This year’s influenza season is unique in that there are additional strains circulating, with unclear medical implications for the US population. I interviewed Dr. Joseph Stubbs, president of the American College of Physicians, to get the inside scoop on what to expect this year with the H1N1 and seasonal flu strains. You may listen to the podcast or read a shortened version of the interview below.
Dr. Val: Why are younger people and pregnant women more susceptible to H1N1 flu?
Dr. Stubbs: What we think is going on with younger people is that some of the genetic material of the H1N1 flu virus was part of the seasonal flu before the 1960’s. Older individuals may have an enhanced immune response to the novel H1N1 virus because their bodies can recognize it and fight it more effectively. Since younger people have never been exposed to this virus before, they’re more susceptible to it.
As far as pregnant women go, we’re not exactly sure why they’re at higher risk for complications from the H1N1 flu, but it’s possible that their susceptibility is related to changes in the immune system associated with carrying a baby. The immune system has to tolerate and accept the growing fetus – which happens to make it less effective at fighting off viruses.
Dr. Val: What’s the latest on the timing of vaccine availability? Do you think we’ll get it in time to head off an epidemic?
Dr. Stubbs: HHS Secretary Sebelius recently announced that the FDA has approved the novel H1N1 flu vaccine, and it appears that it will be effective with one shot. They’re hoping to make it available within the first 2 weeks of October, which is ahead of schedule. However, we still don’t know how much of the vaccine will be available, and how hard we’ll have to ration it. We hope that this will ward off a major pandemic. But here in Georgia, we’ve already been seeing a large number of cases.
Dr. Val: Should physicians prioritize their patients and give the vaccine to the at-risk groups first?
Dr. Stubbs: Right now we are planning to ration the vaccine initially to those who are at risk, which includes: healthcare providers, pregnant women, people who provide care for infants who are less than 6 months old, children 6 months to 24 years of age, and those ages 25-64 who have chronic illnesses that might cause them to have a more severe case of the flu. If we have enough supply then we’ll also vaccinate healthy adults and seniors. But seniors should make sure they get the seasonal flu vaccine this year.
Dr. Val: How does the H1N1 flu differ from the usual seasonal flu?
Dr. Stubbs: The seasonal flu vaccine continues to kill 30,000 of our citizens every year. The people who most need the seasonal flu vaccine are individuals over age 65, immunocompromised, and young infants. We expect the seasonal flu vaccine to be widely available and we recommend that almost everyone get that as soon as possible.
Dr. Val: Is the novel H1N1 flu virus related to the deadly Spanish flu of 1918 in any way?
Dr. Stubbs: They do share some genetic features, but not all.
Dr. Val: Are you concerned about the H1N1 flu virus mutating?
Dr. Stubbs: We certainly are, though we’re concerned about that with any virus. We’re most concerned about the flu becoming resistant to the anti-viral medicines that we have now like Tamiflu – which we use for people with serious cases of the flu.
Dr. Val: How do people know if they have a “serious” case of the flu?
Dr. Stubbs: If someone is experiencing severe shortness of breath within the first 48 hours of getting the flu, or if they have a severe headache and are not acting themselves or if they have uncontrollable diarrhea or vomiting, that requires medical attention.
Dr. Val: What’s the most important thing for Americans to know about the H1N1 flu?
Dr. Stubbs: The most important thing is not to panic. People should not crowd the ERs just because they think they might have the H1N1 flu – they should only go if their illness is severe as I described before. They should wash their hands frequently, and if anyone gets sick, stay home so you don’t spread it to others. The vast majority of people will get better within a few days.
Kraft calls the new line “wholesome,” but are they?
Turkey and Cheddar Sub Sandwich seems like it could be a healthy choice, but actually it is filled with fat, sodium and sugar. Here’s a complete list of ingredients that may shock you.
Digging a little deeper
I’m curious now to find out what’s behind the “New Deep Dish Cheese Pizza.” Here’s how it’s described:
You won’t have to dig deep for our Deep Dish Pizza, made with Kraft 2% Mozzarella and 2% Cheddar, deep dish crust made with whole grain, Tombstone Pizza Sauce, Tree Top® Applesauce, Mini Nilla Wafers, spring water and Tropical Punch Kool-Aid Singles.
It doesn’t sound so bad, does it? Low fat cheese, whole grain crust, pizza sauce, applesauce, mini Nilla Wafers, spring water; what’s so bad about that? One more ingredient includes Tropical Punch Kool-Aid Singles. Hmm…what was wrong with just the water? Why add all that sugar?
Okay, I’m digging deeper now to read the ingredients. Well, take a peek, and you decide. The long list of ingredients isn’t healthy. The Deep Dish Pizza is filled with fat, calories, sodium, cholesterol, and sugar.
Read the Ingredients
It’s really important to read the ingredients and not just the label. The packaging and wording are created in such a way to capture your attention and it gives the appearance that it’s healthy, but in fact it is not.
Playing detective
You could actually make a game out of this with your kids. Take them food shopping with you and have them take the “Food Label Challenge Test.” (I just made that up). Show them the package and the front label, ask them if they think it’s healthy or not. Have them read the ingredients, you may be surprised at what you find! The little gumshoes may enjoy the challenge.
So remember, make sure the next time you’re out food shopping, read the ingredients, not just the front label. Playing detective might not be such a bad idea; you may be surprised at what you find in your foods.
*This blog post was originally published at Health in 30*
I recently joined SVP of the Boys and Girls Clubs of America, Judith Pickens, at ABC News to discuss the childhood obesity crisis and what can be done about it.
In a recent interview with Dr. Oz on Good Morning America, Dr. Oz told Diane Sawyer that he doesn’t think any of the proposed health care plans will work. Why? As Dr. Oz told Diane:
“What we haven’t done is get to the very root reality of the flaws we have in the health care system. True health care reform cannot happen in Washington. It has to happen in our kitchens, in our homes, in our communities. All health care is personal.”
Dr. Oz pointed out that the United States has twice the disease that is found in Europe. He believes that we have to find it impossible for Americans to not embrace good health. According to Dr. Oz:
“If I make your workplace conducive to walking at lunch, or working out at some time during the day, or I get people to use the stairs more by creating incentives to do such, then people will start doing it naturally.”
All you have to do is walk around any place USA compared to anywhere else around the globe to know this is true. Or, just note our friends from around the world who are visiting our country on vacation. Striking how much healthier our friends from other parts of the world appear – and act. They seem more vibrant, have more energy.
For these reasons, Dr. Oz isn’t hopeful any of the healthcare reform plans will work. He feels that until people start living more healthy, how the health care system is paid for is really moot. In his words: “The big debate right now in Washington is health care finance. It’s how are you going to pay for it. I don’t care which program we pick. I’ll tell you why. Because none of them are going to work.”
The sad truth is, he’s right. Americans have shown themselves to be very untrustworthy on the health care front with heeding doctors warnings about healthy living. Until that changes, until we find a way to make healthy living more appealing, how the system is paid for isn’t the path to reform.
After listening to President Obama last night, where does that leave us? No where useful. Sure…he talked a good talk about the insurance changes needed for the economics of the system to work but that has nothing at all to do with the true reforms needed in our system for not only personal health care but the actual ability to practice medicine, a topic the President barely covered last night.
I felt President Obama did an adequate job calming the waters of the misconceptions of the bill he is trying to put forward but let’s not mistaken that bill for the type of true health reform our country will need in the end. That type of reform, as Dr. Oz, pointed out, has to come from within each of us and the start of that may be as simple as looking in the mirror and accepting more individual responsibility for our own bodies and what happens to them.
What about savings, you ask? If we all care for our bodies better, we’ll all save by saving ourselves the time and expense of doctor’s visits, prescriptions, procedures, operations, and treatments of all kinds. Those savings will not only be in dollars to our bank account but years to our lives. Doesn’t sound too bad, huh?
*This blog post was originally published at Dr. Gwenn Is In*
We have been inundated with so much information about the 2009 H1N1 that it’s hard to keep it all straight. Here’s my top ten list of what’s most important to know, much of it coming from the website of the Centers for Disease Control and Prevention, which has done a spectacular job of providing timely and useful information:
1) What is the 2009 H1N1 Flu (Swine Flu)?
Different from the typical seasonal influenza virus, this is a new type of flu virus that appeared in Mexico in April, 2009 and soon spread to the United States and around the world. It contains a combination of genetic material found in influenza viruses that infect humans, birds, and pigs.
2) Why are people concerned about the 2009 H1N1 pandemic?
Over the past century, three major pandemics have swept through the world and caused severe illness and death. The most devastating by far was the influenza pandemic of 1918, which killed 40-100 million people worldwide and 500-750,000 Americans at a time when the U.S. population was only about 100 million. The 1957 “Asian flu” caused about 70,000 deaths when the U.S. population was about 170 million. The last pandemic, in 1968, killed about 34,000 out of 200 million Americans.
3) How does the 2009 H1N1 influenza compare to the typical seasonal flu?
Because the 2009 H1N1 virus is new, most people – especially children and young adults – have little or no immunity against it. It is spreading more quickly than the usual seasonal flu but seems to be somewhat milder – though still capable of causing severe illness and death. The typical seasonal flu affects 15-60 million Americans, leading to more than 200,000 hospitalizations. Annual deaths range from 17,000 to 52,000 annually, averaging about 36,000.
The elderly are especially at high risk of seasonal flu, with over 90% of deaths occurring in patients over 65. In contrast, 2009 H1N1 has preferentially affected young adults and children while older patients appear to have some immunity. Only 18% of deaths from H1N1 have been in patients over 65.
For both the regular flu and the 2009 H1N1, certain groups are at increased risk for complications once infected – children under 5, pregnant women, and patients with underlying medical conditions such as suppressed immune systems, asthma, diabetes, neurological disorders, kidney problems, and heart disease as well as adults over age 65.
4) What Can We Expect This Fall?
Flu virus tends to die down over the summer because it survives better when the weather is cold and dry than warm and humid. That’s why during our summer the H1N1 virus spreads to the Southern Hemisphere, where it’s winter. But the virus never really went away in America and is now surging much earlier than with the regular seasonal flu.
In August, a panel of experts prepared an extensive report for President Obama about the virus. While warning that the exact impact of H1N1 was impossible to predict, the panel outlines a “plausible scenario” that included 60-120 million infected Americans, as many as 1.8 million hospital admissions, and 30-90,000 deaths. Others, including the CDC, have suggested that these estimates are a “worst case scenario.”
Unfortunately, the influenza virus is famously unpredictable and the above “plausible scenario” could be way off in either direction. Although the virus is relatively mild now, it can quickly change on its own through mutation and become more deadly. Another way of changing is if two different viruses happen to infect the same cell at the same time. The two different strains could then trade genetic material. Hypothetically, the 2009 H1N1 that is currently sensitive to the antiviral medication Tamiflu could become resistant to Tamiflu if it combines with last year’s seasonal flu strain which was 99 percent resistant to the drug. Fortunately, until now the virus has been stable genetically and it remains sensitive to Tamiflu and Relenza.
5)What are the symptoms of the 2009 H1N1?
The symptoms are very similar to those seen with the regular seasonal flu: fever, headache, fatigue, cough, sore throat, runny nose, and aches and pains. In addition, there may be gastrointestinal symptoms such as nausea, vomiting, and diarrhea.
6) How can you catch H1N1?
Just as with the regular seasonal flu, the virus enters your body through your nose, mouth, or eyes. People infected with H1N1 shed virus starting a day before symptoms begin and lasting up to a week or longer in some patients. An uncovered cough or sneeze in a patient with influenza can send infectious virus-filled droplets into the air. If you touch a surface that’s infected with flu virus and then touch your mouth, nose, or eyes, the virus can enter your body and cause infection.
7) How do you prevent the seasonal flu and 2009 H1N1?
The most effective way is through vaccination – assuming you are in a group for which immunization is appropriate. The CDC recommends vaccination with both the regular seasonal flu vaccine, which is already being given, and the 2009 H1N1 vaccine once it becomes available around mid-October. So far, the 2009 H1N1 vaccine has been shown to be safe in adults; the CDC told me this week that studies in children and pregnant women should be done within about 2-3 weeks. Health officials want to vaccinate at least 159 million Americans. Experts predict there will eventually be enough vaccine for all Americans who want it. But only about 45 million doses are expected to be available with the first batch in mid-October.
Those on the priority list to get the 2009 H1N1 vaccine include pregnant women, people in close contact with infants 6 months and younger, health care workers, those ages 6 months to 24 years, and people ages 25 to 64 with serious conditions that put them at high risk for complications from flu.
Experts stress the importance of covering your mouth with a tissue when you cough or sneeze. Wash your hands often with soap and water or an alcohol-based hand cleaner. Remember: you don’t get flu from virus that’s only on your hands; you get it when you touch your face and give the virus a way to enter your body. Avoid close contact with sick people. And if you are sick with the flu, the current CDC recommendation is to stay home for at least 24 hours after your fever is gone without the use of fever-reducing medication. In some situations, the use of a face mask may be indicated, especially to try to prevent flu in patients at increased risk for complications; click here for the CDC’s recommendations.
8.) Who should receive treatment with anti-viral medication such as Tamiflu and Relenza?
Last week the CDC said that most people who come down with the 2009 H1N1 flu should just ride it out and not take antiviral medications such as Tamiflu and Relenza. Dr. Anne Schuchat of the CDC said the majority of adolescents, adults and children “can be cared for with mom’s chicken soup at home, rest, and lots of fluids.” But she stressed the importance of early treatment with antiviral medications – within 48 hours if possible – for certain patients at increased risk of complications, especially those hospitalized, under age 5, over age 65, or with chronic medical conditions.
A key change in advice from the CDC involves patients at high risk who may have been exposed to the H1N1 virus. Before last week, doctors were advised to give them medication to prevent infection; now doctors are being given the option of “watchful waiting” – observing the patient closely and only starting antiviral treatment if evidence of flu develops.
9) What warning signs should prompt immediate medical evaluation and treatment?
In adults, warning signs include: trouble breathing, pain or discomfort in the chest or abdomen, dizziness, confusion, severe or persistent vomiting, and symptoms that improve but then return with fever and worse cough. In children, warning signs include: trouble breathing, bluish or gray skin color, inability to drink enough fluids, severe or persistent vomiting, change in mental status (e.g., not waking up, not interacting, or being unusually irritable), and symptoms that improve but then return with fever and worse cough.
10) Should I get the 2009 H1N1 vaccine if I think I’ve already had the H1N1 flu?
The CDC told me “yes” – because the vast majority of patients diagnosed with 2009 H1N1 were not specifically tested for the virus. It may have been some other virus that made you ill. And even patients who had positive “quick tests” in the office for influenza A cannot be absolutely certain they had the 2009 H1N1 virus because the kits are sometimes wrong and because there’s a small chance that the strain of influenza A detected was NOT the 2009 H1N1. So the CDC recommends playing it safe and getting the both the regular seasonal vaccine and the 2009 H1N1 vaccine if you are in a group for which immunization is suggested.
For this week’s CBS Doc Dot Com, I discuss very practical advice – especially for parents – about H1N1 with Dr. Thomas Farley, who was appointed New York City Health Commissioner in May 2009 and immediately found himself smack in the middle of the 2009 H1N1 outbreak.
Click
here to watch the interview.
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This year’s influenza season is unique in that there are additional strains circulating, with unclear medical implications for the US population. I interviewed Dr. Joseph Stubbs, president of the American College of Physicians, to get the inside scoop on what to expect this year with the H1N1 and seasonal flu strains. You may listen to the podcast or read a shortened version of the interview below.
