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With the kids back to school, cold and flu season is just around the corner. Although influenza is most common in North America from December to April, some get it earlier, and now is the time to get prepared.

Because the immune system takes about six to eight weeks to respond to vaccination, the best time to get the flu vaccine is September to mid-November, before the flu season hits, according to the U.S. Centers for Disease Control, which launched a "Diabetes and Flu/Pneumococcal Campaign" this month.

A cold and the flu (influenza) are alike in many ways. But the flu can lead to serious, life-threatening problems, such as pneumonia. At least 45,000 Americans die each year from influenza and pneumonia. Combined, the two conditions are the sixth-leading cause of death in the United States. Ninety percent of the deaths are among people 65 and older.

A stuffy nose, sore throat and sneezing are usually signs of a cold. Tiredness, fever, headache, and major aches and pains probably mean you have the flu. Coughing can be a sign of either a cold or the flu, but a bad cough usually points to the flu.

Typically, colds begin slowly, two to three days after infection with the virus. The first symptoms are usually a scratchy, sore throat, followed by sneezing and a runny nose. Temperature is usually normal or only slightly elevated. A mild cough can develop several days later. Symptoms tend to be worse in infants and young children, who sometimes run temperatures of up to 102 degrees Fahrenheit (39 degrees Celsius). Cold symptoms usually last from two days to a week.

Signs of the flu include sudden onset with a headache, dry cough and chills. The symptoms quickly become more severe than those of a cold. The flu sufferer often experiences a "knocked-off-your-feet" feeling, with muscle aches in the back and legs.

A fever of up to 104 degrees (40 degrees Celsius) is common. The fever typically begins to subside on the second or third day; then respiratory symptoms like nasal congestion and sore throat appear. Fatigue and weakness may continue for days or even weeks.

Influenza rarely causes stomach upset. What is popularly called "stomach flu" -- with symptoms like nausea, diarrhea and vomiting -- is technically another malady: gastroenteritis. What's more, cold and flu-like symptoms can sometimes mimic more serious illnesses like strep throat, measles and chickenpox.

If symptoms persist, become severe or localized in the throat, stomach or lungs, or if other symptoms such as vomiting and behavioral changes occur, contact your doctor.

If a cold is misdiagnosed as flu, there's usually no problem. At worst, a cold can occasionally lead to secondary bacterial infections of the middle ear or sinuses, which can be treated with antibiotics. But if the flu is misdiagnosed as a bad cold, potentially life-threatening flu complications like pneumonia may be overlooked.

Cold viruses can be transmitted in one of two ways: By touching respiratory secretions on a person's skin (when shaking hands, for example) or on environmental surfaces (like doorknobs or handrails) and then touching the eyes, nose or mouth; or by inhaling infectious particles in the air (like respiratory secretions from a cough or sneeze).

Hand-washing is the best way to avoid a cold, along with not touching the nose, eyes or mouth. To minimize the spread, other helpful measures include avoiding close, prolonged exposure to people with colds, and always sneezing or coughing into a facial tissue and immediately throwing it away. Cleaning environmental surfaces with a virus-killing disinfectant is also a good idea.

The most important tool for fighting the ever-changing flu virus is immunization. Studies have shown the vaccine's effectiveness rate to be 70 to 90 percent in healthy young adults. In the elderly and in people with certain chronic illnesses, the vaccine sometimes doesn't prevent illness altogether, but it does reduce its severity and the risk of complications.

The Centers for Disease Control recommends vaccination for the following high-risk groups:

People aged 65 or older.

Residents of nursing homes and other facilities that provide care for the chronically ill.

People who have certain underlying medical conditions including: asthma, anemia, diabetes, or heart, lung or kidney disease in addition to those with an impaired immune system, or those undergoing treatment for cancer or who are taking long-term steroids.

People allergic to eggs, have a medical problem like bronchitis or pneumonia or are pregnant should consult their health-care providers about being vaccinated.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

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