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Should We Fear the Flu?


Poets have long associated autumn with the waning of youth. By comparison, modern-day connotations are more prosaic. We think of buying fall clothes, the start of the school year, and something that could be crucial to our health and well-being: an annual flu shot.

This year, whether or not you get vaccinated will be influenced by a host of factors—not the least of which is last spring’s swine flu (H1N1) outbreak and the potential for a more serious scenario in the coming months. At the time of this writing, the FDA had approved vaccines from six manufacturers. None protect against H1N1. Only two antiviral drugs—Tamiflu and Relenza—have been deemed as effective precautionary measure against swine flu, and they’re available only by prescription to high-risk individuals or those likely to die from flu-related complications. In August, hundreds of Americans in eight cities participated in government-funded testing of experimental swine flu shots in a scramble to find a H1N1 vaccine by fall.

Such uncertainty is no cause for alarm, says Dr. Francesca Litow, who oversees vaccinations for Main Line Health’s Occupational and Travel Health service. For her, “novel” aptly describes H1N1, a mystifying virus that continues to show resistance to vaccines and has an atypical target audience, affecting a disproportionate number of young people.

And yet, like most health officials, Litow looks to the positive changes that have taken place in terms of increased public awareness for all types of flu. “In 2007, we saw recommendations for infants and the elderly,” she says. “Now we’re seeing the CDC include children all the way through the teenage years. There’s nothing now that you can do to prevent the H1N1 virus, but that doesn’t mean you can’t take precautions—like getting a seasonal flu shot and washing your hands frequently.”

As for finding a vaccine, “it takes time to develop, test and introduce to the public,” says Litow of the FDA’s annual evaluation process used for circulating strains of flu. “Then you have to make sure you have enough of it.”

Each year, the FDA works with the World Health Organization and members of the Centers for Disease Control and Protection to collect and examine samples of flu viruses that appear in parts of the world where winter is in full swing. Interestingly, the first wave of H1N1 occurred in the spring, an anomaly the world health community finds disturbing.

Doctors define seasonal flu as a virus that attacks the upper and lower airways. Like the common cold, it spreads from person to person in respiratory droplets that become airborne. What separates the flu from a cold is the tricky way in which the former interacts with the body’s cells. Most strains operate by blocking the immune response and binding to agents that are active only when pathogens are detected, making organs like the lungs more susceptible to bacterial infection. Influenza’s deep penetration into the lungs, in fact, is one of the main reasons why people with cardiovascular and chronic respiratory disorders are at particular risk.

Seasonal influenza A is the most common flu type. It’s also the most virulent—one that frequently shows up on school vaccination requests. It tends to go through annual genetic mutations, which is why vaccines need to be redeveloped each year. To further complicate matters, H1N1 is a variant of influenza A.

While the FDA has the advantage of global disease surveillance, the trick is predicting the strains that will most likely cause illness in the coming season. According to the CDC, an estimated 5-20 percent of the U.S. population is stricken yearly with seasonal flu. More than 200,000 are hospitalized with flu-related complications, and about 36,000 die from flu-related causes.

Continued on page 2, with 7 Flu Facts you should know …

How a person reacts to influenza varies, just as flu season can vary in terms of timing, duration and severity. With so many variables, it’s no wonder that there have been problems with the nation’s immunization programs. In recent years, those have included vaccine shortages and concerns about mismatches between vaccine antigens and the actual strains.

For the most part, though, garden-variety seasonal flu is easy to control. It’s relatively predictable, which is why the recommended course of action—beyond a shot—is to avoid infection when healthy and avoid infecting others when sick.

As for allaying fears of a possible H1N1 pandemic this fall, the CDC has developed diagnostic test kits doctors can use to detect the new virus. And by the time you read this, a H1N1 vaccine may already be available. When it is, the CDC has prioritized the candidates for it: individuals aged 6 months to 24 years, and 25- to 64-year-olds with existing health problems. In total, H1N1 vaccines will be recommended for about 159 million Americans.

Regardless of H1N1’s impact, Litow recommends the standard vaccine, which protects against one type of influenza B and two strains of influenza A. “It’ll help you stay healthy so you can be better prepared,” she says.

For more information and weekly updates on influenza outbreaks, visit health.state.pa.us and cdc.gov/vaccines.

7 Facts about Influenza

1. It’s unpredictable. Mainly because strains of circulating flu differ from year to year, scientists never know when the season will begin or how severe it will be.

2. It’s a good mimic. In its early stages, the flu can seem like a common cold. Watch for symptoms that go beyond a sore throat or runny nose, and include an
unusually high fever and extreme fatigue.

3. It’s sneaky. Scientists are still discovering ways the virus interferes with the body’s immune system. The blocking mechanism often varies and sometimes takes up to four days to produce symptoms, so you can be contagious and not know it.

4. It’s a school menace.
In children, the virus can be especially contagious, since the process known as virus shedding can last up to three weeks or longer. Complications can include sinus or ear infections.

5. It’s a hidden danger. Be vigilant about exposure to sneezing or coughing, and keep your hands and surroundings clean; the virus can live on books, doorknobs and desks for up to eight hours.

6. It’s vulnerable.
Soap and water, or an alcohol-based gel, are effective in killing it.

7. It’s controllable. While no vaccine is 100-percent effective, it can significantly reduce the flu’s severity and your risk for serious complications.

Who Should Be Vaccinated This Year?

• All kids 6 months to 19 years, especially those with asthma, diabetes and on long-term aspirin therapy.
• Those over the age of 50, regardless of medical history.
• Residents of nursing homes or other types of long-term care facilities.
• Women who will be pregnant anytime during flu season.
• Those with diabetes or blood disorders like sickle-cell disease.
• Those with cardiovascular conditions, or chronic liver, lung or kidney problems.
• Those with neurological and neuromuscular disorders like cerebral palsy and seizure disorders.
• Those who’ve tested positive for HIV or who have an immune suppression disorder due to cancer treatments.

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