This result shows that the H1N1 vaccine is performing, as expected, just like the seasonal flu vaccine which is given to millions of Americans every fall.

Public uneasiness with the vaccine seems to center around the idea that this vaccine is “untested.” However, scientists point out that this year’s H1N1 vaccine is made exactly like every other flu vaccine, and that flu vaccines have been shown safe and effective for many years in studies of huge populations who received the vaccines.

H1N1

Because of the public anxiety over this vaccine, public health officials are giving unprecedented attention to this year’s vaccine, with a special program to follow and record any adverse effects amongst the millions of children receiving the vaccine.

The study followed children aged 10 to 17, who showed results similar to the many adult tests of flu vaccines. Younger children are showing to form less resistance from one dose of vaccine, and parents are therefore being advised to bring young children in for a booster one month after the original dose.

Groups with official-sounding names like the Health Sciences Institute (which sells information about herbal remedies purporting to cure influenza) and the National Vaccine Information Center (which promotes the debunked theory that vaccines cause autism) use scare tactics and distortions to convince parents not to vaccinate their children.

The Centers for Disease Control offers clear, scientifically validated information on the safety and side effects of vaccines, including this year’s H1N1 flu vaccine. Concerned parents should also speak to their family doctor about the safety of vaccines and vaccine options for their children.

It is the same group of H1N1 viruses which cause the regular yearly flu outbreaks in humans, but swine flu is caused by different strains of H1N1. The 2009 strain of swine flu, now known as novel influenza A (H1N1), has not previously been found in pigs or humans, and contains a mixture of genetic material from human, pig and bird flu. In other words it is a new variety of flu which people are therefore unlikely to have much immunity to.

H1N1 Vaccine

Although the outbreak of novel influenza A H1N1 first appeared in Mexico, there has since been a growing number of cases reported around the world including the UK. Initially all the confirmed cases of swine flu in the UK were in people who had visited Mexico but these were followed by many more cases that have been the result of virus transmission within the UK. Case numbers rose during the summer (which is very unusual for that time of year as it isn’t typically the flu season) and since schools returned in September 2009 there has been widespread transmission with a steadily rising number of cases.

In the last week of September there were 14,000 new cases, which represented a 45 per cent increase over the previous week. This second wave of swine flu has mostly affected schoolchildren.

What is pandemic flu?

Outbreaks of flu tend to follow certain patterns. Every year the number of flu cases rise during the winter months – this is seasonal flu. If a lot of people are affected it may be said to be an epidemic, and about one per cent of those affected are likely to die from it, usually due to complications such as a secondary bacterial infection of the lungs.

But every so often, with a major change in the flu virus, it spreads rapidly around the world causing a high number of deaths. This is pandemic flu. One of the factors that scientists look out for is when a new strain of flu arises among animals and spreads to humans, changing again to develop the ability to spread from human to human without any contact with the animals.

In the early stages it can be difficult to predict how dangerous a new strain of flu is and whether it could cause a pandemic. It’s still unclear exactly how severe this novel H1N1 flu strain is going to prove to be but as numbers of cases rise, the World Health Organization (WHO) has declared it a pandemic.

However, laboratory studies suggest that novel H1N1 is a relatively mild strain and that further mutation of the virus would be needed to cause severe problems. This is being confirmed by the clinical picture as most people with swine flu are experiencing a relatively mild respiratory illness. It’s not clear why it caused particular problems in Mexico where a higher proportion of people died. Many of these people were previously fit young adults, and the WHO have suggested that pre-existent immunity to this new virus is low or non-existent, or limited to older people (who don’t seem to be so badly affected by the virus). There have so far only been a comparatively small number of deaths in Europe. By October 2009, 84 people with swine flu in the UK had died, most of whom had serious underlying health issues. According to the government’s expert advisory group (The Scientific Advisory Group for Emergencies or SAGE) there are likely to be a lot fewer deaths than originally forecast (with a worst-case scenario estimate of 19,000 people in the UK dying of swine flu.)

The virus does seem to be more contagious than seasonal influenza, with up to twice as many contacts of those affected developing the disease. But overall, novel H1N1 is thought to be far less dangerous than the H5N1 strain of bird or avian flu which has caused so much worry in the past few years.

Causes and risk factors

Although anyone can catch flu, seasonal flu tends to cause more problems among the elderly, the very young and the chronically ill. However pandemic flu tends to affect previously healthy adults – this has been the case with novel H1N1 (swine flu) where many victims have been younger adults.

Initially in this outbreak of swine flu humans picked up the virus through contact with pigs but now it is being passed from human to human in most countries. This is probably occurring in the same way as seasonal flu, through coughing and sneezing which generates an aerosol of virus particles into the atmosphere that can spread for up to a metre, or through contact with contaminated surfaces such as door handles.

Those living in close proximity to someone with the infection are at greatest risk.

Swine flu symptoms

Swine flu symptoms begin within two days of exposure, at which point the person is most infectious. Swine flu is highly contagious and once infected a person soon develops symptoms very similar to those produced by seasonal flu, including :

High fever (usually above 38 ºC).
Cough.
Sore throat.
Headache.
Aching muscles.
Chills and shivers despite fever.
Exhaustion or fatigue.
Diarrhoea or a stomach upset have been a particular feature of novel H1N1.

It can be difficult to tell mild flu from a cold but it is usually more generalised (the symptoms of a cold tend to be limited to the head while the flu causes aching and fatigue all over) and more severe with higher fever.

If complications such as pneumonia develop there may be other symptoms such as difficulty breathing.

The symptoms and signs in an affected person are usually enough to suggest that flu is to blame, but it can be confused with other viral illnesses. Laboratory tests are needed to formally confirm the diagnosis and, more specifically, identify exactly which strain of flu it is.

A number of tests can be done in the laboratory to identify flu, using swabs or washings from the nose or throat for example. These can give results within 15 minutes but may not identify the exact strains of flu involved, only that influenza type A or B is present.

These rapid tests are only 50-70 per cent sensitive for detecting flu and so may give a negative result when a person does in fact have flu.

More reliable tests, which also identify exactly which sub-type or strain of flu is present, may involve growing or culturing the virus in the laboratory, and can therefore take a couple of days to give a definite result. These tests may be needed to confirm a specific strain such as swine flu.

However, as the infection has become more widespread the Department of Health has advised doctors to stop testing and simply treat those with swine flu symptoms straight away with anti-viral drugs.

Treatment and prevention

If you think you have developed flu-like symptoms, you should stay at home and avoid contact with other people. Contact the National Pandemic Flu Service who will use a checklist to diagnose if you have swine flu. If diagnosed, you will be given a voucher number for a ‘flu friend’ to get anti-viral drugs from a collection point.

These drugs, which include Tamiflu (Oseltamivir) or Relenza (Zanamivir), are available free of charge on the NHS. Novel H1N1 (swine flu) seems to respond to these medicines in the same way as seasonal flu. Pregnant women, people with health conditions and the under-ones will still all be referred to their GPs.

The treatments are not a cure but can reduce the risk of infection for those who have been exposed to the virus, reduce the ability of a person with the virus to pass it on, and shorten the course of the illness when someone has flu. Most importantly these drugs treatments reduce the risk of serious complications and death. For maximum effect, the drugs should be given as early as possible to someone who has the flu.

However, as with any medicines there may be side effects from anti-viral drugs. Many people with swine flu will only have mild symptoms and they may decide that a combination of rest and simple remedies for symptoms are all that they need.

Treat symptoms as they arise. Try to keep well hydrated with plenty of clear fluids. Take paracetamol or ibuprofen (children should not be given aspirin because of the risk of Reyes syndrome) for aches and pains, and use simple remedies such as cough syrups and vapour rubs. Try to rest as much as possible.

As with all infections, good hygiene is absolutely essential to reduce the risk of spread or contact with the virus:

Wash your hands regularly.
Cover your mouth and nose when you cough or sneeze.
Use tissues and dispose of them carefully.
Clean hard surfaces regularly with a standard cleaning fluid.
Avoid close contact with people who have fever and a cough.
The effectiveness of wearing a face mask in preventing transmission of the flu virus isn’t yet clear, although it may give some protection to those people such as health professionals who work closely with someone with symptoms of flu.

Don’t worry about eating pork products – there is no evidence that swine flu can be picked up that way. Even if virus is present in the meat, thorough cooking will destroy it.

Swine flu vaccine

At the end of September 2009 a vaccine for swine flu was given a UK licence and should be available for use from mid-October. Priority groups will be given the vaccine first. These include, for example, those with serious heart or respiratory disease, diabetes, or a weakened immune systems due to cancer treatment, as well as frontline health and social care workers.

If you want further information on swine flu, visit the National Pandemic Flu Service, the swine flu page on the NHS Choices site or the websites of leading health and research organisations such as the World Health Organization or the UK Health Protection Agency.

Source: BBC – This article was last medically reviewed by Dr Trisha Macnair in September 2009.

(The next most common complications on the list were diabetes and a weakened immune system, at 15 percent each.)

“Asthma was the most common underlying medical condition that we saw,” says Seema Jain, M.D., a medical epidemiologist at the Centers for Disease Control and Prevention. Jain’s team analyzed 272 people who were hospitalized with swine flu for more than 24 hours between April and June.

Twenty-five percent were admitted to the intensive care unit and 7 percent died. Overall, 29 percent of children and 27 percent of in adults in the study had asthma, while only about 8 percent of the U.S. population has asthma, according to Jain.

Richard Gower, M.D., the president of the American College of Allergy, Asthma and Immunology, says about 25 million people in the United States have the chronic lung condition, including 8 million children.

Asthma is sort of an accident waiting to happen.

–Richard Gower, M.D.
Asthma is more common in children than in adults, and swine flu seems to strike younger people more often than older ones — a complete flip-flop from seasonal flu.

In the study, 45 percent of the hospitalized patients were under age 18, and only 5 percent were 65 or older. “If you are a young adult and you have asthma, you are in double jeopardy,” says Gower.

For many people, swine flu symptoms include fever, congestion, and possibly nausea, diarrhea, and vomiting, which are some of the symptoms that differ from seasonal flu. (Seasonal flu rarely causes nausea or an upset stomach). Most of the time, swine flu symptoms can be successfully battled with time, liquids (chicken soup, anyone?) and bed rest.

But for people at high risk, including those with asthma, an H1N1 infection can be a different story.

“Asthma is sort of an accident waiting to happen,” says Gower, who is also an allergist/immunologist at Marycliff Allergy Specialists, in Spokane, Washington. People with asthma are at risk for breathing trouble with infections in general, not just H1N1.

The lungs of people with asthma tend to bronchospasm, meaning they tighten in response to triggers, such as pollen, pet allergens, bacteria, viruses, or other insults. In the case of an infection like H1N1, the lungs produce mucus in response to the germ, and the mucus can get trapped in the narrow airways, setting the stage for pneumonia.

“You add an insult and it just triples, quadruples, gets 10 times worse very suddenly, and flares the asthma,” says Gower. “The bronchospasm occurs and it squeezes the airways dramatically down to narrow, narrow passages — and, in fact, closure — and the mucus that is dramatically increased gets trapped and that’s a setup for pneumonia.”

So what should you be doing about H1N1 if you — or your children — have asthma?

Take your medication

People with chronic asthma often need to take controller medications that fight underlying lung inflammation. The problem is, they need to take this type of medication every day, even if they are feeling fine. It can help protect the lungs from triggers such as infections.

But many people forget to take the medicine or skip doses when they aren’t having asthma symptoms.

If you have a young child with asthma, make sure they take their medication as directed, says Gower. It gets tricky if your child is a teen, because they are notorious for skipping asthma medication, and may lie about it too, he says.

Parents need to talk to teens and explain that although they may have gotten away with skipping asthma drug doses in the past, “this is a brand new ball game,” he says. “They really should raise the threshold of their lungs by taking chronic medicines if they have chronic asthma.”

Gower also recommends that patients have — and use — a peak flow meter, which is a device that you can blow into to gauge lung function.

“It empowers the patient or the parents,” says Gower. “Even if the patient says they are doing fine and they are giving their best effort to blow into the peak flow meter and it’s going down and it gets into the yellow zone then into the red zone, that’s a real warning sign that that asthma is getting worse no matter what you are doing.”
Get vaccinated

Being in a high-risk group for H1N1 means that people with asthma should get the vaccine as soon as possible, says Gower.

“They have a vaccine that’s good; it’s made the same way as the regular flu shot that’s been out for many, many years, so they really shouldn’t worry more about the side effects on [the H1N1 vaccine] than the other one,” says Gower. “I think it’s very safe. I think they should take it if they meet any of the criteria.”

Although there is a nasal spray version of the H1N1 vaccine, people with asthma should wait for the vaccine administered as a shot, according to the CDC. The nasal spray contains weakened H1N1 virus and is not recommended for high-risk individuals. The shot contains dead virus, which is safer for asthmatics.

“People with asthma would be a group that would be considered high risk; they should wait for the shot to come out,” says Jain. “Remember the seasonal influenza shot is available; they should be able to get that.” People with asthma are also at risk from seasonal flu, she notes, so they should get that shot now.

Because of vaccine shortages, people may have to wait for an H1N1 vaccine. Only 28 to 30 million doses will be available in October 2009, according to theCDC. (Earlier in the year, it was estimated that there would be 120 million by then.) Children ages 6 months to 8 years will need two doses of the flu vaccine, which are given four weeks apart.

In the meantime, if you (or your child) have asthma, one of the best things you can do while H1N1 is circulating is to try to avoid infection in the first place, says Gower.

You may want to consider skipping parties or other events if there will be children attending who could be ill. “You can communicate by phone, congratulate them, but don’t go over and step into the lion’s dens, so to speak, of infection,” he says. He also recommends that parents reinforce public health recommendations to wash hands, and to cover coughs and sneezes.

“You can teach your children that as well and protect others from them and protect them from others,” he says.

Get rapid treatment if you do get sick

If you do have asthma and get sick with H1N1 symptoms, you should call your doctor, experts say. “They don’t necessarily have to go in to see the physician, but they need to contact them if they have high risk conditions,” says Jain.

However, if it’s a child with asthma who is not doing well — say, they have a fever of 103° or 104° and are getting worse — Gower recommends getting help sooner rather than later.

“You can be exposed to things in the hospital, but if you’re that sick, with H1N1 going around, and a respiratory flare, I think it’s better safe than sorry,” he says.

Jain also notes that her study found that early antiviral treatment of hospitalized patients really helped — the sooner, the better.

Although most of the patients had antivirals in the hospital, they found that those who ended up in the ICU or who died tended to get antiviral drugs (such as oseltamivir, zanamivir, amantadine, and rimantadine) later than others.

“If you look at the timing of it, you’ll see that patients in ICU or who died were not treated within two days,” she says. “The median time of onset of illness to initiation of antiviral was three days versus five days, so basically the patients who were most sick had a delay in treatment.”

However, zanamivir (Relenza) is not recommended for treating people with asthma because of a risk of side effects, including bronchospasm, according to the CDC.

Jain says it’s important to focus on both vaccinations and rapid treatment for very ill patients.

“The main issue here is antiviral use; that’s one of our main findings,” she says. “We really would like to emphasize [that] there’s vaccination, and that’s an important message and that’s out there, and you see that in the media, but I think the fact that antiviral also should be utilized in patients who are hospitalized is also key.”

Get vaccinated

Being in a high-risk group for H1N1 means that people with asthma should get the vaccine as soon as possible, says Gower.

“They have a vaccine that’s good; it’s made the same way as the regular flu shot that’s been out for many, many years, so they really shouldn’t worry more about the side effects on [the H1N1 vaccine] than the other one,” says Gower. “I think it’s very safe. I think they should take it if they meet any of the criteria.”

Although there is a nasal spray version of the H1N1 vaccine, people with asthma should wait for the vaccine administered as a shot, according to the CDC. The nasal spray contains weakened H1N1 virus and is not recommended for high-risk individuals. The shot contains dead virus, which is safer for asthmatics.

“People with asthma would be a group that would be considered high risk; they should wait for the shot to come out,” says Jain. “Remember the seasonal influenza shot is available; they should be able to get that.” People with asthma are also at risk from seasonal flu, she notes, so they should get that shot now.

Because of vaccine shortages, people may have to wait for an H1N1 vaccine. Only 28 to 30 million doses will be available in October 2009, according to theCDC. (Earlier in the year, it was estimated that there would be 120 million by then.) Children ages 6 months to 8 years will need two doses of the flu vaccine, which are given four weeks apart.

In the meantime, if you (or your child) have asthma, one of the best things you can do while H1N1 is circulating is to try to avoid infection in the first place, says Gower.

You may want to consider skipping parties or other events if there will be children attending who could be ill. “You can communicate by phone, congratulate them, but don’t go over and step into the lion’s dens, so to speak, of infection,” he says. He also recommends that parents reinforce public health recommendations to wash hands, and to cover coughs and sneezes.

“You can teach your children that as well and protect others from them and protect them from others,” he says.

Get rapid treatment if you do get sick

If you do have asthma and get sick with H1N1 symptoms, you should call your doctor, experts say. “They don’t necessarily have to go in to see the physician, but they need to contact them if they have high risk conditions,” says Jain.

However, if it’s a child with asthma who is not doing well — say, they have a fever of 103° or 104° and are getting worse — Gower recommends getting help sooner rather than later.

“You can be exposed to things in the hospital, but if you’re that sick, with H1N1 going around, and a respiratory flare, I think it’s better safe than sorry,” he says.

Jain also notes that her study found that early antiviral treatment of hospitalized patients really helped — the sooner, the better.

Although most of the patients had antivirals in the hospital, they found that those who ended up in the ICU or who died tended to get antiviral drugs (such as oseltamivir, zanamivir, amantadine, and rimantadine) later than others.

“If you look at the timing of it, you’ll see that patients in ICU or who died were not treated within two days,” she says. “The median time of onset of illness to initiation of antiviral was three days versus five days, so basically the patients who were most sick had a delay in treatment.”

However, zanamivir (Relenza) is not recommended for treating people with asthma because of a risk of side effects, including bronchospasm, according to the CDC.

Jain says it’s important to focus on both vaccinations and rapid treatment for very ill patients.

“The main issue here is antiviral use; that’s one of our main findings,” she says. “We really would like to emphasize [that] there’s vaccination, and that’s an important message and that’s out there, and you see that in the media, but I think the fact that antiviral also should be utilized in patients who are hospitalized is also key.”

Swiss drugmaker Novartis has begun injecting its H1N1 (swine) flu vaccine into people in the company’s first human tests, a spokesman said Wednesday.

The vaccine is being tested in a yearlong trial of 6,000 people of all ages in Britain, Germany and the United States, Novartis spokesman Eric Althoff told The Associated Press, adding that the vaccine will likely be on the market before the trial finishes.

A person in Britain became the first to get the swine flu vaccine about 10 days ago, he said.

Sanofi-Pasteur, which makes about 40 percent of the world’s flu vaccines, expects to start testing its swine flu vaccine within days in the U.S. and Europe, according to spokesman Benoit Rungeard. Sanofi-Pasteur is a unit of Paris-based Sanofi-Aventis SA.

Since swine flu was declared to be a pandemic, or global outbreak, by the World Health Organization in June, pharmaceuticals have been racing to get their vaccines ready. Last month, Australian drugmaker CSL became the first vaccine maker to start testing its vaccine in humans in Australia.

“We initiated clinical trials about 10 days ago,” Althoff said.

Half of Novartis’ vaccines being tested are grown in chicken eggs, the traditional way of making flu vaccines, while the other half use a new cell-based technology.

The trial will test the vaccine’s safety and whether one or two shots are necessary.

“Our assumption is that two doses will be required,” Althoff said.

The vaccines being tested in Europe use an adjuvant, an ingredient used to boost the body’s immune response. In the U.S., however, Novartis is only testing vaccines without adjuvants, Althoff said.

WHO recommends that countries use vaccines with adjuvants, to stretch the global supply of swine flu vaccine. However there are no licensed flu vaccines with adjuvants in the United States.

Once Novartis AG has preliminary data from the trial, they will submit that to drug regulators including the European Medicines Agency. European and U.S. regulators have a fast-track process for approving swine flu vaccine, to ensure it is available before the flu season starts in the fall, when swine flu is expected to surge.

The European Medicines Agency has previously said swine flu vaccines based on a pre-approved bird flu vaccine could be licensed within five days, even without extensive testing in humans.

Last month, WHO reported that the swine flu viruses being used to make the vaccine were not growing enough of a key ingredient, and said they were only producing half as much “yield” as regular flu viruses. The agency asked its laboratory network to produce a new set of viruses for vaccine makers to use.

Althoff confirmed that Novartis is only getting about 30 to 50 percent of the usual yield it gets from flu viruses to make vaccines. Novartis made its vaccines with WHO’s original set of flu viruses, and hasn’t yet started working with the new viruses.

The low virus yield could mean delays in when countries get their vaccine orders filled.

More than 35 countries have placed orders with Novartis for swine flu, or H1N1 vaccine, including France, the Netherlands, and Switzerland. The U.S. has ordered $979 million worth of bulk vaccine and Novartis’ adjuvant.

Althoff said the company expected to start shipping vaccine in the last quarter of 2009 and will continue the deliveries next year.

GlaxoSmithKline PLC, which has orders for 291 million doses of vaccine from countries including Britain, has not yet started testing its vaccine in humans. The U.S. has also ordered $250 million worth of vaccine ingredients from Glaxo.

Since swine flu emerged in April, it has killed at least 1,154 people worldwide and is estimated to have infected millions.

In India on Wednesday, hundreds of anxious people crowded a hospital waiting to be tested for swine flu. Panic spread in the city of Pune and fights broke out at the city’s top hospital after authorities reported the country’s first swine flu fatality two days ago.

In other efforts to fight swine flu, a Saudi health ministry official said Wednesday that authorities will require religious pilgrims to have a medical certificate showing they don’t suffer from chronic diseases.

Khaled al-Merghalani also said children and the elderly will be banned from the annual hajj pilgrimage

H1N1 Flu Vaccine Being Offered in Scotland County

The first shipment of the H1N1 flu vaccine arrived in Scotland County last week, and the local health department has sprung into action to inoculate the most needy patients in the community.

Margaret Curry, Administrator of the Scotland County Health Department stated the first batch of H1N1 flu vaccine was received October 13th at the health department.

“This first round was distributed to those healthy 2-4 year olds, health care workers, EMS workers and contacts to infants under six months of age,” she said.

A portion of the initial batch was used for a special clinic held at the Scotland County R-I Elementary School on October 16th.

School Nurse Patty Eggleston reported more than half of the eligible students participated in the voluntary program. A total of 160 students were vaccinated, with the vast majority receiving the nasal spray version of the medication.

“Most of our shipment is Flu Mist, which is given in the nostrils,” Curry stated.

She noted that the Flu Mist can not be used on individuals with history of allergy to eggs, egg proteins, gentamicin, and gelatin or with reaction to previous flu vaccinations, and in children and adolescents receiving aspirin therapy. She added that if a patient has received a seasonal flu vaccine that was flu mist, they can not receive the H1N1 flu mist for 3 to 4 weeks. There is no waiting period between the seasonal and H1N1 otherwise.

“At this time we have a limited supply of injectable vaccine,” Curry stated adding it initially would only be available to the same high-risk patients.

A second vaccination will be administered to the participating students at SCR-I in approximately 30 days to complete the process. Eggleston noted additional availability of the vaccine at that time could allow the program to be expanded to include fifth and sixth graders at the elementary school as well as students throughout the district.

The Clark County School District announced October 19th that it was canceling classes for the remainder of the week after more than 200 students were out of school that Monday due to a flu outbreak.

To offset such risks, in addition to the H1N1 vaccine, the health department is recommending individuals receive a seasonal flu shot.

“This will provide protection against three other flu strains expected to circulate this season,” said Curry.

You can receive your vaccination at the health department’s regular clinic hours on Tuesdays from 12 to 2:30 p.m. and Fridays 8 a.m. to 3:30 p.m.

The health department is anticipating hosting additional clinics when further supplies of the vaccines become available.

For more information contact the Scotland County Health Department at 465-7275.

Missouri residents can call a new toll-free number for information about the H1N1 flu, from symptoms and basic medical advice to the availability of the new H1N1 vaccine.

The number, 1-877-FLU-4141 (1-877-358-4141), will be answered 24 hours a day, seven days a week.

Specialists with the H1N1 InfoLine will answer questions about flu symptoms, when to seek medical care and ways to limit the spread of the flu, including the new vaccine. Medical professionals will be available to assist the specialists with callers’ questions.

The information line is sponsored by the Missouri Department of Health and Senior Services.

“As we get further into flu season, we know many Missourians will have questions about the H1N1 flu,” said Margaret Donnelly, director of the state health department. “We urge Missouri residents to do everything they can to prevent the spread of the flu and keep their families healthy. The Flu InfoLine can help answer questions they might have.”

Health care professionals can also call the toll-free number for more information about the H1N1 flu and vaccine.

The state health department is encouraging Missourians to get the vaccine as it becomes available. Pregnant women, children and young adults are the most at risk of contracting the H1N1 flu, so they will be given priority to receive the vaccine first. Studies show that older people are less at risk because they appear to have some degree of resistance to the virus.

Missouri received its first shipment of aerosol mist vaccine early this month. Additional shipments of the aerosol mist and the injectable form of the vaccine began arriving from drug manufacturers this week.

The mist version of the flu vaccine can be used by healthy children and adults ages 2 through 49. Because it contains live virus, it is not appropriate for pregnant women, children under 2 years old or anyone with an underlying health condition such as asthma. Those groups should receive an H1N1 flu shot.

“Adequate supplies of the flu vaccine will be available for the high-risk groups,” Donnelly said. “As additional shipments of the vaccine arrive in Missouri, flu shots or vaccine mist should be available to everyone who wants them.”

H1N1 flu symptoms include fever, cough and sore throat. Most cases are relatively mild to moderate and do not require treatment. Most people with the H1N1 flu can recover at home. They should get plenty of fluids, take over-the-counter medication to reduce their fever and stay home and rest.

Most cases of flu require no treatment other than symptom relief. If you have a chronic condition such as respiratory or heart disease your doctor may prescribe additional medication to manage symptoms.

Antivirals
Influenza is sensitive to oseltamivir (Tamiflu) and zanamivir (Relenza), both of which are neuraminidase inhibitors. These antiviral drugs can reduce the severity of symptoms and are most effective if treatment begins within 48 hours of developing symptoms.

Healthy individuals with H1N1 infection do not require treatment with antivirals.

Treatment with either oseltamivir or zanamivir is recommended as soon as possible for suspected or confirmed influenza in people who:

•Are hospitalized
•Show signs or symptoms of lower respiratory tract illness, such as shortness of breath or rapid breathing
•Are younger than 5 years of age
•Are 65 years and older
•Are pregnant
•Are younger than 19 years of age and are receiving long-term aspirin therapy, because of an increased risk for Reye syndrome
•Have certain chronic medical conditions: Chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurologic, neuromuscular, or metabolic disorders (including diabetes mellitus)
•Have suppression of the immune system due to medications or HIV infection or AIDS
Self-Care
If you develop symptoms of influenza but you’re otherwise healthy:

•Stay home from work or school. Anyone who tests positive for Influenza A at this time of the year can be presumed to have H1N1. The CDC recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8°C]), or signs of a fever without the use of fever-reducing medications. In addition, the CDC recommends that health care workers with H1N1 remain off work for seven days from the onset of symptoms or until fever is gone, whichever is longer.
•Drink plenty of liquids.
•Rest. Get more sleep to help your immune system fight infection.
•Consider pain relievers. Use an over-the-counter pain reliever such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) cautiously, as needed.
Remember, pain relievers may make you more comfortable, but they won’t make your symptoms go away any faster, and pain relievers may have side effects. Ibuprofen may cause stomach pain, bleeding and ulcers. If taken for a long period or in higher than recommended doses, acetaminophen can be toxic to your liver.

Talk to your doctor before giving acetaminophen to children. And don’t give aspirin to children or teens because of the risk of Reye’s syndrome, a rare but potentially fatal disease.

What Is the Recommended Treatment for Children 1 Year of Age and Older?

•For those with a confirmed or probable S-OIV infection, antiviral treatment with oseltamivir or zanamivir is recommended and should be initiated as soon as possible after the onset of symptoms. (For case definitions, go to www.cdc.gov/h1n1flu/casedef_swineflu. htm)
•The recommended duration of treatment is 5 days, but that may change as data on antiviral effectiveness, side effects, and antiviral susceptibilities become available. Recommended antiviral doses for treatment of S-OIV infection are the same as those recommended for seasonal influenza and can be found at http://www.cdc. gov/h1n1flu/childrentreatment.htm
•For children older than 1 year with suspected cases of swine influenza A (H1N1) virus infection, especially those with severe illness, empiric antiviral treatment is also recommended.
How Should Children Younger Than 1 Year Be Treated?
Currently, there are only limited safety data available on the use of oseltamivir or zanamivir for seasonal influenza in this age group, and oseltamivir is not licensed for use in children younger than 1 year.

Because infants typically have high rates of morbidity and mortality from influenza, however, the CDC reports that infants with S-OIV infections may benefit from treatment with oseltamivir. In fact, under an Emergency Use Authorization (EUA), oseltamivir was recently approved by the US Food and Drug Administration for use in children younger than 1 year.

The dosing recommendations for treating S-OIV influenza in infants are now:

•< 3 months old = oseltamivir 12 mg twice daily
•3-5 months old = oseltamivir 20 mg twice daily
•6-11 months old = oseltamivir 25 mg twice daily
When considering fever-reducing medications, the CDC recommends the following:

•Do not administer aspirin or aspirin-containing products for confirmed or suspected case of influenza A (H1N1) virus infection in any child 18 years of age or younger due to the risk for life-threatening Reye’s syndrome.
•Instead, antipyretic medications such as acetaminophen or nonsteroidal anti-inflammatory drugs are recommended for the relief of fever.
What Are the Current Antiviral Chemoprophylaxis Guidelines for This Group?
Antiviral chemoprophylaxis is currently recommended for:

•Children with household contacts with confirmed, probable, or suspected cases of H1N1 infection;
•School children or daycare attendees who are at high risk for complications of influenza and who have had face-to-face contact with a confirmed, probable, or suspected case of H1N1 influenza;
•Children who traveled to Mexico recently and are at high risk for complications of influenza; and
•Children with chronic medical conditions.
The CDC’s current chemoprophylaxis treatment recommendations are:

•For children 1 year of age or older, treatment with either oseltamivir or zanamivir is recommended for antiviral chemoprophylaxis of S-OIV infection.
•For those 3-11 months of age, oseltamivir can be used under an EUA (at doses of 20 mg once daily for those 3-5 months of age and 25 mg once daily for those 6-11 months of age).
•For infants younger than 3 months, chemoprophylaxis is not recommended unless the situation is judged to be critical.
Chemoprophylaxis should be given during a potential exposure period and should be continued for 10 days after the last known exposure to a confirmed case of H1N1 infection.

Children With Special Conditions
In regard to seasonal influenza, certain children are more at risk for complications. In fact, a recent study found that almost half of the children who died from influenced-related causes had an underlying medical condition. These conditions include immunosuppression, chronic kidney disease, heart disease, HIV and AIDS, diabetes, asthma or problems with the lungs, sickle cell disease, and chronic neurologic conditions, cerebral palsy, and seizure disorders.

Another high-risk group of children includes those with poor nutritional or fluid intakes because of prolonged vomiting and diarrhea, as well as children with an underlying metabolic disorder.

These children should be particularly monitored for symptoms of influenza. Additional guidance for children with special healthcare needs is expected to be posted on the CDC site soon.

H1N1 (Swine Flu) Treatment Options for People With Cancer

For most people, the best treatment for H1N1 (swine flu) is probably what your grandmother would recommend. Rest and fluids. But for those living with cancer, breathing difficulties and side effects of chemotherapy such as bone marrow suppression, can make the infection riskier. If you develop symptoms suggestive of the H1N1 flu with cancer, check with your doctor as soon as possible to see if she thinks a medication would be helpful.

H1N1 (Swine Flu) Treatment – Supportive Care
The mainstay of treatment for the H1N1 flu is supportive care – taking care of your body while it heals itself. It is easy to say, but taking time to pamper yourself until you feel better, can go a long way in preventing more serious complications of the flu. Try to:

•Drink plenty of fluids. Keep a glass of water handy when you are resting. Filling a pitcher with water in the fridge can be a reminder if you aren’t drinking enough.
•Get enough rest. Daytime naps can be helpful if flu symptoms interfere with your sleep at night.
•A bowl of chicken soup might be just what the doctor ordered.
•Stay home. People are being told to stay home to prevent spreading the flu, but it also gives you more opportunity to care for yourself.
H1N1 (Swine Flu) Treatment – Medications for H1N1 Flu
Two medications are currently available to treat the H1N1 flu. The Centers for Disease Control and Prevention (CDC) recommends that these drugs be reserved for people who are severely ill with the swine flu, or for those people with illnesses such as cancer who are at significant risk from the infection. Since these medications are most effective if taken within 48 hours after symptoms begin, it is important to contact your doctor as soon as you believe you may have the swine flu. Neither of these medications work immediately, but they do appear to shorten the duration of the illness by a day or so. Medications include:
•Oseltamivir (Tamiflu) – Oseltamivir is taken orally twice a day for 5 days. Side effects can include nausea and vomiting, and occasionally, mood changes.

•Zanamivar (Relenza) – Zanamivar is used twice a day for 5 days as an inhaled medication. Since it can cause airways to spasm, it isn’t recommended for people with lung problems such as lung cancer and asthma.

H1N1 Flu: Understanding Treatment Options

Two antiviral medications, oseltamivir (Tamiflu) and zanamivir (Relenza) are active against the H1N1 strain of virus and can be used to treat those who have been diagnosed with (or are strongly suspected of having) this infection. It is important that the use of these medications is started as soon as possible (within 48 hours of the onset of symptoms) if they are to be effective. When used for treating infection, these medications are usually administered twice a day for five days. They do not immediately relieve symptoms, but may shorten the duration of symptoms by approximately one day, on average. There has been some recent publicity that the intravenous administration of a single dose of another antiviral agent has been highly effective in treating H1N1 flu. However, this drug is still being evaluated and is not commercially available.

•Tamiflu is available in capsules and in a liquid formulation that are given by mouth and swallowed. It has been studied and approved for use in adults and children at least one year of age. Some patients experience nausea and vomiting, and there have been rare reports of neurologic/psychiatric adverse events (e.g., delirium) although it has not been proven that the drug was responsible for these effects.
•Relenza is administered by oral inhalation and its use in the treatment of influenza has been studied and approved in patients 7 years of age and older. It is generally recommended that Relenza not be used in patients with asthma, chronic obstructive pulmonary disease (COPD), or other conditions that may be associated with bronchospasm.
Individuals who experience symptoms such as sneezing, nasal congestion, or coughing that may be associated with the flu should speak with a pharmacist, physician, or other health professional. It may be that these symptoms are not due to a flu infection, but rather have developed because of an allergy or common cold, and can be effectively treated with a nonprescription product.

What Is H1N1 Swine Flu?
In the spring of 2009, a novel H1N1 swine flu hit the scene; novel meaning that this influenza virus had previously only infected animals, but has now made the jump to humans. Novel viruses can be especially dangerous. The human immune system has years of experience dealing with the common seasonal flu, but the novel H1N1 virus is brand new, and we have no established immune defense against it.

* Both Novel H1N1 Flu and Seasonal Influenza are Dangerous *

Although both seasonal and H1N1 influenza vaccines are slated to be available in the fall, there may be a shortage of H1N1 vaccines, which means that those with the highest risk of becoming ill from swine flu are likely to be vaccinated first.

But don’t let concern over swine flu distract from the importance of getting vaccinated against the common flu. Every year in the United States, approximately 36,000 people, mostly the elderly, die from seasonal influenza. Any type of influenza that effects humans is cause for concern.

* Populations at Highest Risk from Influenza *

Seasonal Influenza: Those most vulnerable to the seasonal flu are mainly the elderly; but young children, and people with certain health conditions such as asthma, pregnancy and immune suppression, are also at risk.

Novel H1N1 Pandemic Flu: Both children and young adults, as well as those with preexisting health conditions, appear to be at greatest risk of becoming ill with the new swine flu. Young people have been the most vulnerable demographic in flu pandemics of the past as well, such as the Spanish Flu epidemic that killed tens of millions in 1918. Epidemiologists suspect that older adults, over the age of 65, have more experienced immune systems which may provide them with some level of built in resistance to the novel H1N1 virus.

* Typical Symptoms of Influenza *

Seasonal Influenza: Symptoms of seasonal flu often come on suddenly and may include high fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, and muscle aches. Stomach symptoms, such as nausea, vomiting, and diarrhea, may also occur, but are more common in children than adults.

Novel H1N1 Pandemic Flu: Unfortunately, symptoms of novel H1N1 influenza are very similar to the symptoms of seasonal flu. It is not possible to know which type of influenza you have by symptoms alone.

* How Are H1N1 Pandemic Flu Infections Diagnosed? *

In addition to symptoms, the prevention and treatment of novel H1N1 viral infection are very similar to those for seasonal flu. Therefore, it is likely that only those patients who have a high risk of serious complications will actually be tested for the flu.

To test for novel H1N1 influenza virus, an upper respiratory specimen, such as a nasal swab, is collected. The CDC is recommending that all specimens be sent to state public health laboratories for a confirmed diagnosis. If you do get tested for this new pandemic flu, how quickly the results are available depends on the type of testing done.

There are rapid flu tests that can help identify the general type virus in less than half an hour. However, not all family practice offices offer this quick test, and if an provider does, it will likely only test in cases where knowing the viruses identity will make a difference in the treatment course chosen. The information that these rapid flu test can provide is limited.

Rapid flu tests can confirm the presence of an influenza A virus, but are not reliable in distinguishing the novel H1N1 virus from the seasonal flu virus. Infection with the new H1N1 virus can be best diagnosed through sophisticated laboratory analysis, such as reverse-transcription polymerase chain reactions and viral cultures, the results of which take days, not hours, to obtain.

Siriraj Hospital Ready for H1N1 Flu Diagnosis

Siriraj Hospital has announced that it can now diagnose the H1N1 flu. Meanwhile, the Virology Association advised authorities to continue to closely monitor the outbreak and to support local researchers in diagnosing the virus and developing medication.

Dr.Teerawat Kulthanant, dean of the Faculty of Medicine at Siriraj Hospital, today announced that the hospital can now diagnose the H1N1 flu. He said the hospital had obtained samples of the virus from the Public Health Ministry’s Department of Medical Science to develop a diagnostic test.

Dr.Teerawat said the diagnostic procedure, which matches the genome sequence of the virus, is similar to the one used by the Center for Disease Control and Prevention in the United States.

He added that the hospital is also capable of detecting antibodies in a flu patient which can be used in developing a vaccine as well as identifying cells that cause drug resistance.

Meanwhile, the head of the Virology Association, Prasert Thongcharoen, said foreign laboratories are working to develop a vaccine for the H1N1 flu but it would take some time for it to be available for general medical use. He advised authorities to continue to monitor the outbreak closely and to support local researches on the virus.

Diagnosis

Influenza diagnosis is generally based on a self-assessment of symptoms. Fast, accurate diagnosis for flu is essential to early treatment.

When to see a doctor
It’s not necessary to see a doctor if you’re generally healthy and you develop flu symptoms, such as fever, cough and body aches.

Do call your doctor, however, if you:

•Have flu symptoms and you’re pregnant
•Have a chronic disease, such as emphysema or a heart condition
•Have a compromised immune system, such as during cancer treatment, following transplantation, or have HIV/AIDS
In addition, do call a doctor:

•For children under 5 or adults older than 65 who have flu symptoms
•If you or a family member has:
◦Difficulty breathing
◦Chest pain
◦A fever above 103 degrees (that doesn’t go away with fever-reducing medicine)
◦Profuse vomiting or diarrhea
◦Dizziness or lightheadedness
◦Inability to keep fluids down
◦A feeling that something just doesn’t seem right compared with normal flu expectations

H1N1 Swine Flu

By Daniel J. DeNoon
H1N1 swine flu has turned flu death statistics upside down, the CDC today confirmed.

In a normal flu season, 90% of deaths are in elderly people. Since September, 90% of deaths have been in people under age 65 — with almost a quarter of the deaths in young people under age 25.

“It is almost completely reversed. Nearly 90% of our fatalities are occurring in people under 65,” CDC respiratory disease chief Anne Schuchat, MD, said at a news conference. “This illustrates this H1N1 virus is disproportionally affecting the young.”

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As might be expected from the death toll, most people hospitalized with severe H1N1 swine flu are young. Surveillance data from 27 states show that more than half of swine flu hospitalizations — 53% — are in people under age 25. Only 7% of people hospitalized with swine flu are elderly.

While the majority of severe H1N1 swine flu cases are in people with conditions that put them at risk of flu complications, not all these conditions are severe. Well-treated asthma, for example, is common. And pregnancy isn’t an illnesses at all. Yet the risk is there.

“Completely healthy pregnant women are coming down with horrible, horrible illnesses
– and, tragically more deaths,” Schuchat said. “And some conditions like asthma which is well controlled. So even if you have diabetes that’s well controlled, if you have asthma that’s well controlled, we want to you think of yourself as a higher risk and recommend that you be vaccinated.”

H1N1 Swine Flu Vaccine Rollout Still Bumpy
If you’re thinking of taking the CDC’s advice and getting your H1N1 swine flu shot (or sniff), it’s time to start making plans.

The flu. gov web site has a flu vaccine finder that links to each state. Most states have detailed information that show which providers near you will be offering the H1N1 swine flu vaccine.

The first vaccines are going to health care workers and people at risk of flu complications. So far, about 13 million doses have been available to states, more than half in the form of flu shots. States have placed orders for about 11 million of those doses; those orders are being filled quickly.

Spread nationwide, that means not everyone who should get the vaccine will be able to get it this week, or even next week. Availability is increasing, but it’s unlikely that the vaccine will reach everyone who wants it before the end of November.

Will that be too late? The CDC’s mantra is, “It’s too early to say it’s too late.”

Schuchat points to what happened in 1957, when pandemic flu hit hard in the early fall — and was followed by a second wave of flu.

“In 1957, the pandemic hit early around September/October, like what we’re seeing here. They had another big wave after the first of the year,” Schuchat said. “And I think we have an opportunity right now to try to limit the disease and to protect as many people as we can with the vaccine as it becomes available.”

Meanwhile, Schuchat said, the CDC is not planning to stop its H1N1 swine flu effort when all 250 million doses of the vaccine have been delivered.

“At CDC, we’re planning a long response. We don’t want to let our guard down too soon on this,” she said.

Source: WebMD Health News

Like seasonal flu, pandemic swine flu can cause neurologic symptoms in children. These events are rare, but, as cases associated with seasonal flu have shown, they can be very severe and often fatal. Symptoms include seizures or changes in mental status (confusion or sudden cognitive or behavioral changes). It’s not clear why these symptoms occur, although they may be caused by Reye’s syndrome. Reye’s syndrome usually occurs in children with a viral illness who have taken aspirin — something that should always be avoided.

Only lab tests can definitively show whether you’ve got swine flu. State health departments can do these tests. But given the large volume of samples coming in to state labs, these tests are being reserved for patients with severe flu symptoms. Currently, doctors are reserving antiviral drugs for people with or at risk of severe influenza.

Who is at highest risk from H1N1 swine flu?
Most U.S. cases of H1N1 swine flu have been in children and young adults. It’s not clear why, and it’s not clear whether this will change.

But certain groups are at particularly high risk of severe disease or bad outcomes if they get the flu:

Pregnant women are six times more likely to have severe flu disease than women who are not pregnant.
Young children, especially those under 2 years of age
People with cardiovascular conditions (except high blood pressure)
People with liver problems
People with kidney problems
People with blood disorders, including sickle cell disease
People with neurologic disorders
People with neuromuscular disorders
People with metabolic disorders, including diabetes
People with immune suppression, including HIV infection and medications that suppress the immune system, such as cancer chemotherapy or anti-rejection drugs for transplants
Residents of a nursing home or other chronic-care facility
Elderly people are at high risk of severe flu disease — if they get it. Relatively few swine flu cases have been seen in people over age 65.
People in these groups should seek medical care as soon as they get flu symptoms.

A striking number of adults who developed severe swine flu complications have been morbidly obese. However, obesity itself does not seem to be the issue. The vast majority of extremely obese people suffer respiratory problems and/or diabetes, which seem to be the underlying reason for their severe flu complications.

If I think I have swine flu, what should I do? When should I see my doctor?
If you have flu symptoms, stay home, and when you cough or sneeze, cover your mouth and nose with a tissue. Afterward, throw the tissue in the trash and wash your hands. That will help prevent your flu from spreading. If you can do it comfortably, wear a surgical mask if you must be around others.

If you have only mild flu symptoms, you do not need medical attention unless your illness gets worse. But if you are in one of the groups at high risk of severe disease, contact your doctor at the first sign of flu-like illness. In such cases, the CDC recommends that people call or email their doctor before rushing to an emergency room.

But there are emergency warning signs.

Children should be given urgent medical attention if they:

Have fast breathing or trouble breathing
Have bluish or gray skin color
Are not drinking enough fluid
Are not waking up or not interacting
Have severe or persistent vomiting
Are so irritable that the child does not want to be held
Have flu-like symptoms that improve but then return with fever and a worse cough
Have fever with a rash
Have a fever and then have a seizure or sudden mental or behavioral change.
Adults should seek urgent medical attention if they have:

Difficulty breathing or shortness of breath
Pain or pressure in the chest or abdomen
Sudden dizziness
Confusion
Severe or persistent vomiting
Flu-like symptoms that improve, but then come back with worsening fever or cough
Keep in mind that your doctor will not be able to determine whether you have H1N1 swine flu, but he or she may take a sample from you and send it to a state health department lab for testing to see if it’s swine flu. If your doctor suspects swine flu, he or she would be able to write you a prescription for Tamiflu or Relenza.

These antiviral medications aren’t a question of life or death for the vast majority of people. Most U.S. swine flu patients have made a full recovery without antiviral drugs.

What To Do If You Get Sick: 2009 H1N1 swine and Seasonal Flu

How do I know if I have the flu?
You may have the flu if you have some or all of these symptoms:

•fever *
•cough
•sore throat
•runny or stuffy nose
•body aches
•headache
•chills
•fatigue
•sometimes diarrhea and vomiting
*It’s important to note that not everyone with flu will have a fever.

What should I do if I get sick?
If you get sick with flu-like symptoms this flu season, you should stay home and avoid contact with other people except to get medical care. Most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.

However, some people are more likely to get flu complications and they should talk to a health care provider about whether they need to be examined if they get flu symptoms this season. They are:

•Children younger than 5, but especially children younger than 2 years old
•People 65 and older
•Pregnant women
•People who have:
◦Cancer
◦Blood disorders (including sickle cell disease)
◦Chronic lung disease [including asthma or chronic obstructive pulmonary disease (COPD)]
◦Diabetes
◦Heart disease
◦Kidney disorders
◦Liver disorders
◦Neurological disorders (including nervous system, brain or spinal cord)
◦Neuromuscular disorders (including muscular dystrophy and multiple sclerosis)
◦Weakened immune systems (including people with AIDS)
Also, it’s possible for healthy people to develop severe illness from the flu so anyone concerned about their illness should consult a health care provider.

There are emergency warning signs. Anyone who has them should get medical care right away.

What are the emergency warning signs?
In children

•Fast breathing or trouble breathing
•Bluish skin color
•Not drinking enough fluids
•Not waking up or not interacting
•Being so irritable that the child does not want to be held
•Flu-like symptoms improve but then return with fever and worse cough
•Fever with a rash
In adults

•Difficulty breathing or shortness of breath
•Pain or pressure in the chest or abdomen
•Sudden dizziness
•Confusion
•Severe or persistent vomiting
Do I need to go the emergency room if I am only a little sick?
No. The emergency room should be used for people who are very sick. You should not go to the emergency room if you are only mildly ill. If you have the emergency warning signs of flu sickness, you should go to the emergency room. If you get sick with flu symptoms and are at high risk of flu complications or you are concerned about your illness, call your health care provider for advice. If you go to the emergency room and you are not sick with the flu, you may catch it from people who do have it

Are there medicines to treat 2009 H1N1 flu?
Yes. There are drugs your doctor may prescribe for treating both seasonal and 2009 H1N1 called “antiviral drugs.” These drugs can make you better faster and may also prevent serious complications. This flu season, antiviral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications. Your health care provider will decide whether antiviral drugs are needed to treat your illness. Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.

How long should I stay home if I’m sick?
CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other things you have to do and no one else can do for you. (Your fever should be gone without the use of a fever-reducing medicine, such as Tylenol®.) You should stay home from work, school, travel, shopping, social events, and public gatherings.

What should I do while I’m sick?
Stay away from others as much as possible to keep from making them sick. If you must leave home, for example to get medical care, wear a facemask if you have one, or cover coughs and sneezes with a tissue. And wash your hands often to keep from spreading flu to others.

Swine Flu (Swine Influenza A (H1N1) Virus)

What are the symptoms of swine flu?

Although uncomplicated influenza-like illness (fever, cough or sore throat) has been reported in many cases, mild respiratory illness (nasal congestion, rhinorrhea) without fever and occasional severe disease also has been reported. Other symptoms reported with swine influenza A virus infection include vomiting, diarrhea, myalgia, headache, chills, fatigue, and dyspnea. Conjunctivitis is rare, but has been reported. Severe disease (pneumonia, respiratory failure) and fatal outcomes have been reported with swine influenza A virus infection. The potential for exacerbation of underlying chronic medical conditions or invasive bacterial infection with swine influenza A virus infection should be considered.

H1N1 Flu and Seasonal H1N1 Flu: Symptoms, Prevention and Treatment

As winter approaches each year we brace for flu season. This year brings an extra complication: the H1N1 virus, also known as swine flu. In June, the World Health Organization declared H1N1 a pandemic. Since then, the media has brimmed with H1N1 stories, governments have stockpiled Tamiflu, flu vaccines have been developed, temperature sensors have been installed in Asian airports, and gallons of hand sanitizer have been dispensed.

While the concerns are justified, we have always been vulnerable to various forms of the flu (influenza) virus. Flu viruses continually undergo genetic modification, presenting our immune systems with new challenges each season. To help you make sense of what’s in the news and plan your own best course of action, here’s a quick look at what you need to know about H1N1 and seasonal flu, and how to stay healthy.

H1N1 and Factory Farms
Big changes can happen when influenza viruses jump species. Birds, humans and pigs each have their own viruses that circulate among their populations. Pigs, however, can become infected with avian, swine and human viruses. Viruses can trade genes, potentially creating a novel virus capable of infecting humans, such as H1N1. Some authorities have tied industrial-scale hog farms — where animals are crowded together — with the origin and spread of the H1N1 virus.

How Flu Viruses Spread
Influenza viruses are very contagious. Sneezes and coughs propel the viral droplets into the air, and an infected person begins shedding viruses a day before symptoms strike, thus thwarting quarantines from being a completely effective tactic. These viruses can survive on inanimate objects for two to eight hours. You touch that object (a borrowed pen, a shopping cart), then rub your eye, nose or lips — and presto, inoculation.

Recognizing Flu Symptoms
One to three days after exposure, flu symptoms develop: fatigue, fever, body aches, headache, sore throat, cough, and even vomiting or diarrhea. Children may also develop middle ear infections. People with respiratory ailments, such as asthma and chronic obstructive pulmonary disease, are especially vulnerable to complications such as pneumonia.

Who Gets the Flu?
Whereas the seasonal flu or influenza viruses take a greater toll on the very young and the very old, the H1N1 virus (swine flu) has so far proved most dangerous to children and young adults. So far, most of the deaths have been of people with other significant health problems, and the vast majority of the million or so H1N1 flu cases have been mild, on par with seasonal influenza

Vaccines for Seasonal Flu and H1N1

The vaccine for this season’s expected influenza viruses, though recommended to protect against these viruses, doesn’t work against the H1N1 virus. The Centers for Disease Control (CDC) anticipates a vaccine against the novel H1N1 will be available this fall. The CDC’s Advisory Committee on Immunization Practices has prioritized the H1N1 vaccine for groups at higher risk of complications: people who work in the health care industry, live with or care for babies younger than 6 months old, are pregnant, are between the age of 6 months to 24 years old, or are 25 through 64 years old with chronic illnesses or immune dysfunction.

Seasonal and H1N1 Flu Prevention Tips
Basic hygiene measures can prevent the flu’s spread.

•Wash your hands (and your small children’s hands) frequently with soap and water or use an alcohol-based cleaner.
•Sneeze or cough into a tissue or your elbow.
•If you or your child falls ill, stay home. The contagious period stretches from one day before symptoms strike to five to seven days thereafter. The CDC recommends people stay home until they’re without fever for 24 hours.
Natural Flu Prevention and Remedies
Healthy lifestyle choices can keep your immune system in fighting shape. Sleep deprivation, stress, smoking, malnutrition and alcohol excess all undermine immunity. Conversely, a healthy diet, adequate sleep, regular exercise and relaxation improve immune health.

Some herbs have antiviral activity, including against some influenza strains. The list includes ginger, licorice and garlic (use it raw in food). Two small studies have shown that a proprietary elderberry syrup (Sambucol) shortens the duration and severity of influenza.

Immune-enhancing herbs such as ginseng and eleuthero (Siberian ginseng) have been shown to help prevent viral respiratory infections, including the flu. One study found that giving ginseng a few days before the flu vaccine boosted the subsequent immune response. The Chinese herb astragalus also acts as an immune tonic. Taken in adequate dosages, echinacea and andrographis have both been shown to curtail upper respiratory infections. Whether any of these herbs can help counter H1N1 flu is unknown.

Vitamin D and the Flu
Vitamin D plays a role in many bodily processes, including immune function. Some scientists have pointed to a correlation between wintertime troughs in vitamin D intake and respiratory viral infections. New research published this year in the Archives of Internal Medicine linked low blood levels of vitamin D with a heightened risk of upper respiratory infections, particularly among people with chronic lung conditions. No studies have yet determined whether supplementing with vitamin D can prevent the common cold, much less influenza. Because few foods provide vitamin D, many experts recommend supplementation with at least 1,000 IU a day of vitamin D — several times the current guidelines for 200 to 600 IU.

Antiviral Medications and the Flu

The antiviral medications Tamiflu (oseltamivir), which is derived from Chinese star anise, and Relenza (zanamivir) may make flu symptoms milder. Most experts recommend these medications be reserved to prevent disease in people at high risk for complications (in the face of suspected exposure) and to treat people who develop severe flu symptoms. (Overuse of these medications can lead to viruses becoming resistant to their effects.)

Anyone under the age of 18 should avoid aspirin, which, when taken during a viral illness, can lead to a serious condition called Reye’s syndrome, a rare disease characterized by neurological disorders, brain swelling and enlargement of the liver.

When to Get Medical Treatment for the Flu

Seek medical attention if you develop signs of severe illness: shortness of breath or difficulty breathing, chest or abdominal pain, dizziness, confusion, or severe vomiting. Signs that a child needs immediate care include rapid breathing, poor fluid intake, extreme irritability and lethargy (the child is difficult to wake and won’t interact).

What percentage of deaths for 2009 H1N1 flu occur in different age groups in the United States?

The percentage of deaths for 2009 H1N1 flu in the United States varies by age group. From August 30, 2009 through October 10, 2009, states reported 292 laboratory-confirmed 2009 H1N1 deaths to CDC. The percentage of 2009 H1N1 related deaths that occurred among people 0 years to 4 years was 3%; among those 5 years to 18 years was 14%; among people 19 to 24 years was 7%; among people 25 to 49 years was 33%; among people 50-64 years was 32%; and among people 65 years and older was 12%. For a graphical representation of this data, please see the chart below.

—————

What Is H1N1 Flu?
H1N1 is a new influenza virus causing illness in people.

The virus was first detected in people in the U.S. in April, 2009. The virus spreads from person to person in much the same way as seasonal influenza viruses.

Symptoms of H1N1 flu in people appear to be similar to those of regular seasonal flu and include:

•fever of more than 100 degrees Fahrenheit
•cough
•sore throat
•muscle aches
•headache
•chills
•fatigue
•diarrhea (not common)
•vomiting (not common)

———————-

H1N1 Flu

2009 H1N1 Flu
What is 2009 H1N1 (swine flu)?
2009 H1N1 (sometimes called “swine flu”) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States 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.

Why is 2009 H1N1 virus sometimes called “swine flu”?
This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America. But further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and bird (avian) genes and human genes. Scientists call this a “quadruple reassortant” virus.

2009 H1N1 Flu in Humans

Are there human infections with 2009 H1N1 virus in the U.S.?
Yes. Human infections with 2009 H1N1 are ongoing in the United States. Most people who have become ill with this new virus have recovered without requiring medical treatment.
CDC routinely works with states to collect, compile and analyze information about influenza, and has done the same for the new H1N1 virus since the beginning of the outbreak. This information is presented in a weekly report, called FluView.

Is 2009 H1N1 virus contagious?
The 2009 H1N1 virus is contagious and is spreading from human to human.

How does 2009 H1N1 virus spread?
Spread of 2009 H1N1 virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person 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.

What are the signs and symptoms of this virus in people?
The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1 and have respiratory symptoms without a fever. Severe illnesses and deaths have occurred as a result of illness associated with this virus.

How severe is illness associated with 2009 H1N1 flu virus?
Illness with 2009 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.

Young children are also at high risk of serious complications from 2009 H1N1, just as they are from seasonal flu. And while people 65 and older are the least likely to be infected with 2009 H1N1 flu, if they get sick, they are also at “high risk” of developing serious complications from their illness. See People at High Risk of Developing Flu-Related Complications for more information about who is more likely to get flu complications that result in being hospitalized and occasionally result in death.

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.

How does 2009 H1N1 flu compare to seasonal flu in terms of its severity and infection rates?
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.

When the 2009 H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the 2009 H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are relatively fewer cases and deaths reported in people 65 years and older, 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 to others?
People infected with seasonal and 2009 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 from getting sick? Oct 8
This season, there is a seasonal flu vaccine to protect against seasonal flu viruses and a 2009 H1N1 vaccine to protect against the 2009 H1N1 influenza virus (sometimes called “swine flu”). A flu vaccine is the first and most important step in protecting against flu infection. For information about the 2009 H1N1 vaccines, visit H1N1 Flu Vaccination Resources. For information about seasonal influenza vaccines, visit Preventing Seasonal Flu With Vaccination.

There are also everyday actions that can help prevent the spread of germs that cause respiratory illnesses like the flu.

Take these everyday steps to protect your health:

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. If soap and water are not available, use an alcohol-based hand rub.*
•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.
Other important actions that you can take are:

•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 * (for when soap and water are not available), tissues and other related items could help you to avoid the need to make trips out in public while you are sick and contagious.
What is the best way to keep from spreading the virus through coughing or sneezing?
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. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.

If I have a family member at home who is sick with 2009 H1N1 flu, should I go to work?
Employees who are well but who have an ill family member at home with 2009 H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including covering their coughs and sneezes and washing their hands often with soap and water, especially after they cough or sneeze. If soap and water are not available, they should use an alcohol-based hand rub.* If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs. For more information please see General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers.

What is the best technique for washing my hands to avoid getting the flu?
Washing your hands often will help protect you from germs. CDC recommends that when you wash your hands — with soap and warm water — that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used.* You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn’t need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?
For information about what to do if you get sick with flu-like symptoms this season, see What To Do If You Get Sick: 2009 H1N1 and Seasonal Flu. A downloadable flyer containing this information also is available at http://www.cdc.gov/flu/freeresources/2009-10/pdf/what_to_do_if_you_get_sick.pdf .

What are “emergency warning signs” that should signal anyone to seek medical care urgently?

In children:

•Fast breathing or trouble breathing
•Bluish skin color
•Not drinking enough fluids
•Not waking up or not interacting
•Being so irritable that the child does not want to be held
•Flu-like symptoms improve but then return with fever and worse cough
•Fever with a rash
In adults:

•Difficulty breathing or shortness of breath
•Pain or pressure in the chest or abdomen
•Sudden dizziness
•Confusion
•Severe or persistent vomiting
Are there medicines to treat 2009 H1N1 infection?
Yes. There are drugs your doctor may prescribe for treating both seasonal and 2009 H1N1 called “antiviral drugs.” These drugs can make you better faster and may also prevent serious complications. This flu season, antiviral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications. Your health care provider will decide whether antiviral drugs are needed to treat your illness. Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.

What is CDC’s recommendation regarding “swine flu parties”?
“Swine flu parties” are gatherings during which people have close contact with a person who has 2009 H1N1 flu in order to become infected with the virus. The intent of these parties is for a person to become infected with what for many people has been a mild disease, in the hope of having natural immunity 2009 H1N1 flu virus that might circulate later and cause more severe disease.

CDC does not recommend “swine flu parties” as a way to protect against 2009 H1N1 flu in the future. While the disease seen in the current 2009 H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.

CDC recommends that people with 2009 H1N1 flu avoid contact with others as much as possible. 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.) Stay away from others as much as possible to keep from making others sick.

Contamination & Cleaning

How long can influenza virus remain viable on objects (such as books and doorknobs)?
Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.

What kills influenza virus?
Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time.

*What if soap and water are not available and alcohol-based products are not allowed in my facility? Updated on Sept 14
If soap and water are not available and alcohol-based products are not allowed, other hand sanitizers that do not contain alcohol may be useful.

What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.

How should waste disposal be handled to prevent the spread of influenza virus?
To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.

What household cleaning should be done to prevent the spread of influenza virus?
To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.

How should linens, eating utensils and dishes of persons infected with influenza virus be handled?
Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.
Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid “hugging” laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.

Eating utensils should be washed either in a dishwasher or by hand with water and soap.

Exposures Not Thought to Spread 2009 H1N1 Flu

Can I get infected with 2009 H1N1 virus from eating or preparing pork?
No. 2009 H1N1 viruses are not spread by food. You cannot get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe.

Is there a risk from drinking water?
Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of 2009 H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as 2009 H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.

Can 2009 H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?
Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of 2009 H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as 2009 H1N1 virus would also be similarly disinfected by chlorine.

Can 2009 H1N1 influenza virus be spread at recreational water venues outside of the water?
Yes, recreational water venues are no different than any other group setting. The spread of this 2009 H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

H1N1 Flu Virus

The Simcoe Muskoka District Health Unit has adjusted its seasonal flu vaccine plans, following recommendations from the Ministry of Health and Long-Term Care announced on Sept. 24.

The H1N1 vaccine clinics will occur first (Nov), followed by the seasonal flu vaccine. The exception will be for those who are 65 years and older and those people who are in long-term care homes who are more susceptible to serious illness caused by seasonal flu. Seasonal flu vaccine will be available for these two groups in October. See more about this year’s flu vaccines.

The Simcoe Muskoka District Health Unit will continue to monitor H1N1 flu virus in our communities, to provide advice and resources to health care providers and partners and to inform the public on what precautions they can take to protect their health.

For local totals of cases see the Ontario Influenza Bulletins, which are updated weekly by the Ministry of Health and Long Term Care.

What is H1N1 Flu Virus?

Symptoms of H1N1 flu virus are similar to seasonal influenza (flu) including: fever, extreme tiredness, muscle aches, lack of appetite, coughing, runny nose, shortness of breath and sore throat. Nausea, vomiting and diarrhea may occur in adults as well as in children. In more severe cases, or in people with chronic conditions, complications such as pneumonia may develop.

To learn more about the virus and what to do if you have symptoms visit the Ministry of Health and Long Term Care website or visit FightFlu.ca.

What can you do?
To stay healthy and prevent the spread of influenza and other infections it is always good practice to:

wash your hands with soap and water often or use hand sanitizer
sneeze and cough into your upper sleeve
clean shared surfaces
stay at home when you are sick—from school, work and community activities
and, talk with your health care provider about seasonal and H1N1 flu vaccines

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