Editor—Fowler raises some important issues. My editorial was focused primarily on influenza, but I agree that efforts to contain the ravages of influenza-like illness have mainly been concentrated on preventing and treating the effects of infection with influenza A and B viruses. These agents cause only a variable but “on average” minor share of the yearly burden of influenza-like illness. The development of effective vaccines and antivirals against influenza-like illness has so far failed for various reasons.
For example, topical interferon, although effective against the common cold, caused unintended effects similar to the symptoms of influenza-like illness.1 Manufacture of effective rhinovirus vaccines would have to include antigens from more than 100 different serotypes.2 As influenza-like illness is a syndrome, the only realistic current alternatives are the building of local and general immunity or the symptomatic or natural remedies that Fowler advocates. Apart from hyperthermia, there are a few interventions that are based on evidence (table). All of them are cheap and have few, if any, unintended effects.
Table 1.
Evidence based interventions for influenza-like illness
| Perspective | Intervention | Rationale | Reference |
|---|---|---|---|
| Prevention | Hand washing |
Interrupts transmission of most ILI agents |
w1-w4 |
| Not blowing nose |
Forces mucus into sinuses and Eustachian tubes |
w5 |
|
| Treatment | Drink spicy chicken broth |
Accelerates clearance of nasal mucus and vasodilates |
w6, w7 |
| Steam inhalation or sauna | Conditions of high temperature and humidity impede transmission and replication of respiratory viruses | w8, w9, w10 |
Overall, the underlying problem is insufficient research on the mechanisms and containment of influenza-like illness. Had the MRC Common Cold Unit not closed in 1989 we might have a better understanding of this very common illness and not rely on the unwelcome arrival of new infective agents to stir up temporary interest in the topic. It is a sad fact that lack of commercial appeal and passing trends have stunted research in this important health field.
Supplementary Material
Additional references w1-w10 are on bmj.com
Competing interests: TJ has received consultancy fees from Roche, GlaxoSmithKline, and Sanofi Synthelabo. He was HC Roscoe fellow for the study of the common cold between 2000 and 2002.
References
- 1.Jefferson TO, Tyrrell D. Antivirals for the common cold. Cochrane Library. Issue 3.;(1). Chichester: John Wiley, 2004.; (Cochrane Database Syst Rev 2001(3): CD002743.) [DOI] [PMC free article] [PubMed]
- 2.Jefferson TO, Tyrrell D. Vaccines for the common cold (protocol for a Cochrane review). Cochrane Library. Issue 3. Chichester: John Wiley, 2004.
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