Everything You Wanted To Know About The Flu and H1N1.
Why is this Flu season different than other flu seasons?
We are all facing two very similar but distinct forms of the Influenza virus this year. First, we have the seasonal Flu or the regular flu. The symptoms of that are similar to any other influenza like virus and not generally indistinguishable from the H1N1 Influenza virus (previously known as the Swine Flu virus). While your physician prefers to be very precise in evaluating each patient for the specific type of illness and virus upon presentation, it is somewhat more complicated this year since the viruses have symptoms that have initial presentations similar to each other. Not to mention all the other winter illnesses that are traditional residents for this cold and flu season time of year. The H1N1 is more dangerous just by the nature of how easily and widely it will spread this year and the number of people who are expected to contract the virus. Even though it is not any more virulent or deadly than any other flu, it is this fear of a pandemic spread that is causing the heightened vigilance by all health care workers.
Why are we so worried about the H1N1 influenza virus? Isn’t it basically the same virus as the seasonal virus?
The significant concern right now by the health care community is based on the fact that H1N1 is a new virus. The vast majority of people on the planet Earth have not been exposed to it in any form previously and have no immunity to any aspect of it. The real fear is that because H1N1 is currently classified as a pandemic, millions of individuals will be infected at the same time. Even if only a very small percentage become very ill, we will not have the resources to take care of them all at the same time. The anticipated overwhelming number of sick people will strain every aspect of the health care system including primary care doctors, clinics, pharmacies, drug supplies, emergency rooms, and hospitals. The main fear is that too many people will become sick at the exact same time.
Having said that, the truth is the vast majority of the population will have either mild viral symptoms, or suffer from the same familiar symptoms that anyone who has had previous Influenza experiences will recognize. A very small percentage could become severely ill requiring hospitalization. The biggest worry for the public is the random nature regarding who gets the worse cases and symptoms. In past flu epidemics, only the very young, the elderly and people with chronic medical conditions and immune depressed states were the most susceptible to the severe symptoms and possible death. In this pandemic, it is still true that up to 75 % of the most severe cases will be in those that are chronically ill. A large number of previously healthy young people and pregnant women have been documented to develop severe symptoms and complications. Even though this number is extremely small, the fear of anyone anytime being susceptible elicits more alarm than generally warranted.
So how do we prepare?
The CDC (Centers for Disease Control and Prevention), the Department of Health and Human Services (HHS), and the American Academy of Pediatrics (AAP) strongly recommend both the seasonal and H1N1 influenza virus vaccinations. Prevention is the best cure, always. The vaccines are now available through your county health departments and distributed through avenues such as clinics, pharmacies, supermarkets, schools, and doctor’s offices. Hopefully as production and distribution of vaccine improves, it will become available to everyone.
General vigilance in basic hygiene habits is the second most important thing you can do for yourself and your children. The current recommendations to (a) wash your hands after any person to person contact, and prior to every meal, (b) avoid touching your face and nose without washing your hands or using cleaner, (c) cove your nose and mouth prior to coughing and sneezing, (d) stay home and removing yourself from public exposure if you or anyone you know has possible flu symptoms, (e) stay home from school or work until all of your symptoms have resolved and your physician has cleared you from being contagious to limit other people from catching the virus. The contagious period can be from 48 hours prior to developing obvious symptoms, especially fever and to 7 days after onset. Recent studies have shown that an individual infected with H1N1 may be contagious even longer if one of their prominent remaining symptoms is a strong cough.
I am worried about receiving the new H1N1 vaccine. Should I be worried about getting a completely new vaccine right out of the box?
Although the H1N1 virus is new, the method for creating the vaccine (using eggs to grow the virus) is the same as for the seasonal Flu. This is a standardized scientific process that has been screened and studied. The risk should not be any greater for complication than any other flu vaccine in any other season.
I am concerned that even if the process is the same, the actual vaccine is new and could have side effects that we do not know about yet. I do not want my child to be a guinea pig.
Although this vaccine went into production rather quickly, all the same standards for use have been followed. Up to this point thousands of individuals of all ages have been receiving and no remarkable reactions have occurred in mass amounts. You should listen to news reports of untoward reactions, and recalls of a particular lot. If you are concerned visit the CDC site (CDC.gov) to be up to date on all the news surrounding the vaccination process. The CDC has set up an incident event hotline for any reportable reactions to the vaccine. This will allow quick response and notification if there were any problems with the distribution and vaccination.
What are the most common side effects of the vaccine?
Early reactions have included fever, some aches and pains and upper respiratory symptoms. A relatively common reaction so far has been stomach upset including abdominal pain, nausea, and vomiting.
As with the yearly Seasonal Flu vaccine, any of the common Flu symptoms in a mostly milder form, could be experienced as well as some of the very rare complications such as Guillian Barre.
How do I know which Flu my child has? I understand that the rapid Flu test in my doctor’s office only tests for Influenza A. Are both the seasonal Flu and H1N1 Influenza A viruses?
H1N1 and the regular garden variety Seasonal Flu are both an Influenza A strain. Currently, reports suggest that up to 80% of the circulating lnfluenza virus in your local town is H1N1.
Many physicians and clinics have the Influenza quick test available for use in their offices. The reliability for these tests range anywhere from 20 % t0 70%. They are most useful as a tool in the hands of a trained physician as part of the evaluation and diagnosis process. A health care provider should use the Flu test and his or her clinical judgment in deciding what course of treatment to implement in the care of a possible H1N1 infected patient.
When should I call the doctor?
Although most of the early symptoms are similar to many other viruses it is important to contact your doctor, primary health care provider or clinic if your child develops any or all of the following symptoms:
(a) Fever or fatigue will be the first warning sign that a viral illness it beginning.
(b) Headache
(c) Sore throat
(d) Aches-pains-chills
(e) Lethargy
(f) Vomiting
(g) Pronounced cough
(h) Gastrointestinal symptoms
All of the above symptoms should be brought to the attention of your physician.
The following questions will help your doctor in the evaluation and treatment of you or your child’s care.
1. Exposure
“Have you been exposed to anyone with diagnosed Influenza A either seasonal or H1N1? “An important component of determining if a person has the Flu is their exposure to someone else that has had a documented H1N1 or simple Seasonal Influenza virus. If a person precisely knows someone who was diagnosed with the flu that they were around, then the likelihood of their symptoms being related to the flu are raised. In addition, if this individual is in an epidemic area, state of emergency zone, or works or goes to school in a high risk setting than the likelihood is greater.
2. Which Flu?
“ Was the Flu you were exposed to or concerned about the Seasonal/regular flu or do you have reason to believe you have the H1N1 flu?”The seasonal flu and the H1N1 have many similar characteristics but diagnosis and treatment may be different. For this reason it is important to have as much information as possible regarding the type of Flu you might have been exposed to.
3. Timing of exposure
“When do you think you were exposed to the person diagnosed with the Flu?”The timing of the exposure is also crucial. The incubation time from contact to feeling symptoms is generally 48 hours to 10 days. If the presumed exposure is outside of this window of opportunity to develop symptoms, then the likelihood is not eliminated but definitely decreased.
4. Onset of illness
This answer is crucial to the early diagnosis and treatment. Treatment is most effective for Influenza A if it is initiated within the first 48 hours after the onset of symptoms. Generally the onset will be decided by the timeline for first onset of one of the following symptoms.
a. Fever-“Do you have fever and for how long?”
b. Weakness and fatigue? – “Do you feel very tired and weak?”
c. Headache and body aches? – “Do you have muscle aches, pains, and chills, and does your head hurt?”
d. GI symptoms- “Have you had any vomiting, nausea, or diarrhea?”
e. Sore throat- “Does your throat hurt?
f. Respiratory- “Do you have cough, runny nose, or congestion?” “Any difficulty breathing?”
g. Have you had these symptoms before? When was the last time? How often have you had these symptoms?
PLEASE NOTE:
If symptoms persist or change even after beginning treatment, you should contact your primary health care provider immediately. Please ask your health care provider to explain the expected course and the time for improvement. Also request that they be specific regarding when you should be seen again and what additional symptoms or change in condition should warrant you or your child getting immediate or emergency medical care. The Flu often arrives in tandem with other viruses or can elicit secondary infections. If you or your child are not improving or are worsening, you should seek medical attention immediately.
How long should the symptoms last?
Generally a course of Influenza lasts 7 days and possibly longer. It is recommended that you or your child stay out of school or daycare for at least a week. Some of the milder presentations of this Flu will have complete resolution sooner. Please contact your physician for the precise time to return to work or school for your individual case.
What about the antiviral medications like Tamiflu (Oseltamivir) and Relenza (Zanamivir)?
They are most effective if started within the first 48 hours of the onset of H1N1 influenza.
Shouldn’t I just take Tamiflu or Relenza or give it to my child the second they get a fever and seem to be getting ill?
NO! First of all, most of what you and your child will catch this year will not be the H1N1. The common cold, also a virus and other common viral illnesses are more prevalent. The CDC recommends that physicians reserve the treatment of the H1N1 to severe or relatively ill individuals or those fitting the most at risk for severe illness like children under 5, especially under age 2, pregnant women, elderly, individuals with immune compromised states (e.g. cancer, HIV), asthmatics or those who suffer from chronic lung conditions and or other chronic illnesses. Your health care provider can help you to decide whether you need to take an antiviral medication.
If I wait until I am very ill or my child is, won’t it be too late to start treatment? I don’t want to watch them get very ill before I can do something. Can’t I start it earlier, or for that manner can’t I get Tamilfu ahead of time and give it when I think I need to?
Self medicating is dangerous. Medictions of this kind should be prescribed by your healthcare provider. Much in the same way that many of today’s common illnesses have become resistant to antibiotic overuse, we are very concerned that the same thing will happen with antivirals. It has already happened with Seasonal Influenza A and Tamilflu. Because the Influenza virus changes so rapidly from season to season and even during the same season, the likelihood of over usage leading to resistance of the H1N1 to the antivirals is a legitimate concern.
So what should I do? When should I start treatment? What do I tell my doctor?
With the onset of any signs of illness, namely fever and sore throat you should contact your doctor’s office. However, there are some signs (also see above) that make it more likely that your child may be developing Influenza and be a good candidate for antiviral therapy.
I refer to the constellation of symptoms as an “Influenza Misery Index”
(a) Fever and sore throat as mentioned previously plus-
(b) Significant fatigue- lethargy, you or your child cannot lift your head up off the pillow. Excessive sleeping and tiredness. Does not want to play or get up off the couch. Very weak.
(c) Not hungry. Eating very little
(d) Aches, pains, chills, especially a headache
(e) Vomiting especially without subsequent diarrhea
(f) Cough congestion, very strong cough
(g) Any respiratory difficulty- trouble breathing, change in color.
You should speak to a trained health care professional before beginning any treatment and prior to assuming the nature of the illness you or your child may have.
REMEMBER: THESE ARE GENERAL GUIDELINES. YOUR PHYSICIAN OR HEALTH CARE PROVIDER IS THE ULTIMATE SOURCE FOR INFORMATION, CARE, AND MANAGEMENT OF ANY HEALTH CONCERN INCLUDING SEASONAL INFLUENZA AND H1N1.
For more information, please read “Should You Get the Novel Influenza A H1N1 Vaccine” and “Be Prepared for the Flu of 2009” also in the Nerdel News.
Posted in: The Flu
