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H1N1 vaccine Q&A

by Lorna Benson, Minnesota Public Radio
October 15, 2009

Minnesota Public Radio News health reporter Lorna Benson held an online chat to answer questions about H1N1 and seasonal flu. Below is an edited transcript of the discussion.

Q: Is H1N1 any more dangerous than the regular seasonal flu?

A: It seems to behave much like mild to moderate seasonal flu for most people. But it can be very severe and deadly for some people. What's different about this flu is that it affects younger people disproportionately. Typically older people experience the worst flu symptoms. But with this new pandemic virus, there have been many severely ill kids, and some have died.

Q: I've heard that with H1N1, unlike seasonal flu, symptoms may include vomiting. Do you know how many who get H1N1 experience that specifically?

A: I have not seen any specific data on this, but public health officials have described it as a possible side effect. I don't get the impression that it's happening to most people who get H1N1.

Q: If someone in your household is sick, is there really any chance you won't get sick yourself?

A: Yes. I've heard of lots of stories where only a few family members have contracted the illness. You minimize your risk of getting the virus by keeping your distance from sick people and sanitizing your hands frequently.

Q: Can I receive both flu shots (H1N1 and seasonal flu) at the same time? How do I find a location to get immunized?

A: Yes, you can get both at the same time if you get the injectable vaccine. You can't get two nasal sprays at the same time. However, you can get one injectable and one nasal spray dose at the same time. You can always call your doctor to see if they are planning to offer the vaccine. Otherwise go to Flu.gov for a list of public vaccination clinics. It's early in the vaccination campaign, so that list probably won't be available for a few weeks.

Q: If you have already had the flu this year, do you still need to be vaccinated?

A: With specific medical questions, you should always consult your doctor. If you know that you had a confirmed case of H1N1 virus, then you are probably protected against getting it again. But very few patients have had confirmation of their illness, so it is recommended in those cases that you get vaccinated.

Q: The CDC says most flu cases are H1N1 right now. My children were recently sick with fevers around 102, coughing, headaches and body aches. A nurse told me over the phone that it was probably H1N1. If my children already had the virus, why would I get them vaccinated when the vaccine becomes available?

A: It's true that most of the viruses are H1N1 right now. But there are other illnesses circulating too, and there could be even more than people realize because not everyone goes to the doctor when they get sick.

Q: Can you be infected with H1N1 more than once?

A: I haven't heard of anyone being infected with H1N1 more than once during this pandemic season. But I'm not a doctor or a scientist. It may be possible. It seems unlikely though.

Q: Why aren't health officials testing everyone that has H1N1 symptoms? If you know that you have already had it, wouldn't it cut down on the number of people who have to get vaccinated?

A: They are not testing everyone because it's expensive and time-consuming, and they strongly suspect that most of the flu viruses circulating at the moment are H1N1. If you absolutely know that you had H1N1, you don't need to get vaccinated. But if you don't have that lab confirmation, then you can't really be sure.

Q: When there are so many high risk groups, how will they determine who gets the first shots?

A: Health officials are prioritizing within the highest risk groups right now. At Children's Hospitals on Wednesday, they were giving out injectable vaccine. They've decided to give it to their highest of high risk patients, such as kids with severe asthma, neurological conditions and heart conditions. In many of these cases the kids have several risk factors.

Q: If you are in a high risk group, would you try to stay home until you are able to be vaccinated?

A: This is a tough question. I haven't heard any public health officials suggesting this strategy and for most people it wouldn't be an option anyway due to work obligations, etc. But if you have some serious health issues, it's not a bad idea if you are content staying home while you wait for the vaccine to become available. The good news is that at least some of the vaccine has already arrived. So within another week or two you should be able to get it.

Q: Once you get the H1N1 vaccine, how long does it take before it's effective?

A: The latest data shows that a good immune response develops within about 10 days of receiving the vaccination. But for children under 10, they don't develop a strong immunity with just one dose. That's why they need to get a second vaccination within a month of the first one.

Q: Should I get on a plane with what I hope are the waning flu symptoms, including a fever of about 99.5 degrees?

A: You really shouldn't congregate with other people while you're running a fever. You should be fever free for at least 24 hours. And even then you can transmit the virus for a few more days.

Q: How long do surfaces stay contaminated?

A: This is a matter of great debate in public health circles. I have heard well-respected scientists say that the virus can only live for a few minutes outside the body. But there are other equally respected scientists who say the virus can live for several hours.

Q: There is a lot of concern, and a lot of misinformation, about ingredients in vaccines such as adjuvants and Thimerosol. To what extent are these ingredients present in the H1N1 vaccine, and is the vaccine safe?

A: There are no adjuvants in any of the flu vaccines. There is Thimerosol in some of the vaccine supply. It is not in FluMist and it is not in some of the single-dose vials. So you can ask for Thimerosol-free vaccine. The CDC says the H1N1 vaccine is as safe as the seasonal flu vaccine because it is manufactured in exactly the same way. They only changed the virus strain -- something they do every year when they make a new seasonal flu vaccine.

Q: If an adult is home caring for a child who has H1N1 flu, how soon should he or she return to work?

A: If an adult is not showing any symptoms of the virus, she or he should be able to return to work at any time.

Q: It seems like we're not being as proactive as we could be about shutting down public facilities to slow the spread of the virus. Why?

A: Public health officials have said that they really can't contain the virus at this point. It is just too widespread. They also worry that shutting down certain public facilities would have a very negative effect on the economy.

Q: It appears some airlines aren't being flexible with those who have become ill, so how do you avoid catching the flu on an airplane, where air is circulated and you are in such close quarters with strangers? Will masks help?

A: A mask probably would help if it was the right type of mask and if it was fitted properly. But there is still a lot of debate on the effectiveness of masks for the general population. Some of the best ones are hard to wear for a long period of time. For example, I carry an N95 mask along with my equipment. But I also know that if I use it once I have to throw it away and get a new one.

Q: I have an out-of-town funeral to attend, and I'm wondering if I should go because I've had a lingering cough. I'm not sure if it's the flu or not, but my daughter is ill now with a flu-like illness with all the symptoms: fever over 100 degrees, aches and cough. Should I consider myself contagious and stay home?

A: If you are worried about getting other people sick you should consider staying home -- especially if you have someone in your family with all of the flu-like symptoms.

Q: My 7-month-old daughter already got two seasonal flu shots. Assuming she will also get the H1N1 vaccine, she would also get two of those shots. That would be four flu shots in three months. Are there any concerns about that being too many?

A: According to the guidance I've read, your daughter would need two H1N1 vaccine doses. Public health officials say there should be no problem for children who receive a total of four flu shots in a short amount of time. You can ask for Thimerosol-free vaccine if you are worried about that preservative.

Q: President Barack Obama has declared a national emergency because of H1N1 flu. How will this declaration affect what is happening in Minnesota?

A: The declaration gives hospitals flexibility to set up off-site clinics to treat H1N1 patients if they can't handle the volume of patients showing up in emergency rooms. Federal rules normally prevent hospitals from setting up an auxiliary clinic if it's more than a couple hundred feet from the hospital, but the declaration means clinics can be placed at other locations. Hospitals in southern states have set up tents to treat patients with flu symptoms, but cold weather prevents states like Minnesota from setting up tents at this time of year. Assuming it gets permission from the Secretary of Human Services, a hospital in Minnesota can now set up a flu clinic in a building farther away from the hospital if needed.

Q: What is the current state of the outbreak here in Minnesota?

A: The flu outbreak is considered widespread throughout Minnesota. One way to track this is through hospitalizations, and health officials have said all eight regions of the state have reported hospitalizations.

Another way to track the outbreak is through 28 health care providers that report each week the number of patients sick with flu-like illness. During the past week, those providers reported that nearly 13 percent of their clinic visits were for flu. In contrast, only about 4 percent of clinic visits were related to flu-like illness during the peak of the flu season two years ago.

Q: The Minnesota Department of Health last week introduced the phone-based FluLine for people with symptoms. Are officials getting many calls?

A: The FluLine has been overwhelmed with calls. In the first 21 hours, the service received more than 2,100 calls from people wanting to speak with a nurse. And there were many more people who didn't get through.

Q: How does the situation here compare with the rest of the country?

A: According to the Centers for Disease Control and Prevention, H1N1 is widespread in 46 states. The remaining four states (Hawaii, South Carolina, Connecticut and New Jersey) are experiencing regional or localized outbreaks.

Q: What is happening with H1N1 flu vaccine?

A: It's just trickling out to the states. About 40 million doses were expected to arrive this month, but there have been some delays. As of Friday only 16 million doses were available to states. Federal officials are now saying that there might be 50 million doses by mid-November. About 117,000 doses have been shipped to Minnesota, according to the CDC. At the same time, 2.7 million Minnesotans are in at least one of the priority groups to receive the vaccine, so it's in very high demand.

The delays appear to be related to the challenges of growing the virus in chicken eggs, from which manufacturers have said they had trouble getting a good virus yield.

Q: How is the flu affecting schools and businesses in the state?

A: Besides a few temporary school closings, nearly all schools have remained open. There are currently 230 schools reporting excess absences to the health department.

Businesses don't have to report their absences to the health department the way schools do, but anecdotal reports indicate some businesses are experiencing a lot of absences.

Meanwhile, long-term care facilities have reported no flu outbreaks this week. It seems to fit with reports that indicate older people might have some natural immunity to the H1N1 virus possibly because they had been exposed to an earlier version of the virus when they were younger.

Q: When do experts think this outbreak will peak?

A: Some experts think we're seeing the peak right now, but it's hard to say. This is a new virus that isn't following the rules we're used to seeing with seasonal flu, which is active from October to May. Usually seasonal flu peaks in December, January or February.

It's also hard to know how long the outbreak will last. It could retreat for a few weeks and then come back for a third wave of illness in January or February. Or we could see this wave continue through the winter. If most people get sick this fall, at some point the virus could start having trouble finding new hosts. But at this point, it's too early to guess how this will play out.