‘Tis the Season

Imagine you open your newspaper and find this headline story:

"A highly infectious disease is sweeping the planet, affecting nearly every industrialized nation and killing hundreds of thousands of people. A vaccine is available, but thousands are refusing it out of fear over its safety.  In the United States alone this viral plague has resulted in 36,000 deaths, 3 million days of hospitalization, 30 million doctors visits, and culminated in total medical costs of $10 billion and a societal financial impact of over $80 billion.”

While this sounds like the plot from a Roland Emmerich disaster movie, with disease and mayhem on a biblical scale, it is nothing more than the seasonal influenza that we face on a yearly basis.  I use these grim statistics (published in 2007 and based on a study of the flu of 2003) to put the current swine flu (or H1N1 flu) pandemic into perspective.

First, a little overview on influenza—a “Flu 101,” if you will.  Flu is a viral illness caused by a variety of influenza viruses that affect birds and mammals.  We are all familiar with the typical symptoms: fever, sore throat, cough, muscle aches, and the overwhelming desire to sip hot tea and lounge on the couch.

While certain strains of flu virus have taken on exotic monikers such as Asian flu, Spanish flu and Hong Kong flu, the more technical nomenclature for the virus uses the letters N and H to refer to specific proteins the virus contains.  As examples, this year’s famous swine flu is due to an H1N1 virus and the bird flu that swept through Asia a couple years ago was an H5N1 variant.

The most deadly flu outbreak in recorded history was the Spanish flu pandemic of 1918.  This H1N1 virus managed to infect a third of the world’s population and killed between 50 and 100 million people.  It’s not clear why this particular strain of H1N1 was so dangerous—it was unusual in the sense that it seemed to be deadlier in healthier, younger people than in the older, feebler population.  We’ve had several other outbreaks of H1N1 since then (including the current one) but none have been so devastating.

This autumn we are facing two influenza threats: the usual, seasonal flu (which no one seems to get very excited about) and the looming explosion of the swine flu (which is in the news on almost a daily basis).  The swine flu started out in Mexico (hence the other name “Mexican flu”) and migrated northward.  It has now been confirmed in every industrialized nation.  Thus far the US has seen 26,000 confirmed diagnoses with fewer than 600 deaths. It turns out that for all the excitement and fear surrounding this new menace, it appears the H1N1 swine flu virus is only about one-third as deadly as the annual seasonal flu.

You can get great information about seasonal flu and the H1N1 swine flu on many internet sites, including chihealth.com and the Centers for Disease Control.  Here are my boiled-down recommendations:

1. Wash your hands and observe common sense (e.g. don’t cough on other people, at least those people you like).
2. Get your flu vaccines.  If you fall into one of the high-risk groups you’ll need two this year, the usual seasonal flu vaccine and the H1N1 vaccine.
3. Stay home if you’re sick.  Don’t go back to school or work until you are fever-free for 24 hours.

Pretty simple stuff I think.

Here are some of the frequent questions I get from patients regarding the flu and flu vaccine:

What are the signs and symptoms of the H1N1 flu??
The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu and have respiratory symptoms without a fever. Click here for a helpful and concise video on the subject put out by the CDC.

Who should get the H1N1 vaccine when it becomes available?
CDC’s Advisory Committee on Immunization Practices has recommended that certain groups of the population receive the 2009 H1N1 vaccine when it first becomes available. These target groups include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems.

Can a flu shot give you the flu?
No, a flu shot cannot cause flu illness. The influenza viruses contained in a flu shot are inactivated (killed), which means they cannot cause infection. Flu vaccine manufacturers kill the viruses used in the vaccine during the process of making vaccine, and batches of flu vaccine are tested to make sure they are safe. In randomized, blinded studies, where some people get flu shots and others get salt-water shots, the only differences in symptoms was increased soreness in the arm and redness at the injection site among people who got the flu shot. There were no differences in terms of body aches, fever, cough, runny nose or sore throat.

Should patients with heart disease get the flu shot??
Yes.  Interestingly, a study published in this month’s Lancet Infectious Diseases pooled data from numerous studies on the flu vaccine and concluded that getting the flu shot can actually cut your risk of a heart attack.  It appears that the influenza virus can destabilize coronary plaque and trigger heart attacks.

Why are there so many names for this new flu??
All the synonyms are confusing.  The The Mexican government was quick to condemn the name Mexican flu and Tom Vilsack and the pig farmers don’t like the name swine flu.  The World Health Organization and CDC have now settled on the non-pejorative term H1N1 flu (although you must admit it doesn’t really role off your tongue).

Will I get the swine flu if I eat lots of sausage and bacon?
No, just heart disease.

At what point does Bruce Willis assemble a team of rag-tag ruffians to combat this global menace??
Once we learn that the real source of the flu is not a virus but rather a meteor careening through space on its way to destroying our planet.