Archive for December, 2009

Looking for something fun to do over vacation?

Tuesday, December 22nd, 2009

With children home from school and people taking time off from work, holidays are a time for families to do things together. How about getting your flu shots? That may not be the first thing that you thought of doing, but think about it.

Vaccine is available, and available to everyone. We first limited the product to certain priority groups, but now the H1N1 vaccine is in good supply, more is being shipped every week, and it should be easy to find a provider where you can get it. Physician offices, county health departments, and some retail pharmacies are providing it now.

You need it. Although most of the priority groups have been covered, children, adults, and the elderly not in priority groups have not been covered until now, so it is your turn. The virus is still circulating in the US, and many more people will still get the flu this year, so now is a good time to protect yourself.

There is no charge for the vaccine. Some providers may charge a small fee to give it, but the vaccine itself is free to the patient. Think of it as insurance or an investment; you are getting future protection against risk.

You have time now. It is hard to take time off from school or work to get an immunization, but during vacation you don’t have to worry about that. Pack up the kids and grandparents and get everyone immunized. That would be a good way to start the new year off right, by improving your health.

Changes in hospital visitation guidelines

Monday, December 21st, 2009

Hospitals care for people who are sick and very susceptible to infectious diseases. Visitors to hospitals can carry contagious diseases with them and give them to the patients they visit. All hospitals have visitation guidelines to reduce the risk of infection, and hospitals often adjust their visitation guidelines to respond to local infection risk. Michigan has just had an unusually large outbreak of influenza caused by the new H1N1 strain. We adjusted our visitation guidelines in October to make our hospital as safe as it could be, and now that the first wave of influenza seems to be over, we are returning to our prior guidelines. Here are the new guidelines.

“Effective immediately, limited visitation guidelines implemented during the H1N1 flu season are lifted for Bronson Methodist Hospital (BMH), Bronson LakeView Hospital (BLH) and Bronson Vicksburg Hospital (BVH). These guidelines were put in place to safeguard patients from flu exposure. Since we have seen a steady decline in influenza activity, we feel it is important to lift these restrictions so patients, families and friends may be together. In general, children under age 15 may visit all areas and family and friends outside the immediate family may visit the OB areas. We realize there are times where this may be limited due to the individual patient’s condition and ask you to continue to partner with patients, families and the care team to make this decision. We will continue to monitor our patients’ risk to flu exposure and inform you if it is necessary to limit visitation again.”

The influenza season is not over, and we are likely to have another wave of cases. If it seems prudent to return to the enhanced restrictions again, we will do that. We value the support that loved ones give to our patients, but keeping our patients safe is our primary responsibility, and we hope you understand if we have to limit visitors during epidemics. If you have any questions about this, please make a comment, email the “fludoctor” address, or ask your loved one’s care team about it.

H1N1 vaccine recalled

Thursday, December 17th, 2009

What does it mean that some of the new H1N1 influenza vaccine was recalled recently? In my opinion, very little. So far, four batches of vaccine from one manufacturer have been recalled. This is a small amount of the total vaccine being made, and it will be replaced by the manufacturer.

The recall was not for a safety issue. It related to the stated potency of the vaccine. The FDA approved this vaccine at a potency of 15 micrograms of influenza protein per 0.5 milliliter dose, or 7.5 micrograms per 25 milliliter dose (half-dose) for babies. That doesn’t mean that a slightly lower dose would not work, it only means that the FDA approved that dose.

One can imagine that the pharmaceutical companies that are making this vaccine want to make as many doses as possible with the vaccine they have, so they are not over-filling the syringes with vaccine. The recalled vaccine met the potency requirements when it was made and shipped, but after it sat in the syringes for a while, a little bit of the vaccine may have stuck to the inside of the syringe, and when it was dispensed, it was slightly below the 7.5 microgram amount. The FDA is taking a hard-line position that the vaccine needs to meet the specifications not just when it leaves the factory, but until it expires, so they recalled it. This just shows how rigorous the FDA is with the new vaccine.

There is normally a large cushion of variation when vaccine dosing is set. Different people respond to different doses. Most people will respond to a lower vaccine dose than the FDA-approved one, so there is no reason to think that the recalled vaccine was not strong enough, and it certainly is safe. If your child received the recalled vaccine, don’t worry about it. If you are a provider and had some of the recalled vaccine in your refrigerator, you should turn in the recalled vaccine and replace it with the fresh product.

H1N1 influenza vaccine is available (and recommended) for everyone

Thursday, December 10th, 2009

This week the state of Michigan took the next step in this year’s immunization program against the H1N1 influenza virus. The vaccine was initially offered to certain target groups that were determined to be at higher risk of complications, hospitalization, and death due to the disease. As those groups were covered, the program now moves to its last stage; offering the vaccine to everyone.

There is no cost to the patient for the vaccine. Providers are allowed to charge a small fee for administration of the vaccine if they choose to do that. There is a labor cost for the nurses giving the vaccine, doing the paperwork required, and of course the costs of the space and running the business, so it is fair that providers get paid something for their expenses.

More of the H1N1 vaccine keeps coming every week, as long as the provider continues to order it from the state. Bronson Hospital is offering the H1N1 vaccine to inpatients before they are discharged, to protect them during the remainder of the flu season and prevent them from being readmitted later for the flu.

Because we continue to get H1N1 vaccine, and we cannot get any more seasonal vaccine, the rest of the influenza immunization season has changed to a strictly H1N1 program. It would be nice to have more seasonal vaccine, but it is a good idea to continue to give the H1N1 vaccine, because so far that is the only virus that is causing problems in the United States.

How long will we continue to give patients the vaccine? We will give it until we can’t get any more vaccine or until about the beginning of April. Isn’t that late? Not really. Remember when the H1N1 epidemic hit the United States last season? It was the third week of April. That could happen again.

If you have not received your H1N1 vaccine yet this year, now is the time to get it. There is a timing factor to any epidemic, holiday gatherings are good opportunities for the virus to spread, and it is a good idea to get immunized now so you will be protected by the last week of December.

Applying Technology to Healthcare

Wednesday, December 9th, 2009

A few weeks ago this site mentioned a new online registration system for reserving influenza vaccine at Bronson-associated physician offices. Users can log on from home, answer some simple questions, and be placed in a pool of patients to be contacted as soon as their vaccine dose arrived. Nearly 600 people have used this site in less than a month. The site was recently expanded to cover physician offices affiliated with Bronson LakeView Hospital, located in the next county to the west.

Things like this seem simple and easy to the younger generation, but it was actually a lot of work to set it up, and we are very glad that so many of our patients are finding it useful. The telephone is not the only or best way of communicating with people anymore. Things like this are examples of ways in which technology can improve healthcare delivery. Many people do not realize it, but in many ways healthcare is behind the latest technology. We use some fancy pieces of equipment, so people assume that all of healthcare is high-tech, but it is not. Many pieces of information still exist only on paper, communication takes place over telephone lines, and important information gets lost or misinterpreted.

If you are technically savvy and wonder why hospitals and physician offices don’t do more things online, please forgive us and remember that some of us are members of the baby boomer generation. We’re trying to stay with you, and we are working on a lot of new things in the near future. And if you don’t use a personal computer much or at all, be assured that we will never forget you either.

Flu and Holidays

Friday, December 4th, 2009

There is an association between influenza (and other contagious diseases) and winter holidays. Some of the things we do to celebrate these important occasions with family and friends can increase the risk of getting sick. The CDC has noticed this and launched a travel health campaign this holiday season.

We often see a spike in influenza cases right after the December holidays, and we often see a shift in the influenza cases from primarily children to adults and the elderly. That transmission from children to the elderly may take place during holiday gatherings.

Travel itself can incease your risk, especially if you use airline or other public transportation. Airline travel these days is a perfect example of crowding people together in a small space; a great opportunity to share germs. Don’t travel at all if you have a fever, and if you have a cold, control your respiratory secretions. I know it is tempting to travel while you or your child is sick if you have paid a lot of money for a plane ticket, but it really is better for the sick person and the people you will be traveling to if you stay home until your fever breaks.

Carry and use hand hygiene products routinely as you shop, go through airports, or visit other public places. Most viruses enter your body when you get them on your hands and touch your face. Wash your hands when you get on and off your plane, before you eat, after you use the restroom, and after you cough or sneeze.

Try to get both the seasonal and H1N1 influenza vaccines at least two weeks before you travel. It takes that long for the vaccine to produce full immunity.

Watch your over-all health when you are on vacation. Get plenty of sleep, watch your diet, stay well hydrated with water, avoid places where people may be smoking, and if you choose to drink alcohol, do it in moderation.

Most of the things that increase or decrease our risk of getting sick on vacation are things we choose to do. Let’s make healthy choices this year.

Should I still get immunized if I think I had the flu?

Tuesday, December 1st, 2009

This is a good question that does not have a clear answer. We will assume that we are talking about the H1N1 influenza virus, because that is the only one around right now.

From a biological point of view, if your body’s immune system has been exposed to a virus through a natural infection, you should be protected against it on your next exposure. That might imply that you don’t need to be immunized that year against that particular influenza virus.

But it is not quite that simple. Influenza virus is genetically unstable, and it keeps mutating all the time. The virus you had, if it was H1N1, could come back in a little different form, and the vaccine may give you a little more protection against it. Remember, too, that seasonal influenza is still coming, so you need the seasonal vaccine too. Lastly, it is usually not completely clear whether anyone had H1N1 this year, because most cases are not being identified by laboratory testing. There are three or four other respiratory viruses circulating right now that can all cause flu-like symptoms, so you may not have had H1N1 influenza. For all those reasons, the CDC is recommending that you should get both influenza vaccines this year, even if you think you already had influenza in the past year.

What Just Happened?

Tuesday, December 1st, 2009

National reports on the H1N1 influenza situation mirror what we are seeing in West Michigan. After a cluster of cases in April and May, the virus smoldered all summer, causing a few cases here and there but not enough to start an outbreak. Then in October, with the opening of schools and more indoor activities, we saw a sharp peak the week of the 17th. Schools were forced to close, our Emergency Department was flooded with mildly ill but frightened people, and doctor’s offices were swamped with phone calls from sick and worried patients. About two weeks later, we began to see the deadly consequences of influenza in patients with complications. They needed to be admitted to the hospital, sometimes required critical care, and some patients died. Then the outbreak ended as quickly as it began, the week of November 7. We are now seeing baseline levels of influenza; several cases a week, but nothing like the peak in October.

Is this pattern normal for influenza or not, and why? What we saw is what influenza would normally do in a population that doesn’t have any immunity to it. The novel H1N1 virus is different from any virus or vaccine we have seen for about 50 years, so the entire population under 50 was susceptible to it. The virus was also more contagious than normal influenza. Those two facts make for a very fast, explosive outbreak. If we had no influenza vaccines, every influenza season would look like this one.

Is the influenza season over? Probably not. We continue to immunize more people as more vaccine is made, but most people even in the most susceptible younger age groups have still not been immunized, so the virus will probably continue to attack susceptible people at a steady level, lower than the peak in October but still quite significant. In other words, you should still get the H1N1 vaccine if you haven’t already. H1N1 isn’t going away anytime soon.

Also, remember that there are several strains of influenza every year, now perhaps four, and each is independent. We could have as many as three more unique influenza peaks yet this season, or they could all come together for another very bad epidemic. Each influenza strain typically lasts for about 10 weeks, and they can overlap, so the influenza season can go on for months. In other words, you should still get your seasonal influenza vaccine if you have not.

I strongly disagree with those who say that we were not prepared for H1N1 and did not handle the October outbreak well. From where I sit, I think my state, county, and hospital did a great job preparing for and handling an unpredictable situation. If we knew then what we know now, we would have done a few things differently, but in general, I think we did the best we could with what we knew and what we had.