H1N1: Nothing to sneeze at

The flu season is upon us with an extra gift, the H1N1 novel virus, or swine flu. The microscopic malady has made national news, daily, since summer, a good five months before its official debut was expected. There are many myths, much confusion and lots to learn about influenza, say local physicians, as this year’s flu season is nothing to sneeze at.

Dr. Dhaval Shah, infectious disease specialist, MountainView Hospital, said there are two types of flu; H1N1, which is the seasonal flu that most are familiar with, and the H1N1 novel, or as it is more colorfully labeled, swine flu.

“H1N1 comes in two flavors, seasonal and novel, and the one that is causing a lot of issue is the H1N1 novel,” Dr. Shah said.

Swine flu is different than the seasonal flu as it contains genes from swine, birds and humans, therefore it has a different severity and it is acting differently, he said.

The severity depends on the person who has become infected. In general people who have a good immune system who get H1N1 novel can get over it.

Many experts say the H1N1 virus isn’t as dangerous as the public may fear in that hundreds of thousands may have already had it and passed through it thinking it was the seasonal flu. However, the H1N1 novel can turn deadly for a small group of people, including pregnant women, children and those with serious immune deficiencies.

The odds of being infected with it in general are very high.

“There’s maybe 70 to 80 percent chance that people will get it,” Dr. Shah said. “It spreads by airborne route and we live in a town where it is easy to spread.”

Very few, less than 2 percent, of the population will be hospitalized, he said.

“Usually what we are seeing is that with H1N1 it’s little different than regular flu, but we are still going to see hospitalization,” he said.

H1N1 novel would cause more hospitalization than regular influenza.

“That’s because seasonal influenza is limited, where people don’t get as sick,” Dr. Shah said, “but H1N1 (novel), they get sicker faster.”

The flu season usually starts in October and runs through February. However this year the flu seems to have gotten an early, and strong, start. In Dr. Shah’s 15 years in practice he has not seen a flu season like this before.

“I’ve been seeing patients since June with flu,” he said.

He expects the season to peak in January, but that can change considering the virus isn’t sticking to its normal pattern this year.

“I’m not sure this flu season is going to be over (in February) but in general the seasonal influenza is October to February,” he said.

While many are accustomed to receiving the seasonal flu shot, they may be leery of the swine flu vaccine.

“Two things that people are afraid of are that it is a new vaccine, so there is no previous data, and they are worried about how safe it is,” Dr. Shah said. “And two, they may be afraid of the same problem that happened in ’67, where people who got this vaccine and end up in the hospital with Guillain-Barré syndrome.”

Guillain-Barré syndrome is an acute neurological disorder involving partial paralysis of several muscle groups after certain viral infections and vaccinations. It is rare and the cause is unknown.

Dr. Shah has studied many research papers and says that the companies which have created the vaccine have done extensive work on the vaccines currently available and the Center for Disease Control and the Food and Drug Administration have both approved it.

“Personally, I would get the shot,” he said. “It is very safe.”

Dr. James Swift, medical director for Sunrise Children’s Hospital, also understands the public’s concern over a new-to-them vaccine as well as the wariness of getting a seasonal flu vaccine if they have never done so before.

“I hear people say they have never taken the flu vaccine because they hear people have gotten ill from it,” he said.

That’s not quite right, he said, because if you get a bit achy or have a mild fever (mild being the operative word), it’s simply your body creating the immunity to the virus that will get you safely through the season.

“But the benefits of the vaccine, based on how aggressive this flu is, far outweighs the risk,” Dr. Swift said.

The FDA has studied this vaccine, and the process to create the vaccine is the same as it  has been every year for seasonal flu, Dr. Swift said.

“That process is pretty tried and true,” he said. “They took the same process for H1N1 and tested in different populations, and FDA did the standard trial and did an extra step for extra scrutiny and it passed muster of the FDA that it was safe and effective.”

Of the two methods of vaccination  available, the FluMist may cause the most alarm, Dr. Swift said, as it is a live virus. However, it is degraded to the point that it can not affect you. The FluMist is recommended for children and adults older than 2 years of age.

“People are scared because they hear terrible stories,” Dr. Swift said. “You might have fevers or chills simply because the immune system works so well.”

Currently the immunizations are for pregnant women and for children and caregivers of children less than 6 months of age, and those ages 2-24 and ages 25-64 with chronic health problems.

“What happens is all of a sudden you get the flu shot and the immune system says that’s abnormal and I want to kill it, so the immune system ramps it up and you have fever and chills,” he said. “The majority of people have no effect from the shot.”

The flu itself, for those not immunized, may cause some minimal symptoms that can be easily kept in check with the usual round of over-the-counter medicines and other tried and true home remedies.

“But the small amount of people that require hospitalization are very, very sick,” he said. “We must acknowledge that certain populations in the high-risk category in the early information from the CDC (get immunized). We can only look at the emerging trend and react to that.”

In all vaccinations, but specifically in flu vaccines, there can be very rare complications or risks, he said.

“But you have to weigh it against the number of people or pregnant women who would have an adverse reaction, which is minimal, to the number who have died (from the flu),” he said.

Most of the patients who are coming in with novel H1N1 are having no different symptoms than the majority, he said.

“We’re seeing more of it, that’s the issue, it’s a pandemic,” Dr. Swift said. “Secondarily we are going to see a higher number who need hospitalization.”

Those who are going to be hospitalized are much more ill in appearance and physicians are seeing more of them than in the usual flu season.

“Is this a more lethal form of the flu? The answer is it appears to be,” Dr. Swift said. “Every year we see a number of deaths from flu, but this year we have seen a higher number already.”

Don’t panic just yet.

“It is in higher risk groups, not normal groups, which is why we are advocating the vaccine to circumvent this phenomenon,” he said.

The Southern Nevada Health District received its first delivery of the injectable 2009 H1N1 influenza vaccine in mid-October Of the 550 emergency first responders with the Las Vegas Fire Department who were encouraged to receive the FluMist inhaled vaccine, only a handful had originally received it when it was made available in early October.

Tim Szymanksi, a fire department spokesman, told the Las Vegas Review-Journal that even he wasn’t completely confident in taking the live virus in the FluMist form and would wait for the injectable vaccine to be made available.

While worry may be widespread, Dr. Swift emphasizes that the vaccine is most needed by the valley’s infants and toddlers.

“We can’t help but acknowledge and recommend to get the vaccine for children,” Dr. Swift said. “What we have seen most notably in the hospital are the infants (seriously ill with the flu).”

Doctors are urging parents to watch for the warning signs that the flu has advanced to a threatening level, as more than 75 children have died in the United States from the new virus since April. Compare that with the 68 who died in all of 2008 and you begin to see why the medical professionals are urging the vaccination so strongly.

“Keep children home, treat with fluids and Tylenol and stay home until fever is done for 24 hours,” Dr. Swift said. “Ask yourself, do I need to take myself or my child to the doctor? If your symptoms are worsening, the answer is yes.”

Most of this is going to be mild symptomology, he said, meaning that it can be treated at home with the usual fluids, Tylenol, Tamiflu (prescription only) and rest, lots of rest. If you have the flu, stay home until you have been fever-free for 24 hours without the use of fever-reducing medications.

An infectious disease clinic is available at MountainView if you have immediate questions or concerns about the flu. (968-2437. www.cidsinfusion.com)

“We want to get the word out because we are trying to keep the emergency rooms from being overwhelmed,” Dr. Swift said. “We’re trying to advocate that we are there and we can help them and we are screening them as they come in.”

If you are in the priority groups acknowledged by the CDC to be eligible to receive the vaccine, local physicians strongly urge you to be vaccinated, stay home if you are sick and to take care to keep your hands clean.

“We all have advocated that those are the recommendations and I believe the vaccine to be safe,” he said. “That’s as much of a guarantee as I can give.”