Ask Dr. Nancy: H1N1 Flu
Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.
I’m worried about Swine Flu. What do I need to know?
Nancy Van Vessem, MD
Chief Medical Officer
Novel H1N1 flu (previously called Swine flu) is in our community now and has been percolating across the country all summer long, passing from infected people to non-infected people. It can range from a mild to a severe illness. The concern is that the number of cases will increase dramatically when the children return to school and start sharing their secretions. Other concerns are that cooler weather is the preferred environment for all influenza viruses and mutations may occur which can make the virus more dangerous and resistant to treatment. New information is coming quickly so refer to the Florida Department of Health’s web site at http://www.myflusafety.com or the Center for Disease Control’s web site at http://www.cdc.gov/h1n1flu or call 1-800-CDC-INFO.
The best defense will be to avoid the spread of flu from infected people to non-infected people through control of droplet spread. Infected people cough, sneeze and spread the virus to other people directly. Indirect spread occurs when infected secretions land or are placed by hands on surfaces which are then transferred to others when handled. Here’s an example: an infected person transfers the virus to a handrail and the uninfected person holds onto the handrail, gets the virus on their hand, touches their nose, mouth or eyes, and ends up with the flu. These modes of transmission are true for any flu and most other respiratory infections so taking precautions protects you from more than novel H1N1.
(Please see information regarding seasonal influenza vaccine in this Healthline. The recommendations for who should get this vaccine have been expanded. This is obtained from your Primary Care Physician’s office.)
People who are sneezing or coughing should cough into their arm or a tissue (then throw the tissue away). Everyone should wash their hands frequently. Alcohol-based sanitizers are also effective. The CDC recommends that anyone with flu-like symptoms stay at home as long as they are ill since they can be contagious as long as they are symptomatic. The latest recommendation is for the infected person to stay home from work and/or school as long as he/she has a fever >100 degrees. The body temperature should be less than 100 degrees for 24 hours without fever reducing medication before returning to school/work. Remember that anyone younger than age 18 should not be given any aspirin containing products because of a rare, but potentially awful, complication called Reye’s syndrome.
What about testing and treatment? The CDC does not recommend testing for the novel H1N1 unless the person is seriously ill or to establish the cause of an outbreak. If the person has the symptoms of flu, assume flu. Those symptoms are fever, sore throat, cough, headache, muscle aches, chills and fatigue. Treatment with antivirals is also not recommended for everyone, rather it is recommended for patients who are severely ill, those at high risk for complications from the flu, health care workers with significant exposure and pregnant women. Close contacts of people who are at high risk for complications should be offered prophylaxis. Overuse of antivirals will increase the likelihood of resistance meaning that people who really need treatment may end up with no treatment options as the season progresses and if the virus mutates.
What about a vaccine for novel H1N1? The government has contracted with multiple vaccine manufacturers for H1N1 vaccine and the hope is that it will be available in October. It will be distributed through the Departments of Health in each state and county to the highest risk groups. The targeted groups for the vaccine are: children/young adults ages 6 months to 24 years, pregnant women, people who work with children and in health care and people under age 65 with a condition, such as diabetes, that makes them more susceptible to catching the flu and having complications. Just how the vaccine will be distributed through the Health Department is being worked out in advance of its arrival.
Complications from the flu include other infections that take advantage of the person’s weakened immunity like pneumonia. People who are in the age ranges to have the pneumococcal vaccine should make sure they are up to date. The pneumococcal vaccine recommendations are also included in this Healthline.
There has been a tremendous effort by the U.S. public health agencies to reduce the health impact from novel H1N1 ever since it made its appearance earlier this year. We all should do our part to follow recommendations not only because it will help us protect ourselves and our families, but also because we can all participate in the efforts to reduce illness in our community.
Dr. Nancy Van Vessem, MD Chief Medical Officer
Dr. Nancy Van Vessem is board certified in internal medicine. She has developed innovative disease management and quality improvement programs promoting the use of best evidence medicine and propelling CHP to national recognition for quality of care.
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