April 28, 2009

April 28, 2009
Swine Flu and You

Welcome to another day in my life as a long term survivor of HIV and AIDS in the United States.

Today is Tuesday and I am still feeling under the weather. Having stomach cramps and nausea to where I do not think it would be wise to try and go out in public. I am hoping I will feel better by the weekend. There is nothing worse than feeling sick.

Speaking of being sick, I know everyone is talking about Swine Flu. It is all you can hear about on the news, the internet and people talking. So I decided to write a blog entry about what is going on.

The threat of a swine flu epidemic in the United States has many people living with HIV concerned about their health and safety. WHO and the CDC latest statement said in short: While there are reasons to be cautious, there’s no reason to panic.

What is swine flu?

Swine flu is a respiratory disease common among pigs. Though people are not usually susceptible to swine flu, animal-to-human transmission has been documented, notably among farmers working closely with pigs. What’s unique about the particular strain now under surveillance—dubbed swine influenza type A/H1N1—is its ability to spread from person to person.

A possible reason for this is the fact that pigs can be infected with not only swine influenza, but also flu viruses that affect humans and birds. The genetic material from multiple influenza viruses can then mix. Swine influenza typeA/H1N1, for example, contains genes from two strains of swine flu, one strain of bird flu and one strain of human influenza.

Is swine flu deadly?

All types of influenza that cause disease in humans can be deadly—approximately 200,000 people are hospitalized and 36,000 people die from flu-related complications every year in the United States.

There is no reason to believe that the swine flu being reported is any more deadly than the regular seasonal flu. Of the 40 confirmed cases of swine flu in humans in the United States as of April 27, none have resulted in death. In fact, according to the Centers for Disease Control and Prevention (CDC), all cases reported in the United States thus far were associated with mild symptoms of illness, with only one patient requiring brief hospital care.

Swine flu has a checkered history in America. Between 2005 until January 2009, 12 human cases of swine flu were detected in the United States with no deaths occurring. However, a swine flu outbreak in Fort Dix, New Jersey, occurred in 1976, causing more than 200 cases with serious illness in several people and one death.

With no deaths among the current American outbreaks, why is swine flu now a public health emergency in the United States?

What is of concern to public health experts is the fact that the disease is caused by an animal influenza virus that doesn’t normally infect humans, and the fact that the virus has been documented in a number of North American communities. Plus, many of those who died of influenza-like illness in Mexico appeared to be otherwise healthy young adults; in contrast, seasonal influenza tends to be most serious among the very young, the very old and people with other chronic health conditions.

According to the World Health Organization (WHO), swine flu is classified as “Phase 3” in its influenza preparedness plan, as of April 27. This means that an animal or human-animal hybrid virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. In other words, transmission thus far has been under such restricted circumstances that the virus has not yet gained the level of transmissibility among humans necessary to cause a pandemic (a geographically widespread epidemic).

Whether the WHO will elevate swine flu to Phase 4 (sustained human-to-human transmission) or Phase 5/6 (widespread human infection) has yet to be determined. (Post-publication editor's note: WHO upgraded its swine flu pandemic status from Phase 3 to Phase 4 on the afternoon of April 27. The change to a higher phase of alert indicates that the likelihood of a pandemic has increased, but not that a pandemic is inevitable.)

Despite the fact that nobody has died of swine flu in the United States, it was declared a public health emergency over the weekend. But according to Janet Napolitano, Secretary of the Department of Homeland Security, this “sounds more severe than it is” and is merely intended to allow funds to be released for public health efforts—such as educational campaigns and close communication with health care providers—and for wider distribution of medications to prevent and treat the infection.

Is swine flu a threat to people living with HIV?

People living with HIV—as well as those with other chronic conditions, such as heart disease, asthma and diabetes—are believed to face an increased risk of serious influenza-related symptoms. According to the CDC, there is often a spike in the number of heart- and lung-related hospitalizations among people living with HIV during the winter influenza season as opposed to other times of the year. Studies also indicate that influenza symptoms might be prolonged and the risks of influenza-related complications—including death—are higher for certain HIV-positive people.

It is not clear that this strain of swine flu poses any more or less of a risk to people living with HIV. One theory: Given that, at least in Mexico, swine flu mimics what was seen during the 1918 influenza pandemic—it appears most serious among people between 18 and 35 years of age; those with healthy immune systems that become hyperactive in response to the virus and causes serious respiratory inflammation and disease—and may be less of a threat to those with compromised immune systems, such as people living with HIV. Unfortunately, it is not clear if this theory will hold up, given that many HIV-positive people are responding well to antiretroviral treatment, compounded by the possibility that a hyperactive immune response to HIV, not the virus itself, is responsible for HIV disease progression and a heightened risk of non-AIDS related health problems.

To help prevent seasonal flu, an annual vaccine is recommended for people with HIV to lower the risk of infection or serious disease if infection does occur. Unfortunately, a vaccine has not yet been developed against swine influenza A/H1N1. But people living with HIV can take steps to prevent infection.

How can I protect myself?

The CDC and other public health experts list fairly simple ways to prevent the spread of swine influenza A/H1N1. These include:

* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. * Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective. * Avoid touching your eyes, nose or mouth. Germs spread this way. * Try to avoid close contact with sick people. * Very little is known about the benefits of wearing face masks to help control the spread of flu. Whenever possible, instead of relying on face masks, try avoiding close contact and crowded conditions—particularly if swine flu reaches pandemic status. * No evidence shows that swine flu can be transmitted through food. Eating properly handled pork—cooked to an internal temperature of 160 degrees—is safe. * If you come down with influenza-like symptoms, contact your doctor’s office immediately and stay home from work or school.

It is possible to rapidly develop a vaccine—if it’s needed. “We’ve identified the virus,” Richard Besser, MD, acting director of the CDC said during a White House press briefing on Sunday. “Should we decide to manufacture a vaccine, we can work toward that goal very quickly.” Though it would likely take at least four months to develop and mass produce a vaccine against H1N1, it could be available in time for a possible second wave of swine flu this coming winter.

What about medications against swine flu?

Good news. Initial tests suggest that swine influenza A/H1N1 is sensitive to two widely available antiviral medications: Relenza (zanamivir) and Tamiflu (oseltamivir). The flu medications Symmetrel (amantadine) and Flumadine (rimantadine) are not effective against this particular strain of influenza.

These medications work much like antiretrovirals do against HIV—they prevent the influenza virus from reproducing in the body. If someone becomes ill with influenza, including swine flu, Relenza or Tamiflu can minimize symptoms and speed up recovery. They may also prevent serious flu complications. For treatment, these medications work best if started soon after getting sick—within two days of symptoms—so call your doctor immediately if you experience flu-related signs.

According to the CDC, people at high risk of serious influenza-related complications—including people living with HIV/AIDS—can take Relenza or Tamiflu if they are likely to be exposed to other people with influenza. For example, if a family or household member is diagnosed with influenza, the exposed person with HIV/AIDS should take either drug for seven days. Relenza or Tamiflu prescriptions might also be a good idea for HIV-positive people who live in institutions experiencing an influenza outbreak.

With the swine flu designated as a public health emergency, the U.S. government has released 25 percent of the 50 million doses of antiviral medications from the nation’s Strategic National Stockpile.

So stay tuned for further developments. Luckily we do not have any cases reported in Florida... yet.

Wishing you health, hope and happiness.

big bear hug,

Daddy Dab