YourHealthMatters

Can You Believe Tamiflu Doesn't Help with H1N1 ?

For any of my readers who have had H1N1 flu already or anyone in their family, if you were treated with Tamiflu and recovered quickly you might get a laugh out of this report from The Cochrane Report.

This group claims there is insufficient proof Tamiflu works. Well, just ask any of the many people I have treated with Tamiflu since H1N1 hit here in July. With Tamiflu they uniformly recovered in about 48 hrs and without it, they took 7-8 days to recover and return to work. I say that difference is not only statistically significant but also very important to people's quality of life and their ability to continue working. But far from it for me to suggest people know better than some researchers.......

Read this article on MSNBC.

drBob

PS - this is not an April Fool's joke but sounds like one doesn't it!

Safety Report on H1N1 Vaccine

This study from CDC reports that 22 million H1N1 shots have been given so far in the US in 2 months and only 10 cases of Guillain-Barre Syndrome have been seen. This is a far far lower rate of this dangerous side effect than seen with the 1976 H1N1 vaccine.

So it appears we should be strongly considering this vaccine if we are in the high risk groups. such as pregnancy, children under 17, people with asthma or lung disease and anyone with a weakened immune system from disease. People in families with very young babies should also consider vaccination.

Healthcare workers are also considered high risk. Here in Mexico the only people who will be receiving the vaccine are healthcare workers. How fortunate we are in the US.

As of this coming week I will finally be receiving a shipment of the vaccine. I will be returning from a wonderful rest in Mexico this weekend and the office opens on Monday, November 30. We already have a "reservation" list of high risk patients in our practice and will begin phoning them next week for a vaccine appointment. Anyone else in the practice who wishes a shot, please let us know next week.

Read the article on MSNBC about the safety of the US vaccine here.


drBob

If You Want an H1N1 Shot, Can You Find One?

MSNBC reported on the weekend that only one in 3 people seeking the H1N1 vaccine can find it. There is an incredible shortage despite recent comments to the contrary by DHE Secretary, Kathleen Sibelius. I have had 500 shots on order for 6 weeks and have received 10. In Liberal the Public Health Department is running clinics to vaccinate the people in high risk groups. They do not seem to be distributing shots to local doctors. If you live in Liberal and want an H1N1 shot, call the Health Department.

Read this MSNBC article for their information on this widespread shortage which at this late date in the year should never have happened.

drBob

Who Will Get the Swine Flu (H1N1) vaccine first?

If you have been thinking about getting the H1N1 shot and you can't find any shots, here is the list in order of priority of high risk groups. When all of these groups have been immunized the rest of us will have our chance.

    •    Pregnant women;

    •    People who live with or care for infants younger than 6 months of age;

    •    Healthcare workers (HCWs) and emergency medical personnel;

    •    Persons 6 months to 24 years of age;

    •    Persons 25-64 years of age who have chronic diseases (including immunodeficiency states) that      pose risk for influenza.

When more vaccine becomes available, the following persons should be vaccinated:
    •    Healthy persons ages 25-64 years; and
    •    Adults 65 years of age and older.

Patients on the high-priority list should be vaccinated as soon as the vaccine is available. Individuals with the highest priority, as listed above, should be vaccinated first, but stringency of methods to restrict vaccine use is unclear.
Contraindications to the inactivated vaccine include:
    •    Previous Guillain-Barré syndrome;
    •    Life-threatening reaction to previous influenza vaccination; and
    •    Severe illness (a "moderately or severely ill" patient is advised to wait, but a mild upper respiratory infection or other illness is not a contraindication).
Note that pregnancy and breastfeeding are not contraindications to receiving the inactivated vaccine.
The above information is from an article posted yesterday on MedScape. I highly recommend you read it for further details, especially the contraindications to using the LAIV - live attentuated nasal vaccine, which is going to be the vaccine form used in many schools to mass immunize children in school without injections.

This article clarifies a number of issues around safety testing, side effects and vaccine production. Adjuvants such as squalene are NOT in this vaccine. Thimerosal (containing mercury) is in the vaccine. If you don't like this idea, think about the alternative which is risking death from the H1N1 infection. 46% of hospitalized adults with H1N1 complications had no prior medical history. The number of children dying from H1N1 is climbing. Read this article for further sad details.
 
Distribution of the shots to doctors in the US is through local Public Health Departments. I have had 500 shots on order since September and received only 10 so far which went to my high risk patients very quickly. No one can tell me when I might get more. No matter what you may see in the news about the shots being widely available., they are not as of now.

drBob

More "Good" News about H1N1 Vaccine !

Read this article and realize that once again the best laid plans may go awry!

We in the US may not get enough H1N1 vaccine fast enough to give people time to develop immunity soon enough in this pandemic. It takes 6 weeks to develop immunity on average from vaccines. It is known that the strain of H1N1 in the vaccine does produce antibody immunity to the currently circulating H1N1 virus infecting the public. But somehow not enough is being produced fast enough. There are a number of reasons cited in this article which could have been avoided perhaps with better preparation. One manufacturer still has not received FDA clearance to release the vaccine they are making. WHY NOT? One company is producing about half the planned number of doses at present. WHY?

So although I have recommended people consider this vaccine, especially people in high risk groups, there may not be enough vaccine soon enough to help people avoid getting an infection.

Plan B - make sure you know the symptoms of the H1N1 flu. You may wish to have a prescription of Tamiflu pills on hand in case an adult at home becomes sick with H1N1. Ask your doctor firmly for the prescription. Be scrupulous about hand-washing and cleaning hard surfaces anyone coughs or sneezes on.

I continue to see new infections in people every week. The infection still reacts quickly and well to Tamiflu. I have seen some very severe cases with chest infections. There has been one pregnant woman die in this area already and one boy died of spinal meningitis due to H1N1. The overwhelming infections develop quickly in often the first 24 hours.

I am submitting 2 samples per week to the KDHE from people I diagnose with H1N1 by history. These samples are being analyzed quickly with the latest PCR gene technology to identify the virus type and whether any mutations are occurring. The viruses recovered are also being tested for resistance to Tamiflu. I am also reporting weekly the number of new cases of H1N1 I am treating in the practice. This information is vital for us to see how fast or slow this virus is spreading and whether it is mutating.

Sadly, although I was the first physician in Liberal to sign up to receive H1N1 vaccine, I have only received 10 shots and they are gone. Public Health is distributing the vaccine as it slowly arrives and they have targeted high risk groups to receive it first which is the best way to use our very limited supplies.

I am resisting blaming any group for this huge error in planning but I know you know who is responsible.

drBob

To Take THE Shot or Not?

Well has my writing helped you decide about taking the H1N1 vaccine or just  made you more confused. I have had some of the highest page views ever on the days I post about H1N1, from my readers and across the country. What will I ever write about after the H1N1 pandemic settles?? I'd appreciate your comments on other topics we should get back to.

So will you take THE shot or not? That is the question it seems on many people's minds.

Some issues to remember.

First and most important H1N1 can rapidly overwhelm the lungs and kill by respiratory failure. Anyone with asthma or chronic lung disease is at higher risk of a severe H1N1 infection. These people need to take H1N1 shots when available. They should never take nasal inhaled H1N1 vaccine.

Second children under 17 seem unusually susceptible to complications of the H1N1, likely because they have never been exposed to any similar flu virus. This group needs to consider the immunization. H1N1 infection seem to spread easily in schools, far easier than I have seen it spread in families.

Third, anyone with a compromised immune system from chemotherapy or autoimmune disease should consider the benefits of protection from H1N1 with a shot versus the risks of getting the actual infection with a weakened immune system.

Fourth, pregnant women seem to be at high risk for a severe H1N1 infection. In this area one pregnant woman has died of H1N1.

Fifth, half of all hospitalized people with H1N1 complications have been very healthy prior to the infection. One in four  adults hospitalized with H1N1 were put in the ICU immediately.

So just staying healthy is no guarantee against a severe H1N1 infection.

drBob

Who Gets Hospitalized with H1N1 Infections?

A major report on the prior health of hospitalized H1N1 patients this week showed that 46% of the hospitalized adults in the study did not have any major prior health problem, such as lung disease or asthma. In other words, just staying healthy and disease-free does not guarantee that an H1N1 infection may not lead to you being hospitalized.

Of the 1400 adults in the study, 34% did have asthma or other lung disease and 6% were pregnant.

The study of the hospitalized children was not completed. Read the article reporting on this study here.

Coupled with the WHO report last week that I posted here showing only mild side effects in 4 people out of 39,000 injected with the H1N1 vaccine, I recommend you seriously consider having the H1N1 vaccine shot when available. The first groups targeted to received the vaccine are children under 5, health-care workers, pregnant moms, and children under 17. Then other groups of adults will be encouraged to get the shot.

drBob