By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

During the H1N1 peak epidemic months of October and November, it seemed like lots of people had lots to complain about in terms of the response to the epidemic. However, listening closely (as I did until I got tired of it), the kvetching kind of came down to a couple of things that weren't really even problems - just poor communication or inconveniences.

For instance, being a mother of young children myself, I know many other mothers of young children. We all wish the vaccine would have been available to our kids sooner. Many of us needed the shot, rather than the mist, which was even later in coming. And, of course, when the vaccines did show up, it often involved hurrying somewhere just to be told that there would be a wait.

Then I heard from my relatives who are older than 65. They wanted the vaccine, too, but were told that they were not in the first priority group (or even the moderate priority group). They were told that they could get the vaccine, but only after everyone who was at higher risk had their chance to get it. They didn't like that. One bit.

However, when we analyze the situation, it turns out we did okay. Government public health officials acted aggressively, but not rashly. They followed logic and data instead of emotion and didn't do things like close down whole school systems. They used a safe vaccine, rather than try something new or add adjuvants, even though the vaccine supply was delayed.

Of course, things could have been better and that is what is the best part of this whole experience: it provided a chance to learn about things in case something worse (deadlier, quicker, more infectious) comes. We also got to observe public behavior around vaccines, which surprised many experts as people screamed for vaccines, complained about delays, then refused to get them.

Of course, none of this is to say H1N1 is a thing of the past. Many experts predict a "3^rd wave," based on how other influenza pandemics have behaved. If that is to happen, it is predicted to come in late winter. The suffering and deaths caused by H1N1 are also not insignificant. However, it could have been worse for many, many people and I, for one, am grateful that this "practice epidemic" was taken so seriously.

For further information, read US Reaction to Swine Flu: Apt and Lucky.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

Remember in April and May when it seemed like every other school was closing down temporarily to try to stop H1N1 swine flu? I wondered at the time if that was doing any good to slow down the number of students that became infected. Well, a recent study seems to have answered my question...

Researchers at the University of Pittsburg used a computer simulation model to see what the effect of closing schools during an influenza outbreak would be.

The results were surprising:

• Closing entire school systems did not help slow an epidemic any more than closing individual schools
• Schools needed to be closed for at least 8 weeks (the length of the worst part of an epidemic) to have an effect on the numbers of students infected. Even when closed 8 weeks, the peak in epidemic numbers were delayed by only one week.
• When schools were closed for 2 weeks or less, the data showed that this could actually make things worse, as susceptible students could be brought back together at the peak of the epidemic.

Researchers concluded that while school closures alone could not stop (or even put a serious dent in) an influenza epidemic, taking such measures could buy time to do something that is effective - vaccinate susceptible students.

Source:

Lee BY, Brown ST, Cooley P et al. Simulating School Closure Strategies to Mitigate an Influenza Epidemic. J Public Health Manag Pract. 2009 Dec 23.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

Do you know someone for whom English is a second language (or doesn't speak English at all)? Then direct their attention to this page from the CDC that presents information about the flu (seasonal and H1N1 swine flu) in Arabic, Chinese, Spanish, French, German, Italian, Korean, Russian, Tagalog and Vietnamese.

There are information sheets that cover topics for specific populations, such as pregnant women and people with certain conditions, such as asthma and diabetes. There are sheets about symptoms and warning signs, as well as information about how to stay healthy at work and about vaccines.

Think about how confused many of us have been at times during this epidemic, even though the news (and the gossip) that we were listening to was in our own language. Now, imagine if you were trying to figure out what was going on in a language that wasn't your native tongue.

Do someone a favor and send them a link to this page so that they can get the plain facts in their own language and make decisions for themselves.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

If you have diabetes, you have probably been advised by your physician to get vaccinated for both H1N1 (Swine flu) and the seasonal flu. Ask about it if you haven't already.

If you end up getting the flu (or experiencing flu-like symptoms), you should contact your doctor for next steps. During the course of your illness, you should follow a couple of simple guidelines:

• Keep taking your medicine, even if you can't eat. Ask your doctor about how to adjust medication levels accordingly.
• Test your glucose levels every four hours. Write down the results. Any levels lower than 60 mg/dL or sustained at over 300 mg/dL means you need to call your doctor or get to the emergency room.
• Try to keep eating normally. If you can't, at least try to get some of your normal carbohydrate levels through soft foods and liquids. If you cannot eat or can't keep food down for more than 6 hours, call your doc.
• Weigh yourself daily to make sure you are not losing weight, which might indicate that your blood glucose is high. If you lose more than five pounds, call your doctor immediately.

The following things should also prompt a call or visit to your doctor immediately: diarrhea, temperature over 101 degrees, trouble breathing, feelings of lethargy or confusion or moderate to large levels of ketones in your urine.

People with diabetes are especially vulnerable to effects of the flu, as well as to complications from pneumonia, which often accompanies the flu. Take care of yourself.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

A. The good news is that now you probably can.

There were a couple of reasons that people age 65 and older were unable to get the H1N1 vaccine for several months.

The first reason was that there was not enough vaccine to go around for everyone who wanted one and the health departments had to prioritize which people should get it first. They made this decision based on statistics and data as to who was at most risk for serious complications and death from this particular strain of influenza. That is why the first group contained pregnant women and people taking care of infants 6 months of age or younger. The groups then expanded to include children, especially those with certain conditions, as well as young adults with known risk factors.

People over 65 did not seem to be dying from H1N1 flu. Researchers think that maybe this is because older Americans had some sort of immunity that they probably got from exposure to the flu of 1957. (However, seasonal flu is a different story - the seasonal flu historically is the most dangerous to the "over 65" crowd, with the majority of the annual 35,000 deaths in this age group.)

The second reason that people over 65 couldn't get the vaccine is that the nasal mist version came out first and there was a delay in the injectible vaccine. The nasal mist vaccine has only been tested in people ages 2 to 49 years of age - anyone falling outside of that range has to get the shot.

Again, the situation is better in terms of availability of the H1N1 shot, so anyone hankering to get themselves vaccinated should be able to find a vaccine (although it might take a little calling around) in their area.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

Usually the word "recall" means that something has injured or sickened many people, prompting manufacturers to get it all off the shelves.

Fortunately, the recall of 800,000 doses of pediatric swine flu (H1N1) vaccine has absolutely nothing to do with safety. I'll repeat that: The H1N1 vaccine that was recalled is SAFE!

The problem with the vaccine that was recalled by Sanofi-Pasteur was that it somehow lost potency from the time of manufacture and packaging over the following weeks. The potency was only slightly below required levels and the company issued a voluntary recall.

The good news is that there is no recommendation for kids to get vaccinated again if the received the two doses of vaccine that is recommended for all children under the age of 10. This is the case even if both doses came from the recalled lots.

Bottom line: If your child got two doses of H1N1 vaccine, don't do anything. If your child is still missing a dose (or two), get them vaccinated. There is nothing to worry about. Leave the stress over this situation to those dealing with the logistics of such a huge recall.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

Until very recently, there was no way to know right away if a person had H1N1 (swine flu) or the seasonal flu. The rapid flu test available would give docs a "yes" or "no" answer. Since seasonal flu was not circulating yet, a "yes" result probably meant H1N1 infection.

Part of the problem with this approach is that many of these tests returned false negative results, as these rapid test kits have only between 49 and 69% accuracy. In other words, even if the result was "no," you still really weren't sure if it was H1N1 or not. To get a real answer, the sample would have to be sent away for confirmatory testing. Since this took too long, many physicians would start patients on an antiviral before they even knew what they were treating, as these drugs work best in the first 24 to 48 hours following onset of symptoms.

This week, the FDA approved the test that is considered the "gold standard" of influenza diagnostics - a real-time PCR test (these tests actually look for the DNA of the virus itself, rather than antibodies). The test, manufactured by DxNA, uses a portable unit that can read samples collected by swabbing the inside of the cheek or nose. It takes about 50 minutes to get results.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

With all of the noise and attention on H1N1 (swine flu), our old friend the seasonal flu has kind of been lost in the shuffle.

I'm going to make this reminder short, sweet and firm: Get your seasonal flu vaccine, if you haven't already. We are heading into flu season and the time is now.

The flu vaccine is available as an injection or as a nasal mist. Kids (under 9 years old) getting vaccinated for the first time need 2 doses of the shot or mist. If you are getting your second (or first) dose of H1N1 vaccine, you can also get your seasonal flu vaccine at the same time (only one can be the nasal mist, though).

Also, all of you people that are 65 or older who were feeling a little left out with all of the H1N1 vaccination going on - it is extra important that you get the seasonal flu vaccine, as the seasonal flu is especially dangerous to older people.

Go ahead, do it now and feel good about taking care of yourself.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

Autopsies performed on people who died from H1N1 and its complications in New York City show that the virus damages the entire respiratory tract. This pattern is very similar to that seen in the other influenza epidemics of 1918 and 1957 - the most extensive damage in the upper airway, but in some cases, even the tiny airsacs called the alveoli were damaged.

These findings were consistent with the animal research (in ferrets, to be precise) that showed that the H1N1 virus infected tissues deeper than those infected by the seasonal flu, which tends to remain in the nasal passages.

Interestingly, the same animal research also showed that the H1N1 virus found its way into the intestinal tracts of some infected animals, which also does not happen with the seasonal flu.

Source: JR Gill et al. Pulmonary pathological findings of fatal 2009 pandemic influenza A/H1N1 viral infections. Archives of Pathology & Laboratory Medicine, Published online Dec. 7, 2009

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

It seems like as the holiday excitement swirls around, so do the lines, the inconveniences and the short tempers, as everyone is frantically preparing. It has gotten so that many people refuse to go to stores after Thanksgiving, preferring online shopping for any outstanding gifts.

However, the venues that seem to have quieted down recently is that of flu vaccine clinics and doctors' offices. More vaccine is arriving weekly to places that have been waiting for it. Cases of flu-like illness are way down, meaning doctors just might be able to squeeze patients in for a shot or nasal mist vaccine. Then there is the rather unfortunate factor of many people deciding that they aren't quite so worried as they were a month ago, and deciding to forego the vaccine altogether.

All of these factors combine to make it much easier to find the vaccine (shot or mist) and get it in a timely, civilized manner than it was just a few short weeks ago. Many places and flu vaccine clinics are opening up eligibility criteria to anyone (not just those considered high-risk).

So, do yourself a favor - give yourself a break from cookie baking or holiday shopping and go have a nice, relaxing flu vaccine experience.