H1N1 Update: Prevalence, Severity, Tamiflu, Current Recommendations

---

H1N1 Update: 
Prevalence, Severity, Tamiflu, 
Current Recommendations

Recent information from the CDC has brought a few facts about how
today's H1N1 epidemic is behaving. It is time to take a look at the
new information.

Prevalence
In keeping with prior posts on this ongoing epidemic, it is clear that
the H1N1 epidemic became quite widespread this October.

All but 2 states in the US reported that H1N1 is widespread.
We know that in our region that very large numbers of people
have had H1N1 infections.

Keep in mind, however, that this H1N1 virus is hard to prove
present using commonly used lab and office testing. The usual
tests for influenza do not accurately work when testing for H1N1.

Advanced Pediatrics follows the lead of infectious disease experts
in only believing the results of H1N1 specific testing, available only
via national laboratories at the CDC, or worldwide at the WHO.

Severity
National reports from the CDC have documented 114 deaths
from H1N1 in children ages 0-21. They estimate that the real
number is closer to 300. Roughly two-thirds of these fatalities
were in children with serious underlying medical conditions, such
as muscular dystrophy and cerebral palsy.

As with nearly any infection, there are rare but reported cases
of death from this infection in otherwise healthy children.

These numbers are technically higher than in previous flu years,
but my read of them is that they are similar. The highest number of
fatalities previously was 88. Now 114 is higher than 88, but the two
numbers are actually quite similar. That is, the number of fatalities
this year has not jumped to 1000 or 10,000. Such a jump would indeed
be evidence that this H1N1 flu virus is particularly dangerous.

But the numbers have not jumped to 1000 or 10,000, they are pretty
much staying around 100 or so. This makes H1N1 very much as little
a risk as the seasonal flu, so far.

On a very local level, Advanced Pediatrics, like all practices,
has seen a huge jump in the number of people with viral
infections in October. But for this month, not a single child
or adolescent got ill enough to be admitted to a hospital
from Advanced Pediatrics.

Our read at Advanced Pediatrics is that this H1N1 virus, at least
this October, was not much more severe than the usual annual flu bug.

Most importantly, it does not matter for your child what the stats are.
The key point for each person who gets ill is to determine if that person,
at any point in time, has mild or serious illness.  

If your illness is mild (cough, fever up to 105.8, runny nose, achy,
poor appetite, poor sleep, sore throat), you are not in danger.
Keep comfy, stay alert for changes to more severity, do not panic.

If your illness is severe (stiff [not just sore], it's hard to get air in
and out of your chest, altered consciousness, severe pain, or a
sense that something terrible is happening), seek medical care
immediately and urgently- call us, get to an ER, call 9-1-1.

Tamiflu
Much will be made of the recent news that the US is releasing the last of
its stockpile of liquid Tamiflu in response to the reported numbers of
childhood fatalities.

Keep in mind, Tamiflu is much weaker than antibiotics for ear infections.
By this we mean that the usual experience of stunning cure seen
with antibiotics for ear infections is simply not seen with Tamiflu and H1N1.

It is estimated that use of Tamiflu may make a 7 day illness perhaps a 6 day
illness. It is not the case that if you take Tamiflu all of a sudden your H1N1 illness
goes away.

For the vast majority of patients with mild (see above) illness, it may not be
apparent that Tamiflu made them any better.

If you have severe illness (see above), then the small degree of help Tamiflu
can offer suddenly becomes relevant. Just a bit of help from a medicine
in a potentially lethal illness could save a life.

And so we continue to propose we all follow the advice of the top
experts: do not use Tamiflu for mild illness since it will not help.
Do use Tamiflu for severe illness, since it may help.


Bottom Line, or Current Recommendations

1. Don't panic. The H1N1 epidemic is widespread but so far mild for nearly all children
2. Stay tuned. The H1N1 virus can change.  
3. We will post any changes in severity, so keep checking these posts.
4. Tamiflu does not work well for mild illness and should not be used if mildly ill.
5. Tamiflu may help with severe illness and should be used if severely ill.
6. H1N1 immunizations will be very widely available as production rolls it out.
7. The first shipment had limited numbers, but plenty more is on the way.
8. Stay posted, we will post when we receive H1N1 immunizations.
9. We recommend all receive H1N1 immunization.
10. At this time, this is a reasonable, not urgent recommendation.
11. Don't panic. It does not help you or your family.
12. Advanced Pediatrics remains committed to being informed, objective, and available.

Dr. Arthur Lavin

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.