Archive for January, 2010

Which flu vaccine now?

Tuesday, January 26th, 2010

This is a very unusual time in the annals of influenza history. Usually by late January we are in full swing with “seasonal flu”, that annual ritual of sickness that typically begins in late October and lasts through late March (and sometimes well into April!). But a funny thing happened on the way to flu season this year – last April, a new strain, H1N1 (“swine flu”) entered the picture at the tail end of the 2009 seasonal flu period. Since that time, hundreds of thousands of cases of H1N1 (“swine flu”) have occurred worldwide with more than ten thousand deaths in two distinct “waves” of disease – one in Spring, 2009 and the other during the Fall and early Winter, 2009. In addition to many of us catching the flu during one of these waves, we also “caught a break” to some extent with this recent pandemic – it was not as severe as feared, causing the same or fewer numbers of serious cases and deaths as a typical seasonal flu might cause each year. That’s “lucky” since adequate doses of vaccine did not become available until just the past 3 months.

But now the weird part. H1N1 is disappearing, apparently having run its course (although everyone is still nervous that a “3rd wave” may yet appear), perhaps in part due to aggressive vaccinations of high risk groups with the newly available H1N1 vaccine beginning in October. So, where is this year’s  ”seasonal flu?”. So far, the reliable annual appearance of seasonal flu appears to have been entirely edged out by the large H1N1 outbreak. Almost all cases of flu being reported across the country are still H1N1, albeit in much smaller numbers than a couple months ago. There have been essentially no cases of seasonal flu, and it’s the end of January!!?

So…what to do regarding vaccines? Since we are in uncharted waters, the recommendations remain to get your kids immunized against both seasonal flu (kids ages 6 months – 18 years) and to H1N1 (ages 6 months – 24 years). That way, if a late seasonal flu outbreak occurs the kids will be protected, and if a “3rd wave” of H1N1 (“swine flu”) occurs, they’ll also be protected.

For more on the unusual history of influenza, the significance of the infections, and strategies to prevent flu, please see Chapters 2,3,7, and 9 of Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008).

Infections complicate Haitian tragedy

Tuesday, January 19th, 2010

In the aftermath of every great natural disaster, infections make things worse – often, much worse. There are waves of infections, beginning with those that complicate wounds and bodily injuries. These germs are usually bacterial: staph, strep, and anaerobic organisms like tetanus and gangrene. The next wave of infections occurs as a result of the lack of clean water and the accumulation of dying victims. The germs in this second wave are typically gastrointestinal, and include both bacteria and viruses: cholera, enteric viruses, dysenteric bacteria. Finally, crowding and unsanitary conditions facilitate respiratory spread of infections, again both bacteria and viruses, resulting in pneumonia.

The key to interrupting the waves of infections is the rapid provision of clean drinking water and bathing water, as well as the removal of decaying material. Antibiotics must be delivered efficiently. Unfortunately, the chaos and disruption following a natural disaster impede all such efforts, and the underlying poverty and destitution in Haiti prior to the earthquake have made recovery operations even more challenging.

Our prayers are with the people of Haiti.