Thursday, October 29, 2009

H1N1 - what do we look for?


I have been listening, intrigued, by the news reports. The key to understanding what is going on is to listen to the experts. That does not mean your best friend, who is a nurse, or the local media. This does not mean listening to those in health care who poo-poo the idea of having a vaccine. We will not run out: Canada ordered 50.4 million doses of vaccine, enough to give 75% of the country two doses. The mad scrambling in lines for clinics is rather disconcerting. Local health officials are having problems meeting these demands across the continent. As people stand for hours in line, waiting for a flu shot, only to be told they have to come back tomorrow. It would be smart for these people to get priority in the morning. I hope this will be thought through. Very angry people are raising a fuss. And rightly so. Yet, our harried nurses cannot work 24/7 or they WILL burn out. We have limited numbers of nurses in Canada, they are being drawn from other work to provide these clinics. 


And fearmongering:

The so-called anti-vaccine movement – a loose collection of concerned parents and PhDs on the lecture circuit trying to educate the public about perceived dangers of immunization – has been around for decades but has gained strength with the rise of social networking and citizen journalism.
(Smith, 2009)

Doctor's offices are giving inaccurate advice:

'Scared' mom finds flu advice falls short

 with mild flu symptoms, do not go to emergency. Your Family Physician (FP) does not want these patients in their waiting rooms. Of course, they will send you to emergency. The Telehealth Ontario phone lines are jammed.


There are two types of vaccines:


Dr. David Butler-Jones, Canada's chief public health officer:
Both versions contain a killed virus, so they cannot cause infection. It trains our immune system to fight off infections. An adjuvant is an additive that boosts the immune system, especially if the virus mutates during the season. It's a natural product containing fish oil, water and vitamin E. Adjuvants have been used since the 1920s and can be found in a range of vaccines including tetanus, hepatitis A and B, and diphtheria.

This isn't new science. It is well-established and reliable. How many thousands have had these shots over the past decades? A great number. We know about allergies and there are those who cannot take them, but the key is to inoculate those around them to prevent the virus from entering a family home.

Part of the clues to H1N1, is the information gleaned from the 1918 Pandemic. Dr. David Butler-Jones, Chief Public Health Officer for Canada, spoke to CBC.  He explained that the vast majority of deaths in the 1918 Pandemic were due to issues such as: lack of ventilators, pneumonia, and subsequent bacterial infections (which accounted for one-third of the deaths). The mortality rate in 1918 was 2 %, but 99.5% of those who contracted the influenza survived.

The influenza pandemic of 1918–1919 was uniquely severe, causing an estimated 20–40 million deaths worldwide. Also unique was the age distribution of its victims: the death rate for young, previously healthy adults, who rarely suffer fatal complications from influenza, was exceptionally high. (NIH, 2001)

Does this sound familiar? What have we learned? In 2009, we have back-up ventilators, antivirals, and antibiotics. The key is recognizing when to get help, what kind of help you need, and when the H1N1 virus has gone bacterial. We know, now, that too often too many kids have antibacterial drugs and a bug becomes able to fight the drugs. We know the signs of bacterial infection: coughing up green gunk, for example. Inappropriate use of antibiotics has helped create strains of bacterial disease that are resistant to treatment with different types of antibiotic medications.(Steckelberg, 2009)

Other signs, says Dr. Butler-Jones: aches, fever, dry cough are 'normal' flu symptoms. There are those who say NOT to give kids medicine to lower their fever, since this is the means by which the body fights these viruses.

What a person must look out for is shortness of breath, chest constriction, as the virus becomes bacterial. The lungs in a normal person become flooded with mucous, as the body tries to drown the virus. This is a normal part of a cold. What is particularly virulent in H1N1 is the speed with which the virus progresses from flu to pneumonia. This is when one may need a ventilator, antivirals, and antibiotics. Again, what is worrisome is that a patient could go to an emergency ward, be thought to be fine, be sent home, and then they get worse very suddenly. Emergency wards are not the place for them. Sitting for 8 hours will make you tired and even worse. You want your body to be able to fight the disease.

The other issue to watch for: seemingly getting better, then a sudden downturn. This is a sign that your body is creating antibodies to fight the virus, but the virus is now bacterials, with infections in the lungs. Again, coughing up green chunks is the key to get immediate care.

Why not go to your FP and get an H1N1 shot?

MDs say rules deter them from providing H1N1 shots

There are barriers, since the powers-that-be packaged them up in 500-dose lots. Some FP may have the vaccines, others may not. But talk to your physician and determine if you should have the shot and if it is available in his/her office.


References

Bacterial infection vs. viral infection: What's the difference ...

Perhaps the most important distinction between bacteria and viruses is that antibiotic drugs usually kill bacteria, but they aren't effective against viruses. In some cases, it may be difficult to determine whether bacteria or a virus is causing your symptoms. Many ailments — such as pneumonia, meningitis and diarrhea — can be caused by either type of microbe. (Steckelberg, 2009)


Characterization of the 1918 influenza virus polymerase genes


Sequence of the 1918 pandemic influenza virus nonstructural gene (NS) segment and …

 - nih.gov (2001) doi: 10.1073/pnas.031575198PNAS February 27, 2001 vol. 98no. 5 2746-2751CF Basler, AH Reid, JK Dybing, TA … - Proceedings of the National Academy of Sciences of …, 2001 - National Acad Sciences
The influenza A virus pandemic of 1918–1919 resulted in an estimated 20–40
million deaths worldwide.


Vaccine myths frustrate doctorsJoanna Smith  (2009)

Public health officials worry that detractors will prevent people from getting H1N1 shots.

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