H1N1 / Swine Flu, Seasonal Flu Facts and Vaccination Recommendations
For those of you who could not make it to the free talk on H1N1 last night at the everyday athlete’s home studio, I thought it might be helpful to summarize the talk and provide some of the medical details. The talk was given by:
Jordan Glaser, MD,
Infectious Diseases
Internal Medicine
Head of Infectious Diseases at Staten Island Hospital
Briefly:
H1N1 has been a relatively mild flu as flu go. It has behaved differently from the seasonal flu in the respect that it seems to infect young people more than the elderly. Compare to other seasonal flu virus it has not been as virulent. However, there are specific types of people who are at high risk of complications specifically: pneumonia
Here are some of the details:
The following people are at high risk and should get the H1N1 vaccine.
- Chronic pulmonary, cardiovascular, renal, hepatic, hematological, or metabolic disorders (including diabetes mellitus)
- Immunosuppression (HIV/AIDS)
- Compromised respiratory function, including conditions which increase the risk for aspiration.
- Chronic Aspirin Use (common in for many males over the age of 50, some females)
- Pregnancy: This is due to the fact that pregnant women share some of the same characteristics immunological deficits present in people with HIV/AIDS Technical notes: both neuraminidase inhibitors and adamantanes are Pregnancy Category C medications).
To reiterate the recommendation is that anybody in the above a category should actively pursue getting vaccinated for both H1N1 and Seasonal Flu.
Prevention:
- Hand hygiene
- covering coughs
- stay at home when ill
- Other considerations : High risk individuals who have no need to travel via air should avoid travel until vaccinated or take above precautions specifically hand washing.
- Appropriate use of Pneumovax. (pneumoncoccal Vaccination see: cdc website: CDC Vaccination Website
This would be as a preventive measure to avoid infection if individual was high risk.
Technical data:
Seasonal human:
H1N1,H1N2,H3N2
Orthomyxovirus
Each year: Contracted by
5-20% of U.S. population,
200000 hospitalized, 36000
deaths
H1N1 swine
Orthomyxovirus
Since 4/09: 1 U.S. million
cases, 1000 deaths, including
76 children, often from
complicating bacterial infection
In 1918: Killed 50-100 million worldwide
Vaccine type Dead, killed* Dead, killed*
recommendation is to not use “live virus” spray.
H1N1,H1N2,H3N2
Guillain-Barre Syndrome Extremely low risk except:
1976, 1992/3^, 1993/4^
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H1N1 swine
Extremely low risk except:
1976, 1992/3^, 1993/4^
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H1N1,H1N2,H3N2
Vaccine Indications
Over 65 years old
HCWs
Nursing Homes
Over 6 months &
immunocompromised
Household members of groups
at risk
H1N1 swine
Pregnancy
HCWs
Over 6 months old
Immunocompromised
Rx Target Groups (Seasonal and H1N1)
DM
COPD
Heart Disease
HIV
Transplants,
Renal Dysfunction
Long term
Aspirin Use
H1N1,H1N2,H3N2 Rx (used 48 hours after exposure/infection)
Amantadine,
Rimatidine,
Oseltamivir (Tamiflu) 75mg
PO q12h or zanamivir
(Relenza)
H1N1 swine Rx (used 48 hours after exposure/infection)
Oseltamivir (Tamiflu) 75mg
PO q12h or zanamivir
(Relenza)
Other data points and notes
Endemic in pigs & humans: H1N2, H3N2
- Manufacturing of Vaccine: Virus grown in hen’s eggs, purify it, treat it with chemical that inactivates it. No adjuvant added (substance that enhances immune response). Since the 1930’s an
ethyl based mercury preservative (thimerosal) has been used in multi-dose vials to prevent bacterial & fungal contamination. Infants can safely receive 8x the amount
used. ^ ~1 case per one million doses
- Hand hygiene, covering coughs & stay at home when ill. Appropriate use of Pneumovax.
- Smart use of antivirals to prevent emergence of resistance. Antivirals most effective when started within 48 hours of symptom onset.
TYPE B INFLUENZA in humans & seals
TYPE C is rare
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I hope that this information will help each of you make more informed decisions.
If you have any further questions, or comments, don’t hesitate to contact me.