Flu of 2009

The 2009 flu season was supposed to be a “routine.” Usually, patients take their seasonal flu shot. Those people who had flu symptoms normally go to the doctor’s office for an exam and testing. It is usually easy to spot the flu patients. Among the usual nasal congestion and sore throats, there are certain people whose appearance is really just sickly. These people usually appear to have just woken up, their hair is mussed, they are unshaven, and they are covered in sweaters or blankets but still shivering. In the doctor’s office, they are brought back and examined for signs of the flu or other problems. If their throat is red, they are usually checked for strep throat.

The flu nasal swab, which is an antibody test for types A or B Flu, then became available. Judging by the patient’s clinical appearance and a positive test for Flu A or B, the doctor might prescribe the antiviral drugs Tamiflu or Relenza to lessen the severity and length of illness. However, 20% of the American population acquired the 2009 flu thus far. Billions of dollars in lost work productivity and hospital expenses come out of the country’s pocket. At least 200,000 patients were hospitalized and there were 36,000 flu-related deaths. On top of that, something new now was added for 2009.

The great scientists at the Centers for Disease Control (CDC) in Atlanta maintain careful observation over flu outbreaks all over the world. They test and name each flu. Using this data, scientists try to predict what seasonal flu will appear in the fall. They supervise pharmaceutical companies in the manufacture of the specific vaccine. When the flu scientists reach their prediction on the button, the vaccine is effective in 70 to 90% of recipients under age 65. It is less effective in recipients over 65, recipients who live in nursing homes, and those with chronic underlying illness. The vaccine is about 30% to 70% effective.

The usual seasonal vaccine contains attenuated virus of the A (H1N1) and the A(H3N3) variety. A virus is not actually a separate live entity, so when we severely debilitate, we then say in the vaccine “attenuation.” A virus is arguably the smallest semi-life form that exists in nature. It can only be seen with an electron microscope. It is called an obligate parasite. This means it must “live” within another living cell. It can only survive and replicate by taking over that cell’s complex biochemical machinery to manufacture other viral units like itself. The influenza virus has its RNA taken up by a host cell to begin the manufacture process. Eventually the host cell dies by its viral infection.Influenza viruses were first identified and studied by scientists in the 1930’s.

Type A viruses were the worst, and the ones typically producing epidemics and global pandemics. An epidemic is a local outbreak of the flu, usually annually, by viruses that already exist in the environment. It usually peaks in three weeks, and subsides after three weeks, sometimes affecting 50% of the population of that area.

The pandemic is a different phenomenon altogether. It is caused by a mutated virus to which humans do not have an immunity. It can be spread worldwide. Scientists found that they could identify Type A viruses into subtypes by protein structures on their outer surfaces. These are called H (Hemagglutinin A) and N (Neuramidase B). There is no division of a Type B virus into a subtype because they cause milder symptoms and are more sporadic. Type C influenza viruses are not subtyped because they cause even milder symptoms and less evidence of outbreaks. The Type A viruses caused the pandemics of 1917, 1957, and 1967 when millions of lives were lost. The worst year for this was 1918.

Pandemics can be caused by a viral mutation or the re-emergence of a virus that has not been around for years. All in all, humans lack immunity to that specific virus and cannot fight them. Viruses do not stay in humans throughout the year as they are prevalent in primarily fall and winter. Where do they stay dormant and hide? Scientists discovered that certain coastal birds seem to be the reservoir for the viruses. There is fairly good evidence that the birds harbor these viruses without manifesting disease and have probably done so for millions of years. You may see a television show where scientists raise huge nets to catch migrating coastal birds to see what viruses they are carrying. Therefore, probably all “flu” is, to an extent, “avian” or “bird flu”. It is theorized that wild ducks infect domestic ducks, which in turn, either spread it to chickens or swine. Therefore, most of the flu is “swine” flu. You are not going to catch the flu from a piece of pork in your refrigerator.

The current H1N1 seems to have started with a small swine population in a desolate area of Mexico. The American pork industry has been recently affected due to the public not buying as much pork. But this is not the problem. The problem seems to be this one batch of flu that arose in Mexico to which humans did not have an immunity. With travel being what it is today, it did not take long for the virus to spread from person to person. It has recently even been announced that a group of swine were found to have the swine flu in Minnesota. It seems that both pigs and possibly chickens have the same viral receptors as humans and thus can be a vector for human transmission.

Some people are not getting “Novel H1N1” (the newer name for the 2009 Swine Flu) because they perhaps gain some immunity from previous H1N1 immunization. Most people who saw the outbreak of swine flu in Mexico thought it was too far away to affect them. However, as we know, times have changed. Swine Flu (“Novel H1N1 Flu”) is now widespread in most of the United States and elsewhere in the world. You will hear about it on almost every newscast and different government agencies hold numerous press conferences. The amount of daily information is enormous.

The best scientists of our time are saying, “Get your Flu shot when it is available.” (Actually they are saying,”Get your seasonal Flu shot now and the Swine or Novel H1N1 vaccination as soon as it is available.”) On the other side are the “nay-sayers” who say, “The 2009 Flu is not as bad as they said. Don’t give it to your children: it will give them autism. It has mercury or thimerosal in it. For my part, I’m siding with the CDC: Everybody should have the seasonal vaccination and the H1N1 vaccination.

One thing to remember is that it takes time for the immune system to respond to the vaccine for the 2009 flu. A conservative estimate is that it takes 6-8 weeks to achieve its desired effect. That is why the vaccine is better if you take it sooner than later. There are two kinds of flu vaccine; more will become available as they are released. Flu-Mist is an attenuated virus that is squirted into your nose. Because it is attenuated, it will not give you the flu and are not infectious. This is approved for use on patients aged 2 to 49.

The other is the Flu Shot, usually administered in the upper arm. The shot can cause some mild symptoms like pain at the injection site, low-grade fever, and slight sluggishness. These side effects respond to Tylenol or Motrin. Neither of the vaccines will give you the Flu, though the guy sitting in the next desk swears up and down that the Flu vaccine always gives him the Flu. Both treatments are grown in eggs, so if you have an egg allergy you must discuss this with your doctor to plan a strategy or avoid the injection.

We know that people with impaired immune systems get worse illness. In pregnancy, the immune system is not up to par. Of the 100 or so patients who have required Intensive Care Unit treatment, 28 pregnant women have died. That is why the 2009 Flu vaccination (both kinds) are so important for all pregnant females. There have been no adverse effects of Flu vaccination in any pregnant female. Others with impaired immunity have worse Flu illness: Diabetics, people with liver or kidney disease, AIDS, chronic neurological impairment, cancer, and/or chronic inflammatory diseases like arthritis and colitis. And the list goes on and on with chronic medical disease. These are the ones that push the numbers into the thousands for Flu-related deaths and prolonged hospitalizations.

And there is one other very important group: Kids. Their immune systems just have matured and acquired the antibody response that healthy adults have. In shear numbers, children get the Flu 2 to 3 more times than adults. That is why we are hearing tragic stories about otherwise healthy 7 or 10 year olds who have died with the Flu (there were 11 pediatric deaths in this country during week 38 of the current epidemic). This is the reason that as the CDC is releasing vaccine, they are targeting children for vaccination among the first to receive it.In Novel H1N1 Flu, 77 people autopsied, fully one third had Streptococcus pneumoniae, or as it is also called, pneumococcal pneumonia. True, it’s variably treatable with antibiotics.

But there is a proven vaccine available for this bacteria. It protects against 23 encapsulated pneumonia bacteria. It’s available for all ages with increased risk for immune deficiency. We know now that only one-third of those who should receive it actually get it. It can be given along with the flu vaccine. Ask your doctor about it: “Pneumovax 23”.The H1N1 2009 Flu is spread by respiratory droplets. This is why students in classrooms and military recruits in barracks are so susceptible. All it takes is one cough or sneeze, and the virus is out there ready to be picked up by the next person. It can persist on surfaces like grocery cart handles for 2 to 6 hours—-touch those hands to your eyes, nose or mouth, and you’re exposed. The incubation is 1 to 4 days after you’ve breathed in the virus-laden droplets. It’s ironic that you, in turn, are at most risk of spreading it to others the day before you first show signs of illness. No wonder it spreads!

Children can be infected for more than 10 days. Severe immune deficiency can cause a person to shed the virus for weeks or months. These people should kindly wear their masks when they are around the rest of us. The symptoms of the 2009 Flu are pretty universally recognized: Malaise (Just feeling tired and sick), chills, fever, headache, bodyache, nasal congestion, sore throat, and sweats to name the most common. There are danger signs, though: A pregnant woman with the Flu, productive cough (say, with discolored sputum), chest pain, altered level of consciousness, (maybe disoriented or hard to arouse), appearing gray or with bluish lips like someone who is not getting enough oxygen, severe vomiting or signs of dehydration. When these are present, it’s time to get to the doctor or the ER. These are signs that you have some potentially serious complication of the Flu.

Most people will not have the serious symptoms, but we all need to be alert for them. Likewise most people with the Flu get better within a week or two. If the symptoms come roaring back after an initial clearing (relapse), this is a danger signal. In these circumstances, one might have pain with each breath, cough up nasty-looking sputum, or have hard shaking chills. Don’t fool around: Get to the doctor. Once again, children can have more serious symptoms and complications: Convulsions due to high fever, middle ear infections, and pneumonia.Let’s now talk about treatment. First of all don’t give aspirin to a child with fever. It is associated with Reye’s Syndrome: A serious multi-organ failure with potentially catastrophic brain injury. You can give Tylenol (acetaminophen) every 4 hours according to body weight for chills, fever, malaise and headache. Motrin (ibuprofen) every 6 hours seems to be a safe alternative. The person should take in a lot of fluids— Water, Gatorade, light soups, and eat lightly as the stomach allows. Bedrest with lots of naps is recommended to shorten the length of illness.

The person should stay home from work or school until there has been at least one full day without Tylenol or Motrin, and no fever. But what about the pregnant woman, the patient with chronic medical conditions, the person with decreased immune function, and very symptomatic children? These are the cases in which the doctor must see and decide whether to prescribe antiviral medication. It can be used prophylactically for persons closely exposed to the Flu patient to lessen or prevent the Flu. The 2 antivirals that we use are oseltamivir (Tamiflu) and zanamivir (Relenza). Tamiflu comes as a caplet for adults or a liquid for children. Relenza comes in a metered dose inhaler. Both are used every day for 10 days. They work best when given within the first two days of symptoms. They decrease the severity of the symptoms and shorten the course of the 2009 Flu. Relenza is not a good choice for patients with asthma or chronic lung disease.

The CDC and the Biopharmaceutical companies have worked exhaustively to prepare a safe vaccine to keep people from getting the severe ramifications of the flu. That’s it, pure and simple. There is a lot of magical, wishful thinking in the population on how to “beat the flu,” but science is not on their side. There is no vitamin, raw vegetable, or special drops to prevent the flu. “Flu Parties” are a terrible idea to get flu immunity. It is time to realize that the CDC is a collection of the best minds in science and medicine, dedicated to the protection of health for the U.S. citizens and person around the world in the event of a pandemic. It is not the IRS, Homeland Security, or the CIA. It is doctors and scientists trying to keep the public well, period. It’s time to stop blowing the conspiracy horn and take your shots. In doing so, you protect yourself, your family, your co-workers, and your fellow citizens in general. So, roll up those sleeves!

I was watching a press conference the other day by Dr. Ann Schuchat, the CDC Immunization Director. She had a very well-constructed report addressing the plans for mass immunization in a tiered way so that the ones at most risk would receive their vaccinations first. She was very candid about flu deaths to the present, and the intricacies of combating the epidemic, or more correctly, the pandemic of novel H1N1 (Swine Flu, as it is often known.) What impressed me a lot was the presence of major news reporting organizations: AP, UPI. Atlanta Journal, Washington Post, ABC, and USA Today. They all asked excellent questions and received excellent answers. The conference lasted about 35 minutes, and if every person could tune in to these informative events or rely on major reporting presentations, there would be a lot less misinformation out there.

Here is the discussion of the 2009 flu in a nutshell:

1.) Get your seasonal flu vaccination, either shot or nasal spray;
2.) Get your Novel H1N1 (Swine Flu) vaccination when it is available;
3.) If you are pregnant or have chronic illness be sure to get both;
4.) Be sure kids are vaccinated;
5.) If you have severe flu or a relapse–see your doctor;
6.) If you have the warning signs of severe illness– see your doctor;
7.) Wear a mask if you are sick or severely immune deficient;
8.) It takes about a week to get over the flu. Do not return to work or school until you have been fever-free for at least 48 hours; drink plenty of fluids, take Tylenol or Motrin for fever, and bedrest as much as possible. Do not give other over-the-counter medicines to young children without consulting a doctor; do not give aspirin for fever as it may lead to Reye’s Syndrome;
9.) Learn as much as you can about the Flu from reliable sources;
10) There are no magical Flu preventatives or treatments out there–Rely on science and a physician to get through this time.