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Hi Dr. Cogen,
Via one of the Type 1 diabetes support groups I attend, I received the following link that includes recent recommendations from the American Diabetes Association and the Centers for Disease Control regarding H1N1 and children with chronic illnesses like diabetes:
http://www.diabetes.org/uedocuments/ad-H1N1-and-legal-protections-for-students-with-diabetes.pdf
Basically, they are recommending that students with diabetes stay home if H1N1 is circulating at their school. The document also includes language the ADA's Legal Advocacy Division has developed to include in a student's Section 504 Plan, IEP or other accommodation plans.
I'm interested in your thoughts on these recommendations.
Thanks,
Stacy Lavery
Hi Mrs. Lavery: I have reviewed the ADA Link attachment and to be honest with you, I have very mixed feelings. Clearly, the ADA is taking the safest possible stance for their high risk group: specifically children with diabetes (sort of "risk" squared- chronic illness in people under age 25.). The biggest problem is that we do NOT have any predictable history with H1N1, hence all the anxiety. The other question to ask is that if one knew that the seasonal influenza virus was making its rounds in the classroom setting, would the parent keep the child home to prevent exposure? I don't think that has been the usual practice in the past and very likely kids with diabetes were sent to school despite the presence of the "flu." In addition, I don't know the projected length of time, H1N! will be with us. My biggest concern is that it is becoming more prevalent now and typically seasonal flu doesn't show up until at least after November and often after the new year. So, the H1N1 bug may be around for awhile. Hence-my mixed feelings. As always, the best thing to do is to get the vaccine asap and short of that, do what we always say to do: whatever makes you able to sleep at night. I should hope that a 504 plan addition may not be necessary; but one never knows.
Thanks for the response. I think you're right that everyone is beside themselves because no one has any idea what this could turn into as far as a risk to our kids. You may remember that Rachel (my diabetic child), who unfortunately didn't have the seasonal flu vaccine last year (as she normally does) because of frequent illnesses, and she did indeed contract Flu B, as did my smaller daughter, Ally (non-diabetic).
I saw first-hand the difference between a child with diabetes and a child without diabetes, with respect to how they weather illnesses like this. Ally did relatively well with the bug, and Rachel truly struggled, ending up on steroids to deal with the respiratory difficulties. She also had symptoms much longer than Ally did.
I think, for me, the part that is most worrisome is that H1N1 didn't seem to take the summer off as is typical in seasonal flu viruses, AND as of now, there is no vaccine. Normally, we wouldn't keep our kids home because we could opt to have the seasonal flu vaccine. We're definitely in new territory, and we're all concerned.
I don't want to be a nervous Nelly and overreact, but at the same time, I want to be prudent. I'm sure many families like ours will be contacting you as scenarios play out within the schools. My sister-in-law, who is a physician herself, says the medical community is very concerned, and she advises as more and more cases start surfacing in our local area, she would even consider limiting time at malls, etc., at least until more in known and a vaccine is released.
Don't even get me started on concerns about the vaccine that's permeating the web! :-)
Thanks for your time,
Stacy Lavery
Dr. C, thank you for the this post. I read in this morning's paper (Washington Post - A2) that the H1N1 vaccine will be available in early October in nasal spray form only and then later in the month in the injectable form. But I had heard from our pediatrician's office last year (with the regular seasonal flu vaccine) that children with diabetes needed to get the injection, rather than the spray, for it to be effective. I'm not sure why this would be the case, but didn't question it last year, as both were simultaneously available.
This year it's a very different story, since the injectable version of the vaccine may not be available for several more weeks. So my question is whether the statement about the lack of effectiveness of the nasal spray for populations with chronic conditions - and particularly children with diabetes - is accurate. And, if so, what the reason is? Wondering if you know or might be able to get the straight scoop through your network. Obviously, would love to do the spray if we can. Thanks so much!
J. Joseph
Hi Mr.J: Yes, I read the same article in the Washington Post today. Here is the pertinent information in regard to the use of flumist vs. injected flu vaccine for seasonal influenza directly from ADA and CDC recommendations:
Who can use the nasal-spray flu vaccine LAIV (FluMist®)?
LAIV (FluMist®) is approved for use in healthy* people 2 to 49 years of age who are not pregnant. Breastfeeding is not a contraindication for FluMist®. The nasal-spray flu vaccine LAIV (FluMist®) can be given to people with minor illnesses (e.g., diarrhea or mild upper respiratory tract infection with or without fever). However, if nasal congestion is present that might limit delivery of the vaccine to the nasal lining, then delaying of vaccination until the nasal congestion is reduced should be considered. FluMist® is contraindicated in people less than age 2 or 50 years of age or older, those with medical conditions at high risk for complications from influenza, including those with chronic heart or lung disease (asthma or reactive lung disease), diabetes, kidney failure, weakened immune systems, or those who take medications that can weaken the immune system, in children < 5 years of age with a history of recurrent wheezing, children or adolescents receiving aspirin therapy, history of Guillain-Barre syndrome, and people who have severe allergy to chicken eggs or nasal spray vaccine components. Please see www.cdc.gov/mmwr/preview/mmwrhtml/rr5306a1.htm for a list of contraindications for FluMist®.
SO, here is the information that the pediatricians have consulted. Anecdotally, many of our diabetes patients have received flumist over the past few years largely without incident. The key difference between the injected vaccine vs. flumist is that the injected vaccine is killed virus and the flumist vaccine is weakened live virus which theoretically could cause more complications.
SO: what to do? I have searched the CDC and the ADA sites and as of today could not find anything saying it is OK/not OK to receive the new H1N1 nasal mist vaccine in children with diabetes due to the urgency of the pandemic. I am certain, though, that as soon as the nasal H1N1 is available for distribution there will be appropriate administration guidelines (BTW, theoretically healthcare workers over 50 can't receive the nasal vaccine either if the same contraindications apply). Therefore, my theoretical answer is pending updated information; my emotional one may be a bit different.
I checked with our company medical dept and the head doctor agreed after he looked it up. This may be a different strain of it but it has been around. another friend owns a pig farm and back then he had to put down several of the pigs.
Now it seems to have mutated to another form since they say that pork is fine.
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good day to you DR. COGEN,
I want to know if what is the most dangerous situation to pregnant women,is it pre ecclamsia or poly hydramnios?
i looking forward to your informations that will allow me to learn more..
Good morning! Unfortunately, I am not an expert in diabetes and pregnancy; but I know that both the conditions you mentioned can be very serious and should be evaluated by a specialist that deals with complicated pregnancies such as a perinatologist. This is usually a physican who monitors high risk pregnant women such as those with diabetes. I hope this information points you to a specialist that can be more helpful. Good luck.
can i ask for that experts contact? even thr the net..
thabks doctor