H1N1 Flu: Questions & Answers

December 1, 2009

H1N1 Flu: Questions & Answers

I received the mist version of the H1N1 flu vaccine. Since I received a live virus, I wondered if I kissed my children more than I usually do whether or not I would be able to transmit inactivated virus to them and therefore protect them from obtaining the real Mccoy. Dr. Dave Quimby with Infectious Disease and Epidemiology Associates was gracious enough to grant me an interview to answer this question as well as some others that I had.

Aaronson: H1N1 influenza virus: what’s the latest? Has anything changed?

Quimby: Not really. One new development: If a person contracts this virus, becomes sick and has to be admitted to an intensive care unit and is unable to take medications orally like tamiflu, there are some new antiviral drugs that we can obtain from the centers of disease control that can be given intravenously.

Aaronson: You and I have been involved in taking care of some patients who have been really sick in the hospital with H1N1. Some have done well, others have not. In your opinion, if someone is sick enough to get admitted to the hospital, what predicts whether a patient will do well or not? If Alegent Nephrology gets called because of kidney failure, what is the patient’s prognosis compared with not having kidney disease?

Quimby: The more organs that shut down, the worse off you are. If the kidneys have failed the person is at high risk.

Aaronson: Is the H1N1 influenza vaccination still effective?

Quimby: It is as effective as any flu vaccine.

Aaronson: Have there been any changes or mutations in the H1N1 bug?

Quimby: There have been a handful of cases where the H1N1 flu was resistant to Tamiflu. But those are very, very few and far between.

Aaronson: Why are some people afraid of the vaccine?

Quimby: Because of a lot of incorrect information out there, you’re going to find people afraid of any type of vaccine. There’s no more reason to be afraid of this vaccine than any other vaccine. The vaccine is safe. I got it. You got it. I gave it to my two and half year old who qualifies under the guidelines.

Aaronson: I would like my kids to get it, but availability of the vaccine is hard to find. Alegent does have a phone number people can call (402-717-H1N1) to check availability and to schedule an appointment. My understanding is there will be more vaccine available soon. I encourage all my patients and everyone I know to call that number and get on the list so they can get their vaccine as soon as possible. If a person has a choice between the mist and the shot, which one should they choose?

Quimby: Because of the shortage, I would go with whichever one a person can get their hands on. If a patient has a bad medical condition such as leukemia or is receiving chemotherapy, I would not recommend a live vaccine in general. I would just do a shot.

Aaronson: Let’s talk about the standard flu shot. There are people who opt out of receiving a regular influenza shot, thinking “if I get the flu, I get the flu. I’ll take the risk.” Now that we are at risk for contracting swine flu, should this opinion change?

Quimby: In general, people usually mistake the common cold for the flu. Actual influenza even in a healthy person, will knock you down for a week and a half. People I see who get the real flu learn how horrible it is and usually decide to get a flu shot yearly from that point on. The reason why H1N1 is so virulent [infectious] is that people have never seen this new strain, and they have no partial immunity to it. The reason why H1N1 can kill healthy people so easily is that it is different from anything most of us have seen before.

Aaronson: Why can’t a person get both the standard flu mist and the H1N1 mist at the same time?

Quimby: I don’t know. But there such a shortage of both of them that it usually is not a big issue at this time.

Aaronson: As you know, I got the H1N1 flu mist. I was wondering if I kissed my children more than I usually do if I could give them an inactivated form of the virus and protect them from the real thing. Is that crazy?

Quimby: It’s not crazy, but it’s not likely to work. The mist is a live virus that has been weakened. Therefore the chance of spreading it person to person is exceedingly low. Since the virus is so weak, it’s very unlikely that it will make you sick. So although well intentioned, your display of affection most likely was just that.

Aaronson: There is a concept called to herd immunity that infectious disease folks like to talk about. Wiki defines it as “a type of immunity that occurs when the vaccination of a portion of the population (or herd) provides protection to unprotected individuals. Herd immunity theory proposes that, in diseases passed from person to person, it is more difficult to maintain a chain of infection when large numbers of a population are immune. The higher the proportion of individuals who are immune, the lower the likelihood that a susceptible person will come into contact with an infected individual.”

So here is my question, if many people in Omaha and its surrounding areas get vaccinated, are the ones that refuse or can’t get vaccinated protected from infection? Does that concept apply here?

Quimby: Not really in this case because the H1N1 flu is so easily spread to others, unless almost all of the people in Omaha get vaccinated, if there’s any flu virus around, those not vaccinated are still at very high risk. These unvaccinated people are at high risk because of the way H1N1 is transmitted person to person. So people need to get their vaccine. Make sure you bold that. Right now, we don’t have enough vaccine to give to everybody, and that’s why we risk stratify – we give it to those who need it the most.

Aaronson: And the Alegent hotline, 717-H1N1, does just that. I would encourage our readers to pick up the phone and give a call so that they can get vaccinated as soon as possible.

Quimby: That is correct. It should be noted that once more vaccine becomes available, anyone who wants it will be able to get it.

Aaronson: I’ve seen in the news the suggestion that now that the first wave of infectious H1N1 has passed through Nebraska the need to get vaccinated has lessened. Since I am a kidney specialist who spends a lot of time in intensive care units helping to take care of very sick patients, I’ve seen some really bad cases of the swine flu. I disagree with the thinking that the unvaccinated population is safer now than before. Is my thinking based on a referral bias, where I think a certain way because I’ve seen the small percentage of people who’ve gotten so sick that they have needed to be admitted to an intensive care unit for support and therapy? Since infectious disease specialists such as yourself are also consulted on these patients, you know what I’m talking about. Are we safer now?

Quimby: No. It is still very important to get vaccinated when you can. Many people still have not been exposed in any fashion to H1N1. So the risk will still be there until H1N1 goes away, you get actual herd immunity from vaccines, or you get actual H1N1. Since most people have not had the flu vaccine or the flu, the risk of getting it is still very high. There are still many people who can get it and that keeps this terrible infection going.

Aaronson: So let’s pretend that I am a patient, and I have cold symptoms. I’m worried that I have H1N1. I go to my primary care Physician and ask the question should I be tested for H1N1? How would you answer?

Quimby: A nose swab can be done in a primary care setting. The problem is that this rapid test for influenza type A is NOT the H1N1 influenza virus. There is a cross reaction, so a positive test implies that there is a possible H1N1 infection. The problem is that a person can test negative and still have H1N1. So in other words, if a person actually has H1N1 influenza, the immediate test done it in a primary care office setting is positive six out of 10 times, which is basically the same as flipping a coin.

Aaronson: That’s why I don’t recommend it unless I’m worried about standard influenza A or B virus. However, I do think it is important for people who are concerned and get sick very quickly to go to their doctor as soon as possible to see if they are a candidate for Tamiflu.

Quimby: I base this diagnosis for the most part on the patient’s clinical picture. How they present.

Aaronson: Thank you professor for your time. We appreciate hearing your expertise on this issue.

In sum, remember to call 717-H1N1 if you have not gotten your H1N1 vaccine yet and get vaccinated as soon as you can! You can also visit the CHI Health Flu Center for the latest updates. Thanks for reading.



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