Flu Without Fever?

Can it be? Should you even wonder if you have the flu if you don’t have a fever? Unfortunately, YES. While it is true that the classic presentation of seasonal flu includes an often HIGH fever, body aches, fatigue, sore throat, cough and abdominal symptoms like nausea, pain or diarrhea, no single symptom is absolutely necessary for a diagnosis.  Children under the age of 6 years frequently do not have fever and cough with their flu symptoms. This year in particular, I have seen more cases of flu with purely fatigue and stomach symptoms…including one in our family this week.

The incubation period for influenza averages about two days, so that means that you are exposed to flu 1-4 days before you have symptoms. Unfortunately, you are contagious (spreading germs yourself) the day BEFORE you have intense symptoms, and then continue to be contagious for roughly 5 – 7 days. Whether or not you have FEVER.

What’s my point? We all have to be responsible about not spreading the flu. It’s hard for anyone to miss work/school/sports, but when we go back too soon, we are just increasing the chance of passing on this illness to our peers. When SHOULD we return to work/school? If you HAVE fever, it’s a clear recommendation to wait to go back until you have been completely fever-FREE for 24 hours, without the benefit of tylenol or ibuprofen (which obviously can lower temperatures, and therefore, mask a fever). If you do NOT have fever, but have a positive flu test, then it is less obvious when you should go back, but on average most otherwise healthy people will need to be at home for at least three days. If you are vomiting and having diarrhea, a good rule of thumb is to wait for 24 hours after these symptoms subside to return to work/school. As a parent, I cringe every time I here someone talking about sending their kid to school after that same kid was up “all evening last night vomiting” or they comment nonchalantly, “I know she’s wiped out, but she hasn’t thrown up since lunch yesterday… and they have a huge test this week.”

The flu is spread via respiratory secretions, and this can be transmitted directly by coughing or sneezing (or simply by talking) or indirectly by transfer as the infected person touches their mouth or nose, then touches surface (leaving the virus there) and then the next person touches that surface before touching their own mouth/nose. Remember all of this is microscopic, not visible.

When we DO go back, perhaps we should at least take some antibacterial hand sanitizer with us. And tell your friends and family to get the flu vaccine. True, this year’s vaccine is not a great match, but at least it lessens the severity of the flu if you still get it.

BOTTOM LINE: Please, if you get the flu, do your part to stop spreading this disease and STAY HOME from work, school, sports, (and restaurants, grocery stores, Starbucks, whatever!) until you feel significantly better AND are FEVER-FREE (and puke-free) for at least 24 hours without taking medicines to stop/blunt those symptoms.

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