I have been writing articles lately about the reasons for the H1N1 vaccine shortage and what to do about it. You can find these pieces in Forbes.com, Slate, and most recently as an oped in Wednesday’s NY Daily News. I believe that fear has played a major role in governing our public health response to H1N1 swine flu and the pressing need for a plentiful pandemic vaccine. I realize that it is easy to bludgeon our officials with the retrospectoscope, on the other hand, many of these nervous responses are chronic, and require significant adjustment going forward:

• Vaccine fear mongers do significant harm. Fear of thimerosal (a mercury-containing preservative that is used to bundle doses and has been shown not to cause autism) led to too much time spent trying to produce single vaccine doses without it.
• The CDC’s fear of overreacting to a possible pandemic, as they did in 1976 when 40 million people were vaccinated unnecessarily for a pandemic that never came, led to too much caution here, where instead a shift in vaccine production to the H1N1 vaccine could have led to many more million doses available now.
• Fear of seasonal flu, which doesn’t peak until much later, if at all (maybe crowded out by the H1N1 pandemic strain), led to 115 million doses of seasonal flu vaccine produced, when there is no seasonal flu around.
• Fear of new vaccines in the U.S. has led the FDA to fail to approve several new vaccines which use more up to date technologies such as mammalian cell culture instead of hen eggs, or additives known as adjuvants which make vaccines more potent so a smaller supply can be used for more inoculations. One American company, Baxter, makes a mammalian cell vaccine that will be used extensively in Europe, especially for those with egg allergies, but is not approved for use here.
• Fear of vaccines has led to poor compliance, especially for children, the group that currently seems to be most at risk for complications of the disease.
• Fear of admitting error has led our public health officials to delay in acknowledging the shortage or in correcting it, delay in accepting that it is H1N1 that is the predominant flu this year, not the seasonal strains.
• Fear of the spreading flu may be useful to combat fear of the vaccine, but a better approach would be a rational discourse based on statistics and real risk.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel’s new Ebook: Swine Flu; the New Pandemic, will be published in early October. Dr. Siegel is also the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

I’ve been getting a lot of questions in response to a recent blog I wrote about monitoring H1N1 vaccine side effects, so I wanted to take the time to address some of your concerns. I know the overload of information on this pandemic can be confusing, but I’m here to help, so keep the questions coming and I’ll do my best to answer them for you.

I thought I heard that the H1N1 vaccine is bad for pregnant women as it has long term effects on the baby. Now, I find nothing on Fox about that. Can you PLEASE clear this up? My daughter is 6 months pregnant and does not know what to do!!
 
You must have heard wrong. We have been saying right from the beginning, as we say every year for the regular flu shot: Pregnant women are considered a high-risk group. Pregnant women have an underactive immune system as well as compromised respiratory capacity, so if a pregnant woman gets the flu, she could have serious side effects, which may not only jeopardize her health – but that of her unborn child. So get both flu shots!

Once you have had H1N1, can you get it again in the same season? What about next season? Can we get it again after it mutates?

We do not know the complete answer to this question however, if you have had the current H1N1 flu strain, you probably have immunity to this specific strain of the virus. So this season, you may have nothing to worry about. However, if the virus mutates or a new strain of H1N1 virus emerges, past exposures to the current flu strain may not be protective.

My son is 15 months old and he is borderline asthmatic. Should I get the vaccine? So many people say yes, and so many people say no. I’m so confused and don’t know what to do!! Please help!

The answer to your question is, yes. The CDC is specifically looking at children with asthma. Many of the complicated H1N1 cases we’ve seen have been in asthmatic children. The combination of viral pneumonia and asthma in a small child could be quite devastating and deadly. So talk to your pediatrician and strongly consider vaccinating your child. And don’t forget to get yourself immunized.

If the H1N1 vaccine is not available, will the pneumonia vaccine help protect your lungs from getting pneumonia if you get the flu?

The pneumonia vaccine is targeted to protect against bacterial pneumonia – specifically pneumococcal pneumonia. This will not offer protection against a viral pneumonia – which can be a complication of the flu. So talk to your doctor before you make any decisions.

Here is the latest about the novel A(H1N1) swine flu pandemic virus, and what we are doing about it. Also check out my new Ebook: “Swine Flu; the New Pandemic.”

The best way to decrease the amount of circulating AH1N1 flu virus is to vaccinate as many people as possible. This is known as herd immunity.

The current H1N1 though mild, has infected millions and hospitalized more than 10,000 here in the U.S., killing close to 1000, so mass vaccination is warranted.

Unfortunately, once the vaccination program starts, it will be TOO easy to blame ANY deaths on the vaccine. This happened in Great Britain with the HPV Vaccine, where Cervarix is expected to cut deaths from cervical cancer by 650 and 1.4 million women have already been vaccinated, the vast majority with no problems. Yet a single death which was later found to be unrelated to the vaccine caused hysteria.

Though the 1976 swine flu vaccine was linked to several hundred cases of Guillain Barre Syndrome (paralysis) for a pandemic that never happened, this time there is a real pandemic, and the vaccine has been well studied in clinical trials and found to be very safe and has not been linked to GBS.

This vaccine is made the same as the yearly flu vaccine, with hen eggs, and will be just as safe, with the major complication in the vast majority of cases being local irritation around the injection site.

In discussions with senior officials at the CDC I have determined that it is acceptable to give both the seasonal flu shot and the H1N1 swine flu shot at the same time.

The CDC also recommends H1N1 vaccines even for those who believe they have had the disease. Serological tests to confirm immunity are considered unreliable and are not readily available.

The flu mist inhaled vaccine is being released this week. Since it is using an attenuated (weakened) live virus, it should not be given to pregnant women, those with chronic conditions, or those who are immunocompromised. It has also not been tested in the elderly.

The injectable inactived H1N1swine flu vaccine will start becoming available in two to three weeks. It uses an inactivated (dead) virus, and can NOT give you the flu. It is safe in all except for those with severe egg allergies. It should be given first to health care workers, pregnant women, children, and those with chronic conditions. 250 million doses should be available by sometime in November, and I will be recommending it for all.

Swine flu parties are a bad idea. They are an example of deliberate infection to provoke immunization. Since flu is so easily transmissable, it can easily get beyond the party and spread to someone who is more likely to have a severe outcome, such as a pregnant woman, a young child, or someone with a chronic condition.

The risk of the flu is far greater at this point than the risk of the vaccine. It is still a very mild virus, but must be taken seriously, as flu is tricky, and can kill. Coming out of the southern hemisphere, whose winter just ended, the prevailing strain of H1N1 swine flu is a good match for the vaccine.

For daily updates on the H1N1 swine flu strain, twitter me at marcsiegelmd.  I will post my latest articles, updates, and answer questions.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel’s new Ebook: Swine Flu; the New Pandemic, will be published in early October. Dr. Siegel is also the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

Recently, I attended a fundraiser for Sophie’s Voice Foundation, a charitable organization founded by actors Boris Kodjoe and Nicole Ari Parker in honor of their daughter, Sophie, who was diagnosed with spina bifida at birth. Spina Bifida is a neural tube defect that affects the development of the spinal cord in unborn infants. Each year, about 3,000 pregnancies are affected by these birth defects, and these children suffer from medical problems, psychosocial issues, learning disabilities, and multiple personal concerns including mobility, bowel and bladder control.

There is a silver lining here, however, with regards to nutrition intervention and prevention. Research has shown that the risk of having a baby with spina bifida can be reduced by up to 70 percent with 400 mcg of folic acid taken daily three months prior to conception and in the first three months of pregnancy. Click here for more research. 

Folic acid is a B vitamin, which our bodies need to make new cells and therefore, is especially important in vitro. The Centers for Disease Control and Prevention recommends that all women of childbearing age who are capable of becoming pregnant get enough of this essential B vitamin daily. Pregnancy isn’t always planned or controlled and therefore, if you are a woman in that age bracket, it is important to heed this advice.

Once pregnant, the FDA recommends you boost your intake to 600 mcg/day and although there’s no toxic level, the FDA advises you keep folic acid consumption to 1000 mcg/day. Here are three ways to ensure you are getting enough in your diet:

1. Have a bowl of folic acid-fortified cereal every morning. The FDA requires that folic acid be added to specific flours, breads and other grains.  Check the label to make sure it is fortified. It might be listed as folate, the natural form of this B vitamin but the amount, 400 mcg, which is usually added remains the same.

2. Take a vitamin. Most multivitamins sold in the United States contain the 400 mcg of folic acid recommended. If you are pregnant, your doctor should prescribe a prenatal vitamin, which also contains at least this amount.

3. Eat a diet rich in folate. In addition to the above, eating a diet rich in folate is not only beneficial for your unborn child but includes foods for overall heart health and disease prevention!

Food Source                                      Folate (mcg)*
Chickpeas, ½ cup                           141
Spinach – cooked, ½ cup              131
Kidney beans, ½ cup                      115
Orange juice, 1 cup                           74
Broccoli – cooked, ½ cup                 84
Green peas, ½ cup                            50
Orange, medium                                39
Strawberries, 1 cup                            35
Romaine lettuce, ½ cup                     32

*Source: USDA National Nutrient Database for Standard Reference

Check out the Sophie’s Voice Foundation Web site for more information on spina bifida, family outreach programs, prenatal education, surgical options, and how you can get involved!

Tanya Zuckerbrot, MS, RD is a nutritionist and founder of www.Skinnyandthecity.com.  She is also the creator of The F-Factor Diet™, an innovative nutritional program she has used for more than ten years to provide hundreds of her clients with all the tools they need to achieve easy weight loss and maintenance, improved health and well-being.  For more information log onto www.FFactorDiet.com.

I’ve been getting many e-mails over the past couple of days concerning swine flu.  So I’ve decided to answer a few of them here.

Dear Dr. Manny,
If I had the swine flu in 1976 after I received the swine flu vaccine as a college student, do I have any anti-bodies that may help ward off this version of the virus?
                  —Amy Gorman
                  Lutherville, MD

Probably not. This current swine flu’s genetic makeup is different from the swine flu from the ‘70s, and therefore the vaccination won’t be protective for you. But the silver lining is that this current swine flu is less lethal, and there may components in it that more Americans have been exposed to. So you may have a greater chance of being protected already which can minimize the symptoms.    

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Dear Dr. Manny,
We have friends who have returned from a trip to Mexico City two weeks ago. How long would it take for swine flu symptoms to show up if they were infected?
Thank you for your time,
—Alan

The typical incubation time for a virus is 48-72 hours.  So if your friends have been back for two weeks, and don’t have any symptoms, you can feel confident that they are safe. 

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Dr. Manny,
My wife and I are very concerned of the complications swine flu/treatment would pose to her pregnancy. Are the approved drugs for treatment approved for use during pregnancy?
Thanks,
Ben Demaline
Jacksonville, FL

Yes, all of the current flu treatments can be given to pregnant women. As a matter of fact, we tend to be more aggressive in treating the flu in expectant mothers because pregnancy can make flu symptoms worse and put the patient at higher risk. That’s why it’s recommended that all pregnant women get flu shots annually.

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Dr. Manny,
I will be flying to Las Vegas next week with a two-hour layover in Atlanta. I had a liver transplant five years ago and have done really well. Do you think that I should wear a mask at the airport and on the plane? I am very concerned about the large crowds and would like your opinion.
Thank you for any answer!
G. Savage

As a liver transplant recipient you are probably taking immunosuppressant therapy drugs and therefore you do have to take precautions to avoid exposure to the swine flu ― or any kind of flu. Even though I’m not a big advocate of wearing masks, I do feel that you should wear one. But remember: Not all facial masks are created equal, so get one that has been proven to protect against viruses. There are many supply stores that carry this specific mask for viruses. Also, try to wipe down all the surfaces on your airplane seat with antibacterial wipes. Be sure to wash your hands before, during and after the trip. And avoid any contact with anyone who you suspect might be sick. I know that this is a big stretch, but until we know exactly the extent of the spread, in your particular case, I would be extra cautious. I hope that this doesn’t ruin your vacation! 

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Dr. Manny,
I have no choice but to commute using public transportation everyday.  How should I take precautions against the swine flu?
                  Thanks,
                  —Paul

If you can avoid public transportation, especially crowded subway cars, then do it.  But if you can’t here’s what you can do:

• If you are a healthy individual you can just use antibacterial products, including wipes and gels, chronically throughout your trip.
• Avoid contact with people who are coughing or appear sick.  If they are in your car, move to another one. 
• As soon as you get home or to the office wash your hands, wipe down your cell phone, iPod or any device that you used during your trip. 

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Dear Dr. Manny,
I’m a chronic nail biter and I’m really concerned about the swine flu.  What should I do?
Best,
                  —Mel

First and foremost — wash your hands. Your hands are the most common tool for picking up germs and viruses in general. So if you are a nail biter, this would be the perfect incentive for you to quit. Also, biting your nails can make you ingest things other than viruses that you don’t want to have in your body.

I have long been concerned about potential overuse of the anti-flu drug Tamiflu, in fact there are sections on this topic in both my book on fear and my book on flu. But in my opinion, the current situation with H1N1 swine flu calls for the careful use of Tamiflu at large camp outbreaks. Use of the drug is warranted to help decrease shedding time in patients with mild cases and to prevent additional cases in their close contacts.

The CDC does not agree with me.

Here are the plusses:

1 – Since Tamiflu is highly successful at slowing spread, its use to squash outbreaks can help keep camps open which has the added benefit of keeping sick kids from bringing flu home to many different zip codes and thereby expanding the outbreak. People who are more at risk (including pregnant women, infants, and those with chronic conditions) may catch it that way. Even though this is a mild virus so far, with millions of cases around the world and only 700 plus deaths, there is always the chance that it will get worse; in fact a recent study shows that it lingers in the lungs of Ferrets (who react to flu like humans), causing lung infections.

2 – More circulating virus may increase the chance of a lethal mutation. The famous second mutation that may have occurred in 1918, when the virus became much more severe in time for the fall flu season, is extremely unlikely, but possible.

3 – Children seem more at risk for severe cases, perhaps because of a lack of immunity to an older H1N1 virus that was circulating before 1957. Older patients who have that immunity may have milder cases.

4 – Isolation of sick people and their contacts is the first priority, but use of Tamiflu (especially when there is no vaccine available), is a useful adjunct which may help to keep the camp open.
Here are the minuses:

1 – Use of Tamiflu may increase the chance of resistance occurring. There are some excellent articles on recent Tamiflu resistance, which also demonstrate that resistance sometimes occurs spontaneously, without exposure to flu:

H1N1 swine flu – the non-sustained Danish and Japanese resistance cases were in patients taking Tamiflu prophylactically. (see New Scientist article)

The interesting case in early July of a girl from San Francisco who picked up Tamiflu resistance in Hong Kong but NEVER took Tamiflu. (see NY Times article)

And the spontaneously generated resistance to seasonal H1N1 (NOT SWINE FLU) in last year’s flu season which led to massive resistance to that strain. (See NY Times article)

2 – Tamiflu shortages could emerge (although the CDC has stockpiled 50 million dose courses, and it is difficult to envision a scenario where there is a shortage of this magnitude, especially with a vaccine in the offing.

3 – Potential side effects of Tamiflu, including nausea, or an allergic reaction. But side effects are rare, Tamiflu is a very well tolerated drug overall.

4 – By having the flu now, when it is mild, a person should be immune later on, during flu season, when the flu could return in a more severe form.

I must admit, some of what drove me to put my own 12 year old son on Tamiflu prophylaxis at Camp Modin where there were more than 80 cases was because I have a 4 year old son at home with asthma and chronic ear infections. I was worried about my older son bringing the flu home. But my own scenario was far from unique, which is why I recommended that all of Camp Modin take Tamiflu.

My article on the Modin Protocol I created was published in Slate on July 10th. (see Slate article)

This was followed by a front page article by Tamar Lewin this past Thursday July 23d in the NY Times which described the problem – and solution – at the camp. (see NY Times article)

The following day, Dr. Anne Schuchat, director of the National Center on Immunization and Respiratory Diseases at the CDC, reacted to the Times article by disagreeing with camps using Tamiflu to control outbreaks. She said she “strongly recommended” giving the drug only to people already seriously ill, or to their family members who are pregnant, have asthma or have other conditions that could be life-threatening if they caught the flu.

Finally, on Saturday, July 25th, Donald McNeil wrote an excellent balanced article in the Times describing Camp Modin’s use of Tamiflu, the rationale for my advice compared to the reasons for the CDC’s disagreement. (See NY Times article)

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

Summer is here and with the kids out of school, it’s a perfect time for a family trip.   Whether driving or hopping on a plane, travel comes with temptation— fast food, dining out and snacking during the day.  And because U.S. Centers for Disease Control and Prevention statistics show more than half of American adults are overweight or obese, it’s more important than ever to watch your diet while you travel. But it is possible to eat healthy on vacation.  See below for my favorite family friendly travel tips.

In-the-Car Snacking:

Rather than stopping at greasy, fattening fast food joints, plan ahead and pack a cooler with healthy snacks.

Pack veggies like baby carrots, sliced celery, cucumber and red pepper with individual cups of ranch dressing for dipping.

Kids love sweet fruit.  Sliced apples, grapes, and dried fruit like raisins, dried apricots and apples are a perfect travel snack because they are not messy and easy to eat.  Avoid fruits you have to peel like oranges, kiwi and grapefruit—the juice and rinds are messy.

Other great snack ideas include:

Yogurts (individual tubes, such a Gogurt are easy to eat since no spoon is necessary)

String cheese

Gnu Food’s Flavor and Fiber Bars: These granola bars come in five yummy flavors and contain 12g of fiber.  Kids love them and moms love that they are all natural.

Trail Mix:  Kids love the sweet and crunchy mix of ingredients.  Mix whole-wheat pretzels, wheat chex, dried craisins or raisins, chocolate chips and nuts for a high-energy, high-protein snack.

Make sandwiches on whole-wheat tortillas—kids love the fun shape of a rolled up sandwich.  Turkey, peanut butter and jelly, chicken are all great options for fillings (avoid tuna fish since the mayo makes the bread soggy and the smell is strong which might bother other travelers on a plane, or stink up your car if you are driving!).

Tanya Zuckerbrot, MS, RD is a nutritionist and founder of www.Skinnyandthecity.com.  She is also the creator of The F-Factor Diet™, an innovative nutritional program she has used for more than ten years to provide hundreds of her clients with all the tools they need to achieve easy weight loss and maintenance, improved health and well-being.  For more information log onto www.FFactorDiet.com.

Nestle USA is voluntarily recalling all of their Toll House refrigerated cookie dough products today after reports of a possible E. coli outbreak linked to the ingestion of raw cookie dough. The FDA and the CDC are investigating reports of 66 cases of illness across 28 states related to these Toll House products. Now, I’m sure we’ve all indulged in a handful of raw cookie dough at one point or another, but this recall is just another reminder (aside from the WARNING printed on the label) — that it’s not safe to eat until it’s heated!

Because of the popularity of these products, we’ve been getting a lot of questions about E. coli, its symptoms and how to prevent infection. Here’s a quick Q&A to help clear things up for you.

What is E. coli?
E. coli is a kind of bacterium called Escherichia coli that lives in the digestive tracts of animals and humans. There are many different strains of E. coli bacteria, and for the most part, many of them are harmless. But some strains can cause extreme abdominal discomfort, diarrhea, bloody stools and vomiting — while others strains can lead to urinary tract infections, respiratory illnesses, anemia, kidney failure and even death.

Where does it come from?
Contaminated food:
The most common way people in the U.S. become infected with E. coli is from eating contaminated food. In fact, the CDC estimates that 85 percent of E. coli infections come from ingesting infected food or water. Because E. coli bacteria live in the intestines of healthy animals, like cows, it is possible for processed meats to become contaminated. If the contaminated meat is not heated to 160°F during preparation, the bacteria can survive and infect you when you eat it.
Raw foods can also carry E. coli. It’s important to check the labels and make sure that all your dairy products are pasteurized, or heated to kill off bacteria before hitting the store shelves. Raw fruits and vegetables can become contaminated if they come in contact with manure or animal feces.

Contaminated water:
While not as common as foodborne E. coli infections, people can also become ill from drinking or ingesting contaminated water that has not been properly treated. And sometimes, accidentally swallowing lake or pool water that has come in contact with human or animal feces can put you at risk for becoming infected with E. coli.

Person-to-person:
E. coli can also be spread from person-to-person if someone does not wash their hands thoroughly after a bowel movement. This is not as common, but it’s especially important for people who work in the restaurant/food preparation industry because they can spread the bacteria from their hands to other objects — including your dinner! I know it’s not a nice thought, but it happens more often than you think, so it sounds simple, but washing your hands is one of the easiest ways to prevent all kinds of infections.

What are the symptoms?
Symptoms usually start 3-4 days after exposure to the bacteria and can include:

• Stomach cramps
• Diarrhea
• Bloody stools
• Nausea
• Vomiting
• Mild fever
• Dehydration

Who is at risk?
People of all ages can become infected with E. coli, but the risk for serious complications is higher for young children, the elderly and those with compromised immune systems or underlying health problems.

How is it treated?
E. coli infections will usually clear on their own in about a week in a healthy person and treatment involves resting and staying hydrated. Often, people just assume they have a stomach bug and don’t go to the doctor, so they don’t know that E. coli caused their illness, but a simple stool test can diagnose the condition. As a rule of thumb, you should contact your physician any time there is blood in your stool.

• How can E. coli infection be prevented?
  Wash your hands thoroughly after using the bathroom and before preparing or eating food;
• Cook meats thoroughly at a temperature of at least 160°F/70°C (use a thermometer to test the meat if you’re not sure);
• Do not drink raw milk, unpasteurized dairy products, and unpasteurized juices (like fresh apple cider);
• Avoid swallowing water when swimming or playing in lakes, ponds, streams or swimming pools;
• When traveling abroad to countries that may have unsafe drinking water, don’t drink tap water or get ice in your drinks. Also, avoid raw fruits and vegetables, except those with skin that you can peel yourself;
• Wash your hands often, and always wash them after you use the bathroom or change diapers — it’s the best way to prevent infection with any bacteria.

Dr. Cynara Coomer is an assistant professor of surgery specializing in breast health and breast cancer surgery at Mount Sinai Medical Center in New York City. She is a FOX News Health contributor providing medical expertise on a variety of topics in cancer research with a focus on women’s health, breast diseases and tips for healthy breasts at any age.

 I don’t want to be picky, but I have to admit that as a fear expert I was more affected by President Obama’s statement a few weeks ago in response to the emerging swine flu threat that we should all wash our hands, then I was to Vice President Biden’s blatant misstatement about not flying on planes. Let me explain: clearly, we carry many bacteria and viruses on our hands, and in fact most of our stomach viruses as well as cold viruses are passed back and forth this way. It is hard to fault anyone for recommending hand washing, but consider that Obama’s statement carried the subliminal message that we might be carrying this virus, despite the fact that the statistical chances of that then and now remain extremely low.

The president followed that up by asking Congress for $1.5 billion to prepare us for this flu, an amount that seems totally reasonable until you consider what other health care needs it might be taken away from. Stockpiles of the anti-flu drug Tamiflu will have to be discarded if they aren’t used in 5 years, and we still have no idea what the extent of spread or severity of this swine flu virus will be. Preparing a vaccine seems wise, taking needed resources away from current pandemics like TB, HIV, or even the yearly flu does not.   It is paramount that at a time when our government is considering expanding the system for health coverage, that issues of allocation and proper use of resources be at the top of the list.

The Centers for Disease Control and Prevention has been front and center during the initial stages of the swine flu outbreak, and they have been very effective at identifying and tracking the virus, somewhat less effective at explaining it in context during press conferences (this may have something to do with the nature of the beast – press conferences themselves immediately become amplified).

I have more of a bone to pick with the World Health Organization in terms of their poor conveyance of contextual information. The WHO all too often seems like “fright night” though they too have been tremendous when it comes to “boots on the ground.”

Check out my article in today’s Slate magazine about how the WHO has dealt with swine flu.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

The following statements are where I think we are currently on the new swine flu H1N1 influenza A strain. I’ve also communicated with Drs. Ann Schuchat and Nancy Cox at the CDC, who responded that they agree with these comments.

• The H1N1 influenza A is a new strain — a swine flu strain — with some genetic components that are characteristic of human and bird flu viruses. It bears watching and tracking, as any new influenza does.
• It is spreading human to human, and may have the attack rate of a typical yearly influenza A, but this is particularly difficult to determine because of both the overreporting (everyone thinks they have it), and under reporting (we are not really tracking the full spectrum of disease as we are not testing those with mild symptoms). It is also too early to really determine transmissability, because there are too few cases.
• Virulence appears to be low and if this continues, it will be a mild pandemic at worst. It currently appears to be very transmissible, but the outbreak could wane further if transmissability decreases. A severe pandemic will likely result only if it mutates into a more virulent strain. But assessment of the strain’s virulence is also based on a limited number of cases.
• It is worthwhile to begin preparing a vaccine, but we don’t yet have the upgraded technology (mammalian cell culture, reverse genetics) in regular use for flu, so we may have to rely on the older technologies (using hen eggs to provide a medium for growing the dead virus). This has yet to be determined.
• It is likely to wane soon due to summer weather, but bears watching carefully over our summer in the southern hemisphere, and mapping carefully for resurgence in the fall.
• Since the WHO designations for pandemic alert don’t include severity of illness or even true extent of illness, raising the pandemic alert levels have led to the public misperception that massive deaths are about to occur, which is part of the reason why the fear level is so high. It is best to provide calm accurate contexted information to avoid this, as I point out in “False Alarm; the Truth About the Epidemic of Fear.”

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com