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• ImmediCenter • WINTER 2009-10 • Swine Flu H1N1 Update •
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By Michael P. Basista, M.D., Director, ImmediCenter Walk In Medical Care
2009-10 H1N1 Swine Flu Update
A flu vaccine is the best way to protect against influenza. There are two types of influenza: seasonal, and H1N1 (swine flu). There is a separate vaccine for each type of flu. The H1N1 vaccine will not protect you from the seasonal flu, and vice versa. Two kinds of H1N1 vaccines are available:
••••The H1N1 “flu shot” - a vaccine (containing a dead virus) which is approved for use in people 6 months and older, healthy people, people with chronic medical conditions, and pregnant women.
••••The H1N1 “nasal spray” - a vaccine (called LAIV for "live attenuated influenza vaccine"), made with live, weakened viruses that do not cause the flu. It is for use in healthy, non-pregnant people from 2 to 49 years.
The same manufacturers make the seasonal flu and H1N1 vaccines, in the same way. About two weeks after vaccination, your body will develop antibodies that protect against H1N1.
Again, the H1N1 vaccine will not protect against the usual seasonal flu viruses. While H1N1 viruses are likely to be the most common flu this season, the CDC still expects that seasonal influenza (regular non-swine flu) will circulate, and recommends that people also get a seasonal flu vaccine.
Vaccination against H1N1 should begin as soon as possible and continue throughout the influenza season, into December, January, and beyond. Flu seasons can last as late as April or May.
Some people should not get any flu vaccine without first consulting a physician:
••••People who have a severe allergy to chicken eggs.
••••People who have had a severe reaction to an influenza vaccination.
••••People who developed Guillain-Barré syndrome (GBS) within 6 weeks
••••of getting an influenza vaccine previously.
••••Children younger than 6 months of age
••••People who have a moderate-to-severe illness with a fever
••••(they should wait until they recover to get vaccinated.)
The same side effects can be expected from the seasonal flu shot / nasal spray vaccines, and the H1N1 flu shot / nasal spray vaccines:
The flu shot:
••••Soreness, redness, or swelling where the shot was given.
••••Fever (low grade).
••••Aches.
If these problems occur, they begin soon after the shot, are usually mild, and last a day or two. Most people who receive flu vaccine have no serious problems from it.
However, on rare occasions, flu vaccination can cause severe allergic reactions.
The nasal spray (LAIV):
••••Runny nose
••••Wheezing
••••Headache
••••Vomiting
••••Muscle Aches
••••Fever
••••Sore Throat
••••Cough.
With the U.S. facing a severe shortage of H1N1 vaccine, scam artists have taken notice, and are cashing in on the crisis.
Health officials are warning those who wish to avoid long line-ups, and those who may not be able to get flu shots this season to beware of flu products being sold online.
Health and Human Services Secretary Kathleen Sebelius said, "We're seeing hoax products being sold on the Internet." Items that claim to prevent and even cure the flu are showing up on the Internet in a big way. Fake merchandise such as air sterilizers, shampoo and bogus Tamiflu are being marketed that do not have the U.S. government stamp of approval.
The FDA purchased and tested 5 Tamiflu products from sites that offered the product without prescription and found that one of them contained talcum powder with some Tylenol in them, and others did contain some Tamiflu but were not approved by the FDA.
Health officials have threatened legal action against more than 140 vendors advertising fake H1N1 related products. Sebelius says, "Unless a product is licensed by the Food and Drug Administration, it is not valuable and may be potentially dangerous."
A list of fraudulent and potentially dangerous H1N1 products can be found at http://www.fda.gov.
H1N1 History:
H1N1 is a new influenza virus that was first detected in April 2009. This virus is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization (WHO) signaled that a pandemic of 2009 H1N1 flu was underway.
H1N1 is a respiratory illness caused by a type A influenza virus that is commonly found in pigs, hence the nick-name "Swine Flu". It was unusual for humans to catch it. Recently, the virus has mutated and it can now infect humans and spread from person-to-person. Most people who have become ill with this new virus have recovered without requiring medical treatment.
The main difference between H1N1 and human flu is that people have not developed a natural immunity to H1N1 because they have not been previously exposed to it.
Bed rest, drinking plenty of fluids, and acetaminophen (Tylenol) are also useful in the treatment of flu. Aspirin or anything that contains aspirin must not be used in children under the age of 18.
An infected person should avoid contact with other people. They should be isolated in a room with the door closed. If they must come in contact with others, the infected person should wear a surgical facemask to avoid the spread of disease.
Covering your face with a tissue will also work. The infected tissues should be discarded into a proper covered receptacle. Anyone who makes contact with an infected person should wash their hands immediately.
In summary, H1N1 has developed into a form of flu that can infect humans. It seems to be behaving like typical human flu. Precautions and treatment are similar to the usual flu. It is probable that the consequences will be no worse than the usual flu outbreaks.
The Center for Disease Control has determined that 2009 H1N1 virus is contagious and is spreading from human to human the same way that seasonal flu spreads- through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.
Symptoms:
Fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Illness with the new H1N1 virus has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred.
In seasonal flu, certain people are at “high risk” of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions. About 70 percent of people who have been hospitalized with this 2009 H1N1 virus have had one or more medical conditions previously recognized as placing people at “high risk” of serious seasonal flu-related complications. This includes pregnancy, diabetes, heart disease, asthma and kidney disease.
One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of 2009 H1N1-related complications thus far. CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibody to 2009 H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against 2009 H1N1 flu by any existing antibody.
With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.
The 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are few cases and few deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this 2009 H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy.
How long can an infected person spread this virus?
People infected with seasonal and H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.
Prevention & Treatment
What can I do to protect myself?
● Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
● Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners* are also effective.
● Avoid touching your eyes, nose or mouth. Germs spread this way.
● Try to avoid close contact with sick people.
● If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.
Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
● Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs,* tissues and other related items might could be useful and help avoid the need to make trips out in public while you are sick and contagious.
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