Archive for October, 2009

The Flu Paradox

Saturday, October 24th, 2009

In the same week that we learned H1N1 (Swine Flu) vaccines were delayed in reaching much of the country, the President yesterday declared the H1N1 epidemic to be a national state of emergency. These are tough developments to reconcile for many people. Is this a true national state of emergency and, if so, how could we have allowed flu vaccine availability to fall below expectations?

Unfortunately, the answers are complicated. Declaration of a national state of emergency allows health care providers to bypass some of the red tape that would have slowed down the delivery of standard care – hospitalizations, clinic visits, the opening of alternate facilities, etc. – all of which will be necesary if the rate of acceleration of the epidemic continues as it has for the past several weeks. On the other hand, the “declaration” of a national state of emergency also raises the public panic level and/or raises the “crying wolf” skepticism, depending on how hard your part of the country has been hit so far. The delays in vaccine availability have not been limited by red tape or by governmental inefficiency. They have been caused by eggs. Yes, eggs. We still produce flu vaccines the way we have for decades – growing live influenza virus in chicken eggs. This is a slow, inefficient, and notoriously delay-prone process. As much of science and medicine have advanced into a high tech, molecular mode, the process of flu vaccine development is stuck in the 1950s. Much more on flu vaccines and the history of flu pandemics in this country can be found in Germ Proof Your Kids (The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008).

So, we’re left with both a national emergency and a national vaccine shortage. A bit of “good news” also emerged this week with the projections by the CDC that as many as 20% of all kids in the U.S. have already been infected with the H1N1 (Swine Flu) vaccine. How is this good news? Because it means the level of immunity in the general population is increasing dramatically – natural immunization, if you will. As the virus has fewer susceptible kids in the community, the spread will slow even without the vaccine.

Meanwhile, as you wait for your H1N1 vaccine, make sure you and your kids get the seasonal flu vaccine – the season for that virus begins in the next couple of months, and right now there’s plenty of seasonal flu vaccine available.

Preventing Swine Flu – Vaccine and more

Sunday, October 4th, 2009

With the first doses of the new Swine Flu (H1N1) vaccine due to roll out this week, attention on prevention has never been greater. More than 10,000 hospitalizations due to Swine Flu have already been reported in the U.S., with 936 deaths, 36 of whom have been kids. As horrific as that is, the projections for deaths during this epidemic still fall below the number of deaths that occur every year in the U.S. due to the common, “seasonal” influenza outbreak.

The recommendations for who should receive the vaccine, which will be in limited supply for the first few weeks, have been issued by the CDC.  “These target groups include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems.”  For the full recommedations, see:(

Many questions have been raised by the public regarding safety. The most important thing I can tell you to reassure you about the safety of this new Swine Flu (H1N1) vaccine is that it is made by the identical processes, and by the same manufacturers, as for the annual “seasonal” flu vaccine that is so widely used every year. Thus, we have essentially been doing “safety” tests for this new vaccine for many years – the seasonal flu vaccine has proven to be very safe.

Vaccines are not the only tools in our tool shed for prevention of Swine Flu. As you’ve read in earlier posts on this blog, and in Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008), personal hygiene, home hygiene, institutional (e.g. school) and community hygiene are critical. I’d like to call your attention to two recent informational sources that cover all the other important ways to protect yourself and your family from Swine Flu. The first is a series of educational videos on WebMD titled “Every Mom’s Germ Fighting Guide” that cover personal and home hygiene for kids in 4 different age groups. I had the privilege of working on those videos with WebMD and you’ll hear the interviews of me on the videos at:

The next resource is a 10-page report by the Preventive Health Advisory Board entitled “Comprehensive Steps for 2009 H1N1 Flu Prevention”, based on a discussion by a group of experts from a wide array of national agencies and organizations concerned with kids’ health, school health, and community health. Once again, I had the prvilege of participating as part of this group of national thought leaders and children’s health specialists. I am posting the full contents of the monograph below, for your reading:

prehensive Steps for 2009 H1N1 Flu Virus Prevention






Advisory Board


Comprehensive Steps for 2009 H1N1 Virus Prevention



Preventive Health


As this flu season approaches, the convergence of the 2009 H1N1 flu and seasonal influenza makes it more important than ever for families to be prepared to help fight flu — both inside and outside the home.

We must help ourselves, our families and our communities stay healthier by taking a holistic, or comprehensive, approach to flu prevention this season. While many of us understand the basic prevention steps, there are other equally important actions, as well as “unsung heroes” on the front lines of prevention that are not often recognized yet have the ability to make a tremendous impact in preventing the spread of the flu virus. Many experts predict that this could be an unprecedented flu season. By practicing responsible prevention in all facets of daily life, we can help protect our health and the health of those around us, and reduce the demand on the health and public health systems.

This paper is based on findings from a meeting of the Preventive Health Advisory Board, a group of thought leaders and specialists in the areas of education and child care, of ice and human resource management, healthcare, infectious diseases and widespread disease preparedness.

Through this discussion, the Advisory Board developed the following comprehensive view of flu prevention, which demonstrates how choices people make in different settings throughout the day — many of them seemingly small — can help prevent the spread of flu among families, and sometimes entire communities.


2009 H1N1 Virus Background and Awareness

As the United States prepares for seasonal influenza and the world braces for the next wave of the 2009 H1N1 virus, health officials are preparing for a potential convergence of the viruses this fall.

The U.S. Centers for Disease Control and Prevention (CDC) and Department of Health and Human Services (HHS) began a robust communications program to inform citizens about the 2009 H1N1 virus, while news media continue to update the public on the spread of the virus. The messages in the media, however, are often mixed and alarmist news sometimes takes the lead over scientific data.

We are surrounded by information about the 2009 H1N1 virus, recommendations on how to fight it and what we might expect this flu season. However, a recent national study, conducted by Opinion Research Corporation and sponsored by The Clorox Company, found that relative awareness and concern about the 2009 H1N1 virus remains low.


In this survey, 68 percent of those surveyed had not heard of the 2009 H1N1 virus. Even after considering the many names the virus has received — from “swine flu” to “pandemic flu” to simply “H1N1” — 12 percent of U.S. adults surveyed still were not able to identify it as a new strain of the flu.

Even when respondents were able to properly identify the 2009 H1N1 virus as a new viral strain, more than a quarter of those surveyed (26 percent) said that they were not concerned about the 2009 H1N1 virus.

A majority of those surveyed were not able to correctly identify the groups at greatest risk for contracting the 2009 H1N1 virus.

When asked which groups were at higher risk for serious health complications from the 2009 H1N1 virus, only 4 percent cited average adults and 9 percent cited teenagers. The CDC indicated that people 5 to 49 years are most vulnerable to the 2009 H1N1 virus.

1 Opinion Research Corporation, August, 2009.

While there is a continued influx of information about the 2009 H1N1 virus, survey findings demonstrate that public awareness or concern about the threat remains low. As we approach flu season, the public seems to be experiencing “H1N1 fatigue.”

Families need to be aware of how the flu virus spreads, and how a few simple, actionable steps — the standard flu prevention steps coupled with the new recommendations outlined in this paper — can help protect against the spread of the 2009 H1N1 virus and seasonal flu.


Helping to Keep You and Your Family Healthy

We are a society on the move. Most people start the day together at home, getting ready for upcoming activities. After that, each person usually follows a different schedule.

At work, school, the grocery store, the gym and the daily commute, we are in contact with numerous places, objects and people. Within each setting, we visit multiple settings and potentially numerous germ “hot spots” — the handle of a shopping cart, shaking hands with a colleague or the desk at school. As each day winds down, family members often regroup at home to eat dinner, relive their days and get some sleep.

Since we come in contact with so many people and places, we need to think holistically about infectious disease prevention rather than practice a set of flu prevention recommendations specific to a single location or point in time. This should be approached in the following four ways:


Remember the basics

of flu prevention and practice these habits throughout the day.


Step it up

by incorporating positive changes into your diet, exercise routine and sleep patterns.


Become a prevention advocate

by encouraging others to adopt these same practices.


Learn the new prevention recommendations

for your home as well as school, work and other community settings and incorporate them into your daily routine. 







In addition to the prevention habits and lifestyle changes we should adopt, there are other things to consider both at home and while we are out in the community, including school, child care, work and other community settings. It is important to remember that we often come in contact with germs in numerous places, and may carry them with us on our hands or clothing. PUBLIC PLACES Workhool

Remember the Basics


Most U.S. adults (82 percent) recognize the basic steps needed to protect against the spread of the 2009 H1N1 virus.




However, this flu season, we need to be prepared to incorporate these practices into all aspects of our daily lives. By consistently taking these steps, we can help prevent the spread of the flu virus and help protect the health of our families and ourselves, as well as our communities. 



Wash Your Hands:

Remember to wash your hands frequently, especially before eating, with warm water and soap for at least 30 seconds. Keep alcohol-based hand sanitizers on hand in case water and soap are not available. 



Cover Your Mouth:

Carry around tissues so you can cover your nose and mouth when you cough or sneeze. Throw the tissue in the trash after you use it. If you don’t have a tissue, cough into your elbow. 







Avoid Touching Your Eyes, Nose and Mouth:

By touching an infected surface — or person — and then touching your eyes, nose or mouth you might contract the 2009 H1N1 virus or one of the seasonal flu viruses. 



Get Vaccinated:

This season, the CDC is advising people to get vaccinated with both the seasonal flu and the 2009 H1N1 vaccines. While the seasonal flu vaccine is available now, pharmaceutical companies are still developing the 2009 H1N1 vaccine. As it becomes available, the 2009 H1N1 vaccine will be a critical first step in protecting ourselves and our families. In addition, the vaccine for this year’s seasonal influenza is designed to protect against the other specific influenza strains expected to be dominant in the upcoming flu season. 


Step It Up

Flu prevention begins with the basics, but there are also lifestyle changes we can make to help protect ourselves and our families. Although these changes may take some additional effort and time, they can be helpful in preventing the flu.


Get Plenty of Sleep:

Sleep (eight hours each night) is a critical way to ensure that our bodies are able to protect against infectious disease. When our bodies are rested, our immune systems are more able to fend off viral infections, including flu. 



Keep Moving:

We all know that regular exercise can help improve our overall cardiovascular health. As a tangential effect, regular exercise may also help our bodies resist respiratory infections, such as the 2009 H1N1 virus and seasonal flu. 



Eat a Healthy Diet:

Eating a well-balanced diet, rich in vitamin C, may also help boost our immune systems and help our bodies fight off viruses. 



Don’t Be a Hero:

Many of us try to “push through” when we are feeling ill. We need to listen to our bodies, taking the time to rest and see a doctor or nurse if we are seriously ill. While it can seem daunting in this economic situation to consider taking time off work, we must protect our health and the health of those around us by staying home from work or school and limiting our contact with others to keep from infecting them. 



Becoming a Prevention Advocate

We should all do our best to prevent the spread of the 2009 H1N1 virus and seasonal flu by serving as “prevention advocates” in our communities. We must share flu prevention information with family members, friends, co-workers and neighbors.

It is also important to recognize that, while we may not always show outward signs of being ill, it is possible to be a “silent carrier” of the 2009 H1N1 virus and to pass the virus on to others. By consistently following the basic flu prevention steps, we can help protect the people we come in contact with throughout the day and lessen the spread of the virus.

Staying Healthy Throughout the Day

In addition to the prevention habits and lifestyle changes we should adopt, there are other things to consider both at home and while we are out in the community, including school, child care, work and other community settings. It is important to remember that we often come in contact with illness-causing germs in numerous places, and may carry them with us on our hands or clothing.

At School and Child Care

As school begins, teachers and parents are bracing themselves for another possible wave of the 2009 H1N1 virus. Some school districts may not have the funds to support simple flu prevention steps, and may only have limited supplies of soap to wash hands, disinfectant to clean desks or even custodial staff to clean surfaces and empty trash at the end of the day. Add to this the fact that schools are often a starting point for the spread of infectious disease — children do not always practice prevention techniques.

With an average of only three feet of personal space per child at school, there is increased potential for germs to spread.

This year, faced with the 2009 H1N1 virus and seasonal flu, parents need to be particularly vigilant, encouraging their children to use the same basic prevention steps they are taught to use at home. Below are additional ways to help prevent the flu at school and child care.


Teach Your Kids:



Parents need to arm their children with the knowledge and tools to help prevent the spread of the 2009 H1N1 virus and other infectious diseases. They should reinforce the same prevention techniques that they are using at home and encourage their practice at school and out in the community. 



Pack the Tools:

Make sure kids have the tools they need to stay healthy. Remind your child to wash his or her hands frequently. If your school allows it, pack an alcohol based hand sanitizer in your child’s backpack and remind him or her to use it frequently throughout the day. Ask if you can donate supplies of hand sanitizer, disposable facial tissues and/or disinfecting cleaning products to your school or have these items added to the school supply list. 



Take a Sick Day:  

A study in the Archives of Pediatrics and Adolescent Medicine  found

that, in a Seattle school, for every 100 children, the flu accounted for an estimated 20 extra days of work missed by their parents. 


If your child is feeling sick, keep him or her home from school and after-school activities and sports. Try to limit his or her exposure to other children and family members until he or she has recovered. 



Raise Your Hand:

Talk to your child’s teacher about disinfecting the classroom, and reach out to the other people your child comes into contact with, including the bus driver, the people serving lunch in the cafeteria and staff in charge of after-school activities to share flu prevention tips. Your child’s school nurse can also be a strong ally in the fight against the 2009 H1N1 virus as nurses are often on the front line of flu prevention in their schools. 



Get Vaccinated:

The CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that certain groups of people receive the 2009 H1N1 vaccine when it first becomes available, including pregnant women and people who live with or care for children younger than 6 months of age. Teachers, child care providers and parents of small children need to make sure they receive the 2009 H1N1 vaccine when it becomes available. 


At Work

For many of us, work can feel like a second home. Even when we feel ill, we often try to maintain our regular routine — we might take some over-the-counter medicine and head off to work, exposing our co-workers and the other people we come in contact with throughout the day to illness. In today’s economic climate we may feel even more compelled to head into work when we are sick.

Employers are not necessarily providing prevention information to their employees, nor are they instituting alternative work options. A recent study conducted by the Society for Human Resource Management found that only 37 percent of workplaces currently send employees home who come to work with flu and cold-like symptoms, and that a third (33 percent) do not plan to in the future. The study also found that only 22 percent of the workplaces surveyed had set up telecommuting options for employees in the event of a 2009 H1N1 virus outbreak in their local area, and that a majority (64 percent) do not have plans to do so. 



As we confront a looming increase in cases of the 2009 H1N1 virus, we need to take every precaution to keep ourselves and those around us healthy.



Stay Home:

If you are feeling ill, do not go to work. Speak with your employer to see if you can work from home, or take the time off to feel better. The CDC recommends that people with flu-like symptoms remain at home at least 24 hours after they are free of fever or signs of fever without the use of fever-reducing medication. 


2 Neuzil KM, Hohlbein C, Zhu Y 2002. Illness among schoolchildren during influenza season. Archives of Pediatric and Adolescent Medicine , 156: 986-991




Talk to Your Employer:  

Encourage your employer to update or develop business continuity and disaster plans for the 2009 H1N1 virus before illness becomes widespread. These plans might include implementing more flexible and relaxed telecommuting guidelines and attendance policies to encourage people with flu-like symptoms to stay away from the workplace. Also, speak with your employer about offering both seasonal flu and 2009 H1N1 vaccinations. 



Work Environment:

Only about half of the workplaces surveyed (52 percent) are frequently disinfecting common areas, such as bathrooms, door handles and elevator buttons. Employers should help make their workplaces safer and healthier through regular cleaning, trash removal and by disinfecting hard surfaces to help prevent the spread of infectious diseases. Remember, viruses like H1N1 can survive on hard surfaces for hours to days, long enough to infect those who come in contact with the surfaces. 



Healthy Work Practices:



Employers should emphasize hand-washing, encourage employees to stay home when they are sick, and provide alcohol-based hand sanitizer and disinfecting cleaning products to help keep workspaces clean and employees healthy. Employers should also educate their employees about the flu virus and encourage them to take precautionary steps to keep themselves and their co-workers healthy.


Global Workplaces:

If you work for a multinational company, ask your organization to implement a plan across its worldwide operations. Ask them to draft a global response plan that complies internationally and can be adjusted to fit with local law. Emphasize that the plan should be created for the 2009 H1N1 virus, but should be broad enough to work during other pandemics. There is still work to be done to ensure offices are prepared for this flu season. As employees, we have a responsibility to ourselves and our colleagues to practice prevention techniques to keep our workplaces as safe and healthy as possible. 


Other Community Settings

According to the recent survey about the 2009 H1N1 virus conducted by Opinion Research Corporation, the community setting where people are most concerned about catching the 2009 H1N1 virus is the shopping mall (20 percent), ranking higher than doctor’s offices (16 percent), schools (14 percent) or offices (12 percent).


Retail locations — such as shopping malls, grocery stores and restaurants — all provide multiple spots for potential 2009 H1N1 virus transmission. We must adopt the same practices in all the community settings we visit in a given day.

Below are ways we can each contribute to the overall health of ourselves, our families and those around us when we are moving through our daily lives.

Champion the Unsung Hero:

There are many people who play a key role in flu prevention who are not always recognized, such as school nurses, bus drivers and janitorial staff. These people have the potential to be the “unsung heroes” in helping to prevent the spread of the 2009 H1N1 virus. We need to recognize the impact they make every day, and provide them with the tools and education they need as they are on the front line of flu prevention. 



Model Good Behavior:  

We need to embody the prevention recommendations outlined in this paper. Every day, in every place, we need to remember the basic ways that the flu can spread and take the simple precautions we know are effective ways to reduce the spread of the 2009 H1N1 virus as well as the seasonal influenza viruses. Flu prevention is not just the responsibility of the CDC or other health departments — we all play a role in preventing the spread of the 2009 H1N1 virus and seasonal flu viruses every day. 



Road Trip:

When traveling, remember to take the same flu prevention precautions. Pack an alcohol-based hand sanitizer for use on public transportation. If you are travelling by plane, pack your own pillow and blanket as these items provided on planes may not be cleaned between flights. 


At Home

The home is the central place for families to interact, and it is a good place to educate family members on flu prevention. Unfortunately, it can also be a good location for all of the germs we come in contact with each day to congregate. When the family is home together, the 2009 H1N1 virus and other infectious germs picked up throughout the day may be passed on to other family members. There are simple steps we can take to protect ourselves from these germs and limit their spread in our homes.


Educate Your Family:

Talk to your children about the basic flu prevention steps they should be practicing throughout the day. Create a family challenge to learn and practice the prevention techniques. Encourage everyone to share the new information about flu prevention with their friends. 



Cleaning vs. Disinfecting:



Understand the difference between cleaning and disinfecting.

Cleaning removes dust and debris from a surface, whereas disinfecting kills a variety of germs. Some disinfectants can also kill germs that cause the flu. Products that claim the ability to control microorganisms must be registered with the U.S. Environmental Protection Agency. 



Disinfect Surfaces:

The EPA believes that, based on available scientific information, currently registered influenza A virus products will be effective against the 2009 H1N1 virus and other influenza A virus strains on hard, non-porous surfaces. Use disinfectants on frequently-touched surfaces in your home — like doorknobs, faucets and plastic toys — to help prevent the spread of the flu virus. 



Start with the Basics and Step it Up:

Start with the basic flu prevention steps, and then work as a family to take it to the next level by eating a healthy diet, getting enough sleep and making exercise a part of your regular routine. If a family member does contract the 2009 H1N1 virus, create a separate space in the home where that person can rest and recuperate and keep other family members at a distance. 




We need to take a holistic approach to flu prevention at all times, but especially this season with the threat of the 2009 H1N1 virus. The basic steps are just the start; we need to make the new recommendations outlined in this paper, which cross over community settings, part of our daily routine. As we approach flu season, we need to consider making improvements to our diet, exercise regimes and sleep patterns, which can help boost overall immunity. Most importantly, we need to embrace new methods for preventing the spread of the flu virus, both in our homes and in the community, and share the importance of this holistic approach to flu prevention with family, friends, colleagues and neighbors.

By taking the steps outlined in this paper, and becoming prevention advocates by sharing this information with others, we can all work together to help protect ourselves, our families and our communities.

About the Preventive Health Advisory Board (PHAB)

The Preventive Health Advisory Board (PHAB) is composed of thought leaders and specialists in the areas of education and child care, office and human resource management, healthcare, infectious diseases and widespread disease preparedness, including National Association of Childcare Professionals (NACCP), National Association for the Education of Young Children (NAEYC), National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health (NCDP), National Education Association Health Information Network (NEA HIN), Society for Human Resource Management (SHRM), Dr. Aliza Lifshitz (Internist, Cedars-Sinai Medical Center and Editor,, Dr. Kelly Reynolds (Associate Professor, Community Environment and Policy, The University of Arizona College of Public Health) and Dr. Harley Rotbart (Professor and Vice Chairman of Pediatrics (Infectious Disease), University of Colorado School of Medicine and author of 


Germ Proof Your Kids.).

The recommendations and information expressed in this paper are solely those of the meeting participants. This paper does not necessarily reflect the ews and opinions of these organizations. The organizations listed here do not necessarily endorse the content of this paper.

The inaugural meeting of PHAB in August 2009 addressed the unmet need for 2009 H1N1 virus preparedness. PHAB will continue to meet periodically to compare perspectives on other timely health issues and prevention tactics.

PHAB is sponsored by The Clorox Company.


Opinion Research Corporation conducted the survey among a sample of 1,046 adults, comprising 503 men and 543 women 18 years of age and older. The online omnibus study is conducted twice a week among a demographically representative U.S. sample of 1,000 adults 18 years of age and older using Greenfield Online sample. Interviewing for this survey was completed on August 6 – 7, 2009.