H1N1: Millions Infected Yet Many Say No to Vaccine

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By The Health and Medicine Foundation

Antiviral Medications Offer Relief to Severely Ill

The H1N1 flu virus is hitting the country hard – and taking its toll. Millions of Americans are affected. It’s widespread in 48 states. And the availability of the H1N1 vaccine is outpacing supply.

Almost half of Americans say they don’t want the vaccine, despite the news that just last week alone, the Centers for Disease Control and Prevention (CDC) confirmed 80 deaths (including 22 children) and 3,000 hospitalizations. That brings the total number of people affected by the flu to record numbers according to information compiled by the Health and Medicine Foundation.

In a nationwide poll conducted by McClatchy-Ipsos, 52 percent of Americans say they are likely to get the vaccine; however, 47 percent say they are not. Health professionals strongly recommend vaccines for both seasonal and H1N1 flu. However, people are waiting in long lines in some areas to receive them and many are turned away when supplies run out.

Flu Facts, Symptoms, Prevention and Precautions

The 2009 H1N1 Swine flu is a new influenza virus that was first detected in the U.S. in April. It is widespread throughout most of the U.S. and expected to affect millions of people. Swine flu can lead to severe illness and death.

Symptoms of Swine flu are the same as regular or seasonal flu: fever, cough, sore throat, runny or stuffy nose, body aches, headaches, chills and fatigue. Many people also report diarrhea and vomiting.

Those at greatest risk for complications of H1N1 are children under age 5, pregnant women and people with chronic conditions such as asthma, heart disease, liver disease, kidney disorders, blood disorders, cancer and HIV/AIDS. The World Health Organization (WHO) notes that obesity may be another risk factor for flu-related complications.

Like seasonal flu, the H1N1 flu virus spreads rapidly and easily through contact with a person who has the virus by hand contact, sharing cups, water bottles, canned drinks, coughs and sneezes or touching a surface or object with flu viruses on it and then touching the mouth or nose. The virus can live for 20 minutes to two hours on an inanimate object. A sneeze can travel up to eight feet spreading its germs.

It’s possible for people to be contagious even before knowing they are ill. People with seasonal or swine flu may infect others from one day before showing symptoms to seven days after. However, this can last longer in some people including children and those with weakened immune systems.

Health care providers, patients and family members providing care should watch for signs that the flu is becoming a more serious disease. Changes can occur rapidly and medical attention should be sought when any of the following danger signs appear: shortness of breath or difficulty breathing, turning blue, sudden dizziness, bloody or colored sputum, severe or persistent vomiting, pain or pressure in the chest or abdomen, confusion, high fever that persists beyond three days.

In children, emergency warning signs that call for urgent medical attention include fast or difficult breathing, bluish or gray skin color, not drinking enough fluids, sever or persistent vomiting, not waking up or not interacting, irritability and not wanting to be held. Also, seek medical help when flu-like symptoms improve and then return with fever and worse cough.

To guard against getting the flu, be sure to wash hands frequently with soap and water or use hand sanitizers. Cover your nose and mouth with a tissue when sneezing or coughing and then dispose of the tissue. Or sneeze and cough into your elbow. Avoid touching your eyes, nose or mouth. Avoid contact with sick people. Stay in good health, exercise, eat healthy meals, and get plenty of sleep.

Keep surfaces in the home clean, including bed tables, bathroom surfaces, kitchen counters, tables, doorknobs and children’s toys. Clean items frequently with a household disinfectant.

“We had anticipated having significantly more (vaccine) available by now than we do and that’s been frustrating to all of us,” said the CDC’s Frieden. “We are, though, beginning to see significant increases in vaccine production and distribution and we think it will get easier to find vaccine in the weeks to come.”

Kathleen Sebelius, U.S. Health and Human Services Secretary said 30 million doses of the vaccine have been released to 150,000 sites in the U.S. and 10 million new doses were released the first week of November.

Frieden has confidence in the vaccine, its safety and ability to do the job. “It has a good safety track record and reduces the chances of getting the flu,” he said. He noted that the groups at the highest risk of severe illness and highest priority for the vaccine are children from age six months to young adults 24 years old, people with underlying health issues, such as asthma, heart and liver disease, health-care providers, and those who provide care for infants age six months and younger. It’s recommended that children under the age of nine get two doses of the vaccine.

Doctors are prescribing the antiviral drugs Tamiflu by Roche and Relenza by GlaxoSmithKline for the very sick and those at risk due to underlying health conditions. The Food and Drug Administration is allowing emergency use of an experimental drug, Peramirvir from BioCyst Pharmaceuticals, Inc. for treating severe cases of the H1N1. The drug is undergoing testing required for formal FDA approval.

The flu and flu-related illnesses are as widespread as they usually are at the peak of the regular flu season. So far this season, U.S. swine flu deaths have surpassed 1,000, including more than 112 children. Visits to doctors’ offices for flu-related illness increased steeply and are up six times over the same time last year. The World Health Organization (WHO) reports 5,700 deaths worldwide and more than 440,000 laboratory confirmed cases of pandemic influenza H1N1 2009 as of Oct. 30.

CDC Director Dr. Thomas Frieden said the H1N1 flu virus is affecting “many millions of people.” Officials can’t provide an exact number because not everyone is tested and only children’s deaths are counted. However, between April and July, 2009 CDC scientists estimate that between 1.8 million and 5.7 million cases of the H1N1 virus occurred in the U.S. and that there were 9,000 to 21,000 hospitalizations during that time.

“The H1N1 flu never went away during the summer,” said Dr. Anne Shuchat, Director of the National Center for Immunization and Respiratory Diseases. “The virus is virtually everywhere.” According to the CDC, more than 99 percent of the flu viruses in the U.S. are H1N1.

In August, President Barack Obama’s advisors on Science and Technology predicted that the H1N1 flu virus could cause as many as 30,000 to 90,000 deaths. Their report also estimated that 30 to 50 percent of the population is at risk of getting the flu with up to 300,000 patients occupying intensive care units. The deaths are predicted to be primarily among children and young adults.

This is the first flu pandemic in 41 years, yet it’s reminiscent of the earlier influenza pandemic of 1918, when 50 million deaths occurred worldwide. During normal flu seasons, between 30,000 and 40,000 deaths occur each year mainly among people over 65 years.

While the ever-growing figures are grim, the CDC reports that 99 percent of Americans who get the flu get better after a few days. That’s due to precautions such as frequent hand washing, avoiding sick people, drinking plenty of fluids, eating healthy meals, exercising and vaccinations.

Two types of vaccine are offered for the 2009 H1N1 influenza virus: a shot in the arm and a nasal spray. The latter is not recommended for pregnant women. Frieden said the H1N1 vaccine is “an excellent match for the virus that’s circulating and will be as highly effective as the seasonal flu vaccine.” To those who are concerned about the safety of the vaccine, Frieden said, “It’s the same manufacturing process, it’s the same factory, it’s the same safeguards” that are used for producing seasonal flu vaccine.

While those over age 65 should be vaccinated for seasonal flu, they aren’t on the list for recommended H1N1 vaccinations at this time. Laboratory tests indicate that older people may have a pre-existing immunity to the virus because they probably had some form of swine flu in their younger years.

The number of patients seeking treatment is overburdening hospital emergency rooms and doctors’ offices. Some hospitals have set up triage in their parking lots while others offer drive-through exams and treatment, especially convenient for entire families sick with the flu. These measures also keep the flu out of emergency waiting rooms and away from heart patients and others whose conditions may be severely worsened if they contracted the virus.

Several school districts across the country are reporting heavy absenteeism. The federal government recommends that schools close only as a last resort, but so far this year approximately 600 schools have temporarily closed their doors due to the flu.

The pandemic prompted President Obama to declare the H1N1 a national emergency, which paves the way for hospitals and local governments to set up alternate sites and procedures to handle large outbreaks of the virus. The presidential proclamation will make it easier for people to seek treatment and for medical centers to handle the expected surge of patients immediately.

The statement issued by The White House said the declaration is intended to prepare the country in case of “a rapid increase in illness that may overburden health care resources.”

It allows for waivers of some requirements for Medicare, Medicaid and other federal insurance programs as needed.

The CDC recommends starting treatment with antiviral medications – Tamiflu, Relenza and Peramirvir – for those who have flu symptoms and not wait for test results to confirm if a patient has seasonal or swine flu. The symptoms and the treatments are essentially the same for both types of flu.

Those with mild cases of the flu may not need antiviral drugs, but should stay home and get plenty of rest. They are the people who will respond to Mom’s chicken soup, said Shuchat.

For more information go to www.flu.gov and www.healthandmedicinefoundation.org

Compiled by the Health and Medicine Foundation (www.healthandmedicinefoundation.org)

By The Health and Medicine Foundation