How is influenza spread? (Posted on Oct.23, 2009)

When a person coughs or sneezes, the influenza virus is spread from person to person by virus droplets that go airborne. These airborne droplets can be transmitted to another person who is within six feet. Any distance greater than six feet away from the infected person is usually safe because flu droplets are relatively heavy (when compared with TB, for instance) and will drop to the floor before reaching the other person. Transmission can also occur through contact such as touching surfaces contaminated with the influenza virus and then touching the eyes, nose, or mouth.

 

Is hand sanitizer as good as soap and water? (Posted on Oct.23, 2009)

For infections like the flu, using a hand sanitizer is just as effective as soap and water. But remember, with soap and water you need to sing "Happy Birthday" twice to insure adequate cleansing. As an aside, hand sanitizers are not effective against C. difficile (a common cause of diarrhea) - you must use soap and water.

 

What are the risks from flu vaccines?  (Posted on Oct.23, 2009)

The most common side effects following vaccination are expected to be mild, such as soreness or redness where the shot was given, headaches, sore or red eyes, itchiness, fever, and muscle aches. If these problems occur, they usually begin very soon after the shot and typically only last 1 - 2 days. In early trials, the side effects from the H1N1 vaccine were similar to those of the typical seasonal flu vaccine. Like any medicine, vaccines can cause severe allergic reactions. However, serious or life-threatening reactions are very rare.

 

Who should not get a flu vaccine? (Posted on Oct.23, 2009)

The following groups of people should NOT receive a flu vaccine:

• Age < 6 months
• Have a severe egg allergy
• Had a severe reaction to a previous flu vaccination
• Currently have a moderate to severe illness (wait until you are feeling better)
• History of Guillain-Barre syndrome (a form of paralysis) 

 

If I can’t get the vaccine right away, is it still worth getting it later? (Posted on November 19, 2009)

Yes. We are not certain how long the seasonal or H1N1 flu season will last, or if we will have several flu seasons or “waves” this year, so when the seasonal and H1N1 flu vaccines become available in your area, everyone in the targeted populations should take advantage of it. (All those doing direct patient care - that includes everyone in a healthcare facility - are considered part of the targeted population.) 

 

How quickly does the vaccine take effect? Is it possible to come down with the flu soon after getting vaccinated? (Posted on November 19, 2009)

After three weeks, most people have an immune response that will protect them from infection. The immune response begins to be detected in the blood stream seven to ten days after the vaccination. These vaccines cannot cause the flu, but you could certainly catch influenza during the time after vaccination when your body hasn’t developed a strong enough anti-influenza immune response. 

 

Will the seasonal flu vaccine protect me from H1N1 illness? (Posted on October 23, 2009)

The seasonal flu vaccine does not provide protection against the H1N1 flu. There will be a separate H1N1 vaccine and it has just become available. I would highly recommend that all GL employees get both vaccines: the seasonal flu vaccine and the H1N1 vaccine. Protect yourself, your family, your patients, and your colleagues.

 

How do the symptoms differ between H1N1 and the seasonal flu? How can you tell which one people have? (Posted on October 23, 2009)

The symptoms are the same - muscle aches, fever, suddenness of onset, cough, sore throat, headache, dizziness, diarrhea - with fever and the suddenness of onset being two of the most consistent signs. There is no way to tell the difference between H1N1 and the seasonal flu without testing.

 

I am confused about the two forms of each vaccine - can you help me? (Posted on Oct.23, 2009)

Both the H1N1 and the seasonal flu vaccines are available in two forms: an injectable ("the flu shot") and a nasal spray. Let's review both types:

• Inactivated Injectable Intramuscular Vaccine: This vaccine does not contain any live virus. To make the vaccine, the virus is killed and then broken up, so the injection contains only certain parts of the virus. It is injected into the muscle. This can be given at the same time as any other vaccine. (In other words, get all the shots you want during the same visit.)
• Live Attenuated Nasal Spray Vaccine: This is a live vaccine but the virus has been changed so it can NOT cause disease. It is given by nasal spray. This should not be given with another live attenuated influenza vaccine. (In other words, one nasal spray vaccine at a time.) Not everyone can get the nasal spray form - ask your physician - it is only recommended for low risk individuals (typically healthy non-pregnant individuals between the ages of 2 and 50).

 

 Why shouldn't pregnant women get the nasal spray vaccines? (Posted on Oct.23, 2009)

The nasal spray vaccines (available for both the seasonal and H1N1 virus) have not been tested in pregnant women and is only being recommended to healthy young (under 49 years of age) people. Live vaccines are not recommended for use in pregnant women because of concerns about the effects of a live virus on the fetus and whether the pregnant woman's immune system can fight off a live virus infection - even the severely weakened vaccine virus.

 

How do I know if one of my patients or someone in my family should go to the hospital? (Posted on November 19, 2009)

There are some key symptoms to watch for, Lisa. These include: rapid or shallow breathing, difficulty in breathing, extreme weakness, inability to swallow enough fluids, or a worsening of symptoms after a few days of illness. A complete list of symptoms can be found at www.cdc.gov/h1n1/sick.htm#3.

 

 

Who should get the seasonal flu vaccine? (Posted on October 30, 2009)

In general, anyone who wants to reduce his or her chances of getting the flu can be vaccinated. However, it is recommended by the CDC that certain people get vaccinated every year because they are at risk for serious complications from the flu or they care for people at high risk for serious complications. Here's the list:

• Pregnant women
• People between the ages of 6 months and 19 years of age
• People aged 50 years and older
• People of any age with chronic health disorders or a compromised immune system
• People who live in nursing homes and other long-term care facilities
• People who care for those at high risk including
• All workers in a health care setting
• Household contacts of persons at high risk for complications
• Household contacts and caregivers of children <5 years of age with particular emphasis on vaccinating contacts of children <6 months of age (these children are at higher risk of flu-related complications)

 

 

How long can the H1N1 virus live on environmental surfaces? (Posted on October 23, 2009)

The influenza virus can live for 2-8 hours on surfaces such as books and doorknobs. Viruses can be spread when a person touches a contaminated surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands. Therefore the best way to protect yourself is to wash your hands frequently, and to keep your hands away from your eyes, mouth and nose.

 

How can I tell if I have swine (H1N1) flu? And does it matter if it’s H1N1 flu or the seasonal flu? (Posted on November 19, 2009)

Virtually every case of influenza occurring at this time is being caused by the H1N1 virus. While individuals with severe flu-like symptoms illnesses are being tested to determine for certain which virus is causing the disease, there is no reason for most people to get tested.

 

What is the best source of information about the H1N1 virus? (Posted on November 19, 2009)

There are a couple of Web sites that provide good general information. The one I like the best is www.flu.gov, but be sure to check your state or county public health department’s sites also.  

 

Who should get the H1N1 vaccine? (Posted on October 30, 2009)

This is a very different group that those recommended for the seasonal flu due to the fact that H1N1 infections and complications are much higher among the young in our population. Because of the possibility of shortages, this list may shrink or expand depending on supplies. Here's the current list of those who should be vaccinated: (Posted on October 30, 2009)

• Pregnant women
• People between the ages of 6 months and 24 years of age
• People between the ages of 25 and 64 years of age who have chronic health disorders or a compromised immune system
• People who care for those at high risk including:
• Healthcare and emergency medical services personnel because infections among healthcare workers can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity
• Household contacts and caregivers of children less than 6 months of age

If there is enough vaccine to go around, the CDC will probably recommend that everyone between the ages of 25 and 64 years of age receive the H1N1 vaccine.

 

Is the injectable H1N1 vaccine safe for pregnant women? (Posted on Oct.23, 2009)

I know this is a hard decision. I am married and have three children and I never wanted to do anything that could possible hurt them. Having said that, there is a risk associated with doing something (getting the vaccine can result - rarely - in significant side effects) and there is a risk associated with doing nothing (not getting the vaccine can result - rarely - in a very severe and even life-threatening infection). Remember, pregnant women have been hospitalized, lost their babies, and some have even died.

If I were you, I would definitely recommend that your wife get the H1N1 vaccine. For some reason, the H1N1 virus is especially dangerous when someone is pregnant. The seasonal flu vaccine is also recommended for pregnant women.

I should add that the seasonal flu vaccine, which has been given to pregnant women for years, has an excellent safety record in pregnant women and so far, in every trial that I have seen, the H1N1 vaccine and the seasonal flu vaccine have had similar safety profiles.

 

I received the swine flu vaccine in the 1970s. Do I need to get the H1N1 (Swine Flu) vaccine this year? (Posted on Oct.23, 2009)

Flu vaccines generally provide protection for only a year or so - so the answer to your question is "yes" - assuming you are in the targeted groups that should get the H1N1 vaccine.

 

 

Are the antivirals, Tamiflu or Relenza, a substitute for the flu vaccine? (Posted on November 2, 2009)

No.  Getting the flu vaccine is the best way to protect against getting the flu and the best way to control the spread of the flu.

 

What do the terms "treatment of the flu" and "prevention (prophylaxis) of the flu" mean? (Posted on November 2, 2009)

Treatment is used when a person is given Tamiflu or Relenza because they have the signs and symptoms of the flu or have been diagnosed with the flu. Tamiflu and Relenza have both been shown to lessen the amount of time people are sick with the flu and they also lessen the severity of the symptoms. Prevention (prophylaxis) is when someone who does not have flu symptoms is given Tamiflu or Relenza to help stop them from getting the flu because they were exposed to or came into close contact with someone who had the flu.

 

Do I take Tamiflu or Relenza the same way for treatment and prevention (prophylaxis) of the flu? (Posted on November 2, 2009)

No. The number of times a day (frequency) and the number of days (duration) that you take an antiviral are different for treatment and prevention of the flu. Prophylaxis should only be given to those populations considered to be at high risk for complications. Both treatment and prophylaxis should be started within 48 hours of symptoms or exposure. Your physician will tell you how to take Tamiflu or Relenza properly but below are the general recommendations for adults:

 

Should everyone who comes down with the flu take Tamiflu or Relenza? (Posted on November 19, 2009)

No. The CDC guidelines recommend that only individuals who are in high-risk groups should receive Tamiflu or Relenza at the first sign of symptoms. (Within 48 hours is best.) If you develop symptoms of severe influenza, Brett, then you should seek out medical treatment and begin to take Tamiflu or Relenza. For most people who come down with the mild form of the disease, the use of Tamiflu or Relenza is not recommended or needed. My middle child (who is 24 years old) just came down with H1N1 over the weekend and we did not treat him with an antiviral.

 

Tamiflu: (Posted on November 2, 2009)

Treatment: 75 mg 2x/day for 5 days

Prophylaxis for exposure: 75 mg 1x/day for 10 days

Prophylaxis in NH if epidemic: 75 mg 1x/day for one week longer than the last outbreak - minimum of 2 weeks

Prophylaxis for community epidemic: 75 mg 1x/day for 28 days

 

Relenza: (Posted on November 2, 2009)

Treatment: 2 inhalations 2x/day for 5 days

Prophylaxis for exposure: 2 inhalations 1x/day for 10 days

Prophylaxis in NH if epidemic: 2 inhalations 1x/day for one week longer than the last outbreak - minimum of 2 weeks

Prophylaxis for community epidemic: 2 inhalations 1x/day for 28 days

 

What should people do if they continue to have or start to develop flu symptoms while taking an antiviral? (Posted on November 2, 2009)

If flu symptoms do not go away, or if new symptoms develop while taking an antiviral, people should contact their physician. Other illnesses cause people to have symptoms similar to the flu, or may occur at the same time as the flu, and they might need other treatment.

 

Tamiflu

 

What is Tamiflu and what is it approved for? (Posted on November 2, 2009)

Tamiflu (oseltamivir phosphate) is an antiviral drug. It works by attacking the flu virus to keep it from multiplying in your body. Tamiflu is used to treat people 1 year of age and older who have the flu. Tamiflu is also used for prevention (prophylaxis) of the flu in people 1 year of age and older. During the H1N1 ("swine flu") public health emergency, the FDA did authorize the use of Tamiflu in children less than 1 year of age.

 

Does Tamiflu come in a liquid as well as capsules? (Posted on November 2, 2009)

Yes, Tamiflu is available as a liquid (oral suspension) and as oral capsules of different sizes. Your physician will prescribe the strength that is right for you. It is very important to make sure the liquid is dispensed properly - matching mg or mL - depending on the prescription.

 

Is there enough Tamiflu suspension? (Posted on November 2, 2009)

For the 2009-2010 flu season there is not enough of the liquid Tamiflu made by the manufacturer.  Some pharmacies can make a liquid form for patients. The strength of the liquid made by the pharmacy may be different than the liquid from the manufacturer.  You should always follow the directions on the medicine label for how much and how often to give the medication. You should speak with your physician or pharmacist if you have any questions.

 

Should women who are pregnant or nursing take Tamiflu? (Posted on November 2, 2009)

Yes. The CDC recommends that pregnant women who are sick from 2009 H1N1 influenza be treated with a flu drug. Clearly, pregnant and nursing women should talk with a physician before using Tamiflu. More information is available at: www.flu.gov/individualfamily/parents/pregnant5tips.html.

 

What are the most common side effects of Tamiflu? (Posted on November 2, 2009)

Tamiflu is generally well-tolerated by most patients. The most common side effects are nausea and vomiting. Usually, nausea and vomiting are mild and happen in the first 2 days of treatment. Taking Tamiflu with food may lessen the chance of getting these side effects. Other side effects include stomach pain, nosebleeds, headache, and fatigue.

 

What are the serious side effects of Tamiflu? (Posted on November 2, 2009)

Children and teenagers with the flu may be at a higher risk for seizures, confusion, or abnormal behavior early during their illness. These serious side effects may happen shortly after beginning Tamiflu or may happen in people when the flu is not treated. Rare cases of allergic reactions, including serious skin rashes, have happened in people who take Tamiflu. If you develop a side effect, stop taking Tamiflu, and contact your physician.

 

Relenza

What is Relenza and what is it approved for? (Posted on November 2, 2009)

Relenza (zanamivir) is an antiviral drug. Like Tamiflu, it works by attacking the flu virus to keep it from multiplying in your body. Relenza is used to treat people 7 years of age and older who have the flu. Relenza is also used for prevention of the flu in people age 5 years or older.

 

How is Relenza supplied? (Posted on November 2, 2009)

Relenza is a powder that you inhale into your mouth using a device called a Diskhaler. The powder is in a pouch called a blister. There are 4 blisters on each circular medication pack (Rotadisks). Each blister contains 5 mg of medicine. Each box of Relenza contains five Rotadisks.

 

How many blisters are used for a dose? (Posted on November 2, 2009)

Two (2) blisters are used for each dose.  The 4 blisters on the Rotadisk are enough medicine for 2 doses.  Your doctor will tell you how many times a day and for how many days you should take the medicine.

 

Are there instructions for people who have never used an inhaler? (Posted on November 2, 2009)

Yes, each box of Relenza has a Patient Instructions for Use leaflet that explains how to take Relenza using the Diskhaler device. These instructions are not a substitute for education and demonstration by your physician. To help make sure children or confused elders use Relenza the right way, it should be used only under supervision. The manufacturer, GSK, created a wonderful video on their website that demonstrates the proper use of the Relenza Diskhaler device, see www.relenza.com/using-relenza-videos.html.

 

Are there any other special instructions to remember? (Posted on November 2, 2009)

Yes, it is important to remember to puncture both the top and bottom of the blister using the Diskhaler before inhaling the medication into your mouth.  Relenza should never be used with any other device but the Diskhaler. The blisters of medicine should never be opened and mixed into a liquid.

 

Are there people who should not take Relenza? (Posted on November 2, 2009)

Yes. Relenza is not for people who have chronic lung diseases such as asthma or chronic obstructive pulmonary disease (COPD). Also, since the Relenza powder contains lactose, people who have a severe allergy to lactose should not use Relenza. Talk with your physician if you have concerns.

 

Should women who are pregnant or nursing take Relenza? (Posted on November 2, 2009)

Yes. The CDC recommends that pregnant women who are sick from 2009 H1N1 influenza be treated with a flu drug.  Pregnant and nursing women should talk with a physician before using Relenza. More information is available at www.flu.gov/individualfamily/parents/pregnant5tips.html.

 

What are the most common side effects of Relenza? (Posted on November 2, 2009)

Relenza is very well-tolerated by most patients. The most common side effects are: diarrhea, nausea, vomiting, headache, dizziness, nasal irritation, and cough. Some people have reported ear, nose, and throat infections.

 

What are the serious side effects of Relenza? (Posted on November 2, 2009)

Some people have trouble breathing while using Relenza, especially if they have chronic lung disease. If you have more trouble breathing after using Relenza, you should stop using Relenza. Children and teenagers with the flu may be at a higher risk for seizures, confusion, or abnormal behavior early during their illness. These serious side effects may happen shortly after beginning Relenza or may happen in people when the flu is not treated. Rare cases of allergic reactions, including serious skin rashes, have happened in people who use Relenza. If shortness of breath, abnormal behavior, seizures, or a rash develops, stop Relenza and contact your physician immediately.