The flu and you: What you need to know, just in case

Pardon the pun, but to clear your head of confusing flu information, The La Jolla Light put the following questions before someone in the know. We are grateful to professor Robert Liddington, Ph.D., director of the Burnham Institute for Medical Research’s Infectious Disease Program, for his answers and advice on how we can all best handle the precarious flu season now upon us.

1 How does the Pandemic H1N1 flu differ from

traditional seasonal flu’s?

The Pandemic H1N1 is attacking mostly children and young adults, although it is people aged 25-50 who seem to be most at risk of serious complications/death. People over age 60 do not seem to be getting this flu in significant numbers.

In a traditional flu epidemic, it is the very young and old who are most at risk, so this is a very different scenario. It seems likely that older people were exposed decades ago to a similar “swine” flu, and so have an “immune memory” and can mobilize their immune system fast enough to deal with Pandemic H1N1.

The risk of complications and death do not appear to be higher for a given individual compared with traditional flu. Also, it seems to be about as easy to catch from an infected person as traditional flu. There is a very real danger, though, that very large numbers of people will contract the Pandemic flu, since they have little immunity (with the exception of older people). This could mean a lot more deaths.

The Pandemic H1N1 does not appear to be “seasonal” like a regular flu. In the past week, the CDC reported that 99 percent of all confirmed flu samples were the Pandemic H1N1. It will be very interesting to see if the regular seasonal flus will make a comeback as we enter the major flu season, or whether they have been “displaced” by Pandemic H1N1.

Pandemic H1N1 is still treatable by the antivirals, Tamiflu and Relenza — there seems to be little evidence that this flu is becoming resistant to them. By contrast, the CDC reported last week that the Traditional H1N1 is now almost 100 percent resistant to Tamiflu (but not Relenza).

1. How do I know when I’ve contracted the Pandemic H1N1 flu? What are the symptoms, how is a diagnosis made?

The early symptoms do not seem to be very different from traditional flu’s: fever (but not everyone with Pandemic H1N1 has a fever); cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people have vomiting and diarrhea, which is not usual for traditional flus.
Adults rarely get fevers from other viruses (such as the common cold). So a fever is a good reason to phone your doctor’s office and describe your symptoms (and follow their advice), BUT THIS IS NOT THE TIME TO PANIC OR RUSH TO YOUR EMERGENCY ROOM.

Since the vast majority of healthy adults will recover from the Pandemic flu by bed-rest, plenty of fluids, Tylenol (to reduce fever), ibuprofen to reduce aches and pains, chicken soup, etc., most people will not need to see their doctor (and may be discouraged from doing so to avoid infecting others).

A fever in children is much more common, but reason enough to call your doctor. Do not use aspirin with children with influenza because it increases the risk of Reye syndrome. Your doctor will make an initial diagnosis, and may decide a test is warranted — the current tests (nose or throat swab, maybe blood test if inconclusive) are less than 100 percent accurate, however.

Mild secondary infections among children are sinus problems and ear infections, which should be treated by your doctor but are not generally serious. A dry hacking cough is also common.

If you have other signs of serious illness, get emergency care immediately.

Reasons to get concerned are if the flu does not resolve within a week, and/or your fever does not subside. In particular, if the congestion/pain is not restricted to the upper respiratory tract, this could be a sign of a serious lung infection — either as a direct effect of the flu or from a secondary bacterial infection (e.g., pneumonia).

Lower chest pains should be taken very seriously, and your health can deteriorate rapidly — call your doctor, or if the pain is severe, go to your emergency ward. Wear a mask if you have one.

These are the EMERGENCY WARNING signs from the CDC Web site:

• In children: fast breathing or trouble breathing; bluish skin color; not drinking enough fluids; not waking up or not interacting; being so irritable that the child does not want to be held; flulike symptoms improve but then return with fever and worse cough; fever with a rash.
• In adults: difficulty breathing or shortness of breath; pain or pressure in the chest or abdomen; sudden dizziness; confusion; severe or persistent vomiting
• How should I care for myself if I have the Pandemic H1N1 flu?

These (actions) should really be the same for any flu. Doctors generally are not prescribing Tamiflu/Relenza to otherwise healthy people (overuse will lead to drug resistance). Monitor your symptoms and check that they are not worsening or unusually prolonged (as above).
DO rest as much as possible; take plenty of fluids, etc. (as above).

DO NOT go to work. Your supervisor should recognize it is a false economy to allow you to spread the flu. Work from home if you can.

DO avoid close contact with other people as far as possible.

DO NOT shake hands, etc. If you do, tell the other person to wash their hands with soap or alcohol-based cleanser.

DO NOT sneeze or cough into an open space (use a tissue and dispose of immediately); sneeze into your elbow if there is nothing else at hand.

1. How long does H1N1 flu last? (Take to run its course?)

It varies but symptoms typically start two to three days after infection, and usually last from several days to a week. The CDC recommends that you stay at home at least 24 hours after your fever has gone (without taking Tylenol during that 24 hours).

1. How can I avoid catching the Pandemic H1N1 flu?

The major way to avoid flu is to avoid places where people congregate, and avoid anyone who is coughing or sneezing, and generally “keep your distance.”
If you do shake hands or touch any surface likely to have been touched by others (especially smooth surfaces such as supermarket carts, gym apparatus), wash your hands with soap/alcohol-based cleaner. NEVER touch your eyes, mouth or nose with unwashed hands. If you must spend time close to others who may be sick, wear a surgical mask.

The second major way is to get vaccinated against seasonal flu and pneumonia (e.g. ‘pneumovax’) — these shots are available to everyone, and get vaccinated against Pandemic flu (when the vaccine arrives, and according to your priority status). The only exceptions are people known to be immuno-compromised and people who suffer or have suffered from the rare conditions, Guillain-Barre syndrome.

There is no evidence that the seasonal vaccine offers protection against Pandemic H1N1. The first batches of Pandemic vaccine will be reserved for those most at risk of having complications/secondary infections. The last people to get them currently will be the over-60s, as they have “seen it before.”

The exact timetable has not been decided yet (the first batches are supposed to become available towards the end of October), as vaccines are coming from various manufacturers at different times, and safety trials have not been completed for all.

The vaccines should be available at most hospitals/clinics, and possibly at your workplace. Frequently check the Web sites listed for updated information.

The CDC has identified the following priority groups to get the Pandemic vaccine: pregnant women; persons who live with or provide care for infants age 6 months and younger; health care and emergency medical services personnel; children and young adults age 6 months to 24 years; and people ages 25-64 who have medical conditions that put them at higher risk for influenza-related complications.

For people not in these groups, a decision will be made at a later date as to how to distribute vaccine.

1. Who is most vulnerable to this flu? Is there a factor for mortality?

The most vulnerable groups are those listed above as the first recipients of the Pandemic vaccine. The “high risk” group includes people who have cancer, blood disorders, chronic lung disease including asthma, diabetes, obesity, heart disease, kidney and liver disorders, muscular dystrophy and multiple sclerosis; and any person with a weakened immune system (including people with AIDS). There is no “mortality factor.” Some apparently very healthy people occasionally get very ill with Pandemic flu.
The least vulnerable groups are healthy adults older than age 64.

1. How easy is it to catch this flu?

This was mostly answered above. It’s as easy to catch as seasonal flu, and spread in the same way. It is not more virulent than seasonal flu, but if many more people get flu, many more people will get very sick or die.

1. How long is one contagious?

It varies, but generally from about one day BEFORE you have symptoms to the end of the illness (five to seven days); but may be longer for children or people with weakened immune systems.

1. Are any over-the-counter meds helpful in treating this flu?

There are only medicines to treat symptoms, such as acetaminophen (Tylenol) to reduce fever, ibuprofen (Motrin, Advil) to treat aches and pains. Keeping well hydrated is very important. There are rehydration formulations available, but I prefer to drink regular ginger ale because it also helps nausea.

1. If this year’s outbreak leads to a communitywide quarantine, how long would such last? Is it likely to occur?

At this stage, there is insufficient information to answer these questions. Again I refer the reader to the local Web sites for up-to-the-minute information. I can only say that we can minimize the chances and length of any quarantine if everyone gets vaccinated and follows the basic health precautions outlined above.
CDC update

During the week of Oct. 3, influenza activity continued to increase in the United States. Flu activity is now widespread in 37 states. Nationwide, visits to doctors for influenzalike illness increased over last week and are higher than expected for this time of year. In addition, flu-related hospitalizations and deaths are increasing as well, and are higher than expected.

— Source: Centers for Disease Control and Prevention