H1N1 burst onto the scene last spring (2009) causing much concern. There were quite a few deaths, especially in young people, which is unusual for the flu. It also caused illness throughout the entire summer, which is also quite unusual. Various health organizations jumped in, and a vaccine was quickly developed, tested, and produced. That vaccine has just been made available to the public. I’ve fielded lots of questions about the swine flu, and hopefully this will help answer some of those.

The H1N1 is a specific strain of flu, and has many things in common with other flu’s we have seen in the past. It spreads like a regular flu. When people sick with the flu cough or sneeze, they spray out flu virus. When others breathe it in, or touch it and touch their mouth or nose, they can get sick. Unfortunately, the flu virus can survive on surfaces like doorknobs for up to 8 hours. Those who are ill with H1N1 are infectious for 1 day before they get sick, and until 5-7 days after.

H1N1 gives people fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue, just like the regular flu. Some people just have cold symptoms, without the fever. Most people recover without incident, but some get very sick, requiring hospitalization, and some have died. With the regular flu, the elderly, the very young, and people with chronic medical conditions are most likely to become very sick. H1N1 is more dangerous to people under 24 than to the elderly, and the young are receiving priority in vaccination.

The US Government has paid for enough vaccine so that everyone in the country can have one. There is no charge for the vaccine, but providers administering the vaccine will charge an administration fee. In Virginia, we have to report back to the health department on every vaccine we give. The first batch of vaccines goes to high risk individuals, then anyone and everyone can have it.

The CDC recommends the following groups should receive the H1N1 vaccine first:

Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated
Household contacts & caregivers for children younger than 6 months of age because these infants are at high risk for complications and cannot be vaccinated.
Healthcare and emergency medical services personnel so the patients they are caring for are protected. Also so they will not be out sick and be able to continue to work to help care for others that are ill
People between the ages of 6 months and 24 years because they are at higher risks for complications, and they are in close contact with others through school, day care, and other activities, increasing the risk of spread
People between the ages of 25 and 65 with other medical conditions such as diabetes, asthma, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders.

I have been asked many questions about the safety of the vaccine. This vaccine is produced just like the traditional flu vaccine. The flu mist nasal spray (which we will not have here) is a live vaccine, and care must be taken not to give this with other live vaccines, or to people with certain illnesses. The flu shot is a killed vaccine. Therefore you cannot get the flu from the vaccine, and the risks and side effects for the H1N1 vaccine should be similar to that of the regular flu shot. BTW – this vaccine was subjected to extra clinical trials compared to the regular flu vaccine, just to make sure it was safe.

It takes 8-10 days to develop an immune response to this vaccine (which is actually pretty quick). Other prevention measures include washing your hands often with soap and water (use alcohol based hand sanitizer if soap and water are not available), avoiding touching your eyes, nose, or mouth, and avoiding close contact with sick people. If you are taking care of a sick person, using a surgical mask can also be helpful. If you do get sick, stay home for at least 24 hours after your fever is gone (without the use of fever reducing medicine). If a family member is sick but you are well, you can go to work.

Tamiflu and Relenza do work on H1N1, but only if the first dose is taken with 48 hours of onset of symptoms. The CDC is recommending we not treat with antiviral medications unless the person is high risk, but they are leaving it up to our discretion. The bigger issue is developing complications. H1N1 flu can be a very serious illness, and you should seek medical care ASAP for any of the following symptoms:

Difficulty breathing, shortness of breath, or fast breathing in children
Pain or pressure in the chest or abdomen
Sudden dizziness or confusion
Severe or persistent vomiting, or unable to drink enough fluids (children)
Children who are not waking up or interacting, or who are so irritable that they don’t want to be held
Symptoms improve, then return with fever and worse cough

The CDC has an excellent review with more information called 2009 H1N1 Flu and You. I have also updated articles I wrote about The Flu and Colds, Flu, and When to See the Doctor for this (2009-2010) flu season.

I hope this will be helpful in navigating what has already been an eventful flu season. At the beginning of October, we were already reaching flu levels in Virginia not usually seen until February. Please get vaccinated, and please be careful out there!