High-tech Care with Old-Fashioned Values

Flu, Flu and Flu

Well,the H1N1 is upon us in East TN. I thought I would put down some information that might give my take on the ever changing CDC recommendations. First, this is a "novel" H1N1 Influenza A virus. It's genetic makeup resembles viruses from the 1950's and after that they presumably jumped in the hog population living there for 50 years before re-emerging in this past year. Generally flu viruses change over time and occassionally they will have a major genetic shift. Whenever that happens any potential immunity developed from previous years is non-existant and larger numbers of people are prone to getting infected. When a very different strain emerges this is especially true. This virus and variations of it have not been seen by folks less than 50 years old and therefore more young people will be getting ill.

We have known that influenza is especially spread by school children and efforts to immunize them in this country have been increased in the past several years. Generally seasonal influenza is riskier for people who are infirmed, elderly or immun-compromised with healthy kids not being particularly at risk for severe disease and death. The pandemic H1N1 seems to be affecting children group more seriously. Children under 3 years (especially unter 18 months), pregnant women (who's immune system is downregulated to prevent damage to the "parasite" in the womb) and the usual high risk groups are the most likely to get severe disease and even death.

Remember that death from influenza generally is a result of overwhelming pneumonias that developed during or shortly after people contract the flu. Aggressive use of antibiotics may help but people need to understand that the fever and cough of flu are not the fever and deeper cough of pneumonia. Sometimes this is hard to distiguish. See or call your doctor for help.

Early on we thought we would be using a lot of Tamiflu as we faced this deadly strain. However, with experience the CDC has urged more prudent use of the drug. As most people in low risk catagories are not getting very ill they have suggested using the drug for those who are hospitalized, caregivers of high risk persons or housemates of high risk persons. The drug will decrease the illness by about 1/2 day and contagiousness by about 1 day. It is not a wonderdrug.

Finally what to do with immunization. First, the vaccine is safe. It is produced just like seasonal flu. If you are over 50 without high risk designation it is not recommeneded although will be used if someone insists. If you are in a high risk group it is recommended with some younger children needing a booster dose after the initial dose. In east TN where seasonal flu comes in late December through March I have suggested to my patients to try to get the H1N1 first and then get their seasonal flu shot. There is some theoretical benefit to getting the shots in that order and not the other way around. The nasal spray is live virus and you cannot take 2 nasal sprays at the same time. I would space nasal sprays by 1 month for maximum effect. The shots can theoretically be given without spacing but as I said above I would urge people to consider spacing the shots if they can. As usually call us for questions. AND WASH YOUR HANDS!