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Posts Tagged ‘H1N1’

Flu activity seems to have quieted down recently, for which we can all be thankful. But the flu season is not over yet. Influenza is still out there.

Many states are reporting flu activity, which still remains a threat. Seasonal influenza usually peaks in February and March and can continue as late as May. So increased activity from the seasonal influenza, the H1N1 flu or both is still possible.

We need to remember the 1957-58 pandemic, when flu activity decreased in December and January. Thinking the worst was over, officials relaxed their push to get people vaccinated. When flu activity significantly returned in February and March, many were hospitalized, and deaths increased, as well. This could be a good lesson for us today.

So far during this flu season, most activity has been attributed to the H1N1 virus, which first appeared in April.

By the middle of November, the United States had reported roughly 47 million H1N1 flu cases. This resulted in well over 200,000 hospitalizations and caused nearly 10,000 deaths. About a thousand of those deaths were in children younger than 18, a number of whom were healthy before they caught the flu. That is why it is important not to take this disease lightly.

Although I think everyone would benefit from the flu vaccine, it is especially important for certain groups. You should be vaccinated if you:

• Have a chronic illness such as asthma, heart disease, or diabetes.

• Are pregnant.

• Are 65 years or older, and therefore are at increased risk of complications.

• Care for or live with a baby less than 6 months of age, as these infants are too young to be vaccinated for influenza.

Children who are 9 years old or younger need two doses of vaccine about a month apart; however, waiting more than a month between doses does not seem to decrease the effectiveness of the vaccine. Adults need only one dose.

HSN1 Virus Under a Microscope

Regarding popular worries about side effects of the H1N1 vaccine, data from the established surveillance systems would indicate that H1N1 has a safety profile similar to that of the seasonal flu vaccine. No significant pattern of adverse health events have been seen with either of the vaccines.

The bottom line is that although flu activity has died down this past month, the season is not over. It is still important to get vaccinated and be prepared for a possible increase in flu activity, which could occur between now and May. At this time, there appears to be enough vaccine for anyone who wants it.

I would like to thank the Palo Alto Medical Foundation’s Santa Cruz Incident Command Committee for supplying some of the information for this article.

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There’s an abundance of hype in the media these days concerning the safety and necessity of the H1N1 swine flu vaccine.

There are those who oppose any type of immunization, those who believe in conspiracy theories and those who just don’t trust science-based medicine. And, of course, there are many individuals who have a justifiable worries about anything that is new and possibly not adequately tested.

The fact is that this H1N1 vaccine uses the same technology, processes and facilities that are used to make the yearly seasonal flu vaccine, which, over the past 30 years, has proven to be reliable and safe.

The H1N1 vaccine has been tested extensively, and so far, no significant side effects have been noted. The only difference between this vaccine and the yearly flu vaccine is that the H1N1 vaccine targets a different strain of the influenza virus.

We must remember that any time a new drug or therapy is tested on thousands of individuals, it eventually comes to market to treat millions of people. Overall, we have a very good track record of providing new drugs to those who benefit greatly from them.

Smallpox, which was a scourge of the world, has been virtually eliminated by a vaccine. Polio, measles, mumps and rubella have been controlled where vaccinations are available.

Physicians constantly grapple with the concept of risk versus benefit when treating patients. As with life in general, there are no absolute guarantees in medicine, but I believe the benefit of preventing complications from H1N1 flu outweighs the risk of the vaccine itself.

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In my two prior swine flu columns, I advised everyone to be prepared for the flu season by getting vaccinated when the vaccine is available. I also talked about being prepared to stay at home for the duration of one’s flu symptoms.

Now I would like to give advice according to the Centers for Disease Control and Prevention for medical treatment of swine flu.

There are two antiviral drugs available for treatment, Tamiflu (an oral medication) and Relenza (an inhaled medication). Antiviral treatment is recommended for the following groups of patients who display the typical symptoms of H1N1 infection, or swine flu, including fever, cough, aches, sore throat and occasionally vomiting and diarrhea:

  • All hospitalized patients with swine flu
  • Children younger than 5 years old, and especially those younger than 2
  • Adults 65 years or older
  • Pregnant women — treatment is thought to be safe and extremely important in this high-risk group
  • Those with chronic conditions, such as diabetes, asthma, heart-related conditions, cancer, and diseases of the liver, kidney or bloodIn addition to the above recommendations for antiviral treatment, anyone who shows the following symptoms needs urgent medical attention:
  • Difficult or rapid breathing
  • Altered consciousness
  • Persistent vomiting.
  • A return of flu-like symptoms, including fever and a worse cough, after a period of improvement
  • In children, not taking enough liquids, difficulty awakening or extreme irritability.

If an epidemic of swine flu does not materialize this year, there will be adequate treatment facilities available at doctor’s offices, clinics and hospitals to care for those who become ill. But if a truly major epidemic occurs, receiving adequate treatment may prove difficult.

In this scenario, health care facilities may be overwhelmed with sick patients. Medical personnel, including doctors, nurses and technicians, may be in short supply because of being too sick themselves to provide care.

We at the Palo Alto Foundation Medical Group Santa Cruz, like other local medical organizations, are making plans to deal with a worst-case scenario. In such a case, patients arriving at a facility for medical care might be screened and treated outdoors in their cars or in tents. Some clinic buildings might be designated to care for only swine flu patients. More care might be provided over the phone or by e-mail.

We are all exploring novel ideas to deal with a surge of sick patients, while at the same time remaining hopeful that such a situation will not occur.

If we find ourselves with an epidemic, it will be very important for everyone to rely on the media for up-to-date information on what could be a fluid and rapidly changing situation.

In conclusion, I repeat what I said in the beginning of this series regarding swine flu: We must be prepared, not scared.

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Health officials are concerned about the possibility of a surge in swine flu cases appearing soon after students return to school this fall.

The symptoms of H1N1 infection, called swine flu, include fever, cough, sore throat, body aches, headache and, sometimes, vomiting and diarrhea.

To help prevent an epidemic of this illness, we must all do our part. If you become sick with these symptoms, you will probably be ill for at least one week. You should stay at home and avoid close contact with others as much as possible.

Avoid most of your usual activities, such as school, work, shopping, social events and public gatherings. Do not resume any of these activities until at least 24 hours after your fever is gone. This period of isolation is of utmost importance to help prevent the spread of swine flu.

Schools will send sick students home. When an ill child is identified, there may be isolation rooms where students will wait until they can be picked up and taken home.

At all times during your illness, you need to cover your cough or sneeze with a tissue and wash your hands frequently with soap and water for 15 to 20 seconds, or use one of the many available alcohol-based hand sanitizers.

Avoid face-to-face contact with others by keeping a distance of at least 3 or 4 feet between you. If you have to leave home to seek medical care or for some other necessity, wear a mask.

In case of a severe swine flu epidemic, many of us may need to be confined to our homes for a period of time. I recommended having the following supplies on hand to get through a period of home confinement:

  • A one- to two-week supply of food and water.
  • Medication for treating fever, aches and pains, such as Tylenol (acetaminophen) or Advil (ibuprofen).
  • Cough medication, such as Robitussin DM, Vicks 44 or honey/menthol lozenges.
  • Throat lozenges, such as Sucrets Complete (with dyclonine and menthol).
  • Electrolyte drinks, such as Gatorade or Powerade.
  • Alcohol-based hand sanitizer, such as Purell.
  • Surgical masks, obtainable from most pharmacies.
  • In the event of a major swine flu epidemic, being able to see a doctor and receiving treatment may be difficult. That is why I recommend the above list of supplies and home remedies.

    No one knows how the swine flu season will unfold. I hope it will be no worse than any other flu year. But we have to be prepared, just in case.

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I want to spend the next few weeks trying to bring you up to date on the most current information concerning swine flu, which is now being referred to by the experts as the H1N1 virus.

Influenza is almost unheard of during the summer months, but we are experiencing quite a few cases in every state of the United States, as well as in most countries throughout the world.

Santa Cruz County has seen proven cases of influenza this summer caused by H1N1. Most cases have been relatively mild. It seems that H1N1 is so far no worse than the regular flu that occurs each winter season. That’s the good news.

The bad news is that I believe, as do many experts in the field, that we could possibly see a worldwide epidemic — a pandemic — of H1N1 beginning this fall. The worst-case scenario could rival the flu pandemic of 1918, during which 650,000 Americans died and there were 50,000,000 deaths around the world.

But we must also realize that 36,000 people die in the U.S. each year during a typical flu season.

I repeat, a pandemic occurring this year as we had in 1918 is only a theoretical possibility. This year’s flu season could be no worse, or even less dangerous, than usual.

Leading scientists agree that influenza viruses are very unpredictable. Therefore, there is no way to predict which of the various scenarios we will see this year. It could be serious or not. Time will tell, but I believe it is better to be prepared.

One method of preparation is through widespread vaccination programs. Most people will need one shot for the regular seasonal flu and another one (possibly two) shots for swine flu. The regular seasonal flu vaccine may be available as early as September, and it is recommended that people get this vaccine as soon as possible. The swine flu vaccine, which is on a crash development program, may be available as soon as October.

Unfortunately, both vaccines cannot be combined into one shot. They may, however, be given as two separate shots on the same day.

Because quantities of vaccines may initially be limited, some form of prioritizing will be necessary. The Center for Disease Control and Prevention has made the following recommendations as to who should be immunized.

Regular seasonal influenza:

• Health care providers

• People age 65 and older

• Pregnant women

• Those with chronic health or immune diseases

H1N1 swine influenza:

• Health care providers

• Pregnant women

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

• People between the ages of 6 months and 24 years

• Those with chronic health or immune disorders

Once the demand for vaccine for the above priority groups has been met, and if there is still sufficient vaccine available, then all people who remain may be vaccinated.

One bit of good news regarding swine flu is that people age 65 and older seem to have a greater immunity to it than to the normal flu.

Subsequent columns will deal with what treatment may be available if an outbreak begins, how to prepare yourself and your home for a severe flu epidemic, and how medical providers and hospitals would likely cope with a flu pandemic.

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