Preventing, treating influenza for better outcomes

Dr Megat Razeem Bin Abdul Razak, Consultant Physician, Respiratory Physician, and Interventional Pulmonologist, and Dr Noor Zehan Binti Abdul Rahim, Consultant Paediatrician and Paediatric Respiratory Specialist, explain how influenza impacts adults and children differently and emphasise the importance of proactive measures to prevent its spread.

Influenza affects 5-15 percent of the population in Malaysia each year, resulting in serious complications such as pneumonia, and worsening of underlying conditions including asthma, chronic obstructive pulmonary disease, and congestive heart failure. [Available at https://adultimmunisation.msidc.my/influenza/ Accessed on 30 October 2025] Studies have estimated that influenza accounts for 23 percent of severe acute respiratory infection cases and 13 percent of pneumonia-related hospitalisations in Malaysia. [Cureus 2025;17:e85724]

Influenza cases usually surge during school holidays as a result of overseas travel, said Megat. Influenza viruses can easily spread via droplets in the air as well as close contacts, thus making public transport, schools, and offices, hotspots for infection. Further, influenza symptoms are worse than that of the common cold, and usually include sore throat, body aches, high fever, and extreme tiredness.

“For the elderly, pregnant women, young children, and those with chronic conditions like asthma or heart disease, [influenza] can turn serious fast,” said Megat. These high-risk groups may end up with life-threatening complications such as pneumonia and respiratory failure. Therefore, prevention as well as early diagnosis and treatment is critical. Testing is important to differentiate influenza from COVID-19 and other viral infections, as antiviral treatment is most effective when started within 48 hours.

Severe influenza is usually indicated by a fever persisting for more than 3-4 days, nausea, vomiting, diarrhoea, or dehydration. Complications such as bacterial pneumonia can develop after 5-7 days,  he added.

Regarding influenza in children, Noor Zehan said children aged below 5 years are at high risk and more susceptible to severe symptoms than adults because their immune system is not mature yet. “Influenza can progress rapidly in children, which is why early intervention is crucial to prevent long-term complications that may impact their future lung function,” she emphasised.

Severe influenza can lead to pneumonia and dehydration in children. In rare cases, influenza may lead to complications such as encephalitis and myocarditis. Thus, symptoms like high fever, body aches, cough, and fatigue should be treated promptly. Red flags that require urgent care, include difficulty breathing, persistent vomiting, and signs of dehydration.

Preventing serious influenza-related illness
Both Megat and Noor Zehan agreed that influenza vaccination can reduce the risk of severe illness. “Vaccination remains the best defence. I’m also encouraged by the government’s initiative to provide vaccines for the elderly and high-risk groups,” said Megat.

In addition to annual vaccination, practicing good hand hygiene and avoiding crowded places are important preventive steps. Maintaining a healthy lifestyle, wearing masks, and carrying hand sanitisers can further reduce infection risk, especially among frequent travellers to winter destinations.

Despite its effectiveness, influenza vaccination is often misunderstood. Noor Zehan stressed that the influenza vaccine is safe and recommended for children as young as 6 months old. Influenza vaccine contains inactivated or weakened virus strains that may cause mild symptoms post-vaccination as part of the body’s natural immune response, and significantly reduces the risk of severe illness and hospitalisation, she added.

While children typically experience up to six upper respiratory tract infections per year, frequent, severe infections may increase the risk of long-term effects such as asthma. Thus, influenza vaccination in addition to handwashing, proper ventilation, nutritious food, and physical activities in schools and daycare centres are essential, she said.

Myth vs reality on influenza
Noor Zehan addresses common myths and provides essential facts on the risks and realities of influenza.

1.      Myth: The flu is just a bad cold, it’s not serious
·       Reality: While influenza shares some symptoms with the common cold, such as a runny nose and cough, it can cause severe illness, hospitalisation, and even death, especially in young children, the elderly, and those with underlying medical conditions. Young children, especially those under 2 years old, are at higher risk of complications such as pneumonia, bronchitis, and ear infections.

2.      Myth: A child can’t get the flu if they haven’t been exposed to sick people
·       Reality: Influenza spreads easily, even through the air via respiratory droplets, when an infected person coughs or sneezes. Children can contract influenza in crowded environments like daycare centres, schools, or public places where people may be unaware they are contagious.

3.      Myth: The flu vaccine gives children the flu
·       Reality: The flu vaccine contains either an inactivated virus in the form of the injectable vaccine or a weakened virus in the form of the nasal spray. Some children may experience mild side effects like fever or soreness at the injection site, but these are not the same as the flu and usually resolve within a day or two.

4.      Myth: Antibiotics can cure the flu
·       Reality: The flu is caused by a virus, and antibiotics are only effective against bacterial infections. Antibiotics might be prescribed if a child develops a secondary bacterial infection such as pneumonia or ear infections. Antiviral medications can be used to shorten the duration of flu symptoms if started early, but are not a cure.

5.      Myth: If a child has runny nose and cough, it’s definitely the flu
·       Reality: While a runny nose and cough are common symptoms of the flu, they can also occur in other viral infections, such as the common cold, respiratory syncytial virus (RSV), or even allergies. The flu typically also involves fever, body aches, and fatigue. A rapid flu test may be needed to confirm the diagnosis, but symptoms alone are not always conclusive.

6.      Myth: Children can’t get the flu if they’re healthy
·       Reality: Even healthy children are at risk of contracting the flu, and it can cause serious complications, particularly for young children, those with asthma or other chronic conditions, or children with weakened immune systems. Healthy children can still develop severe symptoms like pneumonia or need hospitalisation.

7.      Myth: If my child’s fever goes down, the flu is gone
·       Reality: Fever reduction from medication does not necessarily mean that the flu is over. Even if the fever improves, the child may still be contagious for several days and may have other symptoms like fatigue, muscle aches, and a cough. Influenza can still cause complications even after fever reduction.

8.      Myth: The flu is only contagious while the child has symptoms
·       Reality: Children with influenza can be contagious before symptoms appear and can continue to spread the virus for up to 7 days after symptoms start. This means that a child can spread the flu to others even if they do not feel very sick or before they even show symptoms.

9.      Myth: Over-the-counter medications will cure the flu
·       Reality: Over-the-counter medications such as pain relievers and decongestants may help manage flu symptoms like fever, aches, or congestion, but they do not cure the flu. The virus must run its course, and symptoms can last for several days.