I received the mist version of the flu vaccine. Since I received a live virus, I wondered if I kissed my children more than I usually do whether or not I would be able to transmit inactivated virus to them and therefore protect them from obtaining the real Mccoy. Dr. Dave Quimby with Infectious Disease and Epidemiology Associates was gracious enough to grant me an interview to answer this question as well as some others that I had.

Aaronson: influenza virus: what’s the latest? Has anything changed?

Quimby: Not really. One new development: If a person contracts this virus, becomes sick and has to be admitted to an intensive care unit and is unable to take medications orally like tamiflu, there are some new antiviral drugs that we can obtain from the centers of disease control that can be given intravenously.

Aaronson: You and I have been involved in taking care of some patients who have been really sick in the hospital with . Some have done well, others have not. In your opinion, if someone is sick enough to get admitted to the hospital, what predicts whether a patient will do well or not? If Alegent Nephrology gets called because of kidney failure, what is the patient’s prognosis compared with not having kidney disease?

Quimby: The more organs that shut down, the worse off you are. If the kidneys have failed the person is at high risk.

Aaronson: Is the influenza vaccination still effective?

Quimby: It is as effective as any flu vaccine.

Aaronson: Have there been any changes or mutations in the bug?

Quimby: There have been a handful of cases where the flu was resistant to Tamiflu. But those are very, very few and far between.

Aaronson: Why are some people afraid of the vaccine?

Quimby: Because of a lot of incorrect information out there, you’re going to find people afraid of any type of vaccine. There’s no more reason to be afraid of this vaccine than any other vaccine. The vaccine is safe. I got it. You got it. I gave it to my two and half year old who qualifies under the guidelines.

Aaronson: I would like my kids to get it, but availability of the vaccine is hard to find. Alegent does have a phone number people can call (402-717-) to check availability and to schedule an appointment. My understanding is there will be more vaccine available soon. I encourage all my patients and everyone I know to call that number and get on the list so they can get their vaccine as soon as possible. If a person has a choice between the mist and the shot, which one should they choose?

Quimby: Because of the shortage, I would go with whichever one a person can get their hands on. If a patient has a bad medical condition such as leukemia or is receiving chemotherapy, I would not recommend a live vaccine in general. I would just do a shot.

Aaronson: Let’s talk about the standard flu shot. There are people who opt out of receiving a regular influenza shot, thinking "if I get the flu, I get the flu. I’ll take the risk." Now that we are at risk for contracting swine flu, should this opinion change?

Quimby: In general, people usually mistake the common cold for the flu. Actual influenza even in a healthy person, will knock you down for a week and a half. People I see who get the real flu learn how horrible it is and usually decide to get a flu shot yearly from that point on. The reason why is so virulent [infectious] is that people have never seen this new strain, and they have no partial immunity to it. The reason why can kill healthy people so easily is that it is different from anything most of us have seen before.

Aaronson: Why can’t a person get both the standard flu mist and the mist at the same time?

Quimby: I don’t know. But there such a shortage of both of them that it usually is not a big issue at this time.

Aaronson: As you know, I got the flu mist. I was wondering if I kissed my children more than I usually do if I could give them an inactivated form of the virus and protect them from the real thing. Is that crazy?

Quimby: It’s not crazy, but it’s not likely to work. The mist is a live virus that has been weakened. Therefore the chance of spreading it person to person is exceedingly low. Since the virus is so weak, it’s very unlikely that it will make you sick. So although well intentioned, your display of affection most likely was just that.

Aaronson: There is a concept called to herd immunity that infectious disease folks like to talk about. Wiki defines it as "a type of immunity that occurs when the vaccination of a portion of the population (or herd) provides protection to unprotected individuals. Herd immunity theory proposes that, in diseases passed from person to person, it is more difficult to maintain a chain of infection when large numbers of a population are immune. The higher the proportion of individuals who are immune, the lower the likelihood that a susceptible person will come into contact with an infected individual."

So here is my question, if many people in Omaha and its surrounding areas get vaccinated, are the ones that refuse or can’t get vaccinated protected from infection? Does that concept apply here?

Quimby: Not really in this case because the flu is so easily spread to others, unless almost all of the people in Omaha get vaccinated, if there’s any flu virus around, those not vaccinated are still at very high risk. These unvaccinated people are at high risk because of the way is transmitted person to person. So people need to get their vaccine. Make sure you bold that. Right now, we don’t have enough vaccine to give to everybody, and that’s why we risk stratify – we give it to those who need it the most.

Aaronson: And the Alegent hotline, 717-, does just that. I would encourage our readers to pick up the phone and give a call so that they can get vaccinated as soon as possible.

Quimby: That is correct. It should be noted that once more vaccine becomes available, anyone who wants it will be able to get it.

Aaronson: I’ve seen in the news the suggestion that now that the first wave of infectious has passed through Nebraska the need to get vaccinated has lessened. Since I am a kidney specialist who spends a lot of time in intensive care units helping to take care of very sick patients, I’ve seen some really bad cases of the swine flu. I disagree with the thinking that the unvaccinated population is safer now than before. Is my thinking based on a referral bias, where I think a certain way because I’ve seen the small percentage of people who’ve gotten so sick that they have needed to be admitted to an intensive care unit for support and therapy? Since infectious disease specialists such as yourself are also consulted on these patients, you know what I’m talking about. Are we safer now?

Quimby: No. It is still very important to get vaccinated when you can. Many people still have not been exposed in any fashion to . So the risk will still be there until goes away, you get actual herd immunity from vaccines, or you get actual . Since most people have not had the flu vaccine or the flu, the risk of getting it is still very high. There are still many people who can get it and that keeps this terrible infection going.

Aaronson: So let’s pretend that I am a patient, and I have cold symptoms. I’m worried that I have . I go to my primary care Physician and ask the question should I be tested for ? How would you answer?

Quimby: A nose swab can be done in a primary care setting. The problem is that this rapid test for influenza type A is NOT the influenza virus. There is a cross reaction, so a positive test implies that there is a possible infection. The problem is that a person can test negative and still have . So in other words, if a person actually has influenza, the immediate test done it in a primary care office setting is positive six out of 10 times, which is basically the same as flipping a coin.

Aaronson: That’s why I don’t recommend it unless I’m worried about standard influenza A or B virus. However, I do think it is important for people who are concerned and get sick very quickly to go to their doctor as soon as possible to see if they are a candidate for Tamiflu.

Quimby: I base this diagnosis for the most part on the patient’s clinical picture. How they present.

Aaronson: Thank you professor for your time. We appreciate hearing your expertise on this issue.

In sum, remember to call 717- if you have not gotten your vaccine yet and get vaccinated as soon as you can! You can also visit the Alegent Health Flu Center for the latest updates. Thanks for reading.

Imagine you open your newspaper and find this headline story:

"A highly infectious disease is sweeping the planet, affecting nearly every industrialized nation and killing hundreds of thousands of people. A vaccine is available, but thousands are refusing it out of fear over its safety.  In the United States alone this viral plague has resulted in 36,000 deaths, 3 million days of hospitalization, 30 million doctors visits, and culminated in total medical costs of $10 billion and a societal financial impact of over $80 billion.”

While this sounds like the plot from a Roland Emmerich disaster movie, with disease and mayhem on a biblical scale, it is nothing more than the seasonal influenza that we face on a yearly basis.  I use these grim statistics (published in 2007 and based on a study of the flu of 2003) to put the current swine flu (or flu) pandemic into perspective.

First, a little overview on influenza—a “Flu 101,” if you will.  Flu is a viral illness caused by a variety of influenza viruses that affect birds and mammals.  We are all familiar with the typical symptoms: fever, sore throat, cough, muscle aches, and the overwhelming desire to sip hot tea and lounge on the couch.

While certain strains of flu virus have taken on exotic monikers such as Asian flu, Spanish flu and Hong Kong flu, the more technical nomenclature for the virus uses the letters N and H to refer to specific proteins the virus contains.  As examples, this year’s famous swine flu is due to an virus and the bird flu that swept through Asia a couple years ago was an H5N1 variant.

The most deadly flu outbreak in recorded history was the Spanish flu pandemic of 1918.  This virus managed to infect a third of the world’s population and killed between 50 and 100 million people.  It’s not clear why this particular strain of was so dangerous—it was unusual in the sense that it seemed to be deadlier in healthier, younger people than in the older, feebler population.  We’ve had several other outbreaks of since then (including the current one) but none have been so devastating.

This autumn we are facing two influenza threats: the usual, seasonal flu (which no one seems to get very excited about) and the looming explosion of the swine flu (which is in the news on almost a daily basis).  The swine flu started out in Mexico (hence the other name “Mexican flu”) and migrated northward.  It has now been confirmed in every industrialized nation.  Thus far the US has seen 26,000 confirmed diagnoses with fewer than 600 deaths. It turns out that for all the excitement and fear surrounding this new menace, it appears the swine flu virus is only about one-third as deadly as the annual seasonal flu.

You can get great information about seasonal flu and the swine flu on many internet sites, including Alegent.com/Flu and the Centers for Disease Control.  Here are my boiled-down recommendations:

1. Wash your hands and observe common sense (e.g. don’t cough on other people, at least those people you like).
2. Get your flu vaccines.  If you fall into one of the high-risk groups you’ll need two this year, the usual seasonal flu vaccine and the vaccine.
3. Stay home if you’re sick.  Don’t go back to school or work until you are fever-free for 24 hours.

Pretty simple stuff I think. 

Here are some of the frequent questions I get from patients regarding the flu and flu vaccine:

What are the signs and symptoms of the flu? 
The symptoms of 2009 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu and have respiratory symptoms without a fever. Click here for a helpful and concise video on the subject put out by the CDC.

Who should get the vaccine when it becomes available?
CDC’s Advisory Committee on Immunization Practices has recommended that certain groups of the population receive the 2009 vaccine when it first becomes available. 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 because of chronic health disorders or compromised immune systems.

Can a flu shot give you the flu? 
No, a flu shot cannot cause flu illness. The influenza viruses contained in a flu shot are inactivated (killed), which means they cannot cause infection. Flu vaccine manufacturers kill the viruses used in the vaccine during the process of making vaccine, and batches of flu vaccine are tested to make sure they are safe. In randomized, blinded studies, where some people get flu shots and others get salt-water shots, the only differences in symptoms was increased soreness in the arm and redness at the injection site among people who got the flu shot. There were no differences in terms of body aches, fever, cough, runny nose or sore throat.

Should patients with heart disease get the flu shot? 
Yes.  Interestingly, a study published in this month’s Lancet Infectious Diseases pooled data from numerous studies on the flu vaccine and concluded that getting the flu shot can actually cut your risk of a heart attack.  It appears that the influenza virus can destabilize coronary plaque and trigger heart attacks.

Why are there so many names for this new flu? 
All the synonyms are confusing.  The The Mexican government was quick to condemn the name Mexican flu and Tom Vilsack and the pig farmers don’t like the name swine flu.  The World Health Organization and CDC have now settled on the non-pejorative term flu (although you must admit it doesn’t really role off your tongue).

Will I get the swine flu if I eat lots of sausage and bacon?
No, just heart disease.

At what point does Bruce Willis assemble a team of rag-tag ruffians to combat this global menace? 
Once we learn that the real source of the flu is not a virus but rather a meteor careening through space on its way to destroying our planet.

Many of my pregnant patients have recently expressed concern over the flu virus, more commonly known as "swine flu." So, I thought I would answer some of their questions in this video blog entry.  If you have any other questions or comments, feel free to leave them below.