H1n1 In My House

[Angelika_23]

It is official, my youngest son who is 8 has H1N1. He woke up with a high fever this morning. I took him to the doctor and they sent us to Children's to have him tested. It was positive.

So now I am worried because of all the complications my oldest son had with it. All three of my boys have asthma, but the two younger ones have it worse than the oldest one.

Here's hoping the Tamiflu does its job.

Angela

[erik]

So good that you have caught it early. Reportedly that gives Tamiflu the best chance of helping the most. We'll be hoping for a speedy recovery and continued recovery for your other son. So sad for anyone to suffer this, especially a young child. I wish you all well.

[Sophia3]

Thought of you when I saw folks lined up at local Fairgrounds for the vaccine...what a mess and WERE the high risk patients getting the vaccine?.

Keep us posted, Girl. Sending thoughts & prayers & energy for you to keep an eye on things...no easy feat for a busy mom/wife like yourself.

[Angelika_23]

Thought of you when I saw folks lined up at local Fairgrounds for the vaccine...what a mess and WERE the high risk patients getting the vaccine?.

I hear they stopped giving vaccines at 11:00, and they were scheduled to give them until 5:00. I'm not sure why they closed shop early. I guess it is too late for us to get the vaccine now, we are right in the thick of it.

[Sophia3]

Media got the info screwed up. SUCH a long line when they OPENED, no more were allowed on the property within a couple hours of opening. BUT They did continue to give shots as I heard the screaming kids on the local radio news (WLW) at 2pm and 3pm.

Then 6pm news showed the folks cleaning up after the day.

Now they are saying more shots tomorrow when earlier, Cunningham made it sound like they were OUT of the vaccine. So bad mixed messages...Rain made a mess of car parking and lines..and it was getting out of control, the crowds. So it was a mess in more ways than one.

But earlier I also was given impression the place was closed down due to running out of vaccines.

Can't count on National or local media to give out facts these days, can we?

[firewatcher]

My Son just got over H1N1. He received Tamiflu within the first 48 hours and the recovery was extremely rapid. I am praying that your son recovers as speedily as mine did!

[Mrs. Burschman]

Good luck! I hope the sick goes away quick and doesn't spread!

Amy

[tinkerbella]

I pray all is well with your sons. My heart goes out to you. My son called tonight and could barley talk. He's been sick since Tues and has no insurance and is 7 hours away from me. I could tell in his voice, that no matter how old you are sound when your not feeling well that you just want your mom. No, I don't know what flu it is, but it sounds like the H1N1. Tonight I ask for prayers please!!! Thanks you for your kindness and compassion. I feel so trapped being house-bound and want to be near him to take care of him.

Once a mother, always a mother~

Bellamia~

[Angelika_23]

Well, the Tamiflu seems to be doing its job. No big fevers today, and he is eating a little and sitting up. The cough is still there, but not quite as bad. Things seem to be looking up.

Now only 6 days to see if the rest of us (besides the oldest) get it. I heard the incubation is 7 days.

My middle son, who is 13 and has the most severe asthma, has started that awful coughing. No fevers so far though.

Thanks for all the well wishes.

Angela

[erik]

In addition to those already ill, have docs discussed an anti-viral "prophylactically"? It can be considered for those with increased risk of complications:

http://www.cdc.gov/h1n1flu/recommendations.htm#5

[Nauthiz]

just remember lots of fluids, fruits are great also contains vitamin C and majorly water.

[Angelika_23]

I did ask my doctor about giving the rest of us Tamiflu, and he actually got angry and said, "Why? So you miss the flu this time but get exposed to it later in the community? No, if you start with a fever I will give you Tamiflu." I guess that kind of makes sense... Tamiflu might keep me from getting sick this time, but it wouldn't give me an immunity to the virus.

[erik]

True. It could also hold an at-risk person at bay or avoid unnecessary exposure until vaccine was available, however. It is a judgment call. The CDC guideline is simply that it "may be considered" for certain individuals & circumstances (people with certain conditions or in certain public health positions). May or may not be "right" or end up being "better"... one never actually knows, just makes informed guesses.

[Intuit]

Need to correct this misconception: Tamiflu does not prevent you from contracting H1N1 when exposed. What it does is slow down and hinder viral replication, shortening the duration of illness and maybe reducing carriage (viral shedding after symptoms begin to subside).

Your doctor was absolutely correct to tell you 'no'. Regional hospital supply is ok, but community hospitals and clinics are already running into problems with Tamiflu access. Supply isn't nearly as robust as many people think. It needs to be conserved for those who need it.

Tamiflu (Children's formula, especially) - shortage in the news

http://tamiflu-news.newslib.com/

Regarding vaccine access: The CDC and States have really dropped the ball on this one. They KNEW months in advance that the demand at the start of the Fall Wave was going to be higher than supply, but got overconfident on promises back in July and August, of expected production volume that was, even then, falling short because this virus is difficult to culture and 'grow'.

In many places, clinics and pharmacies are dispensing these shots for as much as $50 a dose, for which you may stand in line for up to 5 hours. The working assumption is: your health insurance will cover it.

Mine does not. They see vaccines as 'electives', and figure them into yearly deductibles.

There is, as far as I can tell, absolutely zero intent by public health officials to sort the most susceptible from those who are least likely to contract Swine Flu (the elderly). In fact, senior citizens dominated the turnout at many 'free shot' community fairs through the nation in the last few weeks. The community health centers I contacted had absolutely no intent of rationing for the most susceptible - the limited supply was handed out on a first come, first serve basis. Their total supply was limited to less than one thousand doses. No repeats possible.

[erik]

I'd stick with the CDC discussion which is not a misconception. One key to understanding this is to realize that one is both trying to inhibit spread and mitigating risk not simply from H1N1 virus itself but from complications such as pneumonia:

http://www.cdc.gov/h1n1flu/recommendations.htm#5

# Post exposure antiviral chemoprophylaxis with either oseltamivir or zanamivir can be considered for the following: :

* Persons who are at higher risk for complications of influenza and are a close contact of a person with confirmed, probable, or suspected 2009 H1N1 or seasonal influenza during that person?s infectious period.

Asthma is a qualifier. All three sons have asthma. H1N1 was confirmed.

This is the scenario for which supplies are to be preserved... not an example of wasteful supply depletion. Even so, it is still a judgment call, not an automatic "yes". It is most certainly not an automatic "no". It also did not merit anger from the doc, nor even a "defensive" attitude about supplies. Neither of those are/were justifiable, especially given that complications of infection are so clearly evident here.

[lissy]

I'd like to add to this discussion why would there be such a shortage of this vaccine if there was this outbreak in 1976 was it.....30 years of research time and preparedness it doesn't make much sense . Hope all is well with those of you and families ill with this virus.

Lissy

[erik]

I believe H1N1 is more like a "family" of virus rather than a specific one. For example, there are other H1N1 as part of the yearly flu vaccine already... different H1N1's than this year's new one, which is sometimes called "2009 Novel H1N1". So this year, since the regular flu vaccine and the Novel H1N1 vaccines are separate for now, it's sort of akin to needing instantaneous double production... next season, reportedly it'll be merged into the regular vaccine along with any significant newbies from this coming flu season.

Are the kids hanging in there Angela? Did the middle son end up sick too? I hope not.

[Intuit]

The shortage of novel 2009 H1N1 animal-human influenza virus arises from several factors.

1. This is a pandemic-type, not seasonal-type influenza. Seasonal influenza in humans is a relatively new occurrence, post-dating the 1918 Spanish Influenza pandemic, with bird-pig influenza genes slowly adapting over the course of years to humans, evolving into a nearly purely human-adapted virus in response to human immunity,. Successive mutations caused the emergence, in the mid-20th c,. of two new strains that became the predominant seasonal flu types we see today.

The previously evolved and now seasonal-H1N1 disappeared for about 20 years, between 1957 and 1971. It re-emerged mysteriously, unchanged - a biological impossibility that has defied explanation. The 1968-1970 pandemic was a different strain, that went on to become immune-adapted as a seasonal influenza strain.

The 2009 H1N1 strain is genetically different enough from the presently circulating seasonal-H1N1, that there is little protection from seasonal flu vaccines.

People who were exposed before 1957 to the older version of H1N1 appear to possibly have immunity to it. Very elderly people who had been exposed to the pandemic-version in the 1920s were found recently to still have a very strong immune response to the reconstructed original 1918 pandemic virus. This reinforces the notion that exposure to strongly immune trigger influenza viruses causes the immune B-cell system to retain and maintain an antibody response for life.

This helps us understand how pandemic strains can eventually become seasonal, as viruses must mutate in the game of virus-against-human immune systems, and thus evolve into less virulent and dangerous viruses because we have at least partial immunity to the previous viral surface protein mutations that allow binding to human lung and human intestinal cells.

2. Pandemic viruses have some important differences in their mode of action when compared against seasonal influenza strains. So they are not the same. It remains to be seen just how effective the present 2009 H1N1 vaccines are - that will take months to analyze the data.

So why else was the vaccine 'late'?

3. Typically, seasonal influenza vaccines take about 6 months to select, generate and mass produce vaccines, from best guess estimates of last years influenza and strain studies of the most recent Southern Hemisphere strains in circulation.

Multiple dominant strains of influenza in global circulation is a VERY recent phenomena. That tells us that something has changed to afford multiple strain emergences as pandemic viruses that crossed easily into humans and become adapted within a decade or less as seasonal strains. Purely animal influenza viruses that can infect humans, like the Bird Flu (H5N1) are VERY RARE. These are pandemic viruses. Before the advent of human adaptation of influenza viruses, they were all bird adapted strains (the original host of the virus).

4. The emergence of this 2009 pandemic virus caught global health officials by surprise. It spread very, very rapidly once it reached a critical threshold, in March-April 2009. It spread far more quickly than other 20th century pandemics (of which there were 4 in total), most likely due to air travel and the infectious ease of this virus.

So, it emerged at a time when vaccine manufacturers were busy producing the 2009 seasonal vaccine. The virus had to be studied and individual samples tested to see if they could be cultured.

5. Culturing this virus was very difficult. Because it carries avian (bird) genes, it was good at culture evasion (traditional vaccines are still produced in duck embryos).

Thus we have surprising emergence at the very end of the regular flu season of last year, exceptional virulence, unknown factors that causes fatality among seemingly healthy adults, an unusual infection rate among age-cohorts not typically made very sick by seasonal influenza viruses, and exceptional difficulty in culturing the virus, which is also rather monotypic - it hasn't changed despite migrating globally in just 2 months time, and infecting virtually every nation on the planet as of October 2009.

A sixth problem is this: the cheap and quick lab test for H1N1 was found to be lower than 50% in accuracy. It has hindered case confirmation, and led nations to stop reporting cases this past summer, because of the rapid spread that made it less important to know exact numbers once it had moved through regions, and because of the difficulty in clinical confirmation of the virus.

While it would seem prudent to use the anti-viral agents like Tamiflu in households where 2009 H1N1 virus is present and where one or more individuals are highly susceptible, a physician must also decide whether to use the spare existing supply ONLY for active cases. In other words, he will readily provide the drug IF one of the other sons becomes ill, but not before. This is typical where dose rationing is required due to drug shortages, at the start of a suspected major infectious illness wave of unknown duration.

[Sophia3]

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