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.

There has been a lot of push back when it comes to the H1N1 flu vaccine. Of course, as with any medication, there could be side effects because not all immune systems are created equal.

But what people have to remember is their reasons for not supporting the vaccine – mainly because of the fear that it was rushed and long-term side effects are not yet known – are some of the same reasons preliminary reports of possible side effects could also be coincidental. For example, if someone has a heart attack after receiving their H1N1 flu shot, are they going to assume it’s directly related to the vaccine or attribute it to unhealthy lifestyle decisions?

The Associated Press recently published an article on this topic that looked at how the government will be intensely tracking the side effects of this vaccine and separating legitimate medical concerns from inevitable coincidences.

This is a proactive plan. The government is going to be putting information together for the public in an effort to stop the spread of false rumors and try to put the public at ease.

One major focus will be miscarriage since they are encouraging pregnant women to get the vaccine and miscarriages are quite common anyway.

Like the seasonal influenza vaccine, medical professionals expect the side effects associated with the H1N1 flu vaccine should be minimal. The most common side effect with all flu vaccines is soreness at the injection site, and sometimes people feel achy.

Many Americans are concerned about the safety and efficacy of the newly developed H1N1 flu shot because of a similar vaccine that was linked to a swine flu-like outbreak at Fort Dix in 1976.

Guillain-Barre occurs naturally following upper respiratory illnesses, digestive illnesses and on rare occasions – is associated with drugs and vaccines. However, the frequency is still 1-2 per 100,000 people.

I’ll be keeping a close eye on this, and if anything is reported, I’ll be the first one to let you know.

With concern over the H1N1 flu reaching an all-time high – Americans are scrambling to find ways to either prevent the virus, cure it if they get it or try to get out of getting the flu shot. And as a result, many people are turning to the Internet for help.

I have said it a thousand times and I’ll say it again: It’s not safe to buy medication over the Internet from sources that are not reputable!  There are thousands of medications available on the Web, and more and more companies are popping up each day offering fast access and delivery of both over-the-counter and prescription medications. We know the dangers associated with buying drugs online, but for some reason, people continue to do it!

In fact, it poses such a problem, that in the midst of the H1N1 flu pandemic and the hysteria it’s created, the FDA felt the need to warn consumers about purchasing products over the Internet that claim to diagnose, prevent, treat or cure the H1N1 flu virus. Trust me — nothing could be more dangerous than thinking that you can fight the H1N1 virus with unregulated medications available on the Web.

The FDA issued the warning after the agency purchased and analyzed several products online that were marketed as Tamiflu, which is an antiviral drug that slows the severity of the flu. After checking out the products, many of them were found to be unsafe.

Here is an excerpt taken directly from the FDA press release:

“One of the orders, which arrived in an unmarked envelope with a postmark from India, consisted of unlabeled, white tablets taped between two pieces of paper. When analyzed by the FDA, the tablets were found to contain talc and acetaminophen, but none of the active ingredient oseltamivir. The Web site disappeared shortly after the FDA placed the order. At the same time, the FDA also purchased four other products purported to diagnose, prevent, treat or cure the H1N1 influenza virus from other Web sites.”

The products that the FDA analyzed contained varying levels of oseltamivir, and were not approved in the U.S. And furthermore if you’re ordering medications from other countries, most of them will not even arrive in time to treat someone suffering from the H1N1 flu! It’s just not worth it, people! When you order medications that are not regulated, you’re putting yourself and/or your loved ones at risk for getting counterfeit or contaminated products, and the effects can be deadly.

So instead of logging onto the Internet the next time you need a prescription drug – pick up the phone and call your doctor. After all — that’s what we’re here for.

 Click here for more information from the FDA on how to protect yourself.

With the change in seasons now fully upon us, days are getting shorter, and the risk of seasonal affective disorder is turning into very real suffering for literally millions of Americans.  Most of this suffering can be prevented, if people recognize the cause of their symptoms and get help.

Seasonal affective disorder (SAD) most often visits patients during the fall or early winter.  It has also been called “winter depression” or “winter blues,” but its symptoms mimic major depression of any other kind—the distinguishing characteristic in this case being its connection to less sunlight.   Those symptoms can include sadness, tearfulness, decreased concentration, decreased self-esteem, low energy, alterations in sleep patterns and appetite, loss of interest in hobbies and work and, in severe cases, thoughts of suicide.

If you have struggled with repeated bouts of depression in the past, it’s very important to figure out if you can identify this kind of seasonal pattern.  But SAD doesn’t necessarily manifest itself with serious symptoms every year, so all of us need to be alert this year to whether we’re burdened by it.

SAD costs the economy dearly in lost productivity from employees, employers and entrepreneurs fighting its symptoms.  But it will also inflict an additional and very substantial financial burden on the millions of families directly affected, at a time when so many families are struggling already.  That’s one reason why SAD may be a bigger threat this year than the H1N1 flu, even though SAD gets a lot less attention.

SAD responds to the same treatments used to fight non-seasonal depression.  Psychotherapy is tremendously helpful, as is exercise and, when indicated, medication.  Another promising and safe treatment is transcranial magnetic stimulation (rTMS), which involves repeatedly stimulating a particular area of the brain using magnetic waves. 

I have seen many, many of my patients also benefit tremendously from the use of bright light therapy, which involves sitting for a short time each day in front of specially designed portable lights (which are relatively inexpensive and widely available) that replicate sunlight (without exposing the user to any damaging “tanning” light).   One of these devices is called the goLite, but just Googling “bright light therapy for depression” will bring up lots of choices.  If fall and winter and “down” times for you, then get one of these lights and use it.  It could change your life—for about $150.

It’s time we took SAD very seriously, given the fact that it causes so much damage to so many lives and is so responsive to treatment.  It’s the psychiatric epidemic that comes every year—and one we already know how to defeat.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement including www.livingthetruth.com. Dr. Ablow can be emailed at info@keithablow.com.

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

If you are a child:

• Children have not shown any immunity to this new strain of flu.
• Kids are super spreaders of flu, with schools being petri dishes for spread.
• Children should wash hands frequently for at least 30 seconds with soap and water, use hand sanitizers, and sneeze or cough into their sleeve.
• Children who have fatigue, fever, sore throat, nausea, or muscle aches, should STAY HOME and the family pediatrician should be consulted.
• Rapid flu tests are about 60% sensitive for H1N1 swine flu, and a presumptive diagnosis can be made by a child’s doctor, based on symptoms.
• Kids with the flu should stay home for at least two days after symptoms resolve.
• The H1N1 swine flu vaccine will be available beginning in late October. ALL children should take it, especially those with chronic illnesses. It will likely be offered in schools. It is not clear yet whether children will require one or two shots.
• The use of Tamiflu (anti-viral) in children is somewhat controversial; recent studies from the UK appear to show that it isn’t well tolerated or effective, though previous studies have shown that it is safe, shortens the course of illness, and can also prevent spread (80-95%) if given to close contacts. This was the experience of several summer camps in Maine this summer, where Tamiflu was also well tolerated.
• Secondary bacterial infections are common, and should be treated promptly with antibiotics.

If you are an adult:

• Especially at risk are adults with chronic illnesses such as COPD, Crohns Disease, Rheumatoid Arthritis, HIV, cancer, etc. These patients should be especially careful, take Tamiflu early for flu symptoms, be on the lookout for secondary infections including bronchitis, pneumonia, sinus and ear infections.
• The H1N1 vaccine should be given to these groups as soon as available, as well as pregnant women (currently in clinical trials), health care workers, and close contacts of those with chronic conditions.
• New studies just published in the New England Journal of Medicine show that the new vaccine works in 7-10 days, is well tolerated, and provides immunity with a single dose.
• Elderly patients appear to have partial immunity to this H1N1 swine flu strain, if born before 1957, probably because of exposure to a related virus when they were younger, but should still be considered for this vaccine, especially if they have chronic medical conditions.
• Those who had H1N1 swine flu in the Spring or Summer are likely immune. There may be a blood test available to test this.

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 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

There’s no doubt that this H1N1 flu, also known as swine flu, has been a real doozy. With more than 1 million people infected in the U.S. alone and approximately 263 deaths, attention must be paid to a potentially worsening condition.

I typically don’t like to scare people into paying attention to health care issues, but I do think that as soon as a vaccine becomes available here in the U.S. for the H1N1 virus, you should get it.

I recently learned of two alarming cases where pregnant women became affected with the H1N1 virus. Any type of flu can be quite devastating for a pregnant patient. The reason for the significant effect in pregnancy is that pregnant women typically have suppressed immune systems and their pulmonary compliance is significantly altered due to the pressure from the pregnant uterus. So when they get the flu, it could very quickly turn into a deadly pneumonia with very high degrees of complication for both the mother and the unborn child.

That was just the case with these two recent reports — one from Australia where a mother fell ill from the swine flu and ultimately the baby died in utero, and in the other case, a woman in Florida had to deliver at 27 weeks of gestation due to the flu, and the infant ultimately died from complications associated with his prematurity.

So the message is loud and clear: This new virus is very contagious. We don’t have natural immunity, and if you have any risk factors — especially if you’re pregnant — get the vaccine as soon as it is available.

Click here to read the full story.