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Are you doing enough to promote your pharmacy as the first line of defence against colds and flu this winter?

AS THE NHS gears up to deal with another unpredictable cold and flu season this winter, research continues to reveal widespread misconceptions and lack of awareness about flu vaccination among ‘at risk’ groups and the general population alike. Just a single particle from a cough or sneeze can contain enough material to pass on bacteria and viruses. And now new data from LloydsPharmacy claims that just one person with flu can cause nearly 16,500 others to become infected within two weeks.

“Despite what we often think, it is not the drop in temperature that causes common colds and an increase in flu during winter,” says Boots pharmacist Deepa Songara. “We spend less time outside and much longer closer together at home or indoors, and it is this ‘togetherness’ that makes it easier to pass germs from one person to another.”

Another reason is that the change in humidity also affects the likelihood of infection. “Most viruses are spread through the air on water droplets. The drier the environment, the more time the droplets hang around in the air, as opposed to a humid climate where water molecules are attracted to each other and fall to the ground before we have a chance to breathe them in,” says Erin McCann, a nutritional consultant.

Cold and flu viruses can survive in water droplets for up to 24 hours after being released from an infected person when they sneeze or cough. It is these infected droplets that also settle on and contaminate various household objects and surfaces so that, when someone else touches these areas, the virus can then be transmitted through further touching of the nose or mouth.

Preventative measures

While it is not possible to avoid coming into contact with everyone who might be harbouring a cold or flu virus, there are plenty of ways customers can guard against infection through healthy living and hygiene measures.

“The best defence anyone can have against fighting illness is a strong immune system,” says Erin McCann. “It will help prevent illness and if you do happen to be struck down by a virus, your infection period will be shorter and your recovery time quicker. This can be assisted through diet and exercise or, for the times when this is simply not enough, taking a good quality immune supplement.”

Maintaining high standards of hygiene and a healthy lifestyle are also vital to avoiding winter bugs. “Disinfect any surfaces that could be contaminated with the virus – this includes telephones, computer keyboards and door handles,” says Ole Wiborg from Enzymatica, a developer of medical technology products, “and don’t share a towel with anyone. Ideally use a paper towel if you are using a public toilet, and if you have had a virus then ensure you wash your sheets on a hot wash to kill any remaining germs.”

A proper hand-washing technique is another important way to avoid transferring the virus from the hands to the face, especially as the flu virus can live on surfaces for up to two days and cold viruses can survive for as long as seven days. Customers should be advised to wash their hands regularly with an antibacterial handwash and warm water, especially after going to the toilet and before touching food, to minimise the spread of infection.

The best defence anyone can have against fighting illness is a strong immune system

Get the jab

Colds are self-limiting conditions so a trip to the doctor is usually not required, but flu is typically more severe. Although most people recover from flu after a week or two, it can cause serious illness and even death, particularly in ‘at risk’ groups such as the young, elderly and infirm.

“Flu is often nothing more than a nasty experience and it can usually be managed without a doctor’s consultation,” says Clive Jolliffe, superintendent pharmacist at Morrisons. “However complications can arise and lead to more serious illness, with the elderly and patients with other illnesses particularly at risk. Complications include sinusitis, pneumonia, ear infections and bronchitis, which can be serious for some patients and may require hospital treatment.”

It is important that your pharmacy publicises the fact that the flu vaccine is free for patients in high-risk categories including those who:

• Are 65 years of age and over

• Are pregnant

• Have chronic heart disease, such as heart failure

• Have a chronic respiratory disease, such as asthma or chronic obstructive pulmonary disease (COPD)

• Have chronic liver disease, such as hepatitis

• Have diabetes or chronic neurological conditions, such as Parkinson’s disease

• Are children or adults with weakened immune systems (due to conditions such as HIV or treatment such as chemotherapy)

• Are healthcare workers with direct patient contact

Although people not in these categories can pay to get the vaccine from their GP or community pharmacy, new research from LloydsPharmacy found that 36 per cent of UK adults who do not receive the vaccine on the NHS felt that they were healthy so did not need to get vaccinated, with 9 per cent saying they didn’t need it as they had never had flu before.

LloydsPharmacy also found a lack of awareness about how contagious flu is, with 52 per cent of people guessing that a person is only contagious for up to 24 hours before starting to show symptoms whereas, in reality, the figure is around 40 hours.

“The findings are remarkable as they show a significant misunderstanding among the public towards flu and how quickly it spreads,” says flu expert Professor Andrew Easton, from the school of life sciences, University of Warwick.

“There needs to be far more understanding about the flu vaccine and its benefits. If you get vaccinated you’re not only protecting yourself but those around you, helping to increase immunity in society as a whole.”

Myth busting

During the last flu season, uptake of the flu vaccine varied in ‘at risk’ groups with just around 40 per cent of pregnant women and 73 per cent of over 65s being immunised, according to Public Health England. Many experts think that flu vaccine myths are putting ‘at risk’ patients off vaccination

. More than half of UK healthcare professionals (53 per cent) believe the main reason ‘at risk’ patients do not take up flu vaccination is because they are concerned the vaccine itself could give them flu-like symptoms, according to the results of GSK’s latest Flu Insights Survey, carried out by Ipsos MORI. “It’s important that health-care professionals explain how serious flu can be and that it can be prevented through simple measures like regular hand washing and using tissues to catch germs when sneezing, but also through vaccination,” says Dr Michael England, medical director for vaccines at GSK. “It’s very worrying if one of these measures is not being used for a reason that is simply down to a misunderstanding.”

And it’s not just vulnerable people who pharmacists should encourage to get a flu vaccination. By spreading the message and dispelling the myths to customers who won’t necessarily be given a free flu vaccination, the sector can help stop them inadvertently spreading flu to other people in their homes, communities and workplaces.

“These people have the power to become the front-line of defence in the fight against this nasty virus and form a shield around their communities by getting vaccinated,” concludes LloydsPharmacy pharmacist Nitin Makadia.

Cold and Flu: Symptoms, Duration and Red Flags

Colds and flu are a part of life when it comes to winter, and many of your customers will think they know how to avoid, manage and treat them. However their decisions are often based on old wives’ tales and misinformation, which is why it is crucial that pharmacy teams provide consistent messages about symptoms and treatments.

“A cold usually first presents as a sore throat, followed by a blocked nose, sinus pain, a runny nose, sneezing, a cough and a general feeling of being unwell,” says Clive Jolliffe, superintendent pharmacist at Morrisons. “Less commonly you can experience a temperature, headache and muscle pain. It will usually last for about a week and is at its worst during the first two to three days.

“Flu can present with the same symptoms but usually has a quicker onset and is more severe. It is also common to experience a fever (temperature above 380C), tiredness and aching muscles or joints. Flu will usually last for about a week, but sometimes it can take longer than this to fully recover.

“You should look out for ‘red flag’ symptoms, which can indicate the infection may be more serious. These include difficulty breathing, blood in sputum, an excessively high temperature, a severe headache, stiffness in the neck and a rash. If your customer experiences any of these they should call an ambulance.”

“Some consumers are more reactive, with 30 per cent of the UK population relieving their symptoms at the first sign,” says Shivani Uppal, GSK’s cold and flu senior brand manager. “By encouraging treatment from the first sign of illness, pharmacists can help drive the category forward.”

OTC relief options

Offering a range of products to satisfy different needs is key to driving growth in the category, says Craig Shaw, a global brand marketing director at RB. “Adults experience two to five colds per year, and children as many as 10, and this represents a massive retail opportunity.”

Cold and flu is the second biggest healthcare category, currently worth £119m, according to Shivani Uppal, with 71 per cent of consumers always having some cold and flu treatment at home.

“Brands will continue to drive value into the category, with shoppers looking for well-known brands and 64 per cent of consumers opting to purchase the same brand again. In-store communication is also imperative to educate shoppers on the benefits of prevention and continuous treatment while suffering and recovering.”

There are a variety of treatments available on the market ranging from pain relief, nasal decongestants and rubs, says Clive Jolliffe. “Although the best way to deal with a cold or flu is to stay well hydrated and get plenty of rest, medicines can also be used to help relieve symptoms and aid recovery. But if customers are on other medications, encourage your team to check that these treatments are in fact suitable to take.

“Sore throat can be treated with sprays or lozenges, and for runny noses oral decongestants can help to dry up nasal secretions. Vaporubs are a useful alternative for those who cannot take oral decongestants or for children under 12 years. Coughs can be treated with syrups or simple linctus, depending on the type of cough, while fever can be treated by paracetamol or ibuprofen, which may also help to relieve aches and pains.

“Combination products can be useful for multiple symptoms that need more than one medicine to treat. However treating babies is often difficult as many products cannot be used for this age group, but there are still some that can be recommended such as paracetamol, ibuprofen, vaporubs and certain cough medicines.”

Almost half of cold and flu sufferers (49 per cent) who treat symptoms start their day by taking a pain relief product, according to GSK. “The use of paracetamol and ibuprofen will help reduce temperature and aches and pains in cold and flu sufferers,” says Superdrug pharmacist Yusuf Patel, “and, of course, ibuprofen also possesses anti-inflammatory properties.”

Antibiotics : Public needs to understand overuse issues

Despite campaigns to remind people of the need to preserve antibiotics by using them sparingly, figures show that prescriptions for antibiotics in England have far from declined in recent years (reports Annabel Saladino).

“Recent data confirm that GPs are prescribing antibiotics as frequently if not more frequently than ever and that the problem of antimicrobial resistance continues to grow,” says Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh.

A report from Public Health England (PHE), released in October, showed a 6 per cent increase in GP and hospital antibiotic prescribing between 2010 and 2013.

The report found a wide variation in prescribing habits and antibiotic usage across England. Not surprisingly, higher rates of resistance were found in those areas with higher rates of prescribing.

“The recent report is the first time both GP and hospital prescribing data have been collated and prescribing trends analysed alongside antibiotic resistance,” says Dr Diane Ashiru-Oredope, pharmacist lead at PHE. “It is a real move forward in our understanding of trends and highlights areas where attention can be focused. The aim is now to reduce levels of prescribing back to those of 2010.”

The threat from antibiotic resistance isn’t just a looming one – it is already here. It is estimated that 25,000 people a year are dying from infections resistant to antibiotic drugs in Europe alone.

Important role

‘Treat yourself better with pharmacist advice’, the PAGB and Pharmacy Voice campaign, is urging people to treat winter ailments themselves and to seek advice from their pharmacist before going to the GP.

It is estimated that 25,000 people a year are dying from infections resistant to anitbiotic drugs in Europe

Research carried out to support the campaign found that one of the commonest reasons people visit the GP (44 per cent) when suffering with a winter ailment is because they want or think they need antibiotics. “Community pharmacists and their teams have a key role in educating the public about the appropriate use of antibiotics and should be seen as the first port of call for many winter illnesses caused by viruses,” says Dr Ashiru-Oredope. “They can help to manage patients’ expectations by explaining the normal duration of these symptoms, what warning signs to look out for and providing effective over-the-counter treatments that will help relieve the symptoms. For example, cough or bronchitis can last up to 21 days and sinusitis up to 18 days.” For more information, see the patient antibiotic information leaflet on the RCGP website (www.rcgp.org.uk).