10-20-09 UPDATE AND CAUTION! – Studies of the pesent H1N1 pandemic have revealed that there are great risks for women who are pregnant of severe complications, primarily superinfections with bacteria because the pregnancy weakens the immune system. The death rate appears to be unusually high in this group. If pregnant, especially if you also have chronic illness, you should talk to your physician and consider obtaining the flu vaccine as the H1N1 flu is now “widespread” and your risks are high.
Those who are very ill or have severe lung or heart conditions, especially if they are born after 1950 should also talk to their physicians about possibly obtaining the vaccine. Anyone in these categories, who become ill with influenza should consider using anti-viral drugs early despite the risks, the first day of fever over 103 degrees. Just make sure they are supervised closely should psychiatric symptoms develop. There are serious risks in these groups from both the influenza and from the medication. However, you must weigh the risks and the risk of death if you are pregnant or have certain chronic illnesses may be great.
Be very careful that if you develop signs of bacterial infection you get very prompt treatment. Read the following that explains signs of complications.
I am concerned that the attack rate (cases per 100,000) is fairly high very early in this flu season , particularly for the young (Age 0-24 = 23-27/100,000, Age 25-49 = 7/100,000, Age 50-64 = 4/100,000, and Age >65 = 1/100,000). This may seem small, but this along with 87 pediatric deaths already is unusual (normally 50-100 pediatric deaths in an entire flu season). 2/3 of the children’s deaths are in children with chronic illness and 1/3 are in healthy children. I believe the risk/benefit ratio for people under age 24 who are chronically ill or pregnant is now near the point a vaccine administration and certainly VERY EARLY use of anti-virals if a chronically ill persons becomes sick with influenza are warranted.
Young adults have a particular aversion to going to the doctor early. If they have signs of complications it is medically extremely important that they seek help quickly – hours may make a difference. THIS IS THE MOST IMPORTANT MESSAGE RIGHT NOW TO GET TO THE PUBLIC!
It is exceedingly important not to use anti-virals willy nilly. If healthy they should not be used as this will encourage development of resistence to the drug. If the virus becomes widely resistant, then it will be VERY DIFFICULT to treat those few who become critically ill. We have to approach the next six months of this flu season in a very smart way. Panic, excess use of anti-virals, will only make things worse. The most important thing is good public health measures (washing hands, etc) and quick and early identification of individual cases of complications or severe illness so treatment can be started early.
Educate yourself! Educate your friends and neighbors! The situation is concerning, but can be handled if we make wise choices! Whatever threats (viral, bacterial, environmental, political) we face as a common humanity, we should face with knowledge, faith, and common purpose. We need to care about others as much as we care about ourselves. Don’t let your chronically ill or pregnant neighbor or friend be ignored if they get ill. Help them judge if they need to see their doctor quickly.
UPDATE – 11-7-09 New studies suggest that influenza vaccines may not give long term protection to related strains like a natural infection would provide.
The present A/H1N1 flu (Swine flu or Mexican flu) has panicked too many people. Government has given confusing and incomplete information to the people. It is turning out that the H1N1 flu this year is exceedingly mild. However, overtreatment has grave dangers. Everyone should consider the following before medicating themselves with anti-virals such as Tamiflu or Relenza.
If drugs are overused the virus will quickly become resistent to it. IF the virus becomes more virulent, as an influenza virus did in 1918, which can occur with the influenza virus and cause a rapid onset deadly illness in persons with NO IMMUNITY, overuse of anti-virals for mildly ill individuals on a large scale may push the virus to evolve so that is becomes RESISTANT to the anti-viral drugs. In any flu season many older persons have a degree of partial resistance due to their previous exposure to many influenza strains. Most people born before 1957 seem to be resistant to this year’s H1N1 strain, and many people born between 1957 and 2001 also seem to have some resistance. The people who are in danger in ANY flu season are those with chronic illness, severe congenital illnesses, or cancer that weakens them.
Everyone should seriously think about simply taking a few days of rest in bed, drinking plenty of fluids, and waiting it out if you catch the flu this year (fever >102 degrees for 3-5 days, intense muscle aches, headache, cough, 25 % have vomiting and/or diarrhea). Influenza is not just a cold. If you have a runny nose and low grade fever you are unlikely to have influenza.
As with any infectious disease, if you become sick, watch for symptoms of worsening. This may mean you are developing complications such as a bacterial infection like pneumonia. What is worsening? Well – If your fever lasts more than five days. If your cough is productive and you are spitting out yellow or green mucus instead of clear or white mucus. If you are becoming weaker instead of stronger after 4-5 days. If you are becoming increasingly confused, increasingly dizzy when standing, increasing vomiting or diarrhea after the first day or two. These are signs that something is wrong – likely a complication – and you should contact your doctor IMMEDIATELY.
Oseltamavir (Tamiflu) or zanamavir (Relenza) are sometimes recommended for prophylaxis, for early treatment, or for treatment only of the sickest. There is nothing wrong with not taking medication if you are healthy and waiting it out. The good part is you are building immunity so that the next time you are exposed in your life to a similar strain you will be at least partially immune. The effect of anti-viral drugs is said to be to shorten duration of illness by 0.5 to 1.5 days, and it is hoped that it might prevent more serious complications. You still will be sick for 3-4 days and infectious to others. Persons are infectious for a day or two BEFORE they become ill and for a total of about seven days to fourteen days in serious cases - usually infectiousness decreases when the fever breaks.
In Japan, two teen suicides and 64 psychological disorders were linked to Tamiflu in 2005. These included panic attacks, delusions, delirium, and convulsions in otherwise normal persons. The FDA added a warning to the label (PsychCentral.com, Nov 17, 2006). This potential does not appear to be widely known among U.S. physicians, who may think that psychological reactions are restricted to amantadine, or that they are more likely to be a manifestation of the influenza itself.
Vitamin D deficiency may play a crucial role in susceptibility to influenza. In an April 2005 epidemic in a hospital for the criminally insane, patients on a ward where they were receiving a supplement of 2,000 units of vitamin D daily were spared (Medical News Today 9/15/06). A decreased incidence of colds and influenza was an incidental finding in a study of vitamin D supplementation and postmenopausal bone loss, one of many benefits reviewed by Joel M. Kauffman in the forthcoming summer 2009 issue of the Journal of American Physicians and Surgeons. Toxicity is rare, Kauffman writes. Increased dose recommendations are lagging trial results. Doses of 1,000 IU/d to 2,000 IU/d are now considered routine, and doses up to 50,000 IU/d for rapid repletion are considered safe.
According to a 2006 review, vitamin D suppresses excessive expression of inflammatory cytokines, likely the cause of death in young persons in the 1918 pandemic, as well as increasing the expression of antimicrobial peptides (Cannell JJ et al., Epidemiol Infect 2006).
While a severe influenza pandemic remains a possibility, use of the threat as a pretext for mandatory vaccination and monumental expansion of governmental power is also a danger. Guillain Barre syndrome is a neurological condition where a person becomes temporarily paralyzed and may have to be put on a ventilator. During the last “swine flu” scare in 1979 there were 46 million people who took the hastily made and poorly tested vaccine and 4000 claims against the government for neurological complications – mostly paralysis. Everything, including taking vaccines has its risks.
A very safe and unknown but theoretical treatment for influenza are anti-inflammatory drugs. Deaths in young, healthy adults in 1918 seem to have been related to intense inflammation. Steroids are the gold standard of anti-inflammatory drugs but they have so many complications and are so dangerous in many ways that they should only be given in severe cases under medical supervision.
Many diseases caused by intense inflammation such as severe acne, Rosacea, and Bullous Pemphigoid (a blistering disease) have been successfully treated with very old medications including one of the safest combination of medications I know. The vitamin niacinamide in high doses (which is thought to be very safe) [500 mg three times daily - available over the counter through health food stores or on the Internet] even on its own is known to be anti-inflammatory. This is an excellent over the counter treatment for inflammatory acne. DO NOT confuse and use niacin in large doses as it may cause uncomfortable flushing and warm feeling. If this is combined with low dose tetracycline (an antibiotic with intense anti-inflammatory properties) the anti-inflammatory affects are increased. Please discuss with your doctor the dangers of excess antibiotic use before using this treatment. If my family member got the flu, I would take supplemental vit D (this can cause problems if excess doses are taken so be careful not to overuse it) and niacinamide.
If I got sick with influenza, I might also want to start tetracycline. I would not take anti-viral if I was a healthy person unless signs of complications. As I have severe intermittent asthma, cardiac, and neurological problems, I would take Tamiflu as soon as my fever hit 103 degrees, even if I did not yet have confirmation it was H1N1. I would ask family and friends to closely supervise me while on Tamiflu due to risks of psychiatric/psychological side effects. I would start antibiotics early. I will not obtain the flu vaccine, because of a personal history of adverse reactions to vaccines and worry about Guillain Barre being an increased risk due to moderate neurological disease.
- “Tamiflu May Be Linked to Risk of Self-injury and Delirium; Vitamin D Suggested for Influenza,” AAPS News of the Day 12/6/06.
- “Influenza Vaccine: Review of Effectiveness of the U.S. Immunization Program, and Policy Considerations,” by David A. Geier, Paul G. King, and Mark R. Geier, J Am Phys Surg 2006;11:69-74.
- “American Scientists Resurrect 1918 Pandemic Influenza Virus, Plan to Send It in the Mail,” AAPS News of the Day 11/15/05.