut the number of times someone coughs. The active ingredient listed is usually dextromethorphan (DM). Other cough suppressants include camphor, eucalyptus oil, and menthol.
Combination cough products have more than one active ingredient. They have both guaifenesin and dextromethorphan. Cough medicines may also contain ingredients to help coat and soothe the throat.
Combination products may have medicines to ease other symptoms, that may include decongestants for stuffy nose, antihistamines for allergies or a runny nose, or painkillers.
Cough drops can also help relieve a cough and may ease a sore throat.
Sore Throat
The following are some of the most common sore throat causes:
• Strep throat: The bacteria group A Streptococcus is the most common cause of strep throat.
• Sore throat (viral pharyngitis): Viruses are the most common cause of sore throat, including rhinoviruses or a respiratory syncytial virus. These viruses can cause other symptoms, such as:
o a cold
o earache
o bronchitis
o sinus infection
Some of the signs of strep throat will be visible. They may include:
• white patches on the tonsils or throat,
• dark red splotches or spots on the roof of the mouth, and
• a skin rash.
Those white spots are pus pockets. In addition, some patients may exhibit swollen, tender lymph nodes in the neck and some with fever above about 101-102 F. The signs and symptoms are the same for both children and adults.
Although these signs may indicate strep, a visit to their GP is necessary to make a full determination. A full diagnosed is impossible by visual signs alone.
Adults are less likely to have this disease than children. For schoolage children, their odds of a sore throat being strep are about 20% to 30%. For adults, the odds are more like 5% to 15%.
Sore throats are often caused by viruses, making them difficult to cure. They can also be caused by
• dry air,
• irritants like pollution,
• smoke, including cigarette smoke, and
• allergies.
Unlike strep throat, everyday sore throats usually go away on their own without any antibiotic treatment.
Nasal Congestion
Nasal congestion is a blocked, stuffy or bunged-up feeling in the nose. Depending on the cause, it can last a short while (a few days) or can be persistent. In adults and children it is usually an annoying symptom rather than a serious one. In babies, however, a blocked-up nose may make it difficult to breathe or feed.
Some of the causes of nasal congestion include:
• Infections: the common cold and other respiratory tract infections, including influenza (flu) and sinusitis.
• Allergies, including hay fever.
• Persistent rhinitis.
Decongestants help relieve a blocked nose by reducing swelling of blood vessels in the nose.
Decongestants are available in tablet form or as a nasal spray. Oral decongestants may take a little longer to work, but their effect can last longer than nasal sprays.
Advise customers that they should not use decongestants for more than five to seven days at a time. This is because they only provide short-term relief and using them for
longer than seven days may make symptoms worse.
