By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

Sure, you might be angry about the delay in vaccines, or the long lines, or what people are calling "empty promises" about the millions of H1N1 (swine flu) vaccine doses that have not yet materialized in expected numbers.

However, if you really want to place the blame on anyone, point your finger at the H1N1 virus itself. It seems like the little guys just do not want to multiply as quickly as seasonal flu in eggs, which is where the virus that is used for vaccine is grown.

To make virus for vaccine, live virus is injected into the tops of eggs, which are then cared for lovingly and kept at just the right temperature for a period of time. It is then harvested and rigorously tested for purity and safety (the entire process from injection of virus into eggs to a vaccine ready to put into a person takes 3 months). To the surprise (and dismay) of companies making the vaccine, they found that the eggs yielded much less virus than was expected, causing a big bottleneck in the vaccine pipeline. Early on, I heard that each egg was providing enough virus for only 1.5 vaccines, whereas the process usually yields enough virus for 4 vaccines per egg.

Company spokespeople and government officials are now assuring people that the problem has been fixed somehow and the virus (and vaccine) production are back on track, so that we should be seeing the millions of doses that we have been expecting very soon.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

The simple answer is "it depends who is vaccinated."

Here is the good news and what we DO know. The H1N1 vaccine has an advantage over the seasonal flu vaccine (which has an efficacy of 70 to 90%), because those vaccines are based on educated guesses as to which strains of flu will be circulating a hemisphere away after a good 8 to 10 months has elapsed. Usually the guesses are pretty good, but there can be some "misses."

With H1N1, the vaccine is made of the exact virus that we know is circulating.

Here is something else we do know - one dose of the H1N1 shot has shown to produce adequate immunity in 92 percent of the pregnant women who were immunized.

However, it looks like children probably will still need two doses, as only about one-third of kids under 10 years old developed adequate antibody levels 10 days following the vaccine. It is possible that they could continue to build immunity, and further reports are going to be coming soon (although adults' antibody levels at 10 days post-vaccine and 21 days post-vaccine were about the same).

Also, it is possible that people who are immunocompromised, such as people with HIV, may require two doses to confer immunity. Trials are still ongoing to determine this.

Bottom line: The H1N1 vaccine works. Depending on who is getting vaccinated, two doses may be required.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

Good news for anyone taking Lipitor, Crestor, Lescor, Zocor, Pravachol or Mevacor (drugs known as statins) to lower cholesterol - people taking one of these statins who were hospitalized for influenza (seasonal, not H1N1) were 50% less likely to die from the flu or flu complications.

The study looked at the records of 2,800 people who had been hospitalized during the 2007-2008 flu season and found that 2.1 percent of people who were taking statins died, while 3.2 percent of those not taking statins died. After controlling for certain factors, such as age and use of antiviral medications, this indicated that stains lowered risk of death from seasonal influenza by more than half.

One explanation is that statins help by lowering the inflammation that comes with infection and keeps the body from reacting in a dangerous way to the flu. Other researchers say that statins can also result in milder flu symptoms.

Read more about the statin drugs here on About.com's Heart Disease site: The Statin Drugs

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

A recent study shows that pregnant women who get the flu shot are doing something great for their babies - reducing risk of prematurity and low birth weight.

The US study from Emory University showed that during the whole flu season (October to May), babies born to vaccinated moms were 40 percent less likely to come early. Babies born during the months when the most flu was reported (usually between late November and early March) were 70 percent less likely to be born prematurely.

Other benefits of maternal flu shots to babies include:

• Higher birth weight - babies born to moms who had the shot weighed half a pound more than those born to unvaccinated mothers.
• Protection from flu - babies born to vaccinated moms were less likely to get the flu in their first year of life.

Unfortunately, less than 25 percent of pregnant women get the flu shot in any given season. There are a number of reasons for this - typically, pregnant women are reluctant to get shots or take medicine. Additionally, obstetricians often do not get the vaccine or do not know how to store it properly, according to some experts.

While the above studies looked at seasonal flu vaccines, it is even more important that pregnant women get vaccinated against H1N1 (swine flu), as that virus has proven deadly for pregnant women. Pregnant women are in the highest priority category for receiving the H1N1 shot.

For more information, read this article on About.com's Pregnancy site: What Pregnant Women Need to Know about the H1N1 Flu

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

You start to wonder how all of those individual reports of death due to complications of H1N1 add up. It seems like there is always one or two every time you look at the news, but what is the bottom line?

The Centers for Disease Control and Prevention (CDC) released information on October 23rd that the 1000th confirmed H1N1 patient has died in the United States. Of those 1000 deaths, almost 100 of them were children.

To put this in perspective, each year an estimated 36,000 people die from seasonal flu. Usually these deaths are in the elderly. In 2008-2009 flu season, a total of 68 children died of the seasonal flu. In other words, 0.18 percent of total deaths from seasonal flu were in children, as opposed to 10% of the deaths from H1N1.

It looks like the H1N1 epidemic is still in the "ramp up" stage, so more deaths are expected. Rather than panicking, use these statistics as motivation to be vigilant for flu-like symptoms and get children vaccinated as soon as possible. Most of these deaths were in people who did not receive antiviral medication within 48 hours and (to my knowledge) NONE of these deaths occurred in people that had been vaccinated against H1N1.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

That's right, fever is not always present in H1N1 cases. The CDC mentions it in the middle of their text about H1N1, and early reports from Mexico say that 30% of confirmed cases of H1N1 did NOT have fever. In Chile, 50% of cases did NOT have a fever.

"Why is this important?" you might ask. Well, think about the last time that you called the doctor or your child's pediatrician with respiratory symptoms. If your doc is like mine, the first question was "how high has the fever gotten?" If the answer was that there was no fever or that there was just a rise of a degree or two, that may have been the last question you were asked before you were told that it was probably nothing and to stay home and take care of yourself.

The fact that some cases of H1N1 present without fever means that the cases are most likely underreported, as many people would not consider going to a doctor for respiratory symptoms or malaise alone. Perhaps just as important, many doctors would not even consider testing or treating for influenza with antivirals in the absence of a flu, even though some of the people that did not develop a fever have gone on to need hospitalization.

There are also implications around the spread of H1N1. In my childrens' school, runny noses are considered normal, with kids kept home for fevers over 100 degrees. That means that some kids could be spreading the virus at the peak of viral shedding with their fever-free sneezes and coughs.

What does this mean for us? Well, it looks like most people do have respiratory symptoms and malaise, so watch for that. If you do develop these symptoms, take them seriously and talk to your doctor. Ask for a test (even though they have a notoriously high rate of false negatives) for peace of mind. However, don't assume that every little sniffle is H1N1 - be smart and vigilant, but stay calm and rational.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

If you are trying to be efficient, is acceptable to get both the seasonal and H1N1 killed injectable vaccines at the same time (along with as many other killed vaccines as you want), or one killed and one live attenuated, if that is what is available. However, as discussed in a previous blog ("Q. Can I Get Both Flu Vaccines at the Same Time?") about getting the seasonal and the H1N1 vaccines, two live attenuated, nasally-administered flu vaccines (FluMist) cannot be given at the same time.

We now know that children 9 years old and younger will need two doses of the H1N1 vaccine. In the case of the nasal mist, these second doses can only be given 28 days and longer after the first dose. This 28-day "waiting period" applies to any live flu vaccine that the child has gotten.

In other words, when you are making your appointments to get your child their first dose of H1N1 vaccine, be aware that if they got the FluMist for seasonal flu recently, you will have to wait until 28 days is up to get the first dose of H1N1 mist.

I wouldn't have even thought about this situation, but when I took my young daughters to get their H1N1 nasal mist vaccine, there was a woman who was told to bring her daughter back in 2 days, as she had gotten the FluMist for the seasonal flu only 26 days before. She begged, pleaded, threatened, but the nurses were having none of it and she left with an appointment for the following week.

If you are unsure of the exact date that you or your child received FluMist for the seasonal flu, your doctor can look it up (if you got it at a doctor's office). Again, save yourself some time by making sure that 28 days (actually, you can get it on the 28^th day) have elapsed before getting in line for the H1N1 mist.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

A. No.

I have had several people write in to ask me this very question. Some people said that they had "the sniffles and a cough," while others said that they were hit with a hard fever for several days. Some people said that family members had a confirmed case of the flu (although not confirmed that it was H1N1), and that they were "certain" that they were now immune because they also got a little sick around the same time.

All of these people (and people in other situations) should get vaccinated if they fall into one of the high-risk categories for H1N1 complications.

No harm will be done if you get the vaccine after you happened to have the flu shot (your immune system will just gobble it up, having been "supercharged" to attack that virus by previous exposure). However, if you are in one of the high-risk categories, you are taking a big chance by assuming that you had H1N1 and forgoing the vaccine.

Bottom line - unless your "H1N1" was actually confirmed with a test that specifically showed that you had that virus, such as CDC rRT-PCR Swine Flu Panel assay, you cannot assume you had swine flu. Even though you may have tested positive on a rapid influenza test. Even though we know that the vast, vast majority of flu circulating now is H1N1 and not seasonal flu. Even if you are pretty sure that you caught your illness from someone who was confirmed to have H1N1...

If you are in a high-risk group, you should get the vaccine. It won't hurt you and it might really, really help you avoid some big problems.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

I really like this article: A Day by Day Look at H1N1 Swine Flu, which takes us on a journey of H1N1 symptoms of a fictional woman named Emily (who happens to have asthma and fairly bad luck with doctors).

The great thing about this article is that it is realistic. Emily does not have health insurance. Emily decides to wait to see if her symptoms get worse. Emily goes to an urgent care clinic ("doc in a box"), then another, seeing physicians that do not know her entire health history. She is prescribed the wrong drug, the correct drug gets delayed and is too expensive, anyway. Emily feels a little better, then gets slammed with a secondary infection. (Sorry for the spoiler.)

The other wonderful thing about this article is that it contains links along the way to answer some of those nagging questions that many of us have when we are sick, but forget to ask the doctor, such as "When to see the doctor for a cough" and "Should you exercise when you are sick?"

This article appears on About.com's Cold and Flu site, where you can find more information about H1N1, seasonal flu and other respiratory infections.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

You hear about hand washing all the time these days, often in the sentence following the one where people are talking about H1N1 (swine flu). While there is some debate whether washing hands can even slow down transmission of H1N1, there is no doubt that it is still a good thing to do.

It seems like a pretty common sense thing to know how to do, yet there are probably very few of us doing it correctly or often enough.

As a review, here are some important tips for how to wash your hands, adapted from the CDC website "Clean Hands Save Lives!":

• Make sure you get the soap on all surfaces of the hands (this includes between the fingers).
• Rub the hands together with the soap for at least 20 seconds (this translates to two entire rounds of the "Happy Birthday" song).
• If you use a paper towel to dry your hands, use the paper towel to turn off the faucet.

Again, simple and commonsense, right. Now, imagine the last time you washed your hands. Can you remember when it was? Do you remember how long you rubbed? I know I am guilty of swiping my hands under the water for about half a second and avoiding some of the antibacterial soaps (one particular restaurant I frequent has soap that leaves my hands red and irritated within seconds of using it).

I have decided to carry a tiny bottle of mild hand soap and a tiny tube of hand cream, so that I have no excuses for avoiding washing my hands when I am out. Silly? Yeah, probably. Will it mean that I am more likely to wash my hands? Yeah, probably. Figure out what works for you and plan to wash your hands at least twice as often as you currently do.