Healthsifter by mary desmond pinkowish, since 2003

The Flu Shot: It's a Necessity, Not an Accessory

Nice job by Ariel Kaminer in the New York Times today, debunking the reasons--some of them pretty funny if completely wrong--that New Yorkers are giving this year for not getting a flu shot. Memo to the CDC: Here's an idea for next year--put out the word that the shot is in short supply but high demand. Apparently that's spirit of competition that gets people in and sleeves rolled up.  

And really, understand this: You can't get the flu from the flu shot. Does anyone still not get this? 

Flu: Who Dies and Why

Why do some people remain healthy in the midst of epidemics? That mystery has been with us forever, and Jerome Groopman and Pamela Hartzband write about it in today's New York Times. Take H1N1 flu, for example. Think you're in a good place because you don't have an underlying condition, or UC? You're definitely in a better place without asthma or diabetes, but 25% of people who've been hospitalized with H1N1 and one third of the children who've died of the infection did not have a UC, according to Groopman and Hartzband. Other people have almost certainly been exposed to the virus and haven't even gotten sick, let alone been hospitalized or died. These patterns have been observed in other flu epidemics and during the great plagues throughout history, when one's continued good health while the neighbors were dying of smallpox was considered a sign of divine intervention. I'm all in favor of divine intervention, but what gives? As this article explain, studies of HIV infectivity may hold some clues. Interesting stuff. 

The Cat Who has H1N1 Swine Flu

Here's Tara Parker-Pope's story in the New York Times about the cat with swine flu. As she points out, this surely isn't the first feline to catch flu from a human, but it was the first to be tested. Interesting. Did you see the one about the pigs in Indiana who got swine flu? That almost sounds like a weird variant of cannibalism...or something...

What You Should Do About the (Swine) Flu

The new head of the CDC, Thomas Frieden, MD, held a press conference today to discuss some new reports and data about the H1N1 (swine) flu pandemic. You can read the reports at the CDC web site. Much of today's discussion concerned the way in which the infection affects kids. As you know, the flu usually hits the elderly hardest and kills tens of thousands of seniors every year. But from what we know about H1N1, it seems to take a heavier toll on kids. To be sure, nearly all of the children and adolescents who got sick in the spring recovered, but kids with what are called "underlying conditions" seem to be a risk. Here's a summary of some of Frieden's major points today, with an emphasis on what you need to know to manage if you or anyone in your family gets sick with a flu-like illness in the coming weeks. 

• Children age 5 years and under are at highest risk. The younger they are, the higher the risk. Babies younger than 6 mos won't be getting the vaccine when it becomes available, so they're in the most danger. This means that if you're in contact with babies or young kids, you should take care to avoid getting the flu yourself--or spreading it to them.
• Two-thirds of the kids who died this spring had underlying conditions like cerebral palsy, muscular dystrophy, asthma, or other cardiorespiratory problems. Kids with these and other conditions need medical attention if they get flu-like symptoms--or even a fever during the flu season.
• Many of the remaining 30% of kids who died had bacterial infections, which brings us to the next point--
• A fever that returns as a person is recovering from the flu could be a warning sign of a bacterial superinfection. Get medical help.
• Pregnant womenare at risk from the flu and should do whatever they can to avoid the infection and should get the vaccine when/if it becomes available.
• A person without an underlying condition and who is otherwise healthy (not pregnant, not under the age of 5 years, no asthma/diabetes/other cardiorespiratory disorder, etc.) probably does not need medical attention--no diagnostic test, no flu medication. Staying out of doctors' offices and emergency departments if you don't really need to be there will slow the transmission of the virus and free up medical personnel to help people who are in more danger than you are. Stay home and rest. Do keep an eye on your fever.
• Stay home from work/school if you get the flu. 
• Stay home from work/school if you get the flu.

The CDC site has more info for specific groups of people. Not exactly sure how sick you are, or whether you're in a high-risk group? Find out here.  And let young Alexander Graden instruct you in the art of safe sneezing.

FLU View: State-by-State Update on H1N1 from the CDC

An update published by the CDC yesterday shows H1N1 flu activity by state:

CDC Q&A About the H1N1 (Swine) Flu Vaccine

Here's everything the CDC wants you to know about the H1N1 (Swine) flu vaccine, which will probably be available this fall. You may end up getting two flu shots this year--one of the regular ones as well as the H1N1 shot.

As Medscape wrote here, the rush to production means that some shortcuts in safety testing may be necessary in order to have 60 to 80 million doses ready by the end of the year. An excerpt:

"Initial doses likely will go to those most severely hit by the pandemic so far: infants, toddlers, school-age children, pregnant women, and adults with risk factors for severe flu disease. Next week, the CDC's vaccine advisory board will recommend a priority list for exactly who will first get the vaccine.

Meanwhile, the Canadians say they will have a vaccine surplus. We'll see.

Flu Pandemic: Hold the Drama, There's Plenty of Time to Panic

The World Health Organization (WHO) has declared the first flu pandemic in 41 years. Here's how they define Phases 5 and 6:

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

As Lawrence Altman, MD, explained in the New York Times Science Times earlier this week, the word pandemic has had various definitions and connotations over the years:

The word implies the rapid spread of an infectious disease to many countries in different regions, hitting each with more or less the same severity. But in fact, severity varies — not all people are infected at the same time, and not every country need be affected.

And there can be many other factors, including the numbers and percentages of people falling ill and dying; a population’s vulnerability to the disease, based on previous rates of infection; and the quality of health care facilities and disease monitoring systems.

Not least is that scientists do not know precisely how pandemics arise, what fuels them, why they vary in their lethality, why some occur in waves and why they stop.

Daniel Henninger puts things in perspective in today's Wall Street Journal:

The WHO reports 141 deaths globally from swine flu, with 106 of those (75%) in Mexico and 27 in the U.S. Seasonal influenza kills 35,000 to 50,000 Americans each year. It is now evident that the current strain of the H1N1 swine-flu virus is a "mild" version rather than a pathogenic killer like the 1918 Spanish flu. In fact, seasonal flu kills 500,000 people annually world-wide, a staggering death toll that occurs with hardly any of the public losing a moment's sleep over it.

Travel Medicine and Vaccines: It's Not Just About Swine Flu

A bit overwrought...

In her column in today's Wall Street Journal, Laura Landro reminds us that Swine flu is the least of the health problems that travelers may encounter this summer. Here's an excerpt:

While swine flu has dominated the news as a concern for travelers, experts say other infectious diseases pose a far greater threat as the summer travel season gets under way. Especially worrisome are mosquito-borne diseases, including malaria, dengue fever, Japanese encephalitis, chikungunya fever and yellow fever, which are now spreading in areas where they weren't previously a danger. Travelers are also at increased risk for intestinal and skin-burrowing parasites, tick-borne diseases, sexually transmitted diseases, typhoid fever and the age-old scourge, traveler's diarrhea.

The CDC's Yellow Book is the bible of travel medicine. You can find the online version here. A new edition comes out online shortly.

Link Seen Between Obesity and Flu Severity

A report published in the Washington Post says that scientists have noticed that many of the people with severe swine flu, ooops, H1N1 flu are obese. Here's a portion of that article:

"We were surprised by the frequency of obesity among the severe cases that we've been tracking," said Anne Schuchat, one of the CDC epidemiologists managing the outbreak. She said scientists are "looking into" the possibility that obese people should be at the head of the line along with other high-risk groups if a swine flu vaccine becomes available.

Other studies have shown that pregnant women are also at higher risk for serious influenza infection, especially in the third trimester, when the fetus and womb compress the lower parts of the lungs. This makes it harder to breathe deeply and cough forcefully; it may also alter blood flow in the chest. A similar thing may be occurring in severely overweight people, some experts speculated.

Will Your Flu Shot Protect You from Swine Flu?

I've been wondering about this myself. Here's a segment from short article from Science magazine:

"The U.S. Centers for Disease Control and Prevention strongly doubts that this year's flu vaccine will offer people any protection from the swine flu. "We don't think that any of the existing vaccines are effective," acting CDC Director Richard Besser said yesterday at a press conference.

But some flu vaccine researchers and public health experts say the jury is still out. "If I hadn't already had the vaccine, I'd take it," says Robert Webster, a flu guru and vaccinemaker at St. Jude Children's Research Hospital in Memphis, Tennessee."