Protecting from H1N1 flu pandemic infection 10/30/2009 12:31 AM By DR. GERALD GORDON Guest columnist
I have heard a great deal of information and misinformation about influenza H1N1 infection (swine flu) and H1N1 vaccine. Because of H1N1 infection a national state of emergency has been declared by President Obama. This certainly would make most people concerned and maybe afraid.
H1N1 influenza is a new strain of influenza to which most people in the world are not immune (causing pandemic influenza). Pandemic influenza means that everyone in the world may be susceptible to infection with this strain of influenza.
This strain of influenza (H1N1) may cause a flu-like illness similar to that seen with seasonal influenza, characterized by sore throat, fever, cough, muscle aches, runny nose, nausea and vomiting, and headache usually causing a person to feel quite ill. This strain of influenza joins the other three strains of influenza A and B that will circulate this season so that a person could potentially get the flu four times this year. This is the reason a susceptible and at-risk person should get both the seasonal flu shot and the H1N1 flu shot.
Treatment for influenza may be prescribed using one of several antiviral medications. Nearly all strains of H1N1 influenza are susceptible to Tamiflu and Relenza. There are strains of H1N1 that have developed resistance to Tamiflu, but this is rare. Many strains of the seasonal influenza may be resistant to the currently available antivirals. Prevention of seasonal influenza is particularly important. Get the seasonal regular flu shot.
While there are reports of seasonal influenza vaccine shortage, there are seasonal flu shots available. If you wish to have one and have trouble getting one I will help you find a source of these vaccines.
The seasonal flu shot and the H1N1 flu shot are made exactly the same way. For those who are concerned that the H1N1 is a new immunization, this is true. However, seasonal flu shots are also new immunizations. The seasonal flu shot is made from strains of influenza viruses that are circulating in the world during the previous year. These seasonal strains generally are different one from another each year.
Both the seasonal flu shot and the H1N1 immunization are excellent matches to circulating strains of influenza so these immunizations should be effective in preventing influenza for vaccine recipients. No vaccine gives 100 percent immunity to recipients. Most years the flu shot is anywhere from 40-85 percent effective in preventing influenza in those who receive the influenza immunization.
The pandemic strain of influenza, (H1N1) is causing severe illness in young people, pregnant women and in those with certain medical illnesses very similarly to that seen in the flu pandemic of 1918. Because the very young and pregnant women and immunocompromised people have the highest risk of bad outcomes when infected with H1N1, this group is first non-medical personnel to received H1N1 vaccine. Refer to the CDC website www.cdc.gov for up-to-date information concerning who needs to have H1N1 influenza vaccine.
Seasonal influenza is a potential life threatening risk to the very young, pregnant women, the elderly and immunocompromised. Seasonal flu vaccine is particularly important in this group of people.
It can be confusing as to who should receive each vaccine type. Many people who were alive during the Hong Kong flu pandemic (1957) may have some resistance to H1N1, though this should not be entirely relied upon. Those of us older than 65 may in fact not need the H1N1 vaccine, though we are giving this vaccine to health care workers of this age at this time. This recommendation may change as more experience with who is getting H1N1 in this country is followed.
Everyone who wishes to receive the seasonal flu shot should receive one especially those with underlying medical illness, women who are pregnant, children and the elderly.
H1N1 vaccine should be first provided to pregnant women, young children and those younger than 26 years. Pregnant women and those with lung disease and other immune deficiency state should receive the inactivated (killed) influenza vaccine. Children older than 2 years who are otherwise healthy and those less than 49 may receive the live attenuate H1N1 vaccine.
Several other groups have been identified who may receive H1N1 vaccine as it becomes available. At this time there is not enough H1N1 vaccine for everyone who should have this vaccine.
The live attenuated influenza intranasal immunization has been manufactured and made available earliest and is more plentiful. DHEC is managing the existing supply of vaccine and is doing the best they can with the limitations they are provided.
Injectable H1N1 influenza shot is in shorter supply at this time, though is available. Medical personnel will be the first to receive this form of the vaccine along with pregnant women and those with lung disease and metabolic or immunosuppressive diseases.
Most people when infected with H1N1 influenza will have a typical illness from which that person will recover, generally during a two-week period. Some people recovering from influenza infection, usually several days into their illness, may develop a superimposed bacterial pneumonia, so that if a person begins to recover from influenza then becomes ill again, that person should seek medical advice immediately.
The declaration of a state of national emergency allows the release of stockpiles of medications effective against influenza (Tamiflu and Relenza) and will avoid shortages that might be seen at pharmacies if treatment is provided to large numbers of people. The response to this declaration has been planned for by DHEC and its consultants for a number of years and this declaration makes resources more readily available to the public. Because such a declaration has been made, one should not become more frightened. This declaration is procedural.
As with all vaccines there may be some limited risk to the vaccine recipient. So far the risk of dying of influenza is far more likely than having a serious complication of the influenza vaccine. One always must balance risk vs. benefit in all vaccine programs. We know that H1N1 poses serious threat to people and this vaccine appears to be as safe as all other influenza vaccines. I personally have received the inactivated vaccine as well as the seasonal flu shot.
There is no waiting time between receiving the H1N1 and the seasonal flu shot. One can receive these immunizations simultaneously or sequentially.
For now there will be limited H1N1 vaccine. The CDC and other governmental agencies have requested that vaccine against H1N1 be provided to people with the highest risk of dying from infection with H1N1 influenza.
Dr. Gerald Gordon is a doctor of internal medicine in practice in Aiken.
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