In this series, the Bangor Daily News and infectious disease experts at Eastern Maine Medical Center and the City of Bangor, Health and Community Services Department provide answers to the questions you have about H1N1 and seasonal influenza. We will respond to as many of the questions you send us as possible to allow you to know what to do and how to protect yourself from influenza.
These responses were prepared by Donna Dunton, RN, CIC, director of Infection Prevention and Control, Eastern Maine Medical Center; Patricia Hamilton, FNP, public health director, city of Bangor, Health and Community Services Department; and Robert Pinsky, MD, hospital epidemiologist, EMMC and St Josephs Hospital.
How can you tell the difference between H1N1 and regular seasonal flu?
You probably cannot tell the difference because both have similar symptoms: fever, cough, and sore throat as well as headaches, muscle aches, pains and fatigue. Occasionally, patients with H1N1and seasonal influenza will also experience diarrhea and nausea/vomiting. Importantly, the treatment is essentially the same for both types of flu: stay home, cover your coughs and sneezes, drink fluids and seek medical care if complications (e.g., shortness of breath, dizziness, dehydration) arise. At the present time, virtually all influenza circulating in the U.S. is H1N1.
Why are the high risk populations who have received vaccine at high risk?
Children, pregnant women, people with coexisting medical conditions are the major risk groups that have been identified. They all share one characteristic: their immune systems—for different reasons—are not sufficiently strong to fight off flu as well as the immune systems of healthy individuals. Pregnant women have a lowered immune system response so that their bodies don’t reject their fetus. Pregnant women have been hospitalized at higher rates and have suffered greater complications including death.
Kids, because of their age, have not been exposed to many illnesses, including H1N1 influenza, so their immune systems don’t “recognize” this virus. Children have also been hospitalized in greater numbers. In addition, because of the symptoms of influenza often arise after the individual is infected, children are also known to spread disease. Vaccinating them also serves to protect others in the community who cannot receive the vaccine. Individuals with coexisting conditions (eg, diabetes, asthma, heart disease) have compromised immune systems and, therefore, are at higher risk of developing complications of flu, such as pneumonia. Other risk groups include caregivers of infants and healthcare providers.
Why won’t my doctor test me for H1N1?
Maine CDC has certain health-care providers, called sentinel providers, who are routinely testing and reporting on the diseases circulating in our communities. To date, we have seen very limited amounts of seasonal flu. The vast majority of cases that have been confirmed in a laboratory have been H1N1 and as a result of these reports, we know that the virus currently circulating is H1N1. Consequently, continued testing is expensive and not necessary because the recommendations and treatment are unchanged by this information.
What are the side effects of the vaccine?
The most common side effects experienced by people who receive the vaccine are soreness or redness at the site of the injection, and/or headache. As many as 45 percent of people experience these mild and transient effects. More serious complications are rare, and include high fever, difficulty breathing, wheezing, hoarseness, hives, rapid heart beat or dizziness. If you experience any of these side effects, seek medical attention immediately. If you have a severe (life-threatening) allergy to eggs or to anything else in the vaccine, you should not get the vaccine.
There is no apparent difference in the percentage of serious health events reported between 2009 H1N1 and seasonal influenza vaccines. Of the 3182 reports to the Vaccine Adverse Event Reporting System, 177 (6 percent) involved serious health events, defined as life-threatening or resulting in death, major disability, abnormal conditions at birth, hospitalization or extension of an existing hospitalization). This is a similar to the number in previous years after a similar number of seasonal influenza vaccine doses.
If I had H1N1 flu should I get vaccinated?
If you had a laboratory-confirmed case of H1N1, there is no need for vaccination; you have what is called “natural” immunity for approximately one year. However, if you were sick and were not tested for this virus and are not sure if you had H1N1, you are encouraged to get the vaccine. You may not have had H1N1 and, therefore, may still be at risk for getting the flu. There is not harm in receiving the vaccine even if you had the disease.
If I had H1N1 should I get a seasonal vaccine?
Yes, while these viruses are similar, they are different. The H1N1 vaccine does not protect against the seasonal flu.
When should antiviral be used?
Most healthy people do not need treatment with antiviral medication for either H1N1 or seasonal influenza. While these illnesses can be very uncomfortable, they are generally self-limiting, and rarely lead to serious complications in healthy people. Furthermore, widespread use of antiviral medication can potentially lead to drug resistance.
Antiviral medications should be considered for persons with confirmed cases of flu or suspected of having influenza if they are at higher risk for complications. These high-risk patients include: children younger than 2 years, women who are pregnant or women who have just delivered a baby within the last two weeks, or individuals with certain chronic medical conditions such as COPD, asthma, kidney or liver disease, diabetes, or immunosuppressive conditions such as HIV/AIDS. In addition, persons aged 65 and older, and people who are younger than 19 years of age who are receiving long-term aspirin therapy who develop flu should also be considered candidates for antiviral medication.
Antiviral drugs may shorten the time you are sick and prevent serious flu complications, especially if treatment is begun within 2 days of getting sick. These drugs must be prescribed by a physician. Maine CDC has also released some antiviral drugs from their stockpile to provide this medication for individuals who do not have insurance.
My daughter is 7 years old and got an H1N1 vaccine at her school. Does she need a second vaccine?
Yes, children 9 years old and under should receive two doses. According to the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, studies have shown that children nine years of age and younger have a significantly improved immune response when given a second dose of 2009 H1N1 influenza vaccine. The second dose should be given approximately one month after the first dose.
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