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 With so much information and misinformation circulating about the novel H1N1 virus, it can be hard to sort through it all. Now Meritus Medical Center is bringing you the most pertinent information for our region, updated frequently by John G. Newby, MD, FCAP, from Hagerstown Medical Laboratory. As a pathologist certified in anatomic and clinical pathology as well as medical microbiology by the American Board of Pathology, Dr. Newby is an expert on the novel H1N1 topic and has been heavily involved in the hospital’s efforts to prepare for and combat the flu in our area.
Why has the swine flu demanded such attention? As Dr. Newby explained in a recent Health Matters show, experts believe that last spring there was an “antigenic shift” in the flu virus, meaning that a variety of different types of influenza virus comingled. Whenever this happens, a virus becomes far more virulent and far more infectious. Novel H1N1 is a virus that has pieces of influenza virus genetic material from human, swine, and bird viruses. When this kind of comingling occurs, we tend to have major epidemics, and the epidemics tend to affect populations that usually aren’t severely affected.
Most people who catch this virus will simply need to stay home, rest, and drink plenty of liquids. But certain populations are more likely to have complications; in particular, pregnant women and those with chronic health conditions like diabetes, asthma, and chronic obstructive pulmonary disease (COPD) have shown increased risk for complications. In addition, young, healthy individuals are more likely to be more severely affected by the novel H1N1 virus than seasonal flu.
Read on to learn the latest news and advice, or submit a question of your own for Dr. Newby.
I have mixed connective tissue disease and wonder if I am able to get the H1N1 shot, as I am not able to get regular flu shots due to an egg allergy. No physician has ever wanted to give me a flu shot, because they say I will have a bad reaction and it will also flare the lupus (which is part of my mixed connective tissue disease). Would you advise someone like me to get the H1N1 vaccination?
A confirmed egg allergy is a contraindication to taking the vaccine. You should practice scrupulous hand hygiene and avoid those with flu-like symptoms.
If your doctor tells you that you have the H1N1 virus, is it necessary to go to the health department to be a confirmed case?
At this time, if you have been diagnosed by your doctor as having Influenza A, you most certainly have the novel H1N1 strain. The Health Department will not confirm routine cases of suspected novel H1N1 in the community unless it is related to a significant outbreak, someone admitted to a hospital with an influenza-like-illness (ILI), or a suspected death from an ILI.
If you have an allergic reaction to the seasonal flu shot, do you have a good chance of having an allergic reaction to the H1N1 shot also?
If you had a true allergic reaction, not local swelling, redness, and/or pain at the injection site, you will probably have a similar reaction to the novel H1N1 vaccine since they are almost identical in composition.
I heard on the news this morning that in Maryland that the H1N1 virus has mutated. Will the present vaccine still be effective if this is true?
We expect to see some antigenic drift (which is a wild mutation) in the virus; however, the vaccine as currently formulated will cover the current strain with minor mutations.
 Have there been any strains in Washington County that are unable to be treated with Tamiflu?
We are beginning to see the emergence of strains resistant (by mutation) to Tamiflu caused by unnecessary prescribing of the drug for otherwise healthy people who were infected by novel H1N1.
Is the H1N1 influenza affecting our area?
Yes, we’re seeing significant absenteeism in schools. We actually had a local private school that closed early for its fall break because thirty of 200 students had influenza-like illness. We’re seeing a lot of absenteeism at work, too.
Where can I get the H1N1 vaccine?
Meritus Medical Center has compiled a table showing a number of local medical practices and pharmacies and which flu vaccinations each is offering. Please click here to view the latest information.
How can I tell whether I have seasonal flu or H1N1 influenza?
I can tell you this: 99% of those people who have had influenza A this fall and who have been tested by the most sensitive methods, had novel H1N1 “swine flu.” The assumption is that if you’ve got flu A, you’ve got novel H1N1.
Is the vaccine safe?
Yes. It’s a very effective vaccine, and people who have received it have not shown any side effects and appear to be protected fairly quickly. It’s made exactly the same way as the seasonal flu vaccine, and we’ve had twenty years of practice making these vaccines. As a matter of fact, next year it will be probably included in the seasonal flu vaccine package.
 How effective is the H1N1 vaccine?
Studies have shown that this is a very effective vaccine. You get levels of protected immunity from the H1N1 virus within eight to ten days after being vaccinated.
What about thimerosal, the mercury-based preservative used in vaccines?
The H1N1 influenza vaccine is manufactured in several formulations. Some will come in multi-dose vials and will contain thimerosal as a preservative. (Multi-dose vials of seasonal influenza vaccine also contain thimerosal, which is used to prevent potential contamination once the vial is opened.) Single-dose units of the H1N1 influenza vaccine will not use thimerosal as a preservative. The live-attenuated version of the vaccine, which is administered through the nose, is produced in single units and contains no thimerosal.
I’m pregnant, in good health, and due very soon. Should I get vaccinated against H1N1?
Absolutely, for two reasons you should do so. First, pregnant women are not dealing with this virus as well as non-pregnant women. Secondly, you’ll have a newborn at home, and newborns are susceptible because their immune systems are not well developed. As soon as you can, get vaccinated to protect yourself and your newborn baby.
 It’s early in my pregnancy. What do I do if I get flu-like symptoms?
Call your doctor right away. Pregnant women who get sick with H1N1 can have serious health problems. They tend to get sicker than other people who get H1N1 flu. Some pregnant women sick with H1N1 have had early labor and severe pneumonia—and some have died. Take flu-like symptoms seriously and call your doctor for advice.
Are people over the age of fifty immune to the H1N1 virus?
Risk for infection among people age sixty-five or older is less than the risk for younger age groups. People in this age group are also not experiencing as severe a reaction to novel H1N1 as those in younger groups. It may be attributed to a 1957 virus with minimal genetic similarities to the 2009 H1N1 virus. After younger age groups receive the novel H1N1 vaccine, providers will offer vaccination to people over the age of sixty-five.
My child is allergic to eggs. Can she still receive the H1N1 vaccine?
People who are allergic to eggs might be at risk for allergic reactions from receiving the seasonal flu and H1N1 vaccines. A regimen has been developed for giving influenza vaccine to children with severe asthma and egg hypersensitivity. Consult your doctor.
 I’ve read that children under the age of nine need an H1N1 booster shot. How soon can a child receive his second dose?
The CDC recommends that the two doses of H1N1 vaccine be separated by four weeks. Some clinics are giving H1N1 vaccines to those who still need the first dose and requesting those who need a booster shot be placed on a wait list. Recent studies indicate that 25% to 50% of children vaccinated with the first dose of H1N1 remained immune to the virus. Although it’s important to get the second shot, a longer waiting period may not be detrimental.
I’m diabetic. Should I get the H1N1 vaccine?
You should get both the H1N1 and seasonal flu vaccines. Because the flu can interfere with controlling blood sugar levels, complications can occur for people living with diabetes. If you have diabetes and experience flu-like symptoms, ask you healthcare provider about taking an antiviral medication such as Tamiflu or Relenza. Antiviral drugs should be taken within forty-eight hours of experiencing flu-like symptoms.
I’ve had flu-like symptoms recently. I might have already contracted H1N1 and didn’t know it. Should I still get vaccinated?
Yes, you should still get vaccinated. Specific testing, called the “rt-PCR test,” is needed to tell if an illness is caused by a specific influenza strain or by some other virus. Since most people with flu-like illnesses will not be tested with rt-PCR this season, the majority will not know whether they have been infected with H1N1 flu or a different virus.
Can natural remedies prevent the H1N1 virus?
Getting vaccinated is the most important step in preventing the flu. Vaccination stimulates an immune response using a killed or weakened virus that uses the body’s own defense mechanisms to prevent infection. CDC's current recommendations to protect against H1N1 virus do not include natural remedies as a sole prevention method. If you want to use a natural remedy to reduce symptoms, talk to your healthcare provider about options.
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