Recently, The Centers for Disease Control (CDC) issued a warning that an H1N1 infection can put patients at risk for serious bacterial pneumonia.  The warning was issued in response to the observation of an increase in serious pneumococcal infections around the country.  This is a warning that should be taken seriously as pneumonia can be both a deadly and a potentially fatal condition.   According to the American Lung Association, pneumonia is currently the 7th leading cause of death in the United States, claiming more than 60,000 lives each year.  In order both to prevent and address a pneumococcal infection satisfactorily (in the event it has already occurred), it is important to be aware of the following facts:

PNEUMONIA – CAUSES AND SYMPTOMS

Pneumococcal disease is an infection caused by bacteria; however, nearly half of all pneumonia cases start off as viral infections.  When bacteria invade the lungs, pneumonia can occur.  The bacteria can also invade the body’s bloodstream and/or the tissues surrounding the brain and spinal cord resulting in a condition known as Meningitis.  This is one of the reasons why it is so critical to do all that is possible both to prevent and control a pneumococcal infection.

If you have had the seasonal flu or an H1N1 infection, it is important to be aware of the following symptoms of pneumonia as these symptoms generally appear secondary to a flu infection: 

• High Fever and/or chills
• Sweating
• Cough with thick mucus OR Dry cough
• Shortness of breath
• Chest pain
• Overall sense of extreme fatigue and weakness

TIPS TO PROTECT YOURSELF FROM PNEUMONIA

1.  Strengthen your immune system – As Influenza infections can easily lead to pneumonia, one of the key factors to help prevent pneumonia is to do ALL you can to recover from a flu infection quickly.  To that end, one of the most important factors is to eat sensibly, and obtain adequate rest to strengthen and boost your immune system.  Those that are overworked and under-rested while fighting a flu are the ones who are most likely to come down with a pneumococcal infection.

2.  Discuss vaccination needs with your doctor – The Pneumococcal Polysaccharide Vaccine (PPSV) protects high-risk individuals 2 through 64 years of age against serious pneumococcal disease.  Generally, only a single dose of PPSV is required in a lifetime.  Children less than 5 years of age should receive a different vaccine called Pneumococcal Conjugate Vaccine (PCV7); and high risk children 2 to 4 years of age need both pneumococcal vaccines.  The decision to obtain vaccination may depend on your individual health status, and must be made in consultation with your doctor.

3.  Throw the cigarettes! - If you are a smoker and want to prevent or overcome pneumonia, quitting the smoking habit is simply essential. 

4.  Follow common-sense rules – Washing hands regularly, disinfecting commonly used surfaces such as doorknobs and telephones, and keeping the living environment as clean and germ-free as possible are all common-sense guidelines that help protect against the spread of both the flu and/or a bacterial pneumonia infection.  They must be observed at all times.

THOSE AT HIGH RISK FOR PNEUMONIA

CDC classifies certain groups of people as being those who may be at a higher than average risk for contracting pneumonia.  Specifically, this list includes those over 65 years of age, and those who may have cardiovascular disease, lung disease, diabetes, a weakened immune system, and/or certain other conditions.  Please refer to the full list of those who may be at high risk at this link.  It is particularly recommended that individuals who fall under the “high-risk” category get vaccinated using the PPSV or other appropriate vaccine.

Ordinary seasonal flu or the H1N1 flu can very easily lead to a prolonged infection resulting in pneumonia if your body gets overwhelmed with lack of adequate nutrition or rest.  Protect yourself from pneumonia using the guidelines above, and please refer to the following resources for authoritative additional information.  Please also forward this post to ALL who may benefit from the guidelines and resources provided here.

RESOURCES

CDC – Prevention of Pneumococcal Infections

Information on Pneumococcal Vaccination

Critical Links and Podcasts on Preventing Pneumonia

For those affected severely by the H1N1 virus, it appears that the most common cause of death has been Pneumonia and Acute Respiratory Distress Syndrome, occurring within twelve days of onset of flu symptoms.  These findings are supported by the World Health Organization’s report on The Clinical Features of Severe Cases of Pandemic Influenza.  According to WHO, Primary viral pneumonia is the most common finding in severe cases and a frequent cause of death.  Secondary bacterial infections have been found in approximately 30% of fatal cases, and Respiratory failure and refractory shock have also been the most common causes of death.

The message to take home from this latest study is that overall, severe symptoms of the H1N1 infection appear to be occurring across all age groups with the highest fatality rates being among those over age 50, contrary to the common perception that H1N1 flu affects mostly young people.  Additionally, both the JAMA study and WHO findings suggest that obesity, and especially morbid obesity,  have been present in a large portion of severe and fatal cases of the virus, although the exact role of obesity is not well understood at present.

For more information on distinguishing the clinical features of a severe H1N1 infection, please refer to the following report: WHO – Clinical features of severe cases of pandemic influenza

As of last Friday, October 9, 2009, a total of 76 H1N1-associated pediatric deaths in the U.S. were confirmed by the Centers for Disease Control and Prevention (CDC).  Over the last three years, deaths among children from the regular seasonal flu have ranged from 46 to 88.  Given that it is yet only early October, the loss of 76 children due to the H1N1 virus raises significant concerns for their protection and safety.  In this post, I address some important facts relevant to the care of children who may be at a higher than average risk for an H1N1-related complication, and also reiterate prevention guidelines that may be of benefit both to physicians and others taking care of such children.

DEFINING WHICH CHILDREN ARE AT A PARTICULARLY HIGH RISK FOR FLU-RELATED COMPLICATIONS:

1.  It is well known that children younger than 5 years of age, and those who have high-risk medical conditions are at an increased risk of Influenza related complications.  Children at higher risk include all children with immune supression, chronic kidney disease, diabetes, asthma, heart disease, sickle-cell disease, or other problems related to the lungs. 

2.  In addition to the above, children with any condition that affects respiratory function including neurological conditions such as intellectual and developmental disability, cerebral palsy, spinal cord injuries, seizure disorders, metabolic conditions or other neuromuscular disorders have higher risk.

3.  Finally, children with poor nutritional and fluid intake because of prolonged vomiting and diarrhea, and children with an underlying metabolic disorder such as Medium-Chain Acyl-CoA Dehydrogenase (MCAD) Deficiency – are more susceptible to both the seasonal flu- and the H1N1 flu related complications.

It is particularly important that parents, caregivers, and physicians stay on the alert for worsening disease symptoms in ALL children, but particularly in high-risk children.  In addition to the expected symptoms of H1N1 (fever, sore throat, cough, etc.), if new symptoms appear in sick children, such as apnea, dehydration, recurring infection, an altered mental state, or extreme irritability - any of these should be a signal to immediately take more aggressive steps to prevent the situation from getting worse.  Children experiencing any one or more of the above mentioned conditions should be under continuous expert care.

CONCERNS ABOUT CONTRACTING PNEUMONIA

One of the main concerns that is relevant both for adults and children is the fact that oftentimes during serious flu outbreaks, bacterial pneumonia infections can also become widespread.  Generally speaking, Influenza predisposes people to community-acquired bacterial pneumonia, and can often be an important related cause of illness and death.   Because of this fact, CDC’s Advisory Committee on Immunization Practices recommends the following:

• A single dose of PPSV23 (pneumococcal polysaccharide vaccine) for all people 65 years and older, and for persons 2 to 64 years of age with certain high risk conditions.  This is due to the fact that people in these groups are at an increased risk of pneumococcal disease as well as serious complications from influenza (both seasonal and the H1N1).
• PCV7 (pneumococcal conjugate vaccine) is recommended for children aged less than 5 years.

COMMON SENSE RULES APPLY

In nearly all cases involving efforts to prevent an H1N1 infection (whether in adults or children), common sense rules must apply – many of which have been stated in previous posts.  Further, keeping well-informed with respect to the types of drugs available, as well as their side-effects is also equally important.  As the H1N1 Flu is an emerging disease, it become particularly critical for us to observe its course carefully, and to stay soundly informed as well as equipped with up-to-date information.  It is quite clear that children are particularly vulnerable to the H1N1 virus; For this reason, it is incumbent upon us to minimize the tragic loss of life in this population by becoming as well-informed as possible with respect to their protection.  To that end, please refer to some critical precautions presented in previous posts (links above) and take advantage of the important resources provided at the end of this one. 

RESOURCES:

Recommendations for use of pneumococcal vaccines & additional links for contraindications, precautions and adverse effects. 

CDC Guidelines for Prevention of Pneumococcal Disease

The Centers for Disease Control announced last week that it had received reports of 60 deaths of children related to the H1N1 flu since April of this year; and 11 of these deaths have occurred within the last week.  Further, between the period from August 30 to September 27, CDC reports that there have been 16,174 hospitalizations nationwide, and 1,379 deaths associated with the H1N1 infection. 

At the present time, the states that are reporting the most widespread flu activity are Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, Texas, Tennessee, Virginia, Washington and Wyoming.

Worldwide, more than 340,000 laboratory-confirmed cases of H1N1 and more than 4,100 deaths have been reported to the World Health Organization.

Given the unexpected and significant toll the Swine Flu has taken, efforts are well underway to make the H1N1 vaccine available to all.  In spite of the significant controversy associated with this vaccine, it was estimated (by a CNN opinion poll in late August) that about two-thirds of Americans are planning to take the vaccine.  The campaign to inoculate millions of Americans against the H1N1 Influenza began yesterday, October 5, with health-care workers in Indiana and Tennessee being the first recipients in queue for the vaccine.   Nevertheless, in spite of the assurance of vaccine availability, it appears that widespread pandemonium remains around the nation due to the toll that H1N1 has already taken thus far.

My Comments – I believe that in spite of the significant and legitimate concern about the Swine Flu, common sense principles must apply and that they should not be overlooked with respect to prevention efforts.  The evidence of previous pandemics suggests that there are those who appear to be able not to get sick in spite of widespread disease.  What then, is the secret (if there is one), to avoid contracting a widespread virus  or other infectious disease? 

The above question is complex, and contrary to common opinion, I do not believe that simplistic answers can suffice.  For example – It is well known that certain groups of people (such as pregnant women, chidren, young adults, and those with certain serious chronic conditions such as lung disease or diabetes) are often more susceptible to infectious diseases such as the Flu.  This fact alone tells us that our ability to resist disease is highly individual; that it may depend on our unique biochemical individuality; and further, that it may be contingent upon numerous additional factors such as individual nutrient levels, rest/stress levels, and the state of our overall immunity.  In addition, the level of exposure to disease is a critical factor as well.  It is of course well known that those who spend the majority of time in public places or crowded areas are much more likely to succumb to the possibility of contracting an infection.

Notwithstanding the above, it behooves us (as it does in the case of all things we cannot control fully) that we do ALL we can to make every reasonable effort to prevent sickness.   In spite of the alarm and concern surrounding the H1N1 virus, I find that too many people I meet appear to be unduly concerned about missing a week of school or work - and this, even after they  have experienced the first symptoms of the Flu!   Now, while I agree that missing work/school may be undesirable, perhaps this perceived loss needs to be viewed in terms of a much larger perspective.  Through this post, I would like to remind as many readers as it reaches to seriously consider some of the statistics presented above.   Upon reflection, would you not agree that the cost of work/school missed for a week, or even more time,  is inconsequential relative to the cost and threat of the possible loss of life, or conceivably, even the permanent loss of health? 

We all tend to think that the worst cannot or will not ever happen to us.  But, the reality is that it can.  With that reminder, please refer again to a previous post on some simple, but potent steps you can take to protect yourself (to the extent it is possible to do so) from the H1N1 virus – including staying home if necessary for a week or more in order to protect both yourself, and others.  Certainly, the H1N1 virus is a formidable enemy, but even mere elementary observation suggests that oftentimes, we humans can be our own worst – and even more formidable – enemies relative to any virus or other external agent.  Let this post be a reminder to us all to first be our own best friends!

Resources:

H1N1 Vaccination Information and Resources

CDC – Flu Update

ZANAMIVIR:

The drug Zanamivir is licensed only for use in persons without underlying respiratory or cardiac disease.   Post marketing surveillance as well as some studies indicate that respiratory function deterioration can occur after inhalation of Zanamivir by those who have underlying airway disease.   For this reason, this drug is notrecommended for patients with such an underlying condition.  Post marketing surveillance has also included reports of allergic reactions such as oropharyngeal or facial edema in some cases with the use of this drug. 

Other common adverse events reported by those using Zanamivir include diarrhea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose, and throat infections.   Each of these symptoms was reported by less than 5% of persons in the clinical treatment studies.

OSELTAMIVIR:

Relative to Zanamivir, a greater number of unpleasant side-effects appear to have been reported with the use of the antiviral medication, Oseltamivir.  In clinical treatment trials,  nausea and vomiting were reported more frequently among adults receiving Oseltamivir for treatment (nausea without vomiting, approximately 10%; vomiting, approximately 9%) than among persons receiving placebo (nausea without vomiting, approximately 6%; vomiting, approximately 3%).  Among children treated with Oseltamivir, 14% had vomiting, compared with 8.5% of placebo recipients.  It is recommended that Oseltamivir be taken with food to help reduce the severity of nausea and vomiting.

Another concern with respect to the use of Oseltamivir has been reports oftransient neuro-psychiatric events(such as self-injury or delirium) that appear to have been associated with its use.  Currently, the FDA has advised that persons taking Oseltamivir be monitored closely for abnormal behavior.

AMANTADINE & RIMANTADINE:

At a dosage of 200 mg/day, both Amantadine and Rimantadine can cause Central Nervous System (CNS) and gastro-intestinal side-effects when given to young, healthy adults.  Data suggest that  incidence of CNS side effects (e.g., nervousness, anxiety, insomnia, difficulty concentrating, and lightheadedness) is higheramong persons taking Amantadine than among those taking Rimantadine.  Generally, side effects associated with  both these drugs are mild and cease when the drug is discontinued.  However, serious side effects have been observed (e.g., marked behavioral changes, delirium, hallucinations, agitation, and seizures) among persons who have renal insufficiency, seizure disorders, or certain psychiatric disorders and also among older persons who have been taking Amantadine as prophylactic treatment at a dose of 200 mg/day.

DRUG INTERACTIONS:

Data vis-a-vis drug interactions is limited with respect to both Zanamivir and Oseltamivir.  With regard to the use of the drug Amantadine, caution is advised in using it concurrently with drugs that effect the CNS, including CNS stimulants.  The concomitant administration of antihistamines or anticholinergic drugs can also increase the incidence of adverse CNS reactions in patients.  Currently, no published data are available concerning the safety or efficacy of using combinations of any of these influenza antiviral drugs.  For this reason, awareness and cautions must always be borne in mind while using these medications.  Use this link to refer to helpful criteria for discerning an adverse drug event/interaction.

SAFETY ISSUES DURING PREGNANCY:

The four drugs discussed above fall under “Pregnancy Category C”medications, which indicates that no clinical studies have been conducted to assess the safety of these medications for pregnant women.  Both Amantadine and Rimantadine have been demonstrated in animal studies to be teratogenic (i.e., able to disturb the growth and development of an embryo or fetus) and embryotoxic when administered at substantially high doses.  CDC recommends that the antiviral medications discussed here should be used during pregnancy only if the potential benefit justifies the potential risk to the embryo or fetus, and further, that the manufacturers’ package inserts should be consulted prior to the use of these medications.

With an astute awareness on how to use drugs safely, a great many potentially serious adverse events can either be circumvented altogether or treated promptly.  If you are currently dealing with the seasonal flu or an H1N1 infection, stay on the alert while using prescribed medications, and use them according to the parameters provided.  You may also want to keep the above information handy or pass it on to others who may benefit.

ADDITIONAL USEFUL RESOURCES:

Prevention & Control of Influenza – Recommendations of the Advisory Committee on Immunization Practices (ACIP) 2008. MMWR 2008 Jul 17; Early Release:1-60.

Prevention & Control of Influenza – Recommendations of the Advisory Committee on Immunization Practices (ACIP) 2004. MMWR 2004 May 28; 53(RR06);1-40.

The latest update on the international situation on the H1N1 virus was recently reported by the World Health Organization on August 23, 2009.  As of that date, the total number of laboratory confirmed cases of the 2009 H1N1 virus were 209, 438 with at least 2, 185 deaths.  The laboratory confirmed cases represent an underestimation of the actual number of cases of H1N1 worldwide as most countries now focus surveillance and laboratory testing in persons with severe illness only. 

Overall, at present, decreases in disease due to the H1N1 virus are being reported from South America, parts of Australia, and the U.K.  On the other hand, increase in disease due to the H1N1 virus is being reported from more countries in Africa, Southern Africa, and other tropical countries. 

 UNITED STATES UPDATE 

The latest report on the domestic situation with the H1n1 virus is from the week of August 16-22, 2009.   The Centers for Disease Control (CDC) estimate that the H1N1 activity is either stable, or increasing in some areas of the U.S.  H1N1 activity appears to be increasing in the SouthEast (especially the state of Georgia) based on data reported by health care providers in that area. 

Most state officials across other parts of the country are currently reporting regional or sporadic influenza activity.  However, Alaska and Georgia are the two states that are reporting widespread influenza activity at this time. 

Both in the U.S. and internationally, the H1N1 virus continues to be the most dominant virus in circulation.  With rare exceptions, the H1N1 virus continues to be susceptible to the antiviral drugs Oseltamivir and Zanamivir.   Read more on the resistance of the H1N1 virus to certain antiviral drugs; how antiviral drugs help provide protection against and treatment for Swine Flu, dosage recommendations, and guidelines for use of antiviral medications at the following link:  Antiviral Drugs and The Swine Flu – Getting Equipped.

Antiviral drugs are prescription medications that are active against Influenza viruses, including the Swine Flu virus.  These medications are effective only against Influenza viruses, that is,  they are incapable of preventing or treating symptoms caused by other viruses.  There are essentially four Influenza antiviral drugs that are currently approved for use in the United States.  These are:

1.  Oseltamivir

2.  Zanamivir

3.  Amantadine

4.  Rimantadine

The H1N1 viruses that have been detected in the United States and Mexico appear to be resistant to the drugs Amantadine and Rimantadine.   Tests conducted thus far indicate that the H1N1 viruses are susceptible to Oseltamivir and Zanamavir.  The Centers for Disease Control (CDC) is presently recommending the use of Oseltamivir or Zanamivir for the treatment and/or prevention of infection with Swine Influenza viruses.  Additionally, recommendations from the CDC state that:

• Oseltamivir (brand name Tamiflu ®) is approved to both treat and prevent Influenza A and B virus infection in people one year of age and older.
• Zanamivir (brand name Relenza ®) is approved to treat Influenza A and B virus infection in people 7 years and older and to prevent influenza A and B virus infection in people 5 years and older.

HOW ANTIVIRAL DRUGS MAY HELP

PREVENTION:  Antiviral drugs can be used to prevent Influenza.  When given to a person who is not ill, but who may have been exposed to another person or persons with Swine Flu, these drugs are about 70 to 90% effective.  For preventative purposes, the number of days they may be used will vary in light of each individual’s exposure or unique circumstance.

TREATMENT:  Antiviral drugs are beneficial from the perspective of treatment in that they may help speed up recovery and reduce the intensity or severity of symptoms.  These drugs can also help prevent serious Influenza-related complications.  Ideally, they should be given soon after the onset of illness, particularly to those who may be at high risk for Influenza related complications.

INTERIM GUIDELINES & RESOURCES FOR USE OF ANTIVIRAL MEDICATIONS FOR THE SWINE FLU

Recommendations issued by the CDC for the use of antivirals drugs may change as data on antiviral effectiveness,  adverse events from antiviral use, antiviral susceptibility, and other critical data become available.  Current guidelines for use of antiviral medications can be accessed at the following link: 

Interim Guidance on Antiviral Recommendations for Patients with Novel Influenza A (H1N1) Virus Infection and Their Close Contacts

Dosage recommendations for use of antiviral medications for both adults and children with respect to treatment of the Novel H1N1 infection may be accessed at the following link.  Additionally, dosage recommendations for children less than 1 year of age can also be accessed through the same link:

Dosage Recommendations 

Finally, information on side effects, possible adverse effects, contra-indications, and drug interactions associated with the use of antiviral medications may be accessed at:  

Antiviral Agents for Seasonal Influenza – Side Effects and Adverse Reactions.

Now, there may be many reading this post who may not take the time to follow the links or study the resources provided above.  But, those who do will become less apprehensive, more informed, and better-equipped both to prevent and to address the H1N1 crisis if it were to arise for them or their loved ones in the near future.  To reiterate, kowledge is the perfect antidote to fear – Now is a good time to become equipped with it.

At present, the Novel H1N1 virus continues to be the dominant Influenza virus in circulation in the world – 71% of all Influenza viruses currently detected globally are the new H1N1.  The Novel H1N1 virus also currently accounts for 66% of Influenza viruses in the Northern Hemisphere and 89% of Influenza viruses in the Southern Hemisphere. 

According to WHO, in the face of the rapid spread of a pandemic virus worldwide, regulatory authorities often have to allow for great flexibility in developing procedures for fast-tracking the approval and licensing of pandemic vaccines.  However, numerous media reports seem to have expressed concern about the safety of vaccines for the H1N1 pandemic influenza due to the fast-tracking procedures in place to bring the vaccine to the market.  The main concern is that the fast-tracking approval of a drug or vaccine generally leads to a situation in which the true adverse effects of the administered agent are fully observed only after the agent has appeared on the market (i.e. at the time of post-marketing surveillance).  Other concerns include the vaccine manufacturing procedure itself.  Numerous individuals appear to be concerned with the use of eggs in the H1N1 vaccine manufacturing process.

Due to the above concers, WHO headquarters issued a briefing recently stating that the regulatory procedures in place for the licensing of pandemic vaccines, including procedures for expediting regulatory approval, are rigorous and do not compromise safety or quality controls.

For those concerned about the safety of the H1N1 vaccine and/or its manufacturing process, here are some useful resources for further study:

WHO latest briefing on the safety of pandemic vaccines

Pandemic influenza vaccine manufacturing process and timeline

The Novel H1N1 vaccine will be available shortly; however, in the meantime, a few cautions bear reiterating as students and teachers get ready to return to school this week.   Here are the top 5 things you can do to protect yourself pro-actively from catching the virus:

1.  Consciously take several breaks during the day to wash your hand frequently with soap.  Encourage children to do the same.

2.  Do not touch your nose, eyes, or mouth unless you have thoroughly washed your hands.  Avoid hand-to-face contact to the extent possible.

3.  If anyone around you is coughing, sneezing, or has other flu symptoms, deliberately avoid close contact with them.

4.  Carry your own water bottle(s) rather than drink from a community water fountain.  Do not share your water bottle with others.

5.  If there is a Swine Flu breakout in your community, avoid being in public places or large gatherings.  If possible, stay home from work or school temporarily, and avoid traveling by public transportation.

The  simple precautions above can help you to improve your chances of warding off the virus significantly.  In addition to the resources from the Centers for Disease Control provided previously, you may also want to refer to the following special resources from The Harvard Medical School:

1.  A report, entitled:  Swine (H1N1) Flu: How to understand your risk and protect your health.  This report has been prepared by the editors of the Harvard Health Publications in consultation with Raphael Dolin, M.D., Professor of Medicine, Harvard Medical School.

2.  Special health report, entitled: Viruses and Infectious Diseases: Protecting yourself from the invisible enemy.  This report has been prepared by the editors of Harvard Health Publications in collaboration with Michael N. Starnbach, Ph.D., Professor of Microbiology, Harvard Medical School.

Stay safe, stay well-informed, and protect yourself.

1.  Pregnant women

2.  People who live with or care for children younger than 6 months of age

3.  Health care and emergency services personnel

4.  Persons between the ages of 6 months through 24 years of age, and

5.  People from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.

The population groups outlined above total approximately 159 million people in the U.S.  Although a shortage in the supply of the novel H1N1 vaccine is not expected, it is believed that initially the availability of – and demand for – the vaccine may be unpredictable.  For this reason, the Committee has provided additional guidelines in the event the vaccine is available in limited quantities, especially initially, and has recommended that in such a case the following groups receive the vaccine before others:

• Pregnant women
• People who live with or care for children younger than 6 months of age
• Health care and emergency services personnel with direct patient contact
• Children 6 months through 4 years of age, and
• Children 5 through 18 years of age who have chronic medical conditions.

It has been further recommended that once the demand for vaccine for the prioritized groups has been met at the local level, providers should begin vaccinating everyone from ages 25 through 64 years.

In light of the above guidelines, the most frequent question seems to be one that expresses concern as to whether the novel H1N1 vaccine is meant to replace the seasonal flu vaccine.  The answer to that question is:  The novel H1N1 vaccine is not intended to replace the seasonal flu vaccine; rather, it is intended to be used alongside the seasonal flu vaccine.  Further, CDC guidelines state that both vaccines may be administered on the same day.

Individuals dealing with specific conditions such as Cardiovascular disease or HIV infection, and groups that may have special needs such as clinicians, child-care providers, etc. should refer to the following key resources for valuable additional information. 

Resources/Further Information:

Read the full CDC Press Release

H1N1 Flu – Important information for specific groups

Information on Antiviral drugs; Self and patient care in the event of an H1N1 infection.

In light of the rapid spread of the H1N1 virus in England, a great amount of concern seems to be developing here in the U.S.  Of greatest concern is the issue of children returing to school during what is considered “peak” flu season.  Although anti-viral medications are available, I sense that there is a great deal of panic surrounding the issue of children contracting the virus in the upcoming Fall months.  Over the weekend, I received numerous e-mails inquiring about the best way(s) to be prepared to deal with a possible infection.

To answer the above, I would like to refer all readers to the Centers for Disease Control Q & A site:  Novel H1N1 Flu and You.   This site should answer all your questions authoritatively and equip you well. 

Panic is never the answer; but being well-armed with knowledge is.  Please stay informed, and pass on the link to all who may benefit.

Due to the fact that the Swine Flu virus has very significant potential to cause illness or hospitalizations, the effort is to have the vaccine tested for safety and effectiveness prior to the flu season — which is officially considered to be in the Fall and Winter.  Upcoming clinical trials are expected to enroll 1000 adults and children at 10 centers around the country.  Additional trials may also be undertaken to test how the Swine Flu vaccine works in combination with the seasonal flu vaccine.

A couple of tips to all concerned as we approach the Fall season:

1.  Like other flu types, H1N1 is thought to be spread mainly from person to person through coughing or sneezing.  Simple precautions of covering one’s nose and mouth while coughing/sneezing, and good hygiene (washing hands frequently) are common sense precautions that all should follow.

2.  CDC recommends that if you are sick, or suspect you are, you must stay at home to prevent the spread of infection to others. 

3.  Stay updated regularly with respect to news on this topic.  Being informed is on top of the list with this pandemic.  The CDC hotline for this subject is 1-800-CDC-INFO.