By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

The Food and Drug Administration (FDA) of the United States has posted a list of Fraudulent 2009 H1N1 Influenza Products.

This list (which at the time of this writing was comprised of 143 items) includes things like face masks, bogus herbal "cures," and all sorts of stuff to boost the immune system. All of these products have been found on websites that are promoting them as effective prevention or treatment of H1N1 (swine flu). However, it is important to realize that many of these claims are NOT made by the manufacturers of the products, but rather people who have obtained them and are trying to sell them for a profit to a nation of people who are becoming increasingly frightened as they hear each reported H1N1 death (that is the strategy, at least).

To reiterate, many of these products have legitimate uses and many products and medications are used by consumers and prescribed by physicians "off-label," meaning for a different use than that which they received FDA approval for. However, it is illegal to advertise any drug or product for any indication other than that for which it received FDA approval. Of course, there are also a number of completely bogus products without any proven use whatsoever that appear on the list.

All of that being said, I can't say that I endorse the idea of obtaining any drugs or products off of the Internet unless your doctor specifically recommends it.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

I have heard quite a few people say things like, "I don't need to get an H1N1 vaccine. My wife had H1N1 and I never got it, so I must be immune."

That is what we call "fuzzy logic" or "magical thinking" in the world of infectious disease epidemiology (when we are being nice). While H1N1 is highly infectious, many people do not get it when someone in their house is infected. In fact, MOST people do not get it when someone in their house is sick with H1N1. This does not mean that they are immune to the disease, however.

In a study conducted in Kobe, Japan, the data only showed a secondary attack rate in households (people who got infected from someone in their family) of 7.6%.

This is lower than the estimate of the secondary attack rate of H1N1 by the World Health Organization (WHO) at 22-33%. However, even the higher WHO numbers indicate that the likelihood is that most household contacts will NOT get H1N1. Certainly, no one should assume that because they lived in the same house as someone who went through a bout of H1N1 that they are somehow teflon-coated and are immune to swine flu.

You can lower these statistics even more by following CDC recommendations on Caring for a Sick Person at Home, which includes precautions to further reduce the chance of a mini-epidemic in your own house.

By Julie Stachowiak, PhD
Multiple Sclerosis Guide; Guest blogger

Hey, remember that stuff back in 2007 and 2008 about the FDA relabeling of over-the-counter cough and cold medicines for young children? There were two reasons for this: 1) No one was really sure that these drugs did a whole lot to relieve childrens' symptoms, as many of them were never specifically studied in kids; and 2) there were safety issues, as some kids got into the medicines themselves and overdosed or parents inadvertently gave their children extra doses, either not realizing that products contained the same active ingredients and using them at the same time or misunderstanding dosing recommendations.

If the specifics of the relabeling of these medicines for kids are a little fuzzy, here are some reminders:

• Do not use cold and cough medicines for kids under the age of 4 (unless your doctor specifically instructs you to do so). Really,  many experts wanted the labeling changed to make the cutoff 6 years of age, so keep that in mind when thinking about how to treat your childrens' symptoms.
• NEVER give medicines for adults to kids. Medicines are complicated and children's bodies often don't process things the same way that adults do.

Bottom line: Ask your doctor what to use, down to brand name. Ask the dosage to give and how often. Write it down. If you can't find your doctor for some reason, ask the pharmacist - they are also well-informed about this issue and what should be used in kids and what should not.

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.