Diabetes: Preparing yourself for the H1N1 Flu
We have now officially entered the holiday season. During this season, travel across the country (and the world) will increase significantly. This presents another opportunity for the exchange of warm affections, gifts, and microbes!
During the last few weeks, H1N1 activity has decreased with the peak noted around October 26. Our Emergency Department at Children's National Medical Center has noted a decrease in visits for the virus as well, with fewer hospitalizations of acutely ill children. As a result of the fall outbreak and subsequent immunization with the H1N1 vaccine we have learned a great deal about the H1N1 virus and the vaccine. The CDC has indicated that the lethality of the H1N1 virus is primarily due to the fact that the H1N1 virus appears to attack in the lower airways, increasing the risk of pneumonia and subsequent infection with a bacterial disease such as pneumococcal pneumonia. Indeed, this is the premise for the advice given via the media: if you have nearly recovered from your bought with H1N1 and become ill afterwards, you are at risk for a bacterial super infection with a bacterial organism such as pneumo or staphylococcus. These organisms may cause life-threatening diseases and need to be treated with antibiotics quickly. The statistics confirm the risk is greater for the high-risk age groups as defined by the CDC.
The good news is that you can protect yourself by receiving the pneumococcal vaccine to prevent the development of pneumococcal pneumonia. I have been notified that there is enough supply available for high -risk groups (including people over the age of 65 who should receive it anyway). Generally, the vaccine is not recommended for children unless they have a chronic illness (such as sickle cell disease). However, I would consider it for children that have chronic asthma, diabetes, or other illnesses, especially if they have been unable to receive the H1N1 vaccine (or elect not to receive it). Should one contract H1N1, there would be less of a chance to develop a lower respiratory disease such as pneumococcal pneumonia.
How is the H1N1 vaccine performing thus far?
Interestingly enough (to me at least), not everyone wants to receive the vaccine. Most people cite that the vaccine is new without enough experience in the general population, general skepticism about vaccines, and fear of the materials that constitute the vaccine itself. All have merit. However, once again, I would like to reiterate that the H1N1 vaccine is manufactured in an identical manner as the typical yearly seasonal flu vaccine. If you are comfortable receiving the seasonal flu vaccine, you should have few qualms about H1N1. In fact, next year, it is very likely that the H1N1 strain will be included in the seasonal flu vaccine and only one vaccine will be suggested.
As far as side effects: 94 percent of side effects are minor, such as a sore arm. That also is typical for the seasonal flu vaccine. Most reassuringly, the incidence of Guillain-Barre Syndrome is identical to the projected incidence as demonstrated with seasonal flu vaccine. Essentially, there has been no increased incidence of G-B syndrome secondary to H1N1 vaccine as compared to the seasonal flu vaccine thus far as healthcare workers report statistics to the CDC. This is a reassuring statistic.
At this writing, children 6 months to 9 years old, will still require two doses of H1N1 immunization. Do not forget to receive the second one at least one month after the first. Anecdotally, I have not heard any reports of major concerns secondary to the H1N1 vaccine in my diabetes patients. For those who have chosen to receive the vaccine, most have been immunized with the killed vaccine (shots) and have reported mild arm tenderness, and on occasion, low grade fevers. Most reassuringly thus far, I am aware of no children/teens/young adults with diabetes for whom we care that have been admitted for severe H1N1 and subsequent sequella. We have, however, been in contact with many of our families by phone to offer advice on how to manage diabetes while ill with H1N1. The same advice should be applied: increase fluids, continue insulin, check blood sugars frequently, check for ketones, watch hydration, give Tylenol, etc., and to call our office with any of the warning signs discussed in previous blogs. Fortunately, we have been able to treat ketones at home before there are increased issues that would require hospital admission. However, the care team needs to know issues right away to quickly counsel on the prevention of dehydration and Diabetic ketoacidosis.
I wish everyone a happy, healthy joyous holiday season! (Bring those hand sanitizers with you - they even make great gifts - perfect for stockings!)