Influenza A (H1N1) Q-and-A with public health expert Lloyd Kolbe
Lloyd Kolbe is associate dean for global and community health at Indiana University's School of Health, Physical Education and Recreation. Before joinging the IU Bloomington faculty, he served as founding director of the Division of Adolescent and School Health at the national Centers for Disease Control and Prevention. Kolbe, a professor of Applied Health Science, discusses Influenza A (H1N1) in this Q-and-A.
Active for Life: How widespread is influenza A (H1N1)?
Lloyd Kolbe: As of May 11, worldwide 30 countries have officially reported 4,694 cases of influenza A (H1N1) infection. Mexico has reported 1,626 laboratory-confirmed human cases of infection, including 48 deaths. The United States has reported 2,532 laboratory-confirmed human cases, including three deaths. Canada has reported 284 laboratory confirmed human cases, including one death.
As of May 10, 44 states in the U.S. officially reported 2,532 cases, including three deaths. The Centers for Disease Control and Prevention expects that more cases, more hospitalizations and more deaths from this outbreak will occur during the coming days and weeks.
As of May 11, the epidemic has met the criteria for Phase 5 of the World Health Organization's (WHO) pandemic alert system, which means that a pandemic is imminent; but has not reached Phase 6, which means a pandemic has been declared.
AFL: How dangerous is this strain of H1N1? Is it more deadly than the normal, seasonal flu bugs that go around every winter, infecting an estimated 5 to 20 percent of Americans, generating 200,000 hospitalizations, and contributing to around 36,000 deaths annually?
Kolbe: Seasonal epidemics occur every year from relatively minor genetic drifts in the genes of normal circulating H1N1 influenza viruses, which we are able to treat with seasonal vaccines. This 2009 Novel H1N1 virus appears to have sustained a more dramatic genetic shift. It is a new virus and one to which the populations will have no immunity.
Further, it appears to have the potential for efficient rapid spread among countries. Although the illness associated with the infection generally seems self-limited and uncomplicated, a substantial number of cases of severe disease and death has been reported in previously healthy young adults and children; the percentage of patients requiring hospitalization appears to be higher than would be expected during a normal influenza season; and the Novel H1N1 virus has been circulating in North America after the peak influenza season.
AFL: Why are we so worried about this pandemic possibility when thousands die every year from seasonal epidemics?
Kolbe: For the reasons listed above, the spread and severity of the upcoming influenza season in the southern hemisphere or the northern hemisphere cannot be predicted. The epidemic may become less widespread and/or severe, or more widespread and/or severe. At this time, there is insufficient information to know.
AFL: Is H1N1 here to stay and should we expect it to be more virulent in the fall? Is there any harm in swine flu parties, like chicken pox parties?
Given the unpredictability of the virus even at the present time, neither WHO nor the CDC has recommended casual methods to spread the virus as a means of potentially conferring immunity, especially because of risks related to infection -- and further infecting more people -- are unknown. Further, the virus potentially could re-assort considerably in the southern hemisphere, possibly rendering little to no potential immunity during the northern hemisphere influenza season.
AFL: Should individuals and families take precautions concerning summer vacations, particularly to museums and theme parks, which often can be crowded? Should any special considerations be given to kids' summer camps?
Kolbe: WHO is not recommending travel restrictions related to the outbreak of H1N1. Today, global travel is commonplace and large numbers of people move around the world for business and leisure. The CDC recently published updated interim guidance for schools and childcare facilities on preventing the virus' spread at: http://www.cdc.gov/h1n1flu/K12_dismissal.htm.
At this time, the CDC recommends the primary means to reduce spread of influenza in schools is to focus on early identification of ill students and staff, staying home when sick, good cough etiquette and frequent hand washing. Decisions about school closure should be at the discretion of local authorities based on local considerations. This guidance could inform those responsible for summer camps.
Everyone should take everyday preventive actions to stop the spread of germs, including frequent hand washing. People who are sick should stay home and avoid contact with others in order to limit further spread of the disease. Avoid close contact with those who appear to be suffering from influenza.
AFL: What should someone do if they think they or their kids have swine flu? Is it really a seven-day, self-imposed isolation? Kids will miss school and adults will miss work.
Kolbe: Novel H1N1 infection has been reported to cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. In addition, a significant number of people also have reported nausea, vomiting or diarrhea.
People at higher risk of serious complications from seasonal flu include people age 65 years and older, children younger than 5 years old, pregnant women, people of any age with chronic medical conditions (such as asthma, diabetes or heart disease), and people who are immunosuppressed, such as those taking immunosuppressive medications, infected with HIV.
If you are sick, you may be ill for a week or longer. Stay home and avoid contact with others, except to seek medical care. If you leave the house to seek medical care, wear a mask or cover your coughs and sneezes with a tissue. In general, avoid contact with other people as much as possible to keep from spreading your illness. At the current time, the CDC believes that this virus has the same properties in terms of spread as seasonal flu viruses. With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to seven days after they get sick. Children, especially younger children, might potentially be contagious for longer periods.
If you have severe illness or are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed. Be aware that if the flu becomes widespread, there will be little need to continue testing people, so your health care provider may decide not to test for the flu virus.
Antiviral drugs can be given to treat those who become severely ill with influenza. These antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including H1N1 flu virus. These medications must be prescribed by a health care professional.
To read other reports from IU experts in matters related to H1N1, please visit: http://newsinfo.iu.edu/web/page/normal/10824.html.
To read more articles from the School of HPER's Department of Applied Health Science, visit http://newsinfo.iu.edu/cat/page/normal/357.html.
