BronsonHealth Flu Blog

It may not be obvious why diabetes and influenza are related, but they are. One disease has to do with blood sugar and the other is an infection caused by a virus. They are related, however, and not in a good way.

People with either type 1 or type 2 diabetes who get the flu are at increased risk of hospitalization and death. The CDC says they are almost 3 times more likely to die of influenza. Diabetes can weaken your immune system, allowing the virus to damage your lungs more severely. A recent study of patients who became severely ill with influenza H1N1 showed that diabetes was the fourth most common risk factor, behind lung disease, obesity, and high blood pressure.

What should you do right now to protect yourself from influenza if you have diabetes?

First, get both the H1N1 and the seasonal influenza vaccines. Get the injection version, not the intranasal version. You are in a high-risk priority group for both vaccines, so you should be among the first to get it when it is available.

Second, if you think you are getting influenza (fever, headache, fatigue, etc), call your doctor immediately. Your doctor should consider starting you on antiviral treatment.

Third, take care of yourself during the influenza season. Take your diabetes drugs consistently, monitor your blood glucose and urine ketones frequently to keep them in the proper range, watch your diet and fluid intake, keep up your exercise and sleep habits, wash your hands frequently and try to stay away from people who might be sick. Ask the people you live and have close contact with to get the flu vaccines too, because they can protect you from getting the disease.

These are all normal, common-sense things you can do to protect yourself. If you can successfully live with diabetes, you can protect yourself from influenza.

Bronson Rambling Road Pediatrics – Oshtemo and Bronson Rambling Road Pediatrics – Portage have launched a Flu Vaccine Sign-Up Form. If you or your family member are a current Bronson patient at either of these practices, please complete this online form to be notified when H1N1 and/or seasonal flu vaccine become available. This is being piloted with Rambling Road Pediatrics. Other practices will be included in the future. You may need to install Microsoft Silverlight.

The online form is being used to meet the needs of our patients and improve the efficiency of our office. Please be aware that we are receiving limited H1N1 vaccine from the health department. Thank you.

Yes. We are having the worst influenza season the US has seen in a long time. Many patients are being hospitalized, some are requiring time in an intensive care unit, and some are dying.

Most people with simple influenza do not require hospitalization, and they certainly don’t often die. The problem with influenza is that it leads to complications, which in some people are very dangerous. One of the serious complications of influenza is bacterial pneumonia.

The influenza virus attacks the lungs, destroys lung tissue, prevents the lungs from delivering oxygen, and causes the lungs to fill with fluid. Some bacteria then love to jump in and go to work after the virus has made the lungs defenseless against infection. We call that a secondary infection or superinfection, because it happens after the first one. Many of the patients who die with influenza are actually succumbing to bacterial pneumonia.

The most common cause of bacterial pneumonia is one species of bacteria called Streptococcus pneumoniae, nicknamed “the pneumococcus.” It is causing lots of trouble this year in patients after they get influenza. The ironic thing about this is that some of these complications may be preventable, because we have two good vaccines against the pneumococcus. There is a vaccine for children called Prevnar, and a vaccine for adults called Pneumovax. They are sometimes called “pneumonia shots,” although they really only protect you against that one type of pneumonia.

I think many more people should get the pneumonia shot than currently do. In fact, I can’t think of anyone who should not get it. The CDC says that we should get one dose as adults if we have any risk factors for pneumonia, and another dose at age 65, but the risk factors are very broad, and the CDC recomendations should be considered minimum, not maximum recommendations. If you go to your doctor to get an annual influenza immunization, ask them for your pneumonia shot if you haven’t already had one. It could save your life.

One aspect of this year’s influenza season that may surprise you is all the attention on influenza and pregnancy. Good data show that the new H1N1 virus attacks pregnant patients at a higher rate, more pregnant influenza patients are hospitalized, more require critical care, and more are dying than we would expect with normal seasonal influenza. We don’t know what it is about the virus that causes this, but it is happening and we need to do something with it.

Obstetricians have had to become experts in managing influenza. That is new for many of them. In the past, influenza was considered part of primary care, not a problem in pregnancy. Many obstetricians did not immunize their patients against influenza, did not diagnose it, and did not treat it. That has changed this year. If you are pregnant, your obstetrician should be talking to you about influenza and making sure that you are immunized against both seasonal and H1N1 influenza, perhaps by providing the vaccines in their office for the first time.

The thinking about vaccines and pregnancy has also changed almost 180 degrees in the last several years. In the past, many doctors and patients thought that immunizing a pregnant patient was risky. Maybe the vaccine would harm the baby, or cause a complication, so doing nothing and allowing the pregnant patient do get influenza, for example, was considered the safest thing to do. Now we approach things differently. All pregnant patients are advised to be immunized against influenza. The vaccine presents virtually no risk to the mother or baby, the risk of influenza disease during pregnancy is significant, and immunization of the pregnant patient transfers some protection to the baby both before birth and also after birth if the mother breastfeeds the baby. That is a big change in thinking over just one generation of doctors and patients.

Many pregnant women go to their mothers for advice on things relating to their pregnancy. That is still a good idea, but this is one issue for which, if you do what your mother did, it might be the wrong thing.

Read CDC recommendations for pregnant women, as well as feeding your new baby

Seasonal Flu Vaccine
Bronson Outpatient Pharmacy and Bronson Pharmacy Mattawan have seasonal intranasal influenza vaccine (FluMist®) available for age 18 through 49. Call ahead for an appointment. More details

Bronson Home Health Care Community Flu Clinics
Medicare and Medicare Plus Blue will be billed directly, all others will be charged $30 cash or check. There are no seasonal flu community clinics being held at this time.

Bronson Physician Practices
Current Bronson patients may call their Bronson doctor’s office to make an appointment for seasonal flu vaccine.

H1N1 Vaccine
H1N1 vaccine is only available to Bronson staff and current Bronson outpatients. There is a very limited supply of H1N1 vaccine for current Bronson patients of Bronson practices. Those on the waiting list will be contacted first. The CDC recommendations are being followed due to the limited supply and H1N1 vaccine is being given to the targeted high-risk populations.

View Bronson Rambling Road Pediatrics – Oshtemo flu vaccine availability

Community Health Department Clinics
Kalamazoo County
Van Buren & Cass County

Many hospitals across the US have recently decided to restrict visitors because of the H1N1 influenza epidemic. My hospital joined with the other hospitals in our region to adopt the same visitor policy and communicate one message to the public. Having all the hospitals adopt the same practice at the same time is a great idea. It reduces confusion for the public and makes the information easier to remember.

Why restrict visitors, why do it now, and why restrict certain people? This is a unique time for hospitals. We are in the middle of the largest influenza epidemic we have seen in a long time. A new influenza virus emerged last April to which few people are immune, and it will sweep across the country unchecked until we can get more people immunized. Most patients in the hospital right now are not immune, they are very susceptible to this infection, and if this virus started to spread in a hospital, it would spread quickly with devestating results. The highest incidence of infection is in children, and children are more contagious than adults when they get influenza. A person with influenza can spread it from the day prior to illness until a couple days after they recover. We call those periods the prodromal period and the convalescent period. Bottom line; people can spread influenza without knowing it.

Most hospitals have some visitor rules. Some rules vary by the type of patient; the visitation rules are often different in critical care units than in non-acute care units, different in maternity units or in cancer units, etc. Some hospitals screen visitors for contagious disease before you can go in.

Why are hospitals restricting certain ages of visitors? We chose to exclude people below age 15. Other hospitals are using 16 or 18. I don’t think it makes a big difference what age restriction you choose. The incidence of H1N1 influenza seems to drop after age 15, and people over 15 can probably be screened and their behavior controlled better than younger children. We went with the lowest age that we thought would protect our patients.

When a person is sick or injured and hospitalized, the support of their loved ones is very important to their healing. We want our patients to be supported as much as they need, and we want their supporters to feel welcome and to participate in the patient’s recovery and care. However, if the visitor is carrying a contagious disease, it is better if they do not visit the patient in the hospital.

October 31 is rapidly approaching in the US. Called Halloween, Americans observe a peculiar ritual that may make it appear that we don’t like our children very much. We make them dress in uncomfortable costumes through which they can’t see very well, walk with impaired vision around neighborhood streets at night when they can’t be seen well by vehicles, teach them to go up to complete strangers and demand they give them candy, accept whatever these complete strangers give them and eat it, and consume far more candy than is good for them. And we do it for the children.

This year is unique for Halloween because it coincides with an influenza epidemic in the population of children participating. Is there anything we should do differently this year? I can think of two things, and there are probably more. If you are distributing candy to the children in your neighborhood, as is my job each year, wash your hands well before you handle the candy. You should reach into your bag to distribute the items, and place the candy in each young pilferer’s getaway bag. Do not let the children reach their hands into your clean container of candy. Remember some of them may be sick, and their hands could contaminate all your candy.

The second thing to remember is that if your child has been sick this week with any illness with a fever, they should not go outside Halloween night and they should not handle the candy you intend to distibute to other children. I know this will be disappointing to them, but it is the safe thing to do. Halloween could be a great way to accelerate the epidemic if you don’t take these simple precautions.

To ensure the safety of our patients, hospital visitors are limited to persons 15 years old or older. Visitors to OB area are limited to immediate family and family members are recommended to wear a mask. Emergency Department visitors are limited to two visitors per patient. During flu season, Bronson encourages limited visitation within all hospital areas and reminds the public that anyone with a fever, cough, sore throat or other sign of illness should not come to the hospital to visit a patient.

Ch. 3 story on visitation guidelines

I am truly amazed sometimes how some totally obscure thing suddenly becomes an item of interest and concern among so many people. This has recently happened to a substance called squalene, which I’m sure no one reading this has ever heard of unless they were a biochemistry major.

People are saying that the H1N1 influenza vaccine has squalene in it and that this is a major threat to us. Squalene is a naturally-occurring chemical that cells make for several purposes. It is made by plants and animals, and in high concentration by sharks, because it helps them float. It is a lipid (fat) chemical in the production pathway for all the sterol-type cell componants like cholesterol. We make it in our skin and it is a natural skin moisturizer. Squalene is sold as a dietary supplement for dry skin and other purported health benefits. It is in some cosmetics to produce smooth skin.

Squalene has also been used as a vaccine adjuvant. An adjuvant is a chemical that is added to a drug to intensify the effect. Vaccine adjuvants hold the vaccine around longer and allow the body to respond to it more strongly. You can reduce the dose of the vaccine if you add an adjuvant, so they are sometimes called vaccine extenders.

Although squalene has been widely and successfully used in Europe and other markets as a vaccine adjuvant, no adjuvants have ever been approved by the FDA in the US, so no US vaccines contain squalene. The H1N1 influenza vaccine given in the US does not contain squalene. It is possible that this vaccine sold in other countries may contain adjuvants, but I am only familiar with US vaccines.

Although the word squalene sounds strange and vaguely dangerous, it is not something to worry about simply because US vaccines do not have it.

You are very fortunate if you live in a community in which H1N1 influenza is not sweeping through schools. Here in the Kalamazoo, Michigan area we are seeing an increase in cases, mostly in children, with schools as common connections between them. We will continue to see spread among children until the H1N1 vaccine is distributed more widely among school-age children.

If your child has a fever, sore throat, body aches, headache, chills and fatigue this week, it is likely that they have influenza, especially if other children in their school have the same thing. There are other respiratory viruses circulating this time of year, but nothing as common as H1N1 influenza. The CDC has a very nice Guide for Parents that answers many questions parents have about influenza.

The most important thing you should do as a parent is to accept that your child is sick and keep them home so they can get better and not spread the virus to other children. The worst thing you can do is deny their illness, give them drugs like Tylenol to reduce their fever, and pretend they are healthy. Drugs of this type are called antipyretics because they lower the body’s set temperature. Lowering a child’s fever is not what you want to do when they are sick. Fever is the body’s response to infection, and it helps the body fight the virus. Your child may feel better when they are on these drugs, but they are just as sick, just as contagious, and just as much at risk for complications, but now you removed the most sensitive indicator of trouble by giving the child drugs to cover up the problem.

Watch your sick child closely for the eight warning signs of complications shown on the CDC Guide for Parents. Call the child’s doctor if they show one or more of these signs. If not, let them rest, keep them eating and drinking, and they should get over their infection in 5 to 7 days. Don’t send them to school, don’t allow them to play sports, don’t leave them at day care with other children, and don’t take them to church or family gatherings where they could infect other vulnerable people. I would put all these things in the category of common sense. Just think about what is best for your child before you do something you might regret.

Bronson Flu Information for Patients Who Are Sick