How to prevent getting swine flu and what to do if you have it

Andrew Pekosz, an associate professor of molecular microbiology and immunology at Johns Hopkins University's Bloomberg School of Public Health in Baltimore, answers questions about H1N1 swine flu.
How can I tell if I have swine flu? And does it matter if it's that flu or the seasonal one? 
Virtually all the cases of influenza occurring at this time are caused by 2009 H1N1. While individuals with severe flu-like illness are being tested to determine for certain which virus is causing the disease, there is no need for most people to get tested. 
How do I know if I or someone in my family should go to the hospital? 
Some key symptoms to watch for include rapid but shallow breathing, difficulty in breathing and lethargy or extreme weakness. A complete list of symptoms can be found at http://www.cdc.gov/h1n1flu/sick.htm#3. 
What is the best source of information about the H1N1 virus? 
There are couple of Web sites that provide good general information on the H1N1 virus; the one I like for information to the general public is http://www.flu.gov, but be sure to check with your state or county public health department. 

Who should get vaccinated? What are the priority groups?

There are several priority groups being targeted for vaccination while the vaccine is in short supply. The complete list is at http://www.flu.gov/individualfamily/vaccination/vprioritygroups.html but includes pregnant women, health-care and emergency medical personnel, household contacts or caregivers of children under the age of 6 months, anyone between the ages of 6 months and 24 years of age, and people age 25 to 64 who have underlying medical conditions.
What's the difference between nasal spray and injection? Who should get what kind? 
The nasal-spray vaccine is a weakened form of the virus that does not cause influenza but does generate a good immune response. The injectable vaccine is an inactivated or "killed" form of the virus which is injected into the muscle of your arm. The nasal spray is only available to healthy individuals age 2 to 49, while the injectable vaccine is available to a wider range of the population. More information is available at http://www.cdc.gov/h1n1flu/vaccination/general.htm.
If I can't get the vaccine right away, is it still worth getting it later?

Yes. . . . We are not certain how long the flu season will last, or if we will have several flu seasons or "waves" this year, so when vaccine becomes available, everyone should take advantage of it. How quickly does the vaccination take effect? Is it possible to come down with the flu soon after getting vaccinated? After three weeks, most people have an immune response that will protect them from infection with 2009 H1N1. The immune response begins to be detected seven to seven to 10 days after vaccination. The vaccines cannot cause the flu, but you certainly could catch influenza during the time after vaccination when your body hasn't developed a strong anti-influenza immune response.

Should everyone who comes down with the flu take Tamiflu or Relenza? 

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. If you develop symptoms of severe influenza, then you should seek out medical treatment and begin to take Tamiflu and Relenza. For most people who will come down with the mild form of the disease, the use of Tamiflu or Relenza is not recommended in order to ensure enough of the drugs are available.

Ukraine to buy additional 700,000 doses of Tamiflu from Swiss producer

The Ukrainian government is planning to buy an additional 700,000 doses of Tamiflu medicines from a Swiss flu medicine producer at a price of UAH 67 per pack, Prime Minister Yulia Tymoshenko has said.
"Next week we’ll buy an additional 300,000 packs of Tamiflu from the Swiss producer Roche at the same price of UAH 67 per pack," she said at an open government meeting with the Ukrainian producers of medicines and medical equipment in Kyiv on Monday.
Tymoshenko said that a pack of Tamiflu medicines includes the ten pills needed to undergo a full course of treatment.
She also said that the government is holding talks to sign in the next two weeks another agreement on the purchase of an additional 400,000 doses of Tamiflu.
Tymoshenko said that the first doses of Tamiflu had been delivered to Ukraine in the early hours of Monday, at a price significantly lower than the retail price in Ukraine.
"The government will act if anyone is involved in real profiteering, and we'll use all possible methods. I won't forget about this [speculation on the pharmaceutical market] even after a certain period of time passes," she said.

Ukraine soon to receive 200,000 doses of Tamiflu

Ukraine will soon receive 200,000 doses of Tamiflu, a medicine used to treat or prevent flu, Ukrainian Foreign Ministry spokesman Valeriy Dzhyhun has said.
"Two hundred thousand doses of Tamiflu will soon be delivered to Ukraine," he said at a briefing on Monday.
He said that 300,000 doses of the medicine had already been delivered to Ukraine.
He said that the ministry had set up an emergency headquarters to fight the consequences of the spread of flu and acute respiratory infections and had launched a round-the-clock phone line.
"The Ukrainian Health Ministry and the World Health Organization have held talks, and [WHO] experts are soon expected to visit [Ukraine]. Lists of the necessary medicines and equipment have been drafted and sent to foreign countries via diplomatic channels," Dzhyhun said.
He also said that Foreign Minister Petro Poroshenko had held talks with a Swiss producer of Tamiflu, F. Hoffmann-La Roche Ltd, on the supplies of medicines at lower prices.
The ministry's headquarters also agreed with Indian pharmaceutical companies on the supply of medicines and medical equipment to Ukraine, he said.
He said that Ukraine is already receiving humanitarian aid from Slovakia, Poland and Hungary, and is expecting assistance from NATO and the European Union.
The ministry also agreed that China and Singapore would provide expert assistance to Ukraine amid the flu epidemic in the country.

Sixty-seven people die of flu in Ukraine

Sixty-seven people have now died of flu and acute respiratory infections in Ukraine, according to First Deputy Health Minister Vasyl Lazoryshynets.
He said at a briefing on Monday that 255,000 patients with flu and acute respiratory infections have been registered so far, and 15,000 of them in hospital, including 170 in intensive care units.
Lazoryshynets said that the Health Ministry had bought 67,000 doses of Tamiflu and received another 60,000 from the World Health Organization.
Moreover, 300,000 doses of Tamiflu were delivered from Switzerland to Ukraine in the early hours of Monday, on the basis of agreement reached between Foreign Minister Petro Poroshenko and Health Minister Vasyl Kniazevych. This amount will be enough to treat patients for a month, he said.

Health experts warn Europe of feared swine flu surge

LONDON - Health authorities across Europe are bracing for a third of their populations to become infected with the new swine flu virus this autumn, but do not plan to close schools or take other drastic measures to stop it. 
 Instead, they plan to educate people about hygiene, get vaccines out as soon as possible, and hope the H1N1 pandemic does not become deadlier than it has been.
 Some 200,000 doses of vaccine have just been delivered in Britain by drug firm Baxter International and many other European countries are expecting it to arrive from October onwards. That should be just in time to prevent mass illness.
 Companies making H1N1 vaccines include AstraZeneca's MedImmune unit, GlaxoSmithKline, Novartis AG , CSL and Sanofi Aventis.
 Epidemiologist Giovanni Rezza, head of Infectious Diseases at Italy's Higher Health Institute said Italy, like Spain, France and others, aimed to vaccinate 30 to 40 percent of its population, a level he said was "practical and sensible".
 "You have to consider that the indirect impact would be enough to stop the virus from spreading quickly among the population," he said.
 France, where schools restart on Sept. 2, unveiled its autumn swine flu plan this week, launching a month-long public information programme of radio, television and Internet adverts urging people to keep clean and vigilant, and suggesting they should sneeze into their sleeves if they have no handkerchief to hand.
 Slovenia and Austria have similar plans.
 "All the teachers have been briefed ... and every household will get a leaflet with instructions on personal hygiene," said Slovenia's Health Ministry spokeswoman Irma Glaner.
 In Spain, the socialist government plans to prioritise health workers and teachers when it gets a vaccine but has rejected opposition calls to delay the start of the new school term and a teachers union request for pregnant teachers to be allowed not to return until a flu vaccine arrives.
 EUROPE AWAITS "WAVE OF TRANSMISSION"
 Large-scale school closures, as in Britain when swine flu first began to take hold in April and May, are not on the agenda for any European government; a decision that health experts generally condone.
 Although the virus causes mild symptoms in many people, some develop severe complications and deaths have occurred among pregnant women, young children, people with underlying health problems like obesity and diabetes and even healthy adults.
 "It remains the case that this disease is not a killer, but it can kill," England's chief medical official Liam Donaldson said on Thursday.
 The H1N1 strain has now spread to 177 countries, causing at least 1,799 deaths, the World Health Organisation said.
 Angus Nicoll, flu coordinator at the European Centre for Disease Prevention and Control (ECDC) in Stockholm, pointed to southern hemisphere countries like Australia where the ECDC's latest data show 147 people have died and 422 are in hospital with the virus, more than a fifth of them in intensive care.
 "They have gone through an intense wave of transmission," Nicoll said. "The numbers of people who have been infected in Europe are pretty moderate, but it seems inevitable to us that Europe should be preparing for an autumn and winter of transmission.
 "There are countries like Spain, Germany, the UK and others, where we have got low-level transmission now. And it won't take a lot to tip them over into accelerated transmission."
 The new school year, which begins in countries across Europe in the next few weeks, could be the trigger.
 Young children can spread any virus from schools and daycare centres, and health and education authorities plan to push hygiene and information about the disease high up the school agenda.
 The government in the United States, where swine flu was first seen in March in California, is not recommending school closures either, nor the widespread use of antiviral drugs such as Roche AG's Tamiflu or GlaxoSmithKline's Relenza to prevent spread. Doctors say they should be saved for people most at risk of complications or death -- pregnant women or people with asthma or diabetes.

Swine flu has killed 36 US children so far - US CDC

WASHINGTON - The new H1N1 swine flu virus has killed 36 U.S. children, the U.S. Centers for Disease Control and Prevention reported on Thursday. 
 It said 67 percent of them had medical conditions putting them more at risk of severe disease, such as asthma, or were disabled with conditions such as cerebral palsy, but 22 percent of the children were under 5 and healthy.
 The CDC said that by August 8 it had reports of 477 deaths from the pandemic H1N1 virus, including 36 children under 18.
 "In two-thirds of those, the child had at least one severe underlying illness or underlying disability ... cerebral palsy, muscular dystrophy, long-standing respiratory or cardiac problems," CDC director Dr. Thomas Frieden told reporters in a telephone briefing.
 "There were some children who didn't have an underlying condition and who did become severely ill, and they were generally infected also by bacteria," Frieden added.
 "When you get the flu, your immune system can be a little weakened. You can be more susceptible to other infections. That's an important message for doctors to know that if someone has the flu, they get better, then they get worse again with high fever, that's a clue that maybe they should be treated with antibiotics."
 The new H1N1 swine flu was declared a pandemic in June and has been spreading globally since then. It has been active in the United States since it was identified in April -- unusual for influenza, which is only usually active in cooler months.
 It affects older children and young adults more than seasonal flu does, something that has concerned doctors. Seasonal flu can kill healthy children as well as those with medical conditions, but doctors worry more children could die because they are being affected more.
 "Each year, there are on the neighborhood of 50 to 100 deaths from influenza among children in this country," Frieden said.
 UNUSUAL FLU SEASON
 "The flu season this past year was very unusual, very unusual because you had first a normal flu season, which was a relatively mild season. Then you had H1N1 influenza. So, these deaths are outside of the normal time period."
 Quick treatment with the antiviral drugs Tamiflu, made by Roche AG under license from Gilead Sciences, or GlaxoSmithKline's Relenza, can help reduce how long and severe a flu infection is. People with health conditions need quick medical attention, Frieden said, as do children who have trouble breathing.
 "Most people with flu don't need treatment," he added. The CDC discourages using antivirals for people not at risk of severe infection, to preserve their power. Viruses and bacteria quickly develop resistance to commonly used drugs.
 A vaccine against H1N1 will not be ready until October, Frieden said.
 The CDC estimates that well over a million Americans have been infected with H1N1 and the infection is expected to spread widely as schools return to session after a summer break.
 "We are going to be trying to reach out to children in large number and parents to get kids' vaccines, because we know that so many kids can get the flu, and the vaccine is likely to be quite effective," Frieden said, adding that he would vaccinate his own children.

Will swine flu spare Ukraine? Not likely, experts say

Ukraine has only had two confirmed cases of swine flu so far, but experts warn that flu cannot be stopped by national borders.
 The H1N1 virus epidemic spreading across the globe. Having claimed more than 4, 200 lives already, the virus may be on its way to Ukraine. While Western experts say that Ukraine will be affected sooner or later, Ukrainian medical experts still hope the nation will be spared.
 Health officials around the world are preparing responses to H1N1 virus, more commonly known as swine flu. The next wave of the virus is expected as soon as October, worsening through December and January. The virus might affect as much as 30 percent of the world’s population, whereas the common flu affects less than 10 percent.
 The H1N1 virus, traced to Mexico, has breached European borders and reached pandemic level worldwide. Ukraine, so far, has been affected very little. Many also fear that Ukraine’s ailing healthcare system has simply failed to detect many cases.
 “It’s not about if, it’s about when H1N1 comes to Ukraine,” said Daniel Hryhorczuk, professor of Environmental & Occupational Health Sciences and Epidemiology at the University of Illinois School of Public Health in Chicago. “The virus is spreading in every other country in the world and just through air travel Ukraine will receive it,” he added.
 Ukraine hasn’t gone entirely unscathed. Officials on Sept. 29 confirmed that a second individual hospitalized that month had contracted it.
 The first case of H1N1 came in early June. The victim was a 24-year-old man who returned to Ukraine after two years in Detroit. He started feeling sick on his way home from the airport, went to the hospital and was preliminary diagnosed with H1NI. He was transferred to Kyiv Infectious Diseases Hospital No. 9, where he tested positive with H1N1. The diagnosis was later confirmed by a laboratory in London. The patient quickly recovered.
 No more cases have been registered, although medical experts say probably more cases exist. Belarus has six cases. Russia registered 457 and Poland 165. But the numbers have been rising in recent weeks. In September, Russia recorded its first known death from the H1N1 flu.
 Many Western countries stopped counting the cases because most people sick with flu-like symptoms were found to have contracted the H1N1 virus, which reached pandemic status quickly.
 The hopes for a long-promised vaccine have dimmed as the World Health Organization released a statement that current supplies of a vaccine are “inadequate for a world population in which virtually everyone is susceptible to infection.”
 Although Ukrainians are unhappy with visa restrictions and an economic crisis that have curtailed their travels abroad, staying home has turned out to be a benefit in avoiding this infectious virus.
 “The reason why Ukraine has a lesser amount of cases is probably the smaller quantity of people travelling to the countries where H1N1 spiked,” said Philippe Guibert, medical director of health programs for International SOS. “When it comes to H1N1 epidemic, there is no geographic difference; just some Western health care systems are more prepared to handle the epidemics.”
 Ukrainian First Deputy Health Minister Oleksander Bilovol is confident that his country is ready to combat H1N1. “We have 200,000 extra beds across Ukraine in storage to supply the infectious diseases hospitals if we see an inflow of patients. We also have some 60,247 packs of Tamiflu, the most effective viral medication recommended by the WHO, in stash and we are planning on acquiring 45,000 more packs,” he said.
 Ukraine has set up a laboratory that can test for H1N1 virus and more test kits are planned to be purchased. Ukraine’s strategy is to contain the H1N1 virus and impede its spread among the population by surveillance in the airports and train stations.
 According to Victor Marievsky, director of the state Gromashevsky Epidemic and Infectious Diseases University, the government’s doctors receive a list of people who have recently come back from the countries where the cases of H1N1 flu were registered. The doctors are instructed to keep an eye on the potential patients.
 “Any person who tests positive for H1N1 will be isolated, treated and not allowed to travel within and out of the country,” Marievsky said.
 The H1N1 virus is not usually deadly, but spreads quicker than usual flu because it’s a new virus against which people have not built immunity. According to the WHO, 2 percent of patients sick with H1N1 come to hospitals with complications. People with lung and heart conditions, diabetes, obesity, pregnant women, elderly and very young children are in the high-risk groups.
 In the United States, where the number of cases has topped one million, surveillance of international travelers has been dropped as a strategy. Education of the population on how to avoid catching the virus and avoid spreading it has accelerated.
 “Because influenza is so [easily] transmittable, it’s an uphill climb to prevent its spread through standard methodology,” said Boris Lushniak, an assistant surgeon general at the US Food and Drug Administration, who came to Ukraine in September for an H1N1 conference. “For Ukraine, it’s very important to make sure that they are finding the real number of the cases and identify the point when the strategy for combating the virus should be changed.”