H1N1 Scrabble
The influenza strain formerly known as swine flu has now been with us for about five months and the first vaccines are arriving, so it’s time for an update.
We are experiencing several unusual events. The last pandemic was in 1968. Influenza rarely occurs during the summer, but this pandemic has continued throughout the hot months. Will it replace the seasonal flu which generally appears about now, or will they occur side by side? We continue to vaccinate high-risk patients with the ordinary flu vaccine but it offers no protection against H1N1. Folks over 60 are immune. Deaths have been uncommon, perhaps 1000 in the U.S. compared to 36,000 in an average influenza year, but the highest rates have been in young adults and infants. So whom to vaccinate?
CDC suggests focus on priority groups, the first being pregnant women, then those caring for infants under 6 months, followed by kids 6 months to 4 years. Vaccine clinics have sprung up with long waiting lines; so far they are the only option. Safety should not be an issue with the killed injectable vaccine, given the better technology we have compared to the 1976 fiasco. I would not consider the live intranasal vaccine safe. The wild card is that by the time we could even vaccinate all those groups, almost all patients will have been exposed to the actual disease. H1N1 is also odd in that it causes more vomiting and diarrhea than other strains and therefore may not be recognized. Moreover, at least 40% of infected people have no symptoms at all. Computer models show that the best we could hope for with a mass vaccination program is a 6% reduction in cases.
Treatment with drugs such as Tamiflu is available but overrated in that it shortens the illness by just a day, and I believe the toxicity in children makes its use unacceptable.
I don’t expect the above information to change much over the next few months. The decision to vaccinate or not is one we need to make together. Clearly the threat of this new virus is more economic than medical. Government mandates to vaccinate have been tried and will backfire, given the mood in the country. We should have some vaccine within the next two weeks (that’s not a promise). In the meantime stay out of crowds, wash hands and store up some herbal tea, chicken soup and your favorite headache remedy.
January 1st, 2010 at 9:01 pm
My brother got infected with H1N1 or Swine Flu in Mexico. He got a mild fever and luckily he did not die.