Column: Breaking down details on HIN1 flu

“When can I get my flu shot? Will I be able to get an H1N1 shot? Is it safe to get the new vaccine?”

These are a few of the many questions being asked around Lincoln County and the rest of the world this fall. You can expect to be dealing with two types of flu this year – seasonal and novel H1N1. So, let’s break it down.

Seasonal flu is what we gear up for every fall by getting our annual flu shots. Seasonal flu kills approximately 36,000 Americans every year and puts about 200,000 in the hospital. If you’ve been tested and found to have the flu, you are not likely soon to forget it. It is an absolutely miserable experience with high fever, body aches, sore throat, headache, cough and upper respiratory symptoms.

Sometimes people also have stomach symptoms, but true influenza always involves the upper respiratory tract. Seasonal flu causes severe complications in those over 65 and those with pre-existing medical conditions. Fortunately there should be plenty of the seasonal flu vaccine to go around this year.

Novel H1N1 Influenza A, originally called swine flu when it emerged in April, is the current pandemic influenza circling the globe. H1N1 flu has killed 593 Americans as of Sept. 4 and put 9,079 in the hospital.

We still have not had any lab-confirmed cases of novel H1N1 flu in Lincoln County. This flu is a pandemic because of how far it has traveled, not because of its severity. In fact, Montana’s Medical Officer, Dr. Steve Helgerson, says, “Nothing we have seen so far in the United States suggests that the H1N1 influenza virus is more dangerous than influenza viruses that circulate every year.”

This influenza virus has mutated just enough to be unrecognized by most people’s immune systems, except for maybe those who are the oldest and wisest among us. Symptoms are much the same as the seasonal flu except that stomach symptoms are seen more frequently. The hallmark symptoms are fever, cough and sore throat.

H1N1 has caused complications and death primarily in pregnant women, children under 5 years old and those 18-49 years old. The median age for persons who died from novel H1N1 virus infection was 37 years. The incidence of infection is lowest among persons age 65 and up. A vaccine for this new H1N1 influenza has been developed and is currently undergoing testing for safety and efficacy.

Seasonal flu vaccine will be distributed in the normal fashion. It is recommended for everyone and emphasized for those over 65 and those with pre-existing medical conditions.

Seasonal flu shot clinics provided by the Lincoln County Public Health Department will be:

• Oct. 9 in Eureka (time and place TBA)

• Oct. 14 at Libby Senior Citizens Center from 10 a.m.-2 p.m.

• Oct. 28 at Kootenai Senior Center in Troy from 1-4 p.m.

• Nov. 11 at Libby Senior Citizens Center from 10 a.m.-2 p.m.

• Nov. 18 at Kootenai Senior Center in Troy from 1-4 p.m.

• Dec. 9 at Libby Senior Citizens Center from 10 a.m.-2 p.m.

If you are unable to make it to one of the seasonal flu shot clinics, there will be many other opportunities just as in years past. For an appointment at the Libby LCPHD office, call Pat Shirk at 293-2660. For an appointment at the Eureka LCPHD office call Jeanne Osler at 296-2023.

You may also talk to your primary care provider about getting a flu shot at his/her office. St. John’s Lutheran Hospital will be having seasonal flu shot clinics at Rosauers Grocery again, too. The cost for seasonal flu shots varies from $15 to $25.

The novel H1N1 flu vaccine is expected to be available in mid-October. This vaccine will be distributed through local public health departments across the country. The Lincoln County Public Health Department is participating in weekly teleconferences and planning meetings with the Montana Department of Health and Human Services Immunization Department to determine the most effective way to distribute the vaccine.

As the vaccine is still in safety and efficacy trials, it is not yet known how many doses will be needed per person. It is also not yet known how many doses will be received in each county. The vaccine will most likely be at no cost to the public. Please look for information to come regarding when and where to get your H1N1 vaccine if you are in one of the groups listed below.

In order to protect the population at large and those at highest risk for influenza infection and related complications, the Advisory Committee on Immunization Practices has made recommendations to the CDC.

The document they produced states, “The guiding principle of these recommendations is to vaccinate as many persons as possible as quickly as possible.”

The recommended initial target groups for the Novel H1N1 flu vaccine are: Pregnant women, persons who live with or provide care for infants aged less than 6 months old, health care and emergency services personnel, persons aged 6 months to 24 years, and persons aged 25-64 years who have medical conditions that put them at higher risk for flu-related complications.

Interestingly enough, this novel strain of influenza virus is least likely to infect those over 65 years of age. Research on the patterns of infection in both the northern and southern hemispheres indicates that the over 65 population is not likely to be strongly impacted by novel H1N1 flu.

Scientists theorize that people over 65 may retain some immunity to the virus from a previously circulating strain. It seems odd indeed to be fighting a flu, which does not pose the biggest threat to our respected elders. Seasonal flu does continue to be a serious threat for this population, though. As in years past, seasonal flu vaccine will be strongly encouraged for those over 65.

If initial H1N1 vaccine supply is low a sub-set of the target groups will be prioritized to get the vaccine first. This list includes: Pregnant women, persons who live with or provide care for infants aged less than 6 months old, health care and emergency services personnel who have direct contact with patients or infectious material, children aged 6 months to 4 years, and children and adolescents aged 5-18 years who have medical conditions that put them at higher risk for flu-related complications.

Vaccine providers will give priority to this group only if vaccine availability is too limited to initiate vaccination for all persons in the five initial target groups. Ideally all age groups will be vaccinated and recommendations may change depending on the patterns that emerge.

Current studies show that the risk for infection with H1N1 among persons aged 65 or greater is less than the risk for persons in younger age groups. This is a distinct difference from the seasonal flu. Decisions about expanding vaccination to include populations other than the initial target groups will be made locally by the Lincoln County Health Board.

The most important thing you can do (besides getting vaccinated if it is recommended for you) is to stay home if you are sick! This might require some planning ahead. Go to the store for cough drops and symptom relieving medications before you get sick. And of course…. wash your hands and cover your coughs and sneezes!

If you find yourself with a fever, sore throat and cough you should keep to yourself as much as possible for the duration of symptoms and until you are fever-free for 24 hours without fever-reducing medications.

If you are thirsting for more information on influenza, please feel free to contact me at 293-3374 or lcphep@libby.org . Or go on your own quest for information online at www.cdc.gov/h1n1flu/general_info.htm .

(Amy Smart, registered nurse, is the public health emergency preparedness coordinator for Lincoln County.)