THE FLU: A SHOT OF REALITY

Kaye Spector | Plain Dealer Reporter

Referred to as swine fl u early on, 2009 H1N1 is an infl uenza A virus of swine origin detected in people in the United States in April. H1N1 causes respiratory illness. It is not a bacterial infection and cannot be treated with antibiotics. H1N1 spreads easily, likely because it’s a newer strain of fl u. Most people don’t have the antibodies that would have developed from previous exposure. H1N1 is di� erent from seasonal fl u in that young and middle-age adults are contracting it the most, while adults older than 64 don’t appear to be at increased risk. Those with weak immune systems, chronic medical problems or women who are pregnant may get sicker faster. The World Health Organization says a pandemic of H1N1 is under way, meaning there is widespread human illness. More than 1 million Americans have been infected; more than 300 have died.

What is swine fl u, and what do I need to know?

How does it spread?The H1N1 virus mainly is transmitted from person to person when infected people sneeze or cough.

If you don’t cover your cough, the large virus-carrying droplets are propelled 3 to 6 feet, then land on a surface. If you cover your cough with your bare hand and don’t wash, you transfer the virus to the surfaces you touch. When someone else touches the surface, then touches their mouths, noses or eyes, they become infected.

Flu viruses can survive on surfaces for up to eight hours, depending on the virus and the surface. The virus lives longer on hard surfaces and if “cocooned” in nasal mucus, say from a sneeze. One study showed a fl u virus can survive on paper money for several days, depending on conditions and strain variant.

H1N1 can live for two hours on surfaces such as cafeteria tables, doorknobs and desks.

People infected with H1N1 shed the virus and may infect others from a day before getting sick to fi ve to seven days after. This infectious period can be longer in some people, especially children and people with weakened immune systems.

PREVENTIONThe vaccine Ohio county health departments will receive the H1N1 vaccine this week. First to get the vaccine will be health care and emergency medical workers. Next in line: pregnant women; people who live with or care for children younger than 6 months; children and young adults between 6 months and 24 years old; and people ages 25 through 64 with chronic health disorders or compromised

immune systems.

The initial 3.4 million doses will be a nasal spray; injectable versions are expected in one to two weeks. Vaccines likely will be available to the general public in mid-October. Doctors can administer both the H1N1 and seasonal fl u shots to adults in a single visit; children need one shot of each over two visits.

The nasal spray is recommended only for healthy children over age 2 and adults under age 50 who are not pregnant. That’s because the spray contains a live, weakened fl u virus and stimulates the immune system in a different way than fl u shots, which contain inactivated virus particles.

Everyday actions Cover your coughs and sneezes, but don’t use your hands. Cough into your elbow, or use a tissue and throw it away. Make sure to wash your hands afterward and especially before touching any shared surfaces like doorknobs.

Wash your hands often — and for at least 15 seconds — with soap and warm water. Or use alcohol-based disposable hand wipes or gel sanitizers (rub your hands until the gel dries).

Avoid touching your eyes, nose or mouth.

Avoid close contact with sick people.

Keep surfaces clean — especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children — by wiping them down with a household disinfectant such as diluted bleach or an alcohol-based commercial product.

Don’t share unwashed bed linens, towels, eating utensils or dishes used by sick people. Linens and towels should be washed with household laundry soap and tumbled dry on a hot setting. Don’t carry dirty laundry close to your face. Wash your hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry. Eating utensils should be washed in a dishwasher or by hand with hot water and soap.

Be prepared in case you get sick and need to stay home for a week or so: store a supply of cough drops, tissues, over-the-counter drugs such as antihistamines like Benadryl for runny noses, sneezing, and watery and itchy eyes, or acetaminophen (such as Tylenol), ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve) to lower fevers and ease body aches. Make sure you have a thermometer and some comfort foods. Having these on hand will help you avoid going out in public while you are contagious.

Covering your face Face masks generally are not recommended under most circumstances. However, surgical masks or a special kind of face mask, called the N95 respirator, might be useful for:

Health care workers caring for people with known, probable or suspected H1N1.

People at increased risk of severe illness from fl u, when in crowded settings in a community where H1N1 has been reported; or when taking care of someone with H1N1.

People with confi rmed, probable or suspected fl u when sharing common spaces with healthy household members, when in public settings, or when breastfeeding to protect the baby.

The N95 masks fi t tightly around the mouth and nose. When fi tted correctly, they can fi lter out 95 percent of small particles. One study showed the N95 was 56 percent effective against lab-confi rmed respiratory viral infections and 75 percent protective against confi rmed infl uenza. The N95 should be used once and thrown away.

Results of a study paid for by the Canadian government and released last week shows surgical masks were almost as effective as the N95 in protecting health care workers against confi rmed infl uenza and H1N1 in routine settings.

Get more informationThe Ohio H1N1 Information line is open from 8 a.m. to 5 p.m., Monday through Friday. Call 1-866-800-1404 for answers to swine fl u questions.

Cuyahoga County Board of Health: 216-201-2091; Updates are available on its Web site: ccbh.net — click on the H1N1 news link on the right.

The Cleveland Department of Public Health: 216-664-3609. Web site: clevelandhealth.org

Shaker Heights Department of Health infoline: 216-491-3170

The Cleveland Clinic will provide free H1N1 vaccinations when vaccines become available later this month. A complete list of sites, dates and times will be posted at clevelandclinic.org/fl u.

University Hospitals H1N1 Flu Hotline: 216-844-7246

What to do if you get sickGet plenty of rest.

Drink clear fl uids (such as water, broth, sports drinks or electrolyte beverages for infants).

Wash hands often with soap and water or an alcohol-based hand rub.

Watch for emergency warning signs (see Complications).

Stay home for at least 24 hours after your fever is gone (without the use of medicine), except to get medical care or for other necessities. Keep away from others while you are sick.

ComplicationsSeek medical care right away, or go to an emergency room, if these warning signs develop:

In children: Fast breathing or trouble breathing, bluish skin color, not drinking enough fl uids, not waking up or not interacting, being so irritable that the child does not want to be held, if fl ulike symptoms improve but then return with fever and worse cough, fever with a rash.

In adults: Diffi culty breathing or shortness of breath, pain or pressure in the chest or abdomen, sudden dizziness, confusion, severe or persistent vomiting.

Prescription drug treatmentAntiviral drugs are prescription medicines that fi ght the fl u by keeping the virus from reproducing in your body. This fl u season, the antiviral drugs are being used mostly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious complications.

Oseltamivir (Tamifl u is a brand name) and zanamivir are two antiviral drugs that can be prescribed for H1N1. Other, older antiviral drugs don’t work with H1N1.

■ This group has the second-high-est rate of H1N1, at 22.9 cases per 100,000.

■ With a death rate* of seven per 100,000, it ap-pears that infants are in less danger than are older children and adults. Infants under 6 months can’t be vacci-nated against it, so it’s important for those caring for these babies to get vaccinated.

■ This group has the largest rate of infection, at 26.7 per 100,000. Death rate is 48 per 100,000.

■ This group has less lifetime exposure to the fl u and less im-munity built up in general. The close contact in day care, school and college dorms increases the risk of getting and spreading the virus.

■ Although the rate of infec-tion is 6.97 per 100,000, these cases are more often fatal — a death rate of 124 per 100,000 — because middle-age adults have higher rates of underlying medi-cal conditions that make H1N1 deadly, such as asthma, diabetes and heart dis-ease.

■ The infec-tion rate for this group is 3.92 per 100,000, with a death rate of 71 per 100,000.

■ Here, the infec-tion rate is 1.3 per 100,000, with a death rate of 26 per 100,000.

■ About a third of adults older than 60 may have antibodies against the H1N1 virus, but it’s unknown how much, if any, pro-tection may be offered against H1N1 by any ex-isting antibody.

Children ages 0-4

Children, adults 5-24

Adults ages 25-49

Adults ages 50-64

Adults older than 65

SOURCE: Centers for Disease Control and Prevention data gathered from April to July 2009

Risk factors of H1N1 by age group

What are the symptoms

■ fever■ cough■ sore throat■ runny or stuffy nose■ body aches■ headache■ chills and fatigue

■ Some people may have vomiting and diarrhea■ People may have the respiratory symptoms without a fever

I’ve already had the fl u this year, do I still need to get vaccinated? And if so, against seasonal fl u or H1N1?

“You don’t know which fl u you’ve had, so the recommendation is that you still get vaccinated — for both,” says Terry Allan, Cuyahoga County’s health commissioner.

Kids and aspirin

Children or teens with the fl u should not take aspirin because it could cause serious problems or even death.

Online

Watch a video of Dr. Charles Emerman, chairman of emergency medicine at MetroHealth Medical Center, describing swine fl u symptoms and what you should do if you catch it. Plus, get updates and continuing coverage on seasonal and H1N1 fl u. cleveland.com/fl u/

Look for signs similar to those of seasonal fl u:

In the 1990s, the classical

swine flu mixed with other flu viruses from birds and people and formed a new version of swine flu that swept through U.S. hog farms.

By 2000, that virus had

mixed again with the classical swine flu virus.

By 2008, the virus mixed again with another swine flu strain from Eurasian pigs.

Classical swine

U.S. swinedescendent

U.S. swine

U.S./Eurasian

H1N1 virus

HumanAvian Eurasian swine

SOURCES: New England Journal of Medicine, Nature, Science magazine

Where did swine flu come from?

1

1

2

2 3

3

4

4

5

5

1990s flu strains, by host. Eight genes shown inside each virus cell*

The pandemic strain of H1N1 influenza is descended from a never-before-seen combination of human and animal flu viruses. The two most important genes — the ones that make the proteins hemagglutinin, or H, and neuraminidase, or N — both originated in pigs.

LOS ANGELES TIMES

* The genome of the influenza virus consists of eight genes. If two viruses infect the same cell, they can

trade some of these genes.

H1N1 strain: Scientists think the resulting H1N1 virus jumped to people by November 2008. Human infections were first noticed in March 2009 and identified in April.

26.722.9

6.97 3.92 1.3

Infections per 100,000 people

* Death rates calculated based on deaths among patients hospitalized with H1N1.

“Infl uenza is simply not a nuisance disease. Here in Ohio, more than 3,000 people die every year from fl u and pneumonia. It’s among the top 10 causes of death in the state.” — Kristopher Weiss, spokesman for the Ohio Department of Health

SOURCE: Centers for Disease Control and Prevention, Cuyahoga County Board of Health, American Medical Association THE PLAIN DEALER