SWINE FLU H1N1 2009 INFORMATION

 

SHORT VERSION: In short, SWINE FLU is basically just like regular INFLUENZA, except its a brand new strain never seen before. We each have partial immunity to the regular flu from past infections or immunizations. When something completely new hits, you have no immunity and could have a worse case. So far, this year's Swine Flu appears to look just like a mild to moderate regular Influenza. Please see the INFLUENZA page on this site for what regular influenza is and its complications. Regular influenza hurts mostly those over 65 years of age and those with risk factors (like pregnancy, diabetes, kidney disease, heart disease, lung disease, asthma and those without a spleen). Each year approximately 35,000 Americans die of regular influenza. 85% of those deaths are in those over 65. In contrast, Swine flu is killing mostly those under 50, especially those under 15 and half of those have no risk factor for complications. The vaccine for swine flu has been produced in exactly the same manner even in the same manufacturing plants as the regular influenza vaccine. They simply put the genes in for swine flu instead of regular influenza. The vaccine has been tested and is safe and has not been rushed. There are NO legitimate safety concerns for this vaccine. The FDA is closely watching this vaccine as it does all vaccines and will pull the vaccine if there is any legitimate concern. The vaccine will be available in nasal and injectable versions. The nasal vaccine cannot be used under 2 years of age and cannot be given within 28 days of the regular nasal influenza vaccine. Those 9 years of age and under will need 2 doses of the swine flu vaccine given 21 or more days apart.

WHAT IS SWINE FLU: Swine flu originated in a pig and then spread to a human, hence the name swine flu. The regular seasonal influenza typically starts in birds in Asia and then spreads to humans, spreading from east to west. Most of the time a swine flu spreads to a single human and then can't spread. This years swine flu has proven to be extremely contagious and has gone from a single boy in Mexico  in Spring of 2009 to tens of million cases worldwide by late Sept 2009. Regular seasonal influenza tends to hurt mostly those over 65 years of age and those with medical risk factors  (like pregnancy, diabetes, kidney disease, heart disease, lung disease, asthma and those without a spleen). Approximately 85% of deaths from regular seasonal influenza are in those over 65 years of age, while swine flu is mainly hurting those under 50 and half of those deaths are in those without any medical risk factors.

WHY IS SWINE FLU DIFFERENT THAN REGULAR INFLUENZA: Influenza is kind of like a car. If you see a car, you know its a car. Take the Ford Mustang for instance. Anyone can tell a Ford Mustang from a different model of car, like a Pinto. Each year, the Ford Mustang has changed slightly. Every dozen or so years, then model changed a lot, but you still knew it was a Ford Mustang. Well, regular seasonal influenza changes itself slightly from year to year. If you had regular seasonal influenza or the vaccine in any given year, you were probably partially immune to the next few years strains of regular seasonal influenza, because it was so similar to the one you had. This is just like one model year of the Ford Mustang having the same parts as the next few years. Well the swine flu is not like a new model of car, its more like a flying saucer. Its something completely different that your body has not immunity to. Because your body has no natural immunity, it might over whelm your immune system, or your over reactive immune system might hurt you. One of the theories of why young people are hurt more than the old, is that their immune system is so powerful, that is over reacts to the brand new virus it has never seen before. The names for the subtypes of influenza use H and N in them, like the Swine Flu is called the H1N1 and the seasonal regular flu might be called the H3N2.

WHY SHOULD I BE CONCERNED ABOUT SWINE FLU: The regular seasonal influenza virus infects 10-15% of the population and kills 35,000 Americans per year. 85% of those deaths are in those over 65 years of age with medical risk factors (like pregnancy, diabetes, kidney disease, heart disease, lung disease, asthma and those without a spleen). In contrast, very few people over 65 had become infected with Swine Flu. Most deaths have occurred in those under 50, with those under 15 years of age being especially high risk and HALF OF ALL DEATHS HAVE OCCURRED IN THOSE WITHOUT ANY RISK FACTORS.  As of late September 2009, there have been just over a million cases of Swine Flu in the USA with almost 3000 deaths. There are approximately 300,000,000 people in the USA.

WHAT DO I DO IF I GET OR HAVE BEEN EXPOSED TO SWINE FLU:

  1. Don't panic.
  2. GET ACCURATE INFORMATION. The Center for Disease Control has an excellent web site with accurate concise information. It is easy to understand and is accurate. See www.cdc.gov.
  3. Please stay off of web sites that do not have accurate information. There is plenty of garbage on the web that can do way more harm than good (see vaccine info).
  4. Watch flu signs of complications or severe influenza. Most swine flu cases are mild to moderate. Most cases of swine flu will go away on their own in a week or so without any complications. Due to the shear number of cases, the experts are advising us NOT to treat or test for swine flu except in specific cases. We are not testing because we simply don't have the resources to test everyone and the results will not change what we do in most cases. We are not treating swine flu for a few reasons. First, there simply is not enough Tamiflu to go around. There are already shortages and we have not hit the peak number of cases yet. Second, most cases go away on their own. Third, we have already had deaths from Tamiflu resistant swine flu cases. Only 1/3 of 1% of the country has had swine flu so far, we are extremely concerned that this flu will become very resistant. We had 4 drugs to treat regular seasonal influenza a few years ago and most are now useless against regular seasonal influenza. We are only treating swine flu in the following instances: Hospitalized cases, Medical risk factors, such as pregnancy, diabetes, kidney disease, heart disease, lung disease, asthma and those without a spleen, Rapidly progressive severe respiratory compromise: this means a sudden worsening is breathing, labored breathing, shortness of breath
  5. DO NOT GO TO THE EMERGENCY ROOM OR COME TO OUR OFFICE WITHOUT CALLING FIRST AND THEN ONLY IN YOU OR YOUR CHILD HAS A SEVERE CASE.  If you have the flu, you are simply going to expose more people and we will not be treating testing or treating you, unless you have a complication (see influenza page). If you don't have swine flu, then you might get it in the ER.
  6. Please follow standard recommendations for treating swine flu at home just like regular seasonal influenza (see influenza and www.cdc.gov ) with Tender Loving Care, Ibuprofen, rest and fluids.
  7. DO NOT GIVE ASPIRIN or products containing aspirin like Pepto-Bismol. Giving aspirin with influenza can lead to Reyes Syndrome a severe brain disorder.
  8. Stay home until the fever is gone WITHOUT FEVER REDUCING MEDICATIONS for a minimum of 24 hours. If you are caring for someone with swine flu, the incubation period (from contact to symptoms) is 2 to 7 days. The contagious period is from 1 day before symptoms showed up, until 5-7 days later, or until you are fever free for 24 hours off of fever reducing medications. At this point, simple exposure should not limit your going to work, unless you work around high risk individuals (hospital workers, daycare workers, etc).

       

VACCINE INFORMATION: (vaccine safety below)

UPDATED 11-05-2009 We received a very small supply of the killed injectable non-preservative free H1N1 vaccine on early October and this RAN OUT 10/28/2009. We do not know for sure when we will get more of the vaccine, but we think early November. PLEASE DO NOT CONTACT OUR OFFICE ABOUT THE VACCINE AVAILABILITY. The number of calls we are receiving about the vaccine is simply overwhelming. We will update this site on the same day we receive the vaccine. We expect a good supply in 2-3 weeks, but cannot say for sure when we will get more. IF YOU CAN GET THE VACCINE AT THE HEALTH DEPARTMENT OR SCHOOL , I SUGGEST YOU DO SO.

In order to receive the vaccine, your child must be at least 6 months of age, not allergic to eggs, and have never had a reaction to any influenza vaccine in the past.

Vaccine Priority groups: (to receive the vaccine, call our office and say your child is on this list or e-mail us at info@babymd.net and tell us your child is on this list and give us multiple ways of contacting you)

1. The most fragile of the high risk groups: Transplant patients, cancer patients, respiratory condition on oxygen, immunosuppressed patients, any medically fragile patient with a chronic medical condition. WE HAVE ALREADY IDENTIFIED THESE PATIENTS AND CONTACTED THEM TO RECEIVE THE VACCINE. IF YOU HAVE NOT BEEN CALLED, CALL US NOW.

2. High risk patients whom are not on above list, but still fragile:

3. High Risk Patients whom are not fragile

4. Everyone else

    

VACCINE SAFETY: The swine flu vaccine has not been rushed to market and is being watched and studied for safety by the best people. The vaccine is being made in exactly the same manner even in the same manufacturing plants as the regular seasonal influenza vaccine. They even stopped making regular influenza vaccine to make enough swine flu vaccine for everyone. The swine version of the influenza vaccine has been in development and has been studied for over 30 years. I am going to tell you about another vaccine for a very important reason. In 1976, we had a different swine flu epidemic. At the time we worried that it would be a bad one. This one is way worse than the 1976 strain and it has barely started. They developed a swine flu vaccine in 1976. That vaccine was not purified as much as we purify vaccines today. The regular seasonal influenza vaccine give 10-15% of people MINOR muscle aches and a MILD fever. 85% have no side effects other than just having a needle stick. The 1976 swine flu vaccine gave more people slightly worse muscle aches and a fever. That year there was a slight increase in Guillian-Barre Syndrome after the vaccine. Guillian-Barre is a temporary nervous system disorder that can follow any viral illness. It occurs in 1 in 100,000 to in in 6,000,000 Americans yearly. A few more people got Guillian-Barre following the vaccine that typical, but to this day we still cannot be sure it was the vaccine or just a normal variation. Since that year, almost every elderly American you talk to remembers that years vaccine and many say they will not get the regular flu vaccine because of it. Every year 35,000 Americans die of regular seasonal influenza because they won't get the vaccine. If you do the math, that is over 1,150,000 Americans that have died since 1976 because they are afraid the flu vaccine will make them sick. Which is worse, spreading unfounded rumors about a vaccine or flying a plane into a building. Those spreading unfounded rumors about our vaccine system's safety are to blame for those deaths. Please don't let their ignorance cause you or your child to be hurt from a very real illness.

VACCINE CHOICE: Many parents are confused about whether to chose the Nasal version, preservative free, live, killed, etc. Lets make it as plain as possible. There are 5 versions of the vaccine being made. The reason for the number is that we want to be able to protect the largest number of people as quickly as possible. The government has ordered 600 million doses. We have never given more than 150 million doses on influenza vaccine in a year. There are many manufacturers and they have been using their technique for many decades. We felt it best not to have them change technique suddenly. The nasal version is a live vaccine. There are a small number of studies that show this vaccine may be 1-2% better than the injectable version in preventing illness mainly since it is going where the influenza virus is most likely to enter your body, your nose. Aside from that, the nasal version works the same and has the same side effects as the injectable version. Of the injectable versions, there are killed and live, then preservative free and containing preservative versions of each. The live version of any of these vaccines should not be given to anyone with an immune deficiency, anyone closely contacting someone with an immune deficiency, or those with the main underlying conditions which your most at risk from influenza for (diabetes, kidney disease, heart disease, lung disease, asthma and those without a spleen). There is a possibility of spread of the live virus in the vaccine to those who cannot fight it and the virus could potentially harm them. The way a vaccine works is to give you a small amount of the virus so that your body makes an immunity to it, so that when you are exposed to the real thing, your immune. Those with a severely weakened immune system cannot to this. In reality, this only happens in extremely rare cases, but we don't want it ever to happen. The preservative containing version uses thimerisol, which has been used to preserve vaccines from about 1910 until 2000. It is only still used in influenza vaccines so that we may manufacture 10 dose vials, not single dose vials. Despite dozens of studies and billions of doses given without ANY evidence of harm, there are still many people who feel that the mercury in thimerisol may be linked to autism. There is absolutely no evidence of this, I do not believe it and my kids received all their vaccines with the preservative. Mercury poisoning gives symptoms similar to but distinctly different than autism. Also, we stopped using thimerisol in all vaccines except influenza in 2000 and the autism rates have actually increased, not decreased. BUT, the government has responded to those unfounded fears by ordering enough thimerisol free vaccine for all pregnant women and children (when it gets here). But until a very good supply is here, we simply have to take what we can get. My personal and professional opinion is that the danger of swine flu massively outweighs even the unfounded fear of harm from a vaccine. There is only one other issue regarding the nasal version. The nasal version of the regular seasonal influenza vaccine should not be given within 28 days of the swine nasal influenza vaccine. They may counteract each other. It won't hurt you, they just might not work. Therefore if you received the nasal version of the one, simply get the shot of the other if they are within 28 days of each other. Otherwise there are no other timing issues with any other version. So which should you chose? If you or a close contact has any of the conditions listed above, you should not take the live virus version. If you received the nasal version of the regular seasonal influenza vaccine within 28 days of when you will get the swine influenza vaccine, then you must get the shot version of the swine influenza vaccine.  If you are absolutely against preservative / thimerisol, you should get the thimerisol free version. Just remember that vaccine supply with be short and we don't known what version we will get. Your risk of getting the swine flu and dying of it far far outweighs any possibility of even theoretical harm form the vaccine.

WHAT IF I HAD SWINE FLU, SHOULD I GET THE VACCINE: Up until recently, there was no real guidance on this. The experts said either way is ok. But there is some new evidence. There have been many people whom have had swine flu twice already. In some cases, both infections were tested positive and in at least one case, the second infection was worse than the first. The CDC reported that there is rapid mutation of the H1N1 virus. The best evidence is that for some people, the vaccine will give better and broader immunity than the immunity obtained from a natural infection with swine flu. Therefore, even if you were tested positive for swine flu, we still recommend you receive the swine flu vaccine. Most recommend waiting a week or two after you are better from the infection before receiving the vaccine. There is no specific reason for the waiting time.

SWINE FLU VACCINE RECALL: 12/15/2009. There is a non-safety related voluntary recall of 800,000 of the Sanofi produced H1N1 vaccine. See the CDC site for more details ( http://www.cdc.gov/h1n1flu/vaccination/syringes_qa.htm ). In short, the government and manufacturer are very careful in producing and testing all vaccines. The vaccine is tested for potency when its produced and then at intervals until the expiration date is reached. There is an acceptable limit for how much potency is lost over time. These lots went below what the manufacturer wants and voluntarily recalled the lots. The vaccines given are still effective enough to not recommend another dose of the vaccine over what is already recommended. Our office received 100 doses of this vaccine, but only gave out 5 doses from one of these lots before the recall was announced. All of those parents have been notified of this recall.