Generic vs. Brand Name Pills (Ask Dr. Laura Berman)

Q: I recently went to a new pharmacy to fill my birth control prescription, and they gave me a pack of pills I've never used before. The pharmacist told me it was a generic, and it was the same as the brand name, but when I called my gynecologist, she told me she'd never heard of that generic and that I shouldn't take it. Who's right?

— Elissa, New Jersey 

A: By law, the generic form of birth control pills and brand-name birth control pills must be have the same active ingredients, and they must have similar bioavailability (which is the amount of time it takes for the active ingredients to begin working on the body.) The only difference that might exist between generic and brand name medicines are the inactive ingredients, but these differences are immaterial, unless you should happen to be allergic to one of them. This might have been one of the reasons your gynecologist advised you not to take the pill. Otherwise, a generic birth control pill and a brand name birth control pill react no differently in your body — so take advantage of the savings whenever you can!


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Pregnant? Get a flu shot - but it may be a hassle

It's hard for pregnant women to escape the message: You're at extra risk from swine flu — it could trigger premature labor, hospitalize you for weeks, even kill you — so be among the first in line for vaccine next month. But only about one in seven pregnant women gets a flu shot each winter.

While federal health officials are working hard to raise that number this year, repeated swine flu warnings won't automatically overcome a key obstacle: Many obstetricians don't vaccinate. And not only are many women reluctant to go hunting for flu shots elsewhere, historically some pharmacists and other providers have been wary of vaccinating them.

"Maybe this year we can change that culture," says Dr. Anne Schuchat of the Centers for Disease Control and Prevention. "It's not supposed to happen that you, when you are pregnant, are fighting for your life on a respirator."

Yet getting simple vaccine information took Charla Bason of Washington, D.C., repeated requests, as she was bounced between her obstetrician's office and her primary care doctor a few weeks ago.

"I feel like if I hadn't brought it up, they never would have mentioned it to me," says Bason, 30, who is seven months pregnant with her first child.

Bason decided to seek vaccination after watching a CDC Webcast about pregnant women and talking with a physician in the family. But she still has no clear answer about where to get one.

"It's been incredibly frustrating. There's a terrible disconnect between the message that was getting out and, once you decide you want it, how do you get it?" she says.

Any kind of flu is risky during pregnancy, and pregnant women have been on the get-a-flu-shot priority list for years. Their reluctance to take any medication during pregnancy is part of the reason for the low vaccination rates.

With swine flu, what doctors call the 2009 H1N1 strain, pregnant women seem at particular risk for complications. Pregnant women make up 6 percent of H1N1-confirmed deaths even though they account for only 1 percent of the population, according to the CDC. They're at least four times as likely to be hospitalized as other flu sufferers.

Vaccine is a two-for-one deal during pregnancy: It can protect not just mom but the baby, too, for the first few months after birth. The mother's body makes flu-fighting antibodies that easily cross the placenta to be carried by the fetus, explains Dr. Neil Silverman of the University of California, Los Angeles. That's important because flu can easily kill newborns, yet babies can't be vaccinated until they're 6 months old.

Once women get that vaccine advice, where do they get the shot?

The American College of Obstetricians and Gynecologists has no count of how many OBs offer flu vaccine. It's still considered a minority although recent surveys suggest many more may be starting this year, especially in large cities.

An extra complication: Each state's health department ultimately will decide who gets to offer the H1N1 vaccine, aiming for locations that vaccinate the most people. Those decisions haven't been made public yet. Even if your OB requested swine flu shots, he or she may not get any, at least from initial shipments.

So the CDC and ACOG are urging obstetricians to partner with a nearby site — a hospital or drugstore, for example — to guarantee their patients a flu-shot source, a message the government will reiterate Tuesday in a swine flu training seminar for obstetricians nationwide.

Yet providers who don't routinely treat pregnant women may not understand flu's risk and the shot's safety record, says Silverman, who helps set ACOG practice guidelines.

Take pharmacists, expected to be key H1N1 vaccinators. Silverman gets occasional phone calls from women who say a pharmacist won't fill the flu-shot prescription he wrote.

"They act like the doctor who prescribed it didn't know what he or she was doing," says Silverman, who settles the standoff by getting the pharmacist on the phone. For every patient who calls, "I know there are at least two who just say, 'Well, OK, I'm not going to do this,' and just walk away."

The American Pharmacists Association is urging its members to follow the CDC's pregnancy guidelines but can't mandate that, and a few stores may still balk, says association chief of staff Mitchel Rothholz.

But some are embracing the potential customers. The large Walgreen's drugstore chain told states that if picked as an H1N1 shot site, it might put get-vaccinated-here signs next to the pregnancy tests, or print vaccine reminders for people who bought prenatal vitamins.

And Louisiana this month lifted its requirement that pharmacists vaccinate by prescription only, making it easier for everyone to get a drugstore flu shot.

Why don't more OBs vaccinate? Largely it's the expense and hassle, but it's not part of routine obstetrician training, says Dr. Stanley Gall of the University of Louisville, an OB and longtime vaccine provider. That's changing as more stock a different vaccine — against the virus that causes cervical cancer — and decide they might as well offer flu vaccine, too.

Because so few pregnant women even have another doctor, "the OB office should be a one-stop shop," he says.

On the Net:
CDC info: http://www.cdc.gov/h1n1flu/pregnancy/

After a tragic loss, family steps up in flu vaccine trials

Sean and Ryan Moise played "rock-paper-scissors" to see who would get their flu shot first. Faith bravely stepped up after her older brothers.

Unlikely pioneers though they may seem, Sean, who turns 13 Monday, Ryan, 11, and Faith, 4 "and a half," are among just 600 children in the USA in government-sponsored pediatric trials of the vaccine for H1N1, or swine flu.

The children are more motivated than most to fight flu. They know how serious it can be. In 2003, their brother Ian, a robust 6-month-old, died of seasonal flu. He lived less than 30 hours after symptoms set in.

INTERACTIVE MAP: Track swine flu by U.S. region

Q&A: All about the flu vaccines

"That's why, when I heard the vaccine trial was coming to Kansas City, I was so eager to get my children into it," says Julie Moise, 42. "I'm more afraid of the flu than the vaccine."

Sean fretted on Facebook that he was signing up to be a pincushion. He decided to go ahead with the trial, anyway. "The first time I was a little, kind of, freaked out because I didn't know what to expect," he says. "After a while, it's not really all that bad. And it's good to know I should be resistant to H1N1 if it comes around."

Flu can kill

An early peek at the trial's results appear to justify the family's confidence. The findings released Sept. 21 show that H1N1 vaccine appears to protect most kids 10 to 17 years old, who are among those hit hardest by the new influenza.

As in seasonal flu, younger children are likely to need two doses. "The response in young children is less robust, but this is not unexpected," Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, the study's sponsor, said when the results were released.

In 2003, Julie Moise made sure all three children had had their flu shots. Just 10 days after Ian had the first of two vaccine doses he would need for full protection, he came down with the flu. Soon he was feverish and short of breath. A pediatrician confirmed the diagnosis and recommended treating his symptoms.

"That night he didn't want to lay flat in his crib," Moise says. "I held him in the recliner all night."

By morning, Moise developed flu symptoms, too. Her husband, Glenn, agreed to get Sean and Ryan off to school. Ian took a turn for the better, or so the family thought. His fever dropped from 104 to 100 degrees. His panting had turned into a sigh, Moise says. Still, she worried. And later that day, she called her husband at work. "I said, 'I don't like how Ian looks. Can you come home?' "

He found Ian sitting in his bouncy seat and picked him up. "At that moment," Julie Moise says, "he stopped breathing."

A postmortem showed his airway was plugged by mucus, which caused respiratory failure and cardiac arrest. Two things still nag at Julie Moise: First, how often doctors and nurses said "it's just the flu." More troubling is the guilt Moise feels because she and her husband weren't vaccinated. "You have to wonder," says Moise, a flight attendant, "did I bring it home?"

Ian's death turned the family into activists. They joined a group of other parents who've lost children, called Families Fighting Flu, to call attention to the risks of neglecting vaccination. They launched Ian's Rainbow Flu Foundation, which sponsors flu walks and vaccination clinics. And when the chance popped up to enroll their children in the vaccine trial, the Moises grabbed it. So did Laura Jaworski, Julie Moise's best friend, who enrolled her sons Zach, 3, and Nick, 6.

Children help out

Christopher Harrison, the lead investigator at Children's Mercy Hospital, says the Moise and Jaworski children were among 121 children from the Kansas City area in the trial. A parent's consent is sufficient to enroll a youngster, but all children sit in on the conversation with doctors as they explain the nature of the trial and ask parents to sign the consent form.

Children who've reached "the age of reason," Harrison says, sign a consent form, too. "It felt kinda cool," Sean says, "like I was taking responsibility for what I was about to do."

Harrison says most people enrolled their children in the trial to protect them from swine flu, especially with school approaching, but many also took into account the good that can come from the research. Most know that the vaccine is similar to standard flu vaccines, so it is likely to be safe and can't transmit the flu. As the trial was enrolling, he says, flu began spreading widely in Kansas City. In the past month, he says, half a dozen children with H1N1 have needed intensive care. A 16-year-old has died.

Moise notes that 36,000 people die each year of seasonal flu and says one death is too many. She begins reciting names of children who have died and whose parents banded together in Families Fighting Flu. "All these children were healthy. Every one had insurance," she says.

"How many times did I say in a 24-hour period, 'Oh, it's just the flu'? I didn't know flu kills healthy children. That's what's so scary."

Second wave of swine flu pandemic begins to hit US

After months of warnings and frantic preparations, the second wave of the swine flu pandemic is starting to be felt around the country. Doctors, health clinics, hospitals, and schools are reporting rapidly increasing numbers of patients experiencing flu symptoms.
While most cases so far are mild, and the health care system is handling the load, officials say the number of people seeking treatment for the flu is unprecedented for this time of year.

In Austin, so many parents are rushing their children to Dell Children’s Medical Center of Central Texas with swine flu symptoms that the hospital had to set up tents in the parking lot to cope with the onslaught.

In Memphis, the Le Bonheur Children’s Medical Center emergency room got so crowded with feverish, miserable youngsters that it had to do the same thing.

And in Manning, S.C., a private school where an 11-year-old girl died shut down after the number of pupils who were out sick with similar symptoms reached nearly a third of the student body.

“It just kind of snowballed,’’ said Kim Jordan, a teacher at Laurence Manning Academy, which closed Wednesday after Ashlie Pipkin died and the number of ill students hit 287. “We had several teachers out also.’’

“H1N1 is spreading widely throughout the US,’’ said Thomas Frieden, director of the federal Centers for Disease Control and Prevention in Atlanta. The CDC reported last week that at least 26 states are now reporting widespread flu activity, up from 21 a week earlier.

Even though some parts of the Southeast that started seeing a surge of cases first now seem to be showing a decline, that could be a temporary reprieve, Frieden said. And other parts of the country are probably just starting to feel the second wave.

“Influenza is perhaps the most unpredictable of all infectious diseases,’’ Frieden said.

The pandemic has prompted scattered school closings around the country in recent weeks, including 42 schools that closed in eight states Friday, affecting more than 16,000 students.

Many colleges and universities have been hit particularly hard, forcing some to open separate dorms for sick students. Ninety-one percent of the 267 colleges and universities being surveyed by the American College Health Association are now reporting cases.

The government is starting an unprecedented system to track possible side effects as mass flu vaccinations begin next month. The idea is to detect any rare but real problems quickly, and explain the inevitable coincidences that are sure to cause some false alarms.

In just a few months, health authorities hope to vaccinate well over half the population against swine flu, which doctors call the 2009 H1N1 strain. No more than 100 million Americans usually get vaccinated against regular winter flu, and never in such a short period.

The last mass inoculations against a different swine flu, in 1976, were marred by reports of a rare paralyzing condition, Guillain-Barré syndrome, a sometimes fatal paralysis. Other possible side effects could potentially include heart attacks, strokes, seizures, and miscarriages.

On top of routine vaccine tracking, these government-sponsored monitoring projects are planned:

■ Harvard Medical School scientists are linking large insurance databases that cover up to 50 million people with vaccination registries around the country for real-time checks of whether people see a doctor in the weeks after a flu shot and why. The huge numbers make it possible to quickly compare rates of complaints among the vaccinated and unvaccinated, said the project leader, Dr. Richard Platt, Harvard’s population medicine chief.

■ Johns Hopkins University will direct e-mails to at least 100,000 vaccine recipients to track how they’re feeling, including the smaller complaints that wouldn’t prompt a doctor visit. If anything seems connected, researchers can call to follow up with detailed questions.

■ The Centers for Disease Control and Prevention is preparing take-home cards that tell vaccine recipients how to report any suspected side effects to the nation’s Vaccine Adverse Event Reporting system.

“Every day, bad things happen to people. When you vaccinate a lot of people in a short period of time, some of those things are going to happen to some people by chance alone,’’ said Dr. Daniel Salmon, a vaccine safety specialist at the Department of Health and Human Services.

Masks may help prevent flu, but aren't advised

The visible symbol of the H1N1 flu outbreak last spring seemed to be face masks. Suddenly, they were everywhere -- in airports and waiting rooms, on buses and trains. Many drugstores sold out of masks. As the nation girds itself for a renewed fall outbreak, however, masks may make a reappearance.

Should I wear a mask? In general, the Centers for Disease Control and Prevention does not recommend use of face masks or respirators in non-health care settings. But there are exceptions. Because the novel strain of H1N1 influenza has led to a pandemic, people who are ill with the virus should consider wearing a mask around other people, if tolerable.

People who are at risk for severe illness from the flu should wear a mask or respirator if they are caring for someone with the flu and should consider wearing one if there is an outbreak of flu in the community. People who are not at high risk for flu complications could consider wearing one if there is an outbreak in the community, but it's not recommended.

What kind is most effective? There are two types of protection -- face masks and respirators. Masks are loose-fitting and designed to stop the spread of droplets from the person wearing the mask, not to protect the wearer from viruses. Respirators are close-fitting and more expensive. They are designed to reduce exposure to airborne particles. The CDC recommends N95 respirators for health care workers. The Food and Drug Administration has approved four models of respirators for use by the general public to help reduce exposure during a flu pandemic: 3M respirators models 8612F and 8670F, and Pasture Pharma respirator models F550G and A520G. These masks have been tested and shown to achieve a satisfactory fit for most adults. It's easiest to find them online.

But do they really work? It's still unclear how influenza is largely spread, whether through direct contact, the spray of droplets from an infected person to an uninfected person (within a proximity of 6 feet) or through inhaling smaller, airborne particles.

Do the cheap ones offer any protection? If a mask fits tightly around your face, it can reduce the chances of breathing in germs and stopping the spread of germs from the wearer.

The key is fit. They are designed to fit tightly over the mouth and nose, with no gaps. Gaps allow air to pass without being filtered. Masks are probably most useful in crowded settings, such as classrooms and airplanes or if you are in close contact with an infected person (within 6 feet). Masks shouldn't replace other precautions such as hand-washing.

Is there a correct way to wear a mask? Wash your hands with soap and water before putting on a mask. Make sure it fits tightly and that no hair, clothing or jewelry comes between the mask and your face. Inexpensive masks have a limited life span -- only about 30 minutes -- because they become moist and may lose shape and allow particles in. They should be removed if they become wet or damaged. Never reuse a mask.

When a mask is removed, throw it away in a closed waste container, wash your hands and put on a new mask.

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The opening of the vaccination campaign for swine flu is “going to be a little bumpy,” the director of the Centers for Disease Control and Prevention predicted Friday as he gave new details about how the vaccine would be distributed.

The first doses should reach doctors by Oct. 6, said the director, Dr.Thomas R. Frieden, but almost all will be the FluMist nasal spray version, which has some limits on who may use it. By mid-October, 40 million doses of both the nasal spray and injectable versions should be out.

The FluMist version is not recommended for infants under 2, adults over 49, pregnant women or anyone with a range of underlying health problems. But it is easy to use, and some pediatricians prefer it because many children fear needles.

With vaccines going from 5 manufacturers to 90,000 distribution points, Dr. Frieden said he expected shortages in some places and oversupply in others. Distribution will be different from that of seasonal flu vaccine, which doctors buy on their own. All the swine flu vaccine has been ordered and paid for by the federal government, which is also paying for its distribution and providing syringes and other items with it.

In some states, the swine flu vaccine will be injected at public sites like schools and city clinics, as polio vaccine was doled out in the 1950s. The best-prepared school systems have already asked parents to sign consent forms and have discussed plans at parent-teacher association meetings, Dr. Frieden said. Doctors, pharmacies and companies may also dispense it; the government is urging them to keep fees minimal.

Dr. Frieden said that the virus had not mutated in any threatening way and that the vaccine was still a good match for it.

Flu activity, normally almost nonexistent in September, is now widespread in 26 states, up from 23 a week ago. Dr. Frieden said activity was “beginning to trend down in some areas,” including Georgia, the site of his agency. But, he added, that predicted little because in New York City, where he was health commissioner last spring, swine flu surged after being introduced at a school in Queens, quieted down briefly and then resumed until schools closed for summer.

Dr. Frieden also discounted news reports in Canada that some doctors there thought that having had a seasonal flu shot made a patient more likely to catch swine flu. No data from Canada supporting that has been published in medical journals, he said, and a review of data from New York City and the United States over all, as well as by Australian authorities of their recent winter flu season, showed no such effect.

Dr. Frieden said seasonal flu shots did not protect against swine flu but did not create a proclivity for it either.

H1N1 hits UND

Student Health confirms four cases of swine flu on campus thus far.

Swine flu has arrived at UND. Four students who were treated at UND Student Health Services have tested positive for H1N1 flu. 
Community providers have also identified confirmed cases of H1N1 flu. According to a UND press release, "Since the Centers for Disease Control estimates that there are over one million cases of H1N1 flu, it is not surprising that we would have confirmed cases in the Grand Forks community and at the university. The students are being treated according to protocols established in consultation with Grand Forks Public Health, the North Dakota Department of Health and the Centers for Disease Control (CDC)."
While students should not panic, UND is reminding students, staff, and faculty to monitor their health and take the necessary precautions when they become ill, including missing class to stay home and recover if they do get sick. According to the Center for Disease Control, those infected have not truly recovered until their fever has subsided for at least 24 hours and students should avoid contact when possible until this point.  
This outbreak is especially important for several high-risk groups. People who have asthma, diabetes, immune-suppression, and heart, lung, or kidney disease should avoid contact with flu carriers as this could lead to severe illness, or in some cases, death. Most people can recover at home with little or no medical attention, but students who have the previously stated conditions should consult a health care provider if they develop flu-like symptoms or even if they have close contact with someone who has the flu. People should get medical attention immediately if they have difficulty breathing, purple or blue discoloration of their lips, feel dizzy and dehydrated or unable to keep liquids down, or have seizures.  

There are a variety of symptoms for the common flu, but students should monitor their health for the following: fever of more than 100 degrees, cough and sore throat, runny nose, headaches and body aches, chills, and fatigue. H1N1 flu manifests itself in very similar symptoms but people may also have vomiting and diarrhea.

Students who become infected should wear a mask where contact with others is unavoidable.  

If students need to go the Student Health Services they should call ahead of time at 777-4500.  
For UND seasonal flu vaccination clinic schedule go to www.undstudenthealth.com. 
This will protect students against the most common types of seasonal flu and help keep others as well as yourself healthy all winter. However, a seasonal flu vaccination will not protect you against Novel H1N1 (swine) flu. 
Novel H1N1 vaccine is expected in early November. Students can keep up to date on current information by going to www.flu.gov.

Drug firms can make H1N1 vaccine for half planet-WHO

Drug makers can only produce enough H1N1 vaccine each year for half the planet because they lack factory capacity, the World Health Organisation said on Thursday.
The H1N1 vaccine looks to be as safe as the regular flu shot, the WHO said in a statement, adding that drug makers worldwide can produce an estimated 3 billion doses per year and a single dose should be enough to give immunity to healthy adults and older children.
But it said companies had "limited, inadequate and not readily augmented" capacity to increase output to cover the planet's 6.8 billion population.
The WHO's previous projection last May was that global production capacity would be close to 5 billion doses, but its new estimate was made on the basis of results from clinical trials and confidential data provided to the U.N. agency.
"There is not enough production capacity worldwide to vaccinate everyone," WHO spokesman Gregory Hartl told Reuters.
"New production capacity takes a long time to come on line. Any new single plant for vaccine production takes about five years to build, test and get approval," he added.
It was not immediately clear whether the WHO's new estimate of 3 billion doses per year implied switching all production from seasonal flu vaccine to H1N1 pandemic vaccine.
Marie-Paule Kieny, director of WHO's initiative for vaccine research, is due to give a teleconference at 1500 GMT on Thursday.
"Outcomes of trials completed to date suggest that pandemic vaccines are as safe as seasonal influenza vaccines," WHO said.
"However, even very large clinical trials will not be able to identify possible rare events that can occur when pandemic vaccines are administered to many millions of people," it said.
Pandemic vaccines are most effective as a preventive strategy when given before or near the peak incidence of cases in an outbreak, it said.
The WHO advised countries to closely monitor the vaccine's safety and report "adverse events". This was vital to determine whether changes in vaccination policies were needed.
Side effects are expected to be similar to those with seasonal flu vaccines, including soreness or swelling at the point of injection and possible fever, headache, muscle or joint aches, according to the United Nations agency.
In almost all people, these symptoms should be mild and last 1-2 days, it said.
Most rich nations have contracts with drug makers to obtain enough vaccine to cover their entire populations, it said.
But most low- and middle-income countries lack the financial resources to compete for an early share of limited supplies, which in such countries would depend mainly on donations.
The WHO said it would begin an initial distribution of some 300 million doses of vaccine donated by rich nations to more than 90 developing countries from November.

'Test pupils for swine flu' call

Public health chiefs want to blood test school pupils in a bid to track the swine flu virus as the anticipated second wave of the pandemic approaches.

It is hoped the move would help the health services to more accurately calculate how many people have contracted the virus.
Dr Jim McMenamin of Health Protection Scotland said it would need pupils in only one secondary school to take part.
The tests would be carried out on a voluntary basis.
Dr McMenamin, a consultant epidemiologist, said the health service had traditionally relied on swabs taken from people's noses or throats to calculate the spread of the virus.
However, these are usually only carried out on people who have displayed symptoms of the virus.
Blood testing would allow health professionals to detect people who have developed swine flu but have only very mild or no symptoms - giving a more accurate picture of its spread.

We are proposing that at most one or two Scottish schools, and perhaps a similar number in other parts of the UK, would be asked to volunteer Dr Jim McMenamin Health Protection Scotland

Dr McMenamin said this would be particularly important when health professionals are planning for the winter period, when it is important to calculate how many people are likely to have swine flu and how easily it is spread between people.
He told BBC Radio's Good Morning Scotland programme: "What we are proposing is, to get a better idea of the spread of this infection, that there is a limited opportunity for us to look at a very small number of the school population.
"We are proposing that at most one or two Scottish schools, and perhaps a similar number in other parts of the UK, would be asked to volunteer to take part in an investigation to see if H1N1 [swine flu] is spreading in their particular school.
"We are proposing this because our colleagues in the Scientific Advisory Group for Emergencies, who advise the UK government, have suggested this would be a good way forward for any investigation to add to the knowledge that we have."
Dr McMenamin said children of school age were of particular interest as they were among the most likely to contract the virus.
He stressed that the blood tests, which would only be carried out on secondary school pupils, would not be compulsory, and parents would be asked to give consent.
But he said it was "not clear at the moment" whether any school would want to take part.

1st dose of local swine-flu vaccine expected soon

Almost all current cases of influenza statewide are swine flu, local health officials say, and they're expecting the first doses of a vaccine to arrive in the next two weeks.

Dr. Bonnie Sorensen, Volusia County Health Department director, and Dr. Richard Duma, Halifax Health director of infectious diseases, told medical professionals and others Wednesday they are preparing for the worst-case scenario, comparing it to a hurricane.
"We do know an H1N1 (swine flu) outbreak is inevitable," Sorensen said.
What you need to know:
TIMETABLE: A total of 100,000 doses of the voluntary and free vaccine are expected by Oct. 31, then 32,000 doses weekly thereafter. The first 4,800 doses, in a nasal form, could arrive Sept. 30 or Oct. 1. for health care workers. Injections for children could start Oct. 24.
FLAGLER COUNTY: Some 87,000 doses ordered. Health care workers will be served first as soon as the vaccines arrive followed by at-risk. Flagler hopes to have Saturday clinics starting Oct. 24.
PRIORITY: Pregnant women; children 6 months and older; young adults under 25; health care and emergency responders; parents of those less than 6 months old and people 25 through 64 who have medical conditions. Only one shot is needed for the swine flu except children under 10 need two shots, health officials said. People are still encouraged to also get the seasonal flu shot.
SYMPTOMS: Fever or chills, cough or sore throat, runny nose, body aches, headache, tiredness, diarrhea or vomiting.
DEATHS: -RD Seasonal flu causes more than 36,000 deaths a year nationally. In Volusia County, 260 people who died last year had their death attributed to seasonal influenza compared to 390 two years ago and 600 three years ago, Sorensen said. There have been 87 deaths in Florida attributed to the H1N1/swine flu, including three in Volusia. There have been none in Flagler.

With Swine Flu Spreading Many Ask How to Stop It?

-- As the Swine Flu spreads many wonder, "How do we stop it?"

Swine Influenza (Swine Flu/H1N1) is a respiratory disease of pigs that is caused by type A influenza viruses. Much like the regular seasonal flu, Swine flu can be spread by human-to-human transmission, such as sneezing or coughing.

The Swine flu has created a panic in many, but with more than 100 schools and over 3000 confirmed cases in the United States alone, and close to 5300 globally, the panic is very reasonable. Though the effects of Swine flu in the U.S have been minuscule in comparison to that of the effects in Mexico, many have to ask what will happen if it gets worse?

During the four major pandemics since 1889, each has begun with a mild spring wave, only to be followed a few months later by a devastating second wave. The most notable of these four pandemics was the Spanish flu of 1918 that killed an estimated 40-50 million people, possibly more.

Experts do however, agree that if a second, more deadly and infectious wave of the virus is still to come, the time it takes for it to arrive will hopefully allow for the development and production of a vaccine to combat the virus. There are still preventative measures through medicine and Non-pharmaceutical interventions.

Oseltamivir , or by its brand name Tamiflu is 1 of 2 antiviral drugs approved for use in the United States, that the Swine Influenza has been susceptible to. Online pharmacies, sell Tamiflu, which has been high in demand since the outbreak of Swine Flu. The Centers for Disease Control and Prevention (CDC) recommends Tamiflu in the treatment and/or prevention of infection with Swine Influenza viruses.

There are additional ways to aid in the prevention of the transmission of the Swine Influenza. Arne Duncan, Secretary of Education says, "Use the same common sense and courtesy that you would use during winter flu season: Wash your hands, cover your mouth when you cough and stay home if you are sick." Duncan could not be more right in saying this, but there are still some more ways to prevent the Swine Influenza. Make sure to get enough sleep, every night, eat a healthy, nutritious diet, and be physically active.

Pediatrician and medical historian Dr. Howard Markel of the University of Michigan said that, "History is not predictive science... But what I have found, studying epidemics, is that good planning and good relationships between local state and federal authorities, goes a long way." The United States, and the rest of the world, can now only wait, while the whole of humanity will have to chip in to help each other and prepare for what may come in the days, weeks, or months to follow.

Flu season This year is different

Prevention is key for what experts think will be the flu season of all flu seasons

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When it comes to the flu, communicable disease experts over the years have learned one cardinal rule: expect the unexpected.
Influenza is one of nature's great quick-change artists, mutating and combining with different strains, foiling both the body's defenses and medical efforts to stop its spread. The genetic gymnastics of the virus often leave public health experts struggling to keep up, to say nothing of trying to stay a step ahead.
“The H1N1 influenza and influenza generally is unpredictable, and that means two things,” Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention, said in a press conference earlier this month. “First, we have to vigorously monitor to see whether it's changing, who it's affecting and what's happening with it. And second, we have to be ready and prepared to change our approach depending on what the virus does.”
The presence of the highly contagious H1N1 strain of influenza, also known as swine flu, means this year's flu season promises to be like none other in the past 30 years. So public health authorities are urging the public to heed two primary messages: Get your annual flu shot early this year, and be prepared to ride out the flu on your own.
A new strain
The H1N1 influenza first appeared in the U.S. in April, and although media attention to new cases and deaths has quieted down, the virus continued to spread through the summer. But typically, flu viruses tend to survive longer outside the body during winter months, coinciding with kids being in school and individuals spending more time indoors, which facilitates its spread. So doctors are bracing for a new wave of cases this fall.
“(H1N1) is no more serious than the regular seasonal influenza we see every single year, which usually starts in the third week in January, peaks in February and burns out the first week of March.
That has been a regular pattern that has been absolutely consistent for the last 20 years, with one exception three or four years ago,” said Dr. John Chunn, a pediatrician with Central Oregon Pediatric Associates in Bend. “I think we're going to see October look like February.”
Chunn said the presence of the H1N1 strain makes this year significantly different. By all accounts, the symptoms it causes seem to be no worse, and possibly milder, than the seasonal flu in past years. But the virus has turned out to be more contagious than other strains of flu and has shown it will probably stick around for a while, at least until more people build up antibodies to it either by getting sick or through a vaccine. Clinical studies have shown that H1N1 tends to crowd out other strains of the flu, meaning most people who come down with the flu this year will likely have the H1N1 strain.
“I compare this to a pot of water that's been left on simmer. We're just waiting for somebody to turn it up to a boil,” he said. “And the person that's going to turn it up to a boil is the schools. And it's going to happen.”
Back to school
Local health officials are keeping a close eye on schools because they act as germ incubators once kids return. In Georgia, for example, where school started in August, there has already been a rise in regional flu activity. And Washington State University in Pullman, Wash., saw a spike in flu cases when students returned for the fall semester. Over a 10-day period, the school's health clinics saw or fielded calls from more than 2,000 students with flu symptoms. The school's health clinic has confirmed several cases of H1N1 but is not testing all the students to determine whether they have H1N1 or another strain of flu.
“The symptoms of this flu have been quite mild in most of the people on our campus who have contracted it; by most accounts, it has been milder than the usual cases of seasonal flu,” university President Elson Floyd said in an update on the outbreak last week. “Most cases have been relatively short in duration — three to five days — so students who have contracted it toward the end of one week might very well be better by early in the next.”
The campus example, however, might not be the best reflection of what might happen if H1N1 begins to spread through local schools. The tight quarters of dormitories and fraternity or sorority houses may increase the likelihood of students passing on the virus. And because students don't generally go home after class each day, the surge in flu cases may not spread to the broader community as easily.
The concern for local school districts is that healthy kids, who face few risks from the disease, may bring the virus home to more vulnerable people at home, such as pregnant women or people with chronic illnesses.
Health officials are also hoping to learn how the virus will act this winter by looking at countries in the southern hemisphere, which have experienced their traditional flu season during the North American summer. “Large numbers of people, particularly school kids, became ill,” CDC's Frieden said. “In some locations, hospitals had challenges to keep up with the number of people coming in, but overall, no increase in the level of severity, no increase in the death rate.”
Experience with H1N1 suggests that otherwise-healthy people may get a miserable illness this year but won't face any serious risks. Evidence suggests that the H1N1 strain has more dire consequences mainly for people with other underlying health conditions.
A CDC report on 36 deaths among children with H1N1 in the U.S. found that two-thirds had some sort of serious underlying illness or disability, such as cerebral palsy, muscular dystrophy, or long-term breathing or heart problems. Most of the other children who died had a bacterial infection in addition to the flu.
Adults with chronic conditions, pregnant women and young children all appear to be at greater risk for complications. As a result, public health response to the virus has focused on protecting those groups from getting sick. Primarily that means vaccinating those groups first once the H1N1 vaccine becomes available. Officials expect the first doses of the vaccine to be available in October and to filter in over the coming months.
Seniors, who typically face greater risks from seasonal flu, appear to have some resistance to the strain, possibly because their bodies have seen similar strains in the past and have created antibodies.
Community response
The Deschutes County Health Department has created a priority list for H1N1 vaccination, starting with pregnant women, those with chronic illnesses, and critical medical personnel and those caring for the sick and infants younger than 6 months. As more vaccine supply becomes available, the county will vaccinate children ages 6 months to 4 years, and then children in schools. The county will be working with school nurses to hold H1N1 flu shot clinics, which will require parental consent before a shot is administered.
“It will be available (to the general public) if we have some left after the target population,” said Shannon Dames, communicable disease manager for Deschutes County. “I hear there's plenty.”
Until the community is widely vaccinated, county officials are urging people to take other steps to prevent the spread. Those include frequent hand-washing or use of hand sanitizer, good coughing and sneezing etiquette, and staying home if you come down with flu symptoms (See flu symptoms chart on Page F1).
Dames said local doctors and clinics have struggled about how to send the right message to patients about when to seek care and when to stay home. On the one hand, they don't want patients waiting at home when they are seriously ill and need treatment. But on the other hand, there may be little they can do for the garden-variety flu, whether caused by H1N1 or another strain.
“What we want people to think about is our most vulnerable populations are in that provider office and the ER,” Dames said. “What you're doing is you're going into that clinic, you're exposing other people and you're coming out with ‘Drink plenty of fluids and get plenty of rest.'”
Officials at Cascade Healthcare Community, which owns or operates hospitals in Bend, Redmond and Prineville, had considered posting signs at the entry to the emergency rooms, asking patients who don't meet the high-risk criteria to consider staying away to avoid infecting vulnerable patients. They backed off that plan to ensure they wouldn't violate laws preventing emergency rooms from turning people away.
CHC Medical Director Dr. Alan Ertle said that for those who simply have the flu with no other complications or risk factors, doctors won't be routinely prescribing antiviral drugs .
The hospital has on hand 150 courses of antiviral drugs, but will be very judicious in how those are used, to avoid the risk of creating drug-resistant strains of the flu virus. Those medications will be released only if the medical director confirms a patient meets the criteria for antiviral use outlined by the CDC.
Pediatricians at COPA, the local pediatrics group, may take a different approach.
“I think there is a lot of pressure this year to not prescribe medications for this because of the potential for it to become resistant,” Chunn said. “I think that is absolutely an unknown at this point. And I am leaning toward treating kids if they present with symptoms.”
Symptoms of the flu include sore throat, a cough that's usually dry, fever and, in particular, body aches from head to toe.
If parents can bring in a child in the first 48 hours of having the flu, Chunn said antivirals can cut in half the duration of illness, the severity of the fever and the risk of a secondary infection.
“It would be very difficult for me if a child comes in with a fever of 104 degrees, very uncomfortable, coughing their brains out, and I do have medicine that will make him feel better, that I'm not going to give because it can potentially become resistant,” he said. “Being asked to do so, by authorities who aren't taking care of patients but are just making recommendations, is a bit cavalier on their part.”
Ertle said the hospital system is running through a variety of contingency plans about how to deal with a surge in flu cases, how to protect its own employees and how to limit the spread of the flu through the community. He believes it's a matter of when, not if, flu cases will spike. “I think every place is going to get hit by this,” he said.
It's also why health officials are urging Central Oregonians not to delay in getting their regular flu shot this year.
“We want everybody to get seasonal vaccine, as soon as possible, bottom line, no exception,” Dames said.
While the regular flu shot probably won't confer any protection against the H1N1 virus, it will minimize the number of people who get the flu, keeping them out of doctor's waiting rooms and emergency rooms. Earlier vaccination with the seasonal flu shot will also limit the chances that H1N1 will interact with other flu strains and mutate to something more life-threatening.
“We don't want people getting two viruses at one time, the seasonal virus and H1N1 virus,” Dames said. “If people don't get vaccinated, there's a higher risk that they're going to get both viruses at the same time. If you get both viruses, you have a higher rate of mortality risk, and we have a higher risk of the two viruses intermingling and mutating.”
Previous media reports in the region erroneously claimed that getting both vaccines at the same time could lead to the vaccines mutating. Dames says that was simply a misinterpretation, and the health department will still give individuals both vaccines at the same time if the opportunity presents itself.
Dames also stresses that the H1N1 vaccine, now in clinical trials, is being developed in exactly the same way as the seasonal flu vaccine, which typically includes three different strains of flu virus.
“It's not like there's a new process that we're testing out on some new vaccine,” she said. “It's just a different strain.”

Swine flu death rate similar to seasonal flu-expert

The death rate from the pandemic H1N1 swine flu is likely lower than earlier estimates, an expert in infectious diseases said on Wednesday.
New estimates suggest that the death rate compares to a moderate year of seasonal influenza, said Dr Marc Lipsitch of Harvard University.
"It’s mildest in kids. That’s one of the really good pieces of news in this pandemic," Lipsitch told a meeting of flu experts being held by the U.S. Institute of Medicine.
"Barring any changes in the virus, I think we can say we are in a category 1 pandemic. This has not become clear until fairly recently."
The Pandemic Severity Index set by the U.S. government has five categories of pandemic, with a category 1 being comparable to a seasonal flu epidemic.
Seasonal flu has a death rate of less than 0.1 percent — but still manages to kill 250,000 to 500,000 people globally every year.
A category 5 pandemic would compare to the 1918 flu pandemic, which had an estimated death rate of 2 percent or more, and would kill tens of million of people.
An estimate published in the journal Eurosurveillance last month by the French Institute for Public Health Surveillance put the mortality rate far higher, at 0.4 percent for all age groups.
HIGHER MORTALITY?
Lipsitch took information from around the world on how many people had reported they had influenza-like illness, which may or may not actually be influenza; government reports of actual hospitalizations and confirmed deaths.
He came up with a range of mortality from swine flu ranging from 0.007 percent to 0.045 percent.
Either way, having new information about how many people were infected and did not become severely ill or die makes the pandemic look very mild, he said.
"The news is certainly better than it was in May and even better than it was at the beginning of August," Lipsitch said.
But another expert cautioned this does not mean the pandemic will not have severe effects on people and communities because it will infect more people than seasonal flu usually does in any given year.
"This is not a severe pandemic," said Dr. Jeffrey Duchin of Seattle & King County Public Health and the University of Washington.
"We are going to see probably twice as many people die from the flu as we do in a typical flu season. That is tens of thousands of people. And many of these people are going to be younger."
H1N1 swine flu was declared a pandemic in June after flashing around the world in six weeks, in part because most people have virtually no immunity to it. Experts all said a true death rate would not be clear for weeks because it is impossible to test every patient and because people with mild cases may never be diagnosed.
This lack of information made the epidemics in various countries and cities look worse at first than they actually were, Lipsitch said. People sick enough to be hospitalized are almost always tested first.
"Yes, there’s been hype, but I don’t think it’s been an outrageous amount of hype," Lipsitch said.
Seasonal flu is usually far worse among the elderly, who make up 90 percent of the deaths every year. In contrast, this flu is attacking younger adults and older children, but they are not dying of it at the same rate as the elderly do during seasonal influenza, Lipsitch said.

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The FDA announced Tuesday, they are ready to release a swine flu vaccine to the market. The vaccine should be in Mobile by the last week in October.

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After 53 deaths in Rio de Janeiro due to swine flu, DGHS recommends Tamiflu as first line of defense

River reports 53 cases of deaths from flu, the second largest in the country, after Lisbon, the team of the Central Government Health Services (DGHS) has recommended the immediate administration of the antiviral drug Tamiflu. Early administration of Tamiflu, which is fundamental and should be high on the agenda of all doctors in private clinics.

A core team led by Dr. Shivalal, director general of Special Health Services, was here in Bangalore to assess whether there is a similarity in the pattern of H1N1 deaths from those reported in Pune with Bangalore. They are also trying to discover the reason for the spread of the virus, the main cause of many deaths of reports. Other team members included Dr. Dhariwal, additional director, National Institute of Communicable Diseases (NICD), Pune, along with three doctors of Ram Manohar Lohia Hospital, New Delhi.

The observations were that 53 deaths were due to delayed admissions to hospitals. They directed health officials in Ontario focus on prevention and early diagnosis, and create a public awareness campaign to the initial report. Cause of death is the same in the two cities of Pune and Bangalore. This is because of similar climatic conditions. Both are home to international airports and has a floating population.

DGHS Officials also reiterated that the clinical audits and the report should be submitted within 10 days, IR Perumal, principal secretary, Department of Health and Family Welfare, Government of Karnataka said Pharmabiz.

Efforts to involve the private hospitals to treat patients with positive results for H1N1 was also appreciated. The state also has given permission for people to opt for homeopathy and Ayurveda drugs to prevent the flu, he added.

In addition, state officials also were instructed not to disclose patient data and hospitals that reported deaths due to social stigma, said Dr. TS Chelvaraj, joint director, communicable diseases, Rio de Janeiro Department Health and Family Welfare.

Bangalore has 91 private hospitals and six hospitals designated as centers of care H1N1.

According to Dr. shashid Buggi, director Rajiv Gandhi Institute of Chest Diseases, which is designated as a center and hospital for the treatment of government for the diagnosis and treatment of H1N1 virus, which contains the disease would be necessary to raise the professional, general prevent deaths.

Most fatalities were reported late complications and suffering from related health problems. The virus is infecting people who have not had any contact with an infected person or the history of international travel. Analyzing the pattern of health officials of the state concluded that the virus is in the community and is spreading rapidly.

Swine Flu Vaccine Research Kicks Off By Russia

Russian investigators in St. Petersburg (Russia) published a report on Thursday, September 10th stating that they have initiated clinical trials of a vaccine against swine influenza in the northwestern city of St. Petersburg.
 
Marina Stukova, lead investigator of the molecular virology and genetic engineering at the Research Institute of Influenza in St. Petersburg, said: "Today we are initiating research to assess the safety and efficacy of a live vaccine.
 
Swine influenza is spreading at an alarming rate worldwide. From 26 August, Russia itself saw 211 cases of swine influenza infected persons. According to the WHO last week, more than 3,200 people who have succumbed to the swine flu worldwide.
 
On 12 May the World Health Organization (WHO) presented the H1N1 strain of vaccine research for the Institute.

Stukova claimed that the investigation, including tests of the inactivated vaccine will be launched after 18 September and was completed in November. The tests will be closed to the press.
 
The vaccination process to be followed in later stages. The first stage consists of a team of 30 volunteers. This stage will be filled within 31 days. The team spent about a week in hospital followed by several visits to the research institute. Stukova said the second group to receive the live vaccine will be tested for 42 days.
 
Another place where the new vaccine will be tested Sergiyev Posad is located 75 kilometers northeast of Moscow. Here, a total of 60 volunteers will participate in the testing process. Each volunteer was paid a ransom of 10,000 rubles ($ 320).

Several volunteers from various walks of life have been presented for the cause. Age and sex are not preclude voluntary participation. Alla, 25, an employee of the charity fund, which is voluntary in the research, says he is motivated by the feeling of helping those in need.
 
Another volunteer, Nastya, 19 years old physics student, said that the reward has been the main driving force for their participation. He also wants to devote his thesis to the question.
 
Eduard, 48, a volunteer at the same institute in the mid-1990s, has come back from this cause with the same dedication as before. He says: "If I can help society and make some money at the same time, why not?" , Told RIA Novosti.

Swine Flu: PROBLEM with vaccination

Now, we have a problem with release a Swine Flu vaccine in USA, Canada and other country worldwide. Read the shot news about it:

• Via CBCnews.ca: Address swine flu vaccine fears, doctor urges. Excerpt: "...Some Canadians at high risk of getting swine flu have said they don't trust the vaccine enough to get the shot. ... Pregnant women, health-care workers, those living in northern and remote communities and people under age 65 with chronic health conditions are expected to be targeted first when the vaccine is released in Canada in November.
• U.S. Health and Human Services Secretary Kathleen Sebelius recently told ABC's George Stephanopoulos that the swine flu vaccine will be available in the United States by the first week of October, 2 weeks earlier than has been previously expected.
• A YouTube video of Dr. Girard being interviewed on French television about this is below, but unless you know French you will not be able to understand it. For those that don't speak French, the following is a translation of the most pertinent portion of his remarks:
  
  A vaccine is being developed in conditions of amateurism such as I have never seen. Lets take the pessimistic hypothesis: one death among every 1000 patients. There are plans to vaccinate 60 million people, and you so you already have 60,000 deaths, and this time, young people, children, pregnant women.   

• By: MARILYNN MARCHIONE, Associated Press: Novel flu drug proves effective; Tamiflu saves lives, not just shortens illness, studies show."...Several other studies showed the value of treatment with Tamiflu. In one study of hundreds of people stricken with bird flu around the world, half of those given Tamiflu survived, while nearly 90 percent of those not given flu medicines died. Other research showed Tamiflu improved survival from regular seasonal flu, too..."
• Tamiflu, made by Swiss-based Roche Holding AG, and Relenza, made by British-based GlaxoSmithKline, came on the market in 1999. Most people who get swine flu don't need them, but these drugs can help save the severely ill, studies sponsored by Tamiflu's maker suggest. You can buy Tamiflu online in Pharmacy-Adviser.com

About Viruses

Viruses are very small living particles. This section reviews information about viruses that will help you understand the H1 N1 flu virus.

Viruses are made of an outer shell that protects genetic material packaged inside. In order for a virus to reproduce, it needs to enter a living cell by attaching itself to the living cell's surface. Viruses tend to infect only specific cells in a specific species. For example, certain viruses may only attack human cells while others can attack only bird cells.

Once inside the cell, the genetic material of the virus blends with the genetic material of the infected cell and copies itself hundreds, if not thousands of times.

The hundreds of copied viruses then kill the cell, burst out of it, and infect many new cells. The cycle repeats itself and can make a person very sick unless the person's immune system destroys the virus. The immune system is responsible for defending the body against viruses.

When a virus is copying itself, the genetic material of the virus can go through changes known as 'mutations'. The virus can also exchange genetic material with the infected cell which can modify the surface of the virus. This may make it possible for the virus to attack the living cells of different species such as pigs and humans. A virus modified by mutation is known as a different strain.

There are three types of influenza viruses, A, В and С. Types В and С are usually only found in humans. Type A can be found in both humans and animals such as birds, pigs, horses, whales, and seals.

Introduction

Swine flu, also called H1N1 flu, is a respiratory disease of pigs that has now spread to humans. "Swine" refers to animals such as pigs, hogs, and boars. "Flu" is an abbreviation of influenza. "H1N1" is the name of the virus that has spread to humans.

People do not normally get swine flu viruses, but human infections can and do happen. Beginning in late March 2009, cases of humans infected with the H1N1 flu virus have been reported in the USA and internationally.

This reference summary explains what the H1N1 flu is. It discusses its symptoms, when to seek medical help, and its treatment options. It also provides important prevention tips.