YMG doctor tells patients to stay wary of ‘swine flu’

[December 2009] While cases of the H1N1, or “swine flu,” seem to be on the decline, advice for patients remains the same: Be aggressive about minimizing your risk, get the vaccine if you are eligible and take care of yourself if you get sick.

“Fortunately it looks like there has been a recent decline in cases, but sometimes there is a second wave after an initial decline with influenza,” says Matthew Ellman, M.D., director of Yale Internal Medicine Associates. “The experts are ‘50-50’ on the likelihood of this for H1N1 – some say there is unlikely to be a second wave, and some say it’s a distinct possibility, so we need to remain alert.”

Federal health officials reported a decline in flu-like illness at the end of November, and the World Health Organization (WHO) proposed that H1N1 may have peaked in North America.

But flu-related hospitalizations and deaths remain high compared to what is expected for this time of year, according to the Centers for Disease Control (CDC) and Prevention. Ellman is seeing new cases every week and expects to see many more before winter is over.

Be aware of H1N1 symptoms

There are currently two strains of flu, seasonal flu and the H1N1, circulating in the United States. Approximately 5 to 20 percent of the population gets the seasonal flu in a typical year.

The 2009 H1N1 is a new influenza virus first detected in people in the United States in April, and it has been spreading from person-to-person worldwide. On June 11, WHO signaled that a pandemic of 2009 H1N1 flu was underway.

Most people who get H1N1 or the seasonal flu will have mild illness, won’t need medical care or antiviral drugs, and will recover in less than two weeks. However, many do not have immune protection against the 2009 H1N1 virus, and there has been concern that the new flu will cause more sickness, hospitalization and death than the seasonal flu, according to the CDC, which follows the flu activity closely. Certain populations, including people with asthma and diabetes, are at higher risk for severe and even life-threatening complications.

Get vaccinated if you’re eligible

The CDC recommends getting a both a seasonal flu vaccine and an H1N1 vaccine as the first step toward preventing the flu. But many people who are eligible for the vaccines are finding supplies to be limited. “Availability is fluctuating week to week,” says Ellman. “I tell people to follow the news about whether or not they are eligible for the vaccine. If they are eligible, I usually direct them to their personal physicians, but local community health departments have had flu shot clinics too.”

Currently groups that are eligible for the 2009 H1N1 vaccine include:

• Pregnant women
• People who live with or care for children younger than 6 months of age
• Healthcare and emergency medical services personnel
• Children and young people between the ages of 6 months and 24 years old
• People ages of 25 through 64 years of age who are at higher risk because of chronic health disorders or compromised immune systems.

If you aren’t eligible, you can still minimize the spread of the flu when you:

• Cover your nose and mouth when you cough or sneeze.
• Wash hands frequently with soap and water, and use an alcohol-based hand rub if you don’t have soap and water.
• Avoid touching eyes, nose and mouth.
• Stay home and limit contact with others if you get sick.
• Follow public health advice regarding school closures and other measures intended to avoid spreading infection.

What to do if you get sick

“If people do get sick with a flu-like illness, I usually go over the early symptoms of H1N1 with them – sudden high fever, a cough, sometimes a sore throat, muscle aches, fatigue and exhaustion,” Ellman says. “Children may have GI symptoms, including vomiting and diarrhea, which are a little unusual for typical flu. Elderly people might not develop a fever.

 “If you or one of your family members does get sick, the most important thing you can do is stay home, avoid contact with others for at least five days, get lots of rest, stay well-hydrated, lower room temperatures and take acetaminophen to reduce the fever,” Ellman said. People with H1N1 should see their doctor if they have a disease such as asthma or diabetes, or are otherwise at high risk for complications.

Anyone with H1N1 should call their doctor immediately if they experience serious symptoms such as shortness of breath, difficulty or pain breathing, a fever that lasts more than five or six days, confusion or disorientation, or chronic vomiting.